Care Homes: Energy Costs

Debate between Baroness Wheeler and Lord Kamall

Thursday 8th September 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, what support will the Government specifically give those care homes whose pre-Covid Care Quality Commission ratings have been downgraded from good to inadequate as a result of staff shortages? This is on top of their deep concerns over energy costs. Recent press reports say that up to three-quarters of care homes in England have been reassessed in this way.

[Lord Kamall (Con)]

Clearly, one of the issues in the overall review of the social care sector is that, when the CQC and others report on care homes and other places, action is taken. One of the things we will do is talk to the right stakeholders and individuals, but we also have to work in partnership with local authorities—as quite often it is their responsibility—to try to make sure we raise the standard.

Thyroid Patients: Liothyronine

Debate between Baroness Wheeler and Lord Kamall

Wednesday 6th July 2022 Lords Chamber

[Lord Kamall (Con)]

I am afraid that I am not able to fully answer my noble friend’s question. However, I know that my right honourable friend the former Secretary of State for Health did organise a round table with some of the relevant charities to discuss this and to discuss where they can source elsewhere, outside of the UK, and whether they could build up UK capacity. My honourable friend Maria Caulfield, the Minister, has also met with a number of organisations on this, and they are determined to get as much as they can. One issue is the stock for the future as opposed to for now, and feeding that through, but I know that the department is on to this.

[Baroness Wheeler (Lab)]

My Lords, the evidence clearly shows that many patients with hypothyroidism would benefit hugely from the declassification of T3 as a high-cost drug back to being a drug that is routinely prescribed in primary care. Can the Minister explain exactly what the Government will do to ensure that the actual NICE guidelines that enable T3 to be prescribed by clinicians according to their judgment reflect this position, are implemented consistently across new NHS structures and stop the current postcode lottery? Would this not be better than repeating the record of the majority of CCGs who ignore the guidelines?

[Lord Kamall (Con)]

The noble Baroness raises a really important point about some of the blockages to patients getting T3. It is both the first and second-line advice from NHS England but also the NICE advice too. NICE always reminds us that it is independent, and that Ministers should not intervene, but we can call for meetings. NICE also recognises that a price change does change the equation. It has told me that it is open to new evidence with people able to consult and contact it about this.

Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Debate between Baroness Wheeler and Lord Kamall

Tuesday 28th June 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, this debate has been a welcome opportunity to clarify the role of responsible and superintendent pharmacists, as set out in the SI, and to take a closer look at the wider industry, its workforce and, in particular, the support and funding community pharmacies need to enable them to operate effectively and undertake the extended role they need as an integral part of the local primary care team.

I congratulate my noble friend Lord Hunt on his excellent speech and presentation of the strong case for his amendment. All speakers have rightly paid tribute to the role played by community pharmacies during the pandemic, which remained open and continued to offer their full range of services. We all acknowledge the huge contribution they made then and make now to front-line care: the delivery of mass vaccination programmes for both Covid and flu, providing essential preventive programmes, such as blood pressure checks, providing medicine support for patients discharged from hospital, and supporting patients, particularly those with long-term conditions, with their self-care and self-management. All this takes pressure off GPs and ensures better access for patients to healthcare information and advice, and more efficient use of NHS resources. The estimate that the NHS could save £640 million through nationwide treatment of minor ailments by community pharmacists is an example of how their role should be extended.

The new community pharmacy consultation service mentioned by my noble friend Lord Hunt—involving GP surgeries, NHS 111 and pharmacies—for minor illness or medication consultations, and the pilot schemes for NHS Direct cancer referrals to pharmacies for patient scans and checks, are both key developments which we very much welcome.

I also pay tribute to my colleague Peter Dowd MP for his excellent Westminster Hall debate last week, which I commend to your Lordships. It set out a compelling case on the contribution community pharmacists could make with the right support and funding and increased collaboration with GPs, a case which had strong cross-party backing from supporting speakers. However, no part of the extended role we all want to see can be delivered unless the major workforce issues across community pharmacies are acknowledged, and the ongoing discussions with the Pharmaceutical Services Negotiating Committee on the current agreement and future funding acknowledge the scale of the resources needed.

On the SI, we support and welcome the aim of clarifying and strengthening the governance requirements of responsible and superintendent pharmacists. I thank the General Pharmaceutical Council for the reassurances in the note it prepared for this debate on extensive public consultation and engagement with patients, the public and the pharmacy and health sector on the rules and standards to operate under the extended remit the SI gives them.

Like my noble friend and the noble Baroness, Lady Brinton, I await the Minister’s response to the concerns of the Secondary Legislation Scrutiny Committee on the profession’s general distrust of the council on the setting of appropriate standards and concerns about patient safety if the pharmacist is absent from the pharmacy. As the committee rightly stressed, the Government need to improve on the reassurances they offered the committee. How are the profession’s concerns and reservations to be addressed? How will the Minister address the Pharmacists’ Defence Association’s deep worry that the new focus of the GPC in exercising its rule-making powers, minimising the burden on businesses, could lead to less focus on patient safety, which surely must be the council’s number one concern?

On workforce, all the excellent stakeholder briefings we received for this debate point to a crisis across the pharmacy industry. While the numbers of pharmacists on the register and of pharmacy technicians have increased, there has been a serious reduction in the numbers of students in training and of dispensary and counter staff. As we have heard, the primary care networks, with pharmacists working in GPs’ surgeries and away from pharmacies, have had a significant impact on staffing levels in high-street pharmacies, which to cover vacancies have to make increasing use of locums, the cost of which is spiralling. The Company Chemists’ Association’s estimate of a shortfall of 3,000 community pharmacies in England is not the setting or context in which any newly extended role for community pharmacies can develop strongly and flourish.

There is also the PDA’s serious concern about the pressures on staff in some pharmacies, such as unsafe staffing levels, poor pay and working conditions, long hours and suffering physical abuse from customers, which cause them to want to change jobs or leave the profession. What are the Government doing to ensure that risk assessment and preventive safety measures are in place, as well as a zero-tolerance approach when incidents occur? How can the welcome development of primary care networks and pharmacy services in GP surgeries develop hand in hand with ensuring enough staff and resources for community pharmacies to provide the quality of professional care that they want to deliver and we all want to see? How will the Government help pharmacies invest in staff training and development?

