Disabled People: Personal Assistants

Debate between Baroness Watkins of Tavistock and Lord Kamall

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an important point about who should be in that room when we are talking about all these issues. Generally, across government, there are a number of joint initiatives in terms of ensuring that we hit our target of equality for disabled people, but as other noble Lords have pointed out, this issue falls between DWP and DHSC. I was surprised when I was briefed on this about where it fell. It clearly must be people in the same room.

[Baroness Watkins of Tavistock (CB)]

My Lords, it was a pleasure earlier to hear the new Health Secretary say that this is the kind of example that she would want to resolve—she did not use a particular one. Could the new integrated care boards not be the trusted sponsor for such personal assistance in each area? It would be straightforward and simple to introduce.

[Lord Kamall (Con)]

On the face of it, that sounds a very sensible suggestion, so let me take it back to the department, and if I am still here, I will respond.

Cannabis: Medicinal Use

Debate between Baroness Watkins of Tavistock and Lord Kamall

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

I do not know how to respond to that. All I will say to the noble Baroness is that nothing could be further from the truth. This is clearly an issue based on medicinal cannabis. The noble Baroness will know that my party is a coalition; there are quite a number of libertarians in my party who would take a very different view on banning these issues. What is really important is that, to be licensed as a medicine, it has to be approved by the MHRA; to be approved by the MHRA, except in very exceptional circumstances, you have to go through trials. These companies make a lot of money; they can afford to go through the trials; they are just choosing not to.

[Baroness Watkins of Tavistock (CB)]

My Lords, NICE has actually supported the limited use of medical cannabis. It has, over many years, supported the limited use of novel drugs in cancer and heart disease, which have been readily available. Does the Minister agree that it is a national scandal that we are discriminating against some of the most vulnerable people with severe epilepsy in our country by not providing this in limited forms on the NHS pre further clinical trials?

[Lord Kamall (Con)]

What I would say is that it is left up to the doctors, who are able to ask for it to be prescribed on the NHS. In some cases, that has clearly not been accepted and that is why people have to go privately, but the best way to solve this problem is for the industry to come forward and go through trials. The offer is open, the NIHR has money available, but for some reason the companies prefer to sell it unlicensed.

Polio

Debate between Baroness Watkins of Tavistock and Lord Kamall

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

Vaccination is already part of a national plan. People should be vaccinated at certain ages—I think it is in the first few months, and then in preschool and then at about the age of 14, when they get their booster at school. A couple of things could have happened. Someone may have travelled overseas, had the oral polio vaccine and then excreted it into the system—and it has happened on more than one occasion. On top of that, the important message is: check your records and make sure that you are vaccinated. It is not a matter of trying to get a new vaccine; it is already part of NHS routine. We encourage more people to come forward.

[Baroness Watkins of Tavistock (CB)]

Can the Minister clarify further what we will do to encourage vaccinations, while schools are still open, for 14 year-olds and for the 11% of under-twos in Greater London who are not vaccinated at the moment?

[Lord Kamall (Con)]

Part of the public health message has been focused on making sure that people come forward, even before this was detected in the sewage works. One thing we saw as a result of lockdown was that some parents in some areas had not taken their young children to their doctor to have the vaccine. Let me be clear: at eight, 12 and 16 weeks, a child gets a 6-in-1 vaccine; at three years and four months, as part of the 4-in-1 preschool booster, they get it; and at 14 years they get one at school as a teenage booster. Some of those are pre school. We are encouraging people to check their red book, check their vaccination record and make sure they take their child in for their vaccine.

Personal Protective Equipment: Waste

Debate between Baroness Watkins of Tavistock and Lord Kamall

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend is absolutely right that there has been an elective backlog. In analysing the backlog across the system we have found that about 75% to 80% of those waiting are waiting not for surgery but for diagnosis. This is why we have rolled out community diagnosis centres and will continue to do so, not necessarily in NHS settings but also in sports grounds, shopping centres, et cetera. On top of that, about 75% to 80% of those who require surgery do not require an overnight stay. We are trying to work through the elective backlog as quickly and effectively as possible.

[Baroness Watkins of Tavistock (CB)]

My Lords, what investment is being made to ensure that we can make our own PPE in this country in future, because the chief problem was that we were competing in an international market in a crisis?

[Lord Kamall (Con)]

I am not aware of detailed proposals on that but I know that there are many British companies who sourced from abroad and others that tried to manufacture. If you look at the relative costs and skills in the value chain, you will find that for many of the entrepreneurs in this country it is not cost-effective to manufacture here.