On funding, the Minister will have heard the concerns from across the House. The CCA’s estimate of funding last being increased for the sector eight years ago, in 2014, and the cuts of £200 million that it had to find two years later, paint a sobering picture of how the industry has fared. The current community pharmacy contractual framework agreed in 2019 has not been adjusted despite the pandemic and rising inflation and costs. The £370 million from the Government to meet pandemic costs was a loan, as we know from valiant attempts in this House to ensure that the industry did not have to repay it. I understand that it was repaid and then a separate admin process was established for the industry to claim back the extra costs incurred during Covid. Does the Minister have any further information on the sums reclaimed under this procedure? Can he reassure the House that the current negotiations with the PSNC on year 4 of the five-year funding agreement will include funding recognition for the extended and full role that community pharmacies need to play?

The need for an overall strategy for the primary care workforce across GPs, pharmacies and community services becomes ever more urgent, as this debate and the questions from noble Lords have clearly demonstrated. I look forward to the Minister’s response. We will fully support my noble friend’s amendment, should he put it to the vote, highlighting the vital importance of having the clear, long-term strategy and vision for community pharmacies that we have all been calling for.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords for their contributions and once again apologise for the delay in bringing this matter before the House. I welcome the essential role that your Lordships play in scrutinising measures. I experienced that during the passage of the Health and Care Bill, and I think we have a better Act as a result of the scrutiny from across the House. I will try to address as many as possible of the points raised before I conclude. I will try to cover most of the points but I pledge to write to noble Lords if I have missed any specific points.

If we look at the overall picture of the NHS, I am sure noble Lords recognise that we seem to have more doctors, nurses and pharmacists than ever before. As someone said to me the other day, that is all very well but the supply is not keeping up with the demand. If we consider our whole understanding of health, some of the things we ignored many years ago are now things we deem as needing treatment. For example, the whole area of mental health was ignored for many years. PTSM, which people talk about now, was officially recognised only in the 1980s. I know that we will probably talk about that in the next debate.

Before a debate the other day about neurological conditions, I asked my officials to give me a list of all the conditions. They said, “Minister, there are 600 of them.” Let us think about this. We were not even aware of that previously. It shows the great complexity as we become more aware of conditions and issues, putting even more pressure on our health service and health professionals, even though we have more health professionals than ever before.

The Secretary of State recently pledged to start with pharmacies when it came to overall primary care. The community pharmacy contractual framework, to which the noble Baroness, Lady Wheeler, referred—the 2019 to 2024 five-year deal—set out a joint vision for the sector, and an ambition for community pharmacies to be better integrated in the NHS and provide more clinical services. We saw this during the pandemic when pharmacies provided vaccines and we have seen recently that they will be providing more initial advice on issues such as cancer—and they welcome this.

At the same time, we are seeing an overhaul of the overall model. It is time to move away from the old model, in which you see your GP for five minutes and then hope for a referral somewhere else. Services previously considered part of secondary care are now being taken over by primary care centres. Areas previously considered the work of GPs are now being taken over by nurses and physiotherapists, as well as by pharmacists in the community.

Despite the challenges of the last few years, we have jointly delivered the introduction of a new range of clinical services at the community level. These are important in their own right and we are negotiating with the Pharmaceutical Services Negotiating Committee on the expansion of additional services to be introduced in the fourth year of the five-year deal. I very much hope that my right honourable friend the Secretary of State will be able to make an announcement soon. Longer term, we want to build on what has already been achieved and make better use of existing skill sets and those that are developing; for example, the prescribing and assessment skills that all pharmacists graduating from 2026 will have acquired during their training.

I turn to some specific points. We now have more pharmacists than ever before. Data from Health Education England shows that we now have an additional 4,122 pharmacists employed in the community compared with 2017, and the number of registered pharmacists has increased year on year. The number of primary care pharmacy education pathway trainees coming from community pharmacy increased by nearly 2,500. Reforms to initial education and training of pharmacists means that pharmacists qualified from 2026 will be qualified to prescribe at the point of registration. On top of the £2.5 billion that we are spending on the sector, Health Education England is investing £15.9 million over the next four years to support the expansion of front-line pharmacy staff in primary and community care.

We are also supporting a significant expansion in primary care capacity through the additional roles reimbursement scheme, enabling primary care networks to recruit clinical pharmacists and pharmacy technicians, two of 15 roles that PCNs can choose to recruit to. We saw the strength and potential of community pharmacies —many noble Lords referred to it—during the Covid vaccination campaign and the role that community pharmacies played in it. It is not yet known whether recurrent boosters will be required annually. We are looking into that and whether pharmacies will be once again called on.

Noble Lords will recognise—we had this debate many times during the stages of the Health and Care Bill—that to support long-term workforce planning, we are looking first at the long-term strategic drivers of workforce demand and supply. Building on this work, we have commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. Once this work is ready, we will share the conclusions and start to home in on what it means for recruitment, skills needed and skill gaps.

A number of noble Lords raised fears or concerns about what the regulators will do with their new powers. This is understandable: community pharmacies are private businesses and increased regulatory burden will be a concern for many of them. However, once again, we have to get the right balance between regulation and making sure of safety. The proposals include safeguards to ensure that any changes the regulators make are subject to full consultation, in much the same way as is expected from the Government. This will ensure that patients, the public, pharmacy professionals and the pharmacy sector have their say on what the standards should say.

There were some concerns about remote supervision. It is important to emphasise that a lot of the issues raised today do not affect this legislation, but I completely understand the point about taking advantage of the situation to debate the wider issues.

Social Care: Adults

Debate between Baroness Wheeler and Lord Kamall

Wednesday 22nd June 2022 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the survey by the Association of Directors of Adult Social Services, published on 13 May, which found that more than 500,000 people in England were waiting (1) for a social care assessment, (2) for their care package to begin, or (3) for a review of their care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

Local authorities are responsible for meeting the needs of those who require care and support under the Care Act. The ADASS survey highlights that their waiting lists are increasing, which is why we are investing to support improved outcomes and experiences of care for people and their families, including through an additional £5.4 billion over three years to begin a comprehensive programme of reform.

[Baroness Wheeler (Lab)]

My Lords, both the ADASS survey on social care waiting lists of 500,000 and Age UK’s estimate of 1.6 million people with unmet care needs are a stark wake-up call for the Government’s mantra of having fixed social care. The Minister knows that the official figures that he always quotes and quotes today are nowhere near enough to meet current and future demands, as key stakeholders and the expert think tanks routinely remind him. What are the Government doing to prioritise care and support in people’s homes and local communities? Does the Minister not recognise that the situation is getting worse, not better?

[Lord Kamall (Con)]

Many noble Lords recognise the challenges faced by not just this sector but all sectors, during Covid. One issue we have been looking at for many years, over subsequent Governments—we discussed this during the Health and Care Bill—is that social care was seen as a Cinderella service for many years. For the first time, thanks to noble Lords’ support, we managed to get the Health and Care Bill through to have a properly integrated health and care system. We are also looking at how we can make sure that we properly understand the health and care landscape, with the register and the hub, and that it is a vocation that more people find attractive.

GP Access

Debate between Baroness Wheeler and Lord Kamall

Tuesday 7th June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question and for highlighting the role of community diagnostic centres. When we look at the backlog and the waiting lists, about 80% of the waiting list is for diagnosis, not necessarily surgery. Of course, once they have been diagnosed, some of those people will require surgery. After that, about 80% of those who require surgery will not require an overnight stay. They can be daily in-patients, as it were. The role that CDCs will play in trying to tackle that backlog is to encourage more diagnosis in the community, so rather than people having to go to NHS settings, diagnosis will go to the people in shopping centres and football stadiums.

[Baroness Wheeler (Lab)]

My Lords, this is national Carers Week, and I am sure the whole House will want to pay tribute to the tremendous work our 6 million unpaid carers do, often at great cost to their own health and well-being. This week’s Carers UK survey highlights the alarming neglect by carers of their own health, be it mental health conditions, long-term illness or disabilities, or putting off treatment because of their caring duties, like the carer who delayed a hysterectomy for five months because of the urgent care needs of the loved one she was caring for. The Carers UK survey shows that only 23% of carers are offered health checks for themselves when they phone the GP’s surgery to make their loved one’s appointments. Rather than just flagging up on the system that a person is a carer, what action will the Government take to ensure that GP surgeries are able to do much more to monitor carers’ health and well-being and what guidance will be issued on this important matter?

[Lord Kamall (Con)]

The noble Baroness raises a very important point, as does the noble Baroness, Lady Pitkeathley, who frequently champions the role of unpaid carers. The new model of primary care is taking on some of the services that were previously provided by secondary care, and it will be a more modern, networked service. Clearly, part of that mix, not only in primary care but at the ICS level, will be how we make sure that we have a proper integrated health and care system and how we can help carers and make sure that they are looked after while they provide a service for people.

National Institute for Health and Care Excellence

Debate between Baroness Wheeler and Lord Kamall

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.

[Baroness Wheeler (Lab)]

My Lords, NICE is a critical participant in the Innovative Licensing and Access Pathway, launched over a year ago. It aims to make use of regulatory freedoms post Brexit to speed up access for NHS patients to new drugs, including cancer treatments. Can the Minister tell the House how many treatments have been or are being considered through ILAP and when we might expect to see the first ILAP treatment being made available on the NHS?

[Lord Kamall (Con)]

I know I have the answer here somewhere but I cannot find it, so I commit to write to the noble Baroness.

Health and Care Bill

Debate between Baroness Wheeler and Lord Kamall

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]

is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

[Lord Kamall (Con)]

I thank all noble Lords who have spoken in this debate. I will turn to the issues as briefly and succinctly as I can.

On workforce planning, I hope I can assure noble Lords that we will engage with stakeholders on the preparation of the report, which will include the regulated workforce in health, social care and public health. I hope your Lordships also understand the work being undertaken by the Government, NHS England and Health Education England to improve workforce planning and to lead the improvements we all seek. This is why we think the amendment is unnecessary. I also remind noble Lords that at local level there is an incredible amount of local planning going on much closer to the ground.

NHS: Pre-pandemic Facility Levels

Debate between Baroness Wheeler and Lord Kamall

Tuesday 29th March 2022 Lords Chamber

[Lord Kamall (Con)]

That is exactly why, as technology has improved, you should be able to book a specific time. In fact, in some practices, it has gone backwards since the 1970s. When I was a child, my mother was able to phone up and ask, “Can my son have an appointment on Tuesday next week?” These days, you have to phone at 8 am hoping to get in the queue to book an appointment. Technology should improve that, and we hope that once we are able to recover, we will be able to use technology to book in advance.

[Baroness Wheeler (Lab)]

My Lords, the BMA’s Rebuild General Practice campaign has warned that GPs’ lack of time with patients, workforce shortages, heavy workloads and administrative burdens mean that patients’ safety is being put at risk when they attend a surgery. Data shows that GPs are conducting nearly 50% more appointments, but staff vacancies continue to soar and GP numbers to decline. In the light of this, can the Minister explain to the House how the Government expect to achieve their target of an extra 6,000 GPs by 2024—just two years away?

[Lord Kamall (Con)]

I thank the noble Baroness for reminding us of the target. We have been quite clear that it is important that we have as many healthcare professionals as possible and fill the vacancies as soon as possible. We made £520 million available to improve access to GPs and expand general capacity during the pandemic. That is in addition to the £1.5 billion announced in 2020 to create an extra 50 million general practice appointments by 2024, by increasing and diversifying the workforce.

NHS: Gambling Treatment Services

Debate between Baroness Wheeler and Lord Kamall

Monday 28th March 2022 Lords Chamber

[Lord Kamall (Con)]

We take the public health aspect very seriously. Public Health England did some work with the DCMS on looking at gambling from a public health perspective, and the Office for Health Improvement and Disparities continues to do that work. While the Department for Digital, Culture, Media and Sport is looking at the gambling industry, we are also looking at this as a public health issue via the Office for Health Improvement and Disparities. I see that the seconds are running out, so I will give the Labour Front Bench time to ask a question.

[Baroness Wheeler (Lab)]

I thank the Minister for that.

GambleAware recently announced a new major public health campaign to raise awareness of the gambling harms that women experience and to highlight the warning signs and the support that is available. It is particularly focusing on women between the ages of 25 and 55 who gamble online. Can the Minister reassure the House that such vital campaigns will continue to be supported through the long-term funding settlement for NHS gambling treatment and support services?

[Lord Kamall (Con)]

I am afraid that I cannot answer on the specific initiative that the noble Baroness refers to, but I know we take very seriously that this is a public health issue that we must tackle in a holistic way. We are looking at how we can allocate funding in the NHS long-term plan to tackle gambling addiction and to ensure that we focus more on prevention rather than simply dealing with people once they have a problem.