NHS Mental Health Patients in Private Hospitals

Debate between Baroness Watkins of Tavistock and Lord Kamall

Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

I begin, if noble Lords will allow me, by paying tribute to the noble Baroness for her doughty and robust opposition, but also for the advice when I was a new Minister suddenly thrown in at the deep end. It was very comforting to have one of the Opposition help me and give advice—I make no comments about the quality of the advice but I was incredibly grateful. I also pay tribute, to requote her words, to the perfectly formed shadow team. I thank them very much for all their holding us to account.

On the issue, when I was looking at the future of mental health, one thing we have to look at its granularity. There are different types of mental health; someone suffering from eating disorders, for example, will have a very different need from someone who is schizophrenic. It is really important that we do not just assume that everyone needs to be in a bed. Where appropriate, we should move people out to the community but make sure that they are supported there, not just kicked out the door and left to fend for themselves. We are looking at a massive programme of investment and at how we can have more targeted interventions for those suffering from different mental health issues.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as the recent chair of a major HEE review, recommending ways to improve and deliver the mental health nursing workforce, which was released on 20 April. Can the Minister really drill down on the extent to which the new ILATs will be accountable for both local provision of mental health in-patient beds—services are not enough and some people need admission and care in hospital—and the consideration of workforce needs, not only locally but for the services they purchase in the independent and not-for-profit sector?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how we ensure that those who require services in their community receive them, while ensuring that we have the appropriate workforce. She will know that throughout debate on the Health and Care Bill, we have discussed the fact that Health Education England, as well as NHS England, is developing workforce strategies—as are local trusts at their level, which know their needs and requirements at the same time. In terms of the specific question, I shall have to write to the noble Baroness.

NHS: Abuse of Nurses

Debate between Baroness Watkins of Tavistock and Lord Kamall

Tuesday 5th April 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord is absolutely right that we have identified the issue, and the NHS is working on a number of plans. All of us abhor any abuse of nurses or indeed any other NHS staff. The NHS has looked into this and has seen that many cases of violence against NHS staff are committed by individuals who are in a mental health crisis, or suffering from dementia or other neurological conditions, rather than the classic perception of attacks on staff by the public. The NHS has not only the violence prevention and reduction programme but a number of other initiatives to try to tackle this unwarranted issue.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register. I particularly want to raise the issue of nurses on shifts who are having difficulty parking both near the hospital for a reasonable cost—that cost was removed during Covid, which made life much easier for them—and in the community, where we have reports of them being abused for parking near patients’ homes. What strategy will the Government achieve to reduce this stress and the associated verbal violence?

Ockenden Report

Debate between Baroness Watkins of Tavistock and Lord Kamall

Wednesday 30th March 2022 Lords Chamber

[Lord Kamall (Con)]

I begin by thanking the noble Baroness, Lady Finlay, not only for her questions today but for the advice she has given me over a number of months since I started in this post. I have learned so much from the noble Baroness, especially from her courage to speak about her own professional experiences and admit where there are issues that need to be addressed. I am very grateful for that.

I completely take the point about working together from day one because, if you do that, you embed that culture of collaboration from day one, rather than just training people and then saying, “Oh, by the way, don’t forget to work collaboratively”. I think that has to be bred into the system and it is something we have to understand.

The other principle, which all noble Lords discussed in debates on the Bill, is the concept of a safe space. In an ideal world, we would find out who was responsible and they would be held to account, but what is really important is that we learn from that and the system learns from its failures. We have to encourage the ability to have a safe space where people feel confident about speaking up. We saw incidents where people felt bullied into not speaking up or where they withdrew their statements. If we can get this through the SHA and throughout the culture of the new HSSIB, this would be a really important first step. I thank noble Lords who, during the debate, pushed for the removal of certain bodies in order to make sure people felt comfortable coming forward.

On the CQC, there are real questions about the inspections in 2014 and 2016 and why it did not recognise safety concerns at the trust. Subsequently, the CQC did recognise the issues and place the trust in special measures. There was some progress made by the trust following this, and there were two subsequent visits. As a regulator, the CQC holds providers to account and makes clear where improvements must be made, but I think it recognises that there are lessons to be learned. There are lessons to be learned not only in government but across the health and care sector. It is important that we look systemically at how we work together and address some of those concerns.

[Baroness Watkins of Tavistock (CB)]

My Lords, I also thank the Minister for the sensitive way in which he has addressed this very difficult statement.