Care Homes: Evicted Residents

Debate between Baroness Wheeler and Lord Kamall

Thursday 10th March 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness has identified a potential issue that we have to address, which is drilling down into detail. One of the things that the CQC does is to look at aggregate numbers of complaints and concerns. Of course, there is a Local Government Ombudsman who looks at this issue as well. We are looking at ways where that works and where it does not work, and at how we could improve the system. This is all part of the ongoing review to build up a better, integrated health and care system.

[Baroness Wheeler (Lab)]

My Lords, on the issue of carers hesitant to make complaints to care providers, the confusion and muddle over the current complaints system and the roles of the care home, the CQC and the ombudsman compound the problem. Does this not underline the urgent need for the review of the current arrangements to ensure that people making complaints about their loved ones feel reassured and protected through the process and comforted that appropriate action will be taken?

[Lord Kamall (Con)]

Having looked at the different procedures, I am sure that the noble Baroness is absolutely right. One thing that we want to do is to ensure that the guidance is quite clear. The CQC collects certain data and the ombudsman can investigate certain cases, but the CQC cannot investigate individual cases. It clearly is confusing and one thing that we want to do to improve the system is to make sure that we have a better complaints system and, overall, a better quality of care for patients all round.

Medical Abortion Pills

Debate between Baroness Wheeler and Lord Kamall

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I think the noble Lord is being slightly unfair. It is a complicated issue and not as simple as people make out. The noble Baroness said that we should be aware of dangers. These are the issues that we considered during the consultation. Whatever we do, we will be criticised— rightly so—but we want to make sure that when we make a decision it is the right decision.

[Baroness Wheeler (Lab)]

My Lords, RCOG data has shown that complications related to abortion have decreased since the telemedicine for EMA service was introduced. The college has warned that failure to make it permanent could lead to more women accessing an illegal abortion. NICE has recommended the service as best practice, so does not its future urgently need to be secured by making it permanent? It does not have to be temporary.

[Lord Kamall (Con)]

As I said, we are looking at the consultation carefully and considering all views. If we made it permanent, there would be lots of criticism, which we have to be aware of and make sure that we have the answers for. If we continue to expect it to be temporary, there will be plenty of criticism. Whatever we do, we will be damned, but we are going to try our best.

Health and Care Bill

Debate between Baroness Wheeler and Lord Kamall

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, very briefly, we welcome the Government’s proposals on mandatory disclosure of payments, a companion piece to the previous debate that we had, as has been pointed out.

As noble Lords have always stressed, greater transparency is highly desirable and a very good thing. I am grateful to the Minister for listening to the voices of stakeholders and parliamentarians on this. Indeed, nine out of 10 medical professional bodies think that patients have a right to know if their doctor has financial or other links with pharmaceutical or medical device companies and they support stronger reporting arrangements, as contained in the amendments. I am grateful for the briefing I have received from the ABPI, which, as we have heard, also supports mandatory disclosure.

I also note that Amendment 312D refers specifically to the consultation with the devolved Administrations in Scotland, Wales and Northern Ireland and to obtaining the

“consent of the Scottish Ministers, the Welsh Ministers or the Department of Health in Northern Ireland … before making provision within devolved legislative competence in regulations relating to information about payments etc to persons in the health care sector.”

We would welcome the Minister reassuring us that full consultation is under way and setting out the timescales involved.

On Amendment 284, the non-government amendment leading this group, the intention of the amendment and the arguments put forward by noble Lords are extremely persuasive. The requirement for companies involved in the production, buying or selling of pharmaceutical products or medical devices to publish any payments made to teaching hospitals, research institutions or individual clinicians is a sensible measure that would complement the Government’s package, and I await the Minister’s thoughts on it, including on the one glitch underlined by the noble Baroness, Lady Cumberlege, on moving from “may” to “shall”.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who took part in this debate, especially my noble friend Lady Cumberlege for her work on the independent review of medicines and medical devices, and other noble Lords who were involved in that. I know that she worked tirelessly to make sure that patients and their families have been heard and I pay tribute to her and her team. I also thank her for her lobbying—or reminding—me of the pledge that I made when I first became a Minister on championing the patient.

I welcome my noble friend’s amendment to increase transparency and promote public confidence in the healthcare system. The Government fully support the intention behind the amendment. That is why I will be moving Amendments 312B, 312C, 312D, 313B, 313C and 314ZB in my name. Before I do so, let me answer some of the questions.

All these amendments relate to the transparency of payments made to the healthcare sector. The Independent Medicines and Medical Devices Safety Review led by my noble friend Lady Cumberlege listened to the brave testimony of over 700 people to understand where improvements needed to be made to make the healthcare system safer for all patients, especially women. The Government have given the review deep consideration and accepted the majority of its nine strategic recommendations and 50 actions for improvement.

To improve transparency, the review recommended that

“there should be mandatory reporting for pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians”.

The amendments deliver on this recommendation by enabling the Secretary of State to make regulations requiring companies to publish or report information about their payments to the healthcare sector. The clause covers any person performing healthcare as part of their duties, benefiting patients and building on initiatives by regulators and industry. I hope that partly answers the questions raised by the noble Lord, Lord Stevens.

The amendment also allows for the Secretary of State to make regulations requiring that the information be made public and make further provision about when and how the information must be published. This could include requiring self-publication or publication in a central database. That ensures that we can adapt the system to improve reporting as necessary. To ensure that companies fulfil the obligation, requirements introduced by the regulations can be enforced using civil penalties.

There are benefits to this duty applying UK-wide, aligning with the approach taken by the pharmaceutical industry with its Disclosure UK system. As the noble Baroness, Lady Wheeler, referred to, the clause contains a statutory consent requirement, so we will work closely with the devolved Governments to develop regulations following the passage of the Bill. We will also work with patients, industry and healthcare providers to create a system that enhances patient confidence while maintaining a collaborative, world-leading UK life sciences sector.

A question was raised about the issue of “shall” versus “may”. The Government have not tabled these amendments in bad faith; we would not have tabled these amendments if we did not intend to work with them. It is the intention of my right honourable friend the Secretary of State to bring forward regulations under the clause to make sure that there is transparency. If that is not reassuring enough, perhaps between this stage and Report there can be some conversations to make sure that noble Lords are assured. It is for these reasons that I ask your Lordships’ Committee to support these amendments.

Covid-19: Lockdowns

Debate between Baroness Wheeler and Lord Kamall

Wednesday 9th February 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes some important points about the meta-analysis in the paper. Undue attention has been given to one paper out of 34 studies. While I am answering the noble Baroness, I will refer to an earlier question. In academia there is a huge debate about meta-analysis in all sorts of fields. The question is what other research should be analysed with meta-analysis. This continues to be an issue of debate among academics in many disciplines.

[Baroness Wheeler (Lab)]

My Lords, I want to follow on from what the noble Lord, Lord Patel, said. The World Health Organization’s authoritative and in-depth research shows the effectiveness of large-scale social distancing measures and movement restrictions—ie lockdown—in slowing down Covid-19 transmissions because they limit contacts between people. Is it not far better to work on the basis of this evidence, as well as our own much-respected evidence from the CMO and his team, rather than a non-peer-reviewed paper from an American think tank?

[Lord Kamall (Con)]

Once again, the noble Baroness makes the point that this paper has not been peer-reviewed. That is an important consideration. The Government were quite clear that they introduced measures including lockdown—in the face of some opposition, but with the support of the Benches opposite—because, on the balance of epidemiological and other evidence, it was important to prevent and reduce the risk of transmission of the disease.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Debate between Baroness Wheeler and Lord Kamall

Tuesday 8th February 2022 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for introducing this SI on Care Quality Commission registration, somewhat at the 11th hour before the current 2014 regulations run out on 31 March 2022. Of course, we fully support their extension beyond that date so that all providers of health and social care in England will continue to be required to register with the commission and to comply with the high patient safety and care quality standards it sets.

The SI is very brief and to the point, with the proposed extension to 31 March 2025 the only amendment to the 2014 regulations, and the activities regulated by the CQC and the fundamental standards with which all CQC-registered providers must comply all unamended and unchanged.

Like the noble Baroness, Lady Brinton, I fully understand the impact of the pandemic on the CQC’s capacity to undertake the full range of its work, but the Minister needs to explain why the extension of the regulations is for another three years, to 31 March 2025. Why so long? The Explanatory Memorandum says the extension is to

“allow the Government to review the 2014 Regulations to determine”

whether the scope of its current regulated activities

“is still proportionate to ensure that regulated activities are delivered safely to a high standard.”

The CQC’s role as regulator and the fundamental standards that it sets to ensure high-quality care are crucial. According to the Minister proposing the SI in the Commons on 26 January, time is needed

“to reform and consider the regulations more fully”.—[Official Report, Commons, 26/1/22; col. 8.]

This is a major review being undertaken by government, and we need to know much more about its extent and purpose. Why are three more years necessary to undertake this review? Can the Minister explain why, given its vital importance, the review cannot be undertaken in a shorter timeframe? What are the timescale, scope and terms of reference of the review? How are all stakeholders, including providers and patient organisations, to be consulted and involved?

As the Minister knows, under the Health and Care Bill currently in your Lordships’ House, the CQC is to take on the not inconsiderable additional duties of reviewing and assessing ICBs and the performance of local authorities in the delivery of adult social care. To what extent will consideration of the impact of this extended role be included in the review, including the significant additional resources that the CQC will need to undertake these new areas of responsibility?

We are less than two months away from when the current regulations expire, and we fully recognise the urgent necessity of this SI to ensure that the CQC’s vital role and that work will continue. I also look forward to the update that the noble Lord will provide on the questions raised by the noble Baroness, Lady Brinton, about care homes and last week’s decision on the mandatory vaccination of staff.

[Lord Kamall (Con)]

My Lords, I thank both noble Baronesses for their questions and I must say how grateful I am that we were able to find a way for the noble Baroness, Lady Brinton, to join us after a technical fault. I turn now to the questions asked and, if I do not have the answers, I will commit to writing to the noble Baronesses.

The noble Baroness, Lady Brinton, asked why it had taken time to lay these amending regulations to extend the date of expiry of the regulations. They came into force in 2014 and a further amendment was made in 2015 to include an expiry date for them. Once it was identified that the 2014 regulations needed to be amended to extend the expiry date, the department took the appropriate action to make the necessary change. However, to make that change there was a long lead-in time, involving a consultation process and securing parliamentary dates to debate the amendment. The department is aware that, since the 2014 regulations came into force, there have been a number of changes in the health and care sector, and any wider review will be subject to a public consultation.

The noble Baroness, Lady Brinton, also asked about vaccination as a condition of deployment policy in adult social care settings. Let me turn, first, to her specific question. After the debate the other day, the noble Lord, Lord Scriven, told me that he needed to clarify a question he asked of me. He very kindly emailed me, clarifying that what he had said in the Chamber was not necessarily absolutely correct, and I sent his email on to my officials. I am sorry, I had not realised that a response had not been given. All I can do is apologise, go back to the department and make sure that we get an answer to him as soon as possible. That is why, to be perfectly frank, I am not in a good position here, because I really did think that this had been dealt with, and I apologise for that.

The noble Baroness, Lady Wheeler, asked several questions about the department’s intention to carry out a post-implementation review of the 2014 regulations. The department intends to carry out such a review and is currently working with the CQC to develop the review questionnaire, which will be shared with health and social care providers. The department is in the early stages of undertaking work to carry out the review, and we have already started working with the CQC. Once we have the responses to the questionnaire, we will publish a post-implementation report setting out the department’s findings.

The noble Baroness, Lady Brinton, also asked about VCOD. One of things we should stress—I know all noble Lords agree on this—is that patient safety is key. We always put the safety of vulnerable people first. I am very grateful to noble Lords for their support for the VCOD policy.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his response. Specifically on the review into the CQC’s work, I did ask for the terms of reference. I know there is going to be a consultation and a questionnaire, et cetera, and I would like to know what the terms of reference are: the timeframes and the scope of the review, and how stakeholders will be involved—I hope it will be not just by a questionnaire.

[Lord Kamall (Con)]

The noble Baroness asks a very reasonable question. I think what I will have to do is look at Hansard and respond to her detailed questions, and also share a copy with the Library, because I do not have the detailed answers with me today.

Health and Care Bill

Debate between Baroness Wheeler and Lord Kamall

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for his question. The goal is to make sure that the NHS and local authorities work better together. The noble Lord talks about resources. One of the reasons for the levy—whatever one thinks of it—is to help plug that gap and to make sure that there is more money going into social care as well.

Turning to the points made about the term “carer”, we believe that the term is used to capture the whole spectrum of carers, including children and adults who care, unpaid, for a friend or family member. By not imposing a statutory definition, we avoid inadvertently excluding groups, and ensure that ICBs and NHS England promote the involvement of all types of carers and representatives.