I was particularly moved by the fact that there are empty bedrooms. I have a daughter who is 31. I took a long time to get pregnant and, at the very end of my pregnancy, I woke up and said that I was ill. I went to hospital and my husband said to me, “I don’t think you’re ill, I just think you’ve never had a baby before”. But as the day went on, he came to see me, and apparently I said to him, “If anything happens to me, you will look after our child, won’t you?” He said it frightened him because I am not given to drama. He went to the midwife in charge of the ward and said, “I’m really worried about my wife”. It was taken seriously. I had a scan, and—the noble Baroness, Lady Finlay, will know that this is very rare—I had a rare form of pre-eclampsia in my liver, called HELLP syndrome. In 10 minutes, I had a caesarean section. I was ill for several months and my daughter was in ITU. She has a bedroom at home—she does not live in it except when she comes back—and it has really made me think, not just about the women who lost families but about how much we train healthcare professionals to listen to the significant other of the person. We have not said a lot about that today. That significant other may be a husband, it may be a man, it may be a same- sex partner, but I urge that training includes listening to the significant other.

I also want to raise that strengthening clinical reporting at board level is essential. I and others did research after the Francis report, where it was very clear that boards were not spending significant time looking at clinical issues but were looking at financial issues. That changed then, but I believe the Ockenden report reminds us that there should be further NHS guidance to boards about their responsibility for examining mortality and morbidity rates in order that that is kept closely under supervision at board level. Believe you me, as an ex-deputy chair of a trust, I know that that was one of the most important things I looked at. I chaired the clinical audit committee and I know that those are the things that can pick up recurring issues early and enable boards to look at what is actually going on in the system. We do not want to have another Ockenden report that may not be about midwifery but about something else.

My final issue is to re-emphasise that we must get workforce planning right for the whole of the NHS, not just midwifery—though I welcome everything the Minister has said in relation to midwives and obstetricians.

[Lord Kamall (Con)]

I thank the noble Baroness, Lady Watkins, for sharing a very personal story. It must have taken quite a bit of courage to share that with us so publicly.

The noble Baroness talked about the “significant other”. Sometimes we consider ourselves the insignificant other. I remember when I became a father about 20 years ago for the first time. When you watched the TV programmes, they quite often told the father, “Go and have a smoke and come back. We’ll let you know.” Clearly, nowadays, you would not advise anyone to go and have a smoke. I remember how involved I was allowed to be. I was in the room for 22 hours for the first birth. Pre-natal care was fantastic, but once the baby was born, my wife was ushered into a bathroom, and I was sent away somewhere else. I could hear her voice. She called me. When I went in, she was sinking into the bath; she was just too exhausted. She was terrified and did not have the strength, and I pulled her out. It might have been a tragedy—I do not know—but it shows that even little things like that could have made a huge difference.

We are all grateful when a wonderful new life comes into this world. Let us think about the preparation that families go through—they prepare a separate room; families buy baby clothes and toys for everyone, expecting that bundle of joy to come home. When that is cruelly snatched away from them due to incompetence, we have to make sure that it happens as little as possible in the future. We know that incidents will occur. It brings a lump to the throat.

Noble Lords will recognise that there has been a debate on workforce. There is a debate in government on it. We shall just have to see how that resolves itself. I have heard loud and clear from noble Lords that it is not only about the maternity workforce; it is also about the wider NHS workforce, as well as making sure that we learn from incidents like this and build in that culture of prevention but also openness when things go wrong.

NHS: Nurse Recruitment

Debate between Baroness Watkins of Tavistock and Lord Kamall

Thursday 27th January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for giving us the opportunity to thank the nurses, and indeed all medical staff, for the incredible work that they do for us, day in, day out. On retaining staff, since 2017 NHS England and NHS Improvement have supported trusts with an intensive retention and support programme. There is also emotional, psychological and practical support for NHS and care staff. It is really important that we not only recruit new staff but retain the great staff that we have.

[Baroness Watkins of Tavistock (CB)]

My Lords, would the Government consider repaying student nurses’ and other healthcare workers’ course fees to retain new, young graduates in the NHS who work, for example, for two or three years?

[Lord Kamall (Con)]

As the noble Baroness will be aware, there is a bursary available to encourage people into nursing but we are looking at completely different training pathways. It is not the old-fashioned way of being trained as you leave school and that being your one chance. We now have a number of different ways in, including degrees and apprenticeships. I could read all the different pathways out but I am happy to write to the noble Baroness with these details.