Turning to the last amendment in this group, existing legislation already requires local authorities to carry out an assessment of need for all young carers upon request or on the appearance of need. This assessment must consider whether it is appropriate or excessive for the young carer to provide care, in the light of the young carer’s needs and wishes. Indeed, as some noble Lords have said, sometimes what happens is that the hospital may decide it is appropriate but those who are supposed to be doing the caring at home do not feel they have the ability.

We hope that under this, as part of the discharge planning, the current discharge guidance can set out any considerations that should be given to young people in the household who have caring responsibilities. We want to strengthen current processes in respect of young carers too. We are also working with the Department for Education to ensure that protections for young carers are reflected in the new guidance, including setting out where young carers should have a needs assessment arranged before a patient for whom they provide care is discharged, or as soon as possible afterwards.

Given the comments from noble Lords, especially the noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Warner—sorry, I should say, General Pitkeathley and Major Warner—clearly there are still some concerns over how this will work. It would be worthwhile having some more conversations on this issue to better understand how we see integrated care working, where there may well be gaps in our understanding and whether we can help to close the gaps between the two sides.

[Baroness Wheeler (Lab)]

My Lords, it has been an excellent debate and I thank all noble Lords for their contributions, all strongly supporting this important group of amendments, which would ensure that the needs of both patients and carers were fully taken into account in the discharge process and that Clause 80 does not just wipe away carers’ rights—legal rights that have been hard-fought for. Although I am pleased that the Minister talked about further guidance being developed and co-produced, I cannot see how that will address the problem of replacing carers’ rights, which are being taken out of this Bill and need to be included in it.

I am also a bit disappointed that the Minister did not respond to my noble friend Lady Pitkeathley or give her the reassurances that she was seeking over the deep concerns about the expectation in the current guidance that unpaid carers will need to take on even more unpaid work. She made her views quite clear on this: it is paid work that unpaid carers need, not to be forced on to or to stay on benefits. They can take up jobs only if they get the care and support that is needed in the home or from the services that they need.

Noble Lords have made it clear that the discharge to assess model has to be matched with proper funding and community and healthcare services. The noble Baroness, Lady Hollins, reminded us of the importance of this in respect of the carers of people with learning difficulties, who face particular problems in caring. It is also overwhelmingly clear that noble Lords strongly support the establishment and the carrying forward into the Bill of existing carers’ rights.

I hope the Minister will meet urgently with my noble friend Lady Pitkeathley, Carers UK and others involved in these amendments, both to address the fundamentally wrong assumptions in the guidance about the role of unpaid carers and to ensure that their existing hard-won legal rights that have been taken away will be included. He also needs to provide the evidence called for by my noble friend on the overall assumption the Government are making that the discharge to assess process is better for carers than the existing rights that they have; it is not. This is a key issue that we will return to on Report, so I hope some action will be forthcoming from the government discussions between now and then.

On my own amendment, I would like to have heard a lot more reassurances about the timescales and timelines involved in the discharge process. I thank the noble Baroness, Lady Altmann, and in particular the noble Lord, Lord Scriven, for his support, and for explaining why this issue is important and how, practically, it would work with local authorities. On young carers, I particularly thank the noble Lord, Lord Young, and everybody who has participated in that.

I remind the Minister of the point from the noble Baroness, Lady Meacher: in the discharge process and in the assessments of carers it is really important that the question be asked whether they are able to care and whether they want to care. I would like the Minister to take up that issue. I know that carers feel strongly about this, but quite often, even if they are asked, no notice is taken and they just have to get on with it and nothing else happens. I would particularly like to see a response to that.

On those few points, I beg leave to withdraw my amendment. I hope the Minister acts quickly to meet carers and their representatives.

Covid-19: Antiviral Pills

Debate between Baroness Wheeler and Lord Kamall

Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

At the moment, they are available to anyone in an at-risk group and unable to have a vaccine. In addition, we have started a new trial to get more data—called the PANORMIC trial—including anyone over 50 who has tested positive through a PCR test and anyone in an at-risk group between 18 and 49 who catches Covid. The difference between vaccinations and antivirals is that vaccinations are there to stop someone getting Covid, or to make sure that they do not suffer the worst symptoms, whereas antivirals are given to anyone who has tested positive.

[Baroness Wheeler (Lab)]

My Lords, we welcome the news over the weekend about high-risk patients getting the Paxlovid antiviral drug from 10 February through the NHS if they test positive. There are also very positive results about the Molnupiravir drug, which has already been rolled out to high-risk patients through the Oxford University study. The British Liver Trust, Kidney Care UK and Cystic Fibrosis Trust are leading urgent calls for people suffering with these very vulnerable conditions to sign up to take part in the on-going clinical trials, which are essential in gathering further evidence and information. What action are the Government taking to ensure that doctors and patients have the latest information about the drug and the trials and to combat the ill-informed and dangerous antiviral scepticism that we know will be forthcoming?

[Lord Kamall (Con)]

I thank the noble Baroness for her question and for making people aware of the PANORAMIC study. One of the things that we are trying to do is look at the communication programme. If we look at the antiviral taskforce, we are looking at a number of different communication channels. For example, tomorrow morning, I believe, I will be co-chairing a webinar with many black and minority ethnic groups and activists to see how we can roll out and get their support in rolling out to those communities. We are looking at a number of different channels and particularly working with a lot of the charities which specialise in things such as chronic kidney disease, liver disease—I have a long list of conditions, which I will not read out now.

Social Care Sector: Private Equity

Debate between Baroness Wheeler and Lord Kamall

Thursday 27th January 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an important point about the level of debt, but I am sure he is aware that a number of private companies operate with levels of debt. As we saw in the financial crisis, the issue is whether that debt is sustainable. The noble Lord, Lord Sikka, who is an accounting standards expert, understands all of the issues around IFRS 9 and all of the downsides to that when sufficient provision is not made for debt.

[Baroness Wheeler (Lab)]

My Lords, the Minister’s predecessor in this role repeatedly told the House that there was nothing wrong with the business model for the care home sector, despite record numbers of closures—particularly of small, independent homes, which are the backbone of residential care—and the dire financial problems that they face, with councils unable to pay going rates for staff pay and residents’ fees. This is all compounded by the pandemic. The Centre for Health and the Public Interest estimates that around £1.5 billion leaks out of the health system each year, listed as

“dividend payments, net interest payments out, directors’ fees, and profits”.

Should this not all be going to front-line patient care?

[Lord Kamall (Con)]

We believe that the quality of care that patients receive is really important—

Health and Care Bill

Debate between Baroness Wheeler and Lord Kamall

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Kamall (Con)]

If it is as straightforward as the noble Lord suggests, I will see if that can be done.

[Baroness Wheeler (Lab)]

My Lords, I thank noble Lords for their many expert and very informative contributions. It has been a fascinating debate on a number of issues.

On specialised care services and rare diseases, I note the Minister’s comments and thank him for some of his reassurances, but there were some issues that he did not cover, particularly in relation to my noble friend’s Amendment 178. However, I welcome the dialogue that is taking place on these issues, and the recognition of their complexity, and am very hopeful that that will continue. We will take stock to see if anything else needs to come back on Report. I also thank my noble friend Lady Pitkeathley for her support on this issue.

In the general debate, noble Lords will, I am sure, follow up on the points that they made, as the noble Lord, Lord Patel, just did. I thought the contributions of my noble friend Lord Hunt and the noble Baroness, Lady Barker, on the hospital food situation, really drove home the importance of this issue. We must make progress on it and move forward.

On the title “nurse”, strong support was expected and we certainly got it from across the House. I hope that progress can be made. The issue will not go away, as the Minister knows, and neither will the determination of my noble friend Lord Hunt to pursue the issue of the availability of T3 for thyroid patients. We hope that progress can be made on that, because again it is a situation that a must be addressed.

The noble Baronesses, Lady Masham and Lady Brinton, and other noble Lords made valuable points on the vital need for a licensing regime for non-surgical cosmetic procedures, again underlining the need for urgent, step-by-step progress, and demonstrating in particular why the current situation is unacceptable. Progress can be made. As the noble Lord, Lord Lansley, pointed out, it was seen in the recent Private Members’ Bill on Botox fillers. We need progress to be made, and steadily.

Finally, on the reference to when the review of the regulatory system will be completed—the noble Baroness, Lady Walmsley, also raised this—the issue was about timescales. We know there is a review. We are told that KPMG is on the case and has delivered its report, but we need timescales and action as soon as possible.

With those comments, I beg leave to withdraw my amendment.

Health and Care Bill

Debate between Baroness Wheeler and Lord Kamall

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the noble Lord, Lord Sharkey, for opening this important group and moving Amendment 106, to which my noble friend Lady Thornton added her name. As he explained, the substance of this amendment was singled out by the Constitution Committee and highlighted by the Delegated Powers and Regulatory Reform Committee. I reinforce the Constitution Committee’s endorsement of the DPRRC’s recommending the removal from Clause 20 of the imposition of legal liability merely by publishing a document. We agree with the two committees that this is a necessary amendment, and I look forward to hearing from the Minister how these concerns will be addressed.

Somewhat paradoxically, Amendments 143 and 144 strengthen the powers of NHS England in its quest for top-down management and imposition. However, they sit within the wider context of describing how NHS England would be able to give directions to integrated care boards under Clause 20 and improve these provisions, so we support them.

The remaining amendments on NHS Continuing Healthcare underline how vital it is to address this urgent issue, although it is not central to the intentions of the Bill. I thank the noble Baroness, Lady Greengross, for ensuring this focus in the debate and for Amendments 133 and 139, which ensure that this crucial issue is specified under the ICB’s duties and included in its annual report and performance review accountabilities.

Today, we heard in detail about the widespread concern about and scale of the problems with the way in which the NHS Continuing Healthcare scheme works and is funded, and the arguments it leads to about who pays for what, as a shared responsibility between the NHS and local government. Patients and their carers feel they are the sideshow, not the central focus of concern, and are deeply traumatised and upset by the whole experience.

As a carer of a disabled adult myself, like my noble friend Lady Pitkeathley, I know, from meeting many other carers and their loved ones, their deep concern about this. The three things that cause most concern and upset, which one hears time and again, are, first, the huge problems with inadequately funded social care packages—or their absence—to meet basic care needs, and deep worries and anxieties about how the care cap will operate; secondly, the trauma of the discharge-from-hospital process for carers and their loved ones, which we will discuss later; and thirdly, NHS Continuing Healthcare, the postcode lottery of whether your loved one receives it or not, the huge bureaucracy around the application and allocation process, the long wait for a response and being stuck in the middle of an NHS local authority fight over funding. As the noble Baroness, Lady Finlay, stressed, there is an urgent need to tackle the accountability gap in this process.

NHS Continuing Healthcare is the absolute manifestation of what our Economic Affairs Committee report on the “national scandal” of social care funding called the “condition lottery”—in other words, the wide disparity between health conditions for which people receive healthcare that is free at the point of use and those for which users usually have to make a substantial contribution with “catastrophic costs”, in the committee’s words. As we heard today, dementia is the condition most cited in this regard, but many of us know of cases where people with motor neurone, Parkinson’s and other degenerative diseases have struggled to get NHS Continuing Healthcare funding, either for home care or support in residential homes.

We support Amendment 161, which ensures that the Care Quality Commission reviews must include this issue. However, I am unclear—and may well learn in a minute from the Minister—what role the CQC currently has in looking into all continuing care matters which traverse NHS and local authority boundaries. However, we support its involvement.

The amendment would also ensure that the CQC reviews include looking in depth at how NHS Continuing Healthcare is working under each ICB. That will mean that at last we can begin to develop the much needed strategic overview of this crucial area for thousands of people in desperate need of care and support.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank the noble Lord, Lord Sharkey, and the noble Baronesses, Lady Finlay and Lady Greengross, for bringing this group of amendments.

I understand the intention behind Amendment 106, on payment to providers, which is to remove new Section 14Z48 in its entirety, but the section will allow NHS England to specify the circumstances in which an ICB is liable to make payments to a provider for services commissioned by another ICB.

The Government are committed to ensuring that delegated powers in the Bill use the most appropriate procedure, so that Parliament has due oversight of their use. We recognise that the Bill contains a significant number of guidance-making powers and powers to publish documents. However, we believe that they are appropriate because, as the noble Baroness, Lady Walmsley, said, they reflect the often complex operational details and the importance of ensuring that the guidance keeps up with best practice, especially as the system flexes and evolves. I understand the noble Baroness’s point about Parliament, but the issue here is whether, every time the system flexes, Parliament has to have another debate. The ICBs will be reading the guidance, not Hansard, and the guidance should reflect that.