Covid-19: PCR and Lateral Flow Test Providers

Debate between Baroness Watkins of Tavistock and Lord Kamall

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for suggesting another price comparison website. There is an accreditation scheme, and every time companies are reported to the Government, we look at how to remove them. There is a four-stage process for UKAS accreditation, and sometimes when companies are reported, another one pops up.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister say what the average cost to the NHS of both a PCR and a lateral flow test is, so that that can inform people in relation to the cost in the private sector?

[Lord Kamall (Con)]

I do not have the exact numbers, so I will write to the noble Baroness. On loss-leading services, anything under £15 was removed because it was deemed that that was dishonest or underpriced.

Adult Social Care

Debate between Baroness Watkins of Tavistock and Lord Kamall

Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness, Lady Fox, makes a valid point: we have to look at not only the long-term vision but the short-term issues raised. This is why, on 3 November, we announced the adult social care winter plan for 2021-22. This was developed in conjunction with the NHS and social care stakeholders. We drew on the recommendations of the review of last year’s adult social care winter plan and listened to a number of different stakeholders in setting out the short-term issues.

As the noble Baroness acknowledges, we are the first Government to set out a long-term vision, not just from one electoral cycle to another but for 10 years. We have set out a vision with three years of commitment to specific spending, some of which is a discovery process, because we still have to know what will and will not work, and how to use and integrate technology. By doing that, we have laid down the gauntlet to whatever Government come after us, of whatever political colour, for them to continue to fulfil this vision. It is a vision against which this and future Governments will be measured.

Other politicians from other parties have known about this for many years. The noble Baroness, Lady Pitkeathley, mentioned waiting for 40 years and others have known about our post-war demographic challenge. We have finally grasped the nettle. We are not going to get everything right, which is why we have not laid out a detailed, prescriptive plan for 10 years. We have laid out a vision of integration, making sure that we use the best technology to support people in their own homes, as much as possible. At the same time, we have committed for the next three years. After that, the challenge is for us to work with all stakeholders to deliver that vision.

[Baroness Watkins of Tavistock (CB)]

My Lords, I am particularly delighted to see this White Paper and congratulate the Government on publishing it in this timeframe. However, we need to look closely at workforce needs, at the same time as we look at workforce needs for the Health and Care Bill, because there is a real mismatch between the vision we now have and the staffing for that vision. I welcome this opportunity to hear how the Government think we can tackle that and give young unemployed people good opportunities to come into a proper caring profession.

[Lord Kamall (Con)]

I thank the noble Baroness for the conversations that we have had about this, and a number of other issues, as I got to grips with my brief. She makes a very important point. We have to make sure that social care is seen as an attractive career path and not just something unskilled; we know that there are skills involved, such as empathy. There will also be an increased need for digital skills, and people management skills will be handy in other areas. For far too long, social care has been seen as the poor relation of other parts of the health system. By bringing health and social care together, we are sending a signal that our vision is to put them on an equal footing. We are also explaining how we intend to spend over the next three years. We challenge everyone—stakeholders, local authorities, everyone—to come forward and help us develop that vision for the long term, and to hold future Governments to account against that vision.

Covid-19 Update

Debate between Baroness Watkins of Tavistock and Lord Kamall

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for the point he just made. If he will allow me, I will take that back and try to get an answer for him.

[Baroness Watkins of Tavistock (CB)]

My Lords, I hear from colleagues in South Africa that nasal swabs alone are not as effective at picking up the new variant and that there have been many false negatives reported. I would welcome the Minister’s comment on that, as we are moving to more nasal swabs. I also suggest that it would be more sensible to encourage the use of face coverings in offices and to encourage people to work from home wherever it is feasible in terms of employers, so that the next two weeks can be used by scientists to really identify other problems that might be associated. This would help to safeguard NHS clinical staff as well as hospitals. If people are getting false negatives and then being admitted to hospital, it puts the very staff we need to keep at work at risk.

Covid-19 Update

Debate between Baroness Watkins of Tavistock and Lord Kamall

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. As noble Lords will know, I see myself as a bit of a civil libertarian. Personally, I have asked a number of questions internally about the whole issue of compulsion. It is a very difficult issue, but I understand the arguments on the other side—that we want patients to feel safe and feel that they are looked after by staff who have been vaccinated. Stakeholder analysis and round-tables came out in favour of compulsion on the Covid vaccine and boosters. When it came to flu, interestingly enough, there was a significant disagreement on the practical timing of the flu vaccine supply and the vast majority of doses being available. We have promised to keep it under review, but that is not mandated at this stage.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a mental health nurse, as outlined in the register. I am concerned about the unintended consequences of making vaccines mandatory for healthcare staff, despite the fact that I fully support the vaccine and have had three doses myself. It is a relatively small number of healthcare staff who are not vaccinated—I accept that it varies across the country—but is it right to give no authority at all to boards in trusts to decide the best way forward for the minority of staff who do not wish to be vaccinated? I am concerned that there will be unintended consequences associated with a lack of care staff, particularly nurses, in mental healthcare environments, which may result in poorer care for patients than if we carefully supported that small number of staff in working perhaps with patients who do not want to be vaccinated themselves.

Covid-19 Vaccinations

Debate between Baroness Watkins of Tavistock and Lord Kamall

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

On the noble Baroness’s first point, about the centres closing at 6 pm, this is the first time that I have been made aware of that. I welcome any feedback about what is working and what is not. This is not necessarily political; we all want it to work, so I welcome any information on that. I will double-check it.

The noble Baroness referred to complacency. It is very interesting when people say that most people are in favour of measures on masks. It is quite often like polling, when we see a difference between stated preferences and revealed preferences. It is claimed that a number of people are in favour of masks and want to wear them, but, when it comes to public transport and the revealed preferences, we see that it depends on the mode of public transport—sometimes take-up is less than 50%. I have said to people, “Make sure you get your boosters”, but maybe we have to take some responsibility for not making it clear that the boosters were important and for not pushing them as much as possible. The first and second vaccines were taken up with such enthusiasm because people wanted to return to as close to normal as possible, but when it came to the booster, it really needed all of us to push it to make sure that more people took it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a nurse. Would it be helpful to reinforce the message that some of the most vulnerable people should contact their specialist nurse practitioners, who in many cases are much more obtainable than both consultants and general practitioners? I would really like the Government to emphasise that.

Turning to 12 to 15 year-olds, I declare my interest in that my daughter is a secondary schoolteacher in south London. Anti-vaxxers outside schools are creating a real problem. I understand that the Government have powers to reduce their access within the area of a school. Is this being seriously considered? The uptake of vaccines in the 12 to 15 year-old age group requires the consent of an adult. Therefore, it is imperative that schools are part of that system.

[Lord Kamall (Con)]

I thank the noble Baroness for that really important point: it is about not only consultants and GPs but nurse practitioners. When you go to book a booster jab and look at availability, you might well expect it to be at a hospital or a surgery, but many community pharmacies are offering it. It is important that we have those conversations. I agree with the noble Baroness on the advice that she has given.

I also share the noble Baroness’s concerns about the anti-vaxxers. It is a difficult balance: I believe in freedom of speech, but they should not inhibit people. It is really important that we make the case. As of 2 November, 24% of 12 to 15 year-olds had received their first dose. They will have received it through school. The NHS is also working closely with schools to offer vaccines to young people as soon as parents or guardians consent. We are also expanding our programme of walk-in centres to make sure that we can provide parents with extra choice over where and when their children are vaccinated. The vaccines are safe and will protect children from Covid-19. We repeat this. The current advice is to give the majority of children a single dose, which means that they will be afforded a high level of protection.

On people protesting outside schools, the Government have explained their concerns about that. At the moment, I have no further information. As soon as there is further information, noble Lords will be informed.

Social Care

Debate between Baroness Watkins of Tavistock and Lord Kamall

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall]

The funding commits us from 2022 to 2025—it is three years’ funding. The point that the noble Baroness makes is that, of course, we are hoping that we can clear as much of the elective backlog as possible. After that, the money will be moved and will focus on social care reforms. On her specific question, I will write to the noble Baroness.

[Baroness Watkins of Tavistock (CB)]

My Lords, my question builds on that of the noble Lord, Lord Young of Cookham. Can the Minister explain how social care is to cope now, when there is a crisis, without a larger allocation of the levy in addition to funds announced, and, in particular, how delayed transfers of care from acute hospitals may be reduced? Should there be central guidance to the NHS to commission social care services to assist in safe rapid discharge?

[Lord Kamall (Con)]

In looking at how we reform the adult social care workforce, we have consulted a wide range of stakeholders, not only on what we do from 2022 to 2025 but on what we do in the short term. Further details will be announced soon.