Nor is it our intention to interfere unduly in the financial affairs of ICBs. Instead, the intention is to resolve specific circumstances, such as emergency services. The legislation makes it clear that each ICB has to arrange for urgent care services to be available for all people physically present in the area, not just for the people who are its core responsibility by virtue of their GP registration. I am sure noble Lords will agree that it would be neither fair nor in the best interests of promoting an efficient health service for the ICB to both arrange and cover the cost of all additional emergency treatment brought by visitors to the area, particularly in areas with high visitor numbers. A number of noble Lords referred to that principle in debates last week.

Instead, this provision allows NHS England to mandate a different payment rule for those services, ensuring that, where necessary, the ICB where a patient is registered will pay, rather than the ICB where they receive treatment. This ensures that the financial impact is felt in the right commissioning organisation and eliminates the risk of some ICBs having unreasonable financial demands placed on them—for example, during the holiday season.

The wording of this provision replicates almost exactly the National Health Service Act 2006 as amended in 2012, but it is updated to reflect the new ICB structure. As my noble friend Lord Howe mentioned to me, we had a massive debate about this 10 years ago, but the provision seems to have worked effectively in the CCGs, and we wish to continue that with the ICBs.

Amendments 143 and 144, in the name of the noble Baroness, Lady Finlay, are about NHS England directing ICBs. I understand the interest in ensuring that NHS England has the necessary tools to intervene in ICBs where necessary. However, we believe that NHS England already has sufficient powers to direct ICBs. NHS England already has certain powers to direct an ICB under Section 14Z59(2), and powers to intervene over ICBs in order to prevent failure and to ensure that the lines of accountability from ICBs through NHS England to Parliament are strong.

However, this power has a threshold in that it can be used only if NHS England deems an ICB to be failing to discharge a function or at risk of failing to do so. The threshold removes the possibility of NHS England overdirecting the system while retaining the power for use if necessary. This balances the need to prevent failure and to support accountability with allowing ICBs the autonomy they need to operate effectively.

Amendments 133, 139 and 161 expressly require that ICB annual reports and NHS England performance assessments of ICBs include specific consideration of commissioned services, including NHS Continuing Healthcare, which noble Lords have spoken about, and that the CQC reviews of ICSs include specific consideration of that. We agree with the principle, but we believe that it is already covered in the Bill. NHS England already has a key role in overseeing ICBs. For example, the Bill requires NHS England to assess the performance of each ICB every year, and ICBs are required to provide NHS England with their annual report. These reports will include an assessment of ICB commissioning duties, which would encompass any arrangements for NHS Continuing Healthcare.

In addition, as noble Lords are aware, Clause 26 gives the CQC a duty to assess integrated care systems, including the provision of relevant healthcare and adult social care within the area of each ICB. This would include the provision of NHS Continuing Healthcare. We intend the CQC to pilot and develop its approach to these reviews in collaboration with NHS England, but also with other partners in the system. This should ensure that the methodology does not duplicate or conflict with any existing system oversight roles.

With this in mind, we believe that these amendments are not necessary, because commissioned services, which we would expect to encompass NHS Continuing Healthcare, are already included in these clauses. I hope that I have been able to somewhat reassure your Lordships. For these reasons, I ask noble Lords not to press their amendments.

Health and Care Bill

Debate between Baroness Wheeler and Lord Kamall

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I congratulate the four noble Lords who have produced this excellent suite of amendments across the Bill to ensure that ICBs procuring or commissioning goods and services on behalf of the NHS are firmly focused on their responsibility for NHS England’s commitment to reaching net zero by 2040. It has been an excellent and informed debate, and one with much enthusiasm to reassure the noble Baroness, Lady Hayman.

We fully support the amendments and have little to add from these Benches following the expert contributions of those proposing the amendments and the other noble Lords who have spoken. I am sorry my noble friend Lady Young, who put her name to the amendments, cannot be here. She was a key member of our team during the recent passage of the Environment Bill, and her expertise and wisdom always guides and reflects our approach. The House is clearly interested in this vital matter, as we saw this week in an important Oral Question on the Prime Minister’s promise for a new, overarching net-zero test for new policies. Assuming the Government fully support the key commitment from NHS England, I hope that, in his response, the Minister will accept the need for the amendments and will not argue that the proposed new clause is unnecessary as NHS England already has a commitment that will percolate down to ICBs.

As we have heard, the power of public sector procurement is a massive issue and there is no bigger part of the public sector than the NHS. The NHS has such an important impact on other environment issues, such as waste, pollution and resource consumption, especially for plastics, paper and water. We should ensure we are on the front foot in using that impact to deliver the net-zero commitment.

The NHS has made a start, but there is much more to do. These amendments would reinforce the importance of action in these areas for the new bodies and processes that the Bill creates. The NHS is a big player and, as noble Lords have stressed, it can play a big role in tackling all of these climate change and environmental challenges. Procurement is a strong lever that the NHS can utilise in key markets, particularly in those areas where it is the sole purchaser. The noble Lord, Lord Stevens, was very eloquent on this issue and I look forward to the Minister’s response in the light of his contribution.

Like other speakers today, my noble friend Lady Young wanted to stress that action so far is only the beginning. In the light of the importance of climate change and other environmental challenges, we strongly support such a duty being in place for all the public and private bodies with significant impacts when future legislation comes through Parliament. We did that when inserting a sustainable development duty into the remit of every possible public body from the late 1990s onwards, but this time it has to be not only enacted but managed, delivered, tracked and reported.

As the Minister, the noble Lord, Lord Callanan, told the House this week, every sector of government needs to do its bit, and we need to hold them to that. These amendments are vital, since every public body will have to take further action this decade if we are to restrain temperature rises to two degrees—far less, 1.5 degrees.

Finally, I too thank Peers for the Planet both for its work and, especially for me, its excellent briefing. As noble Lords have stressed, the NHS has committed to net zero and aims to be the world’s first net-zero national health service. It is responsible for around 5% of the UK’s carbon emissions. That is why the NHS’s role and contribution to net-zero targets should be fully integrated into the Bill. I look forward to the Minister’s response and his detailing of how the NHS is to achieve its ambitions. I hope that he will acknowledge that its commitment must be in the Bill. These amendments present a vital opportunity to enshrine in law a commitment that I think most, if not all, would want to see delivered.

[The Parliamentary Under Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank the noble Lord, Lord Stevens, for the amendments and the noble Baroness, Lady Hayman, for her opening remarks. I also thank the noble Baroness for her suggestion yesterday that it might make my life a lot easier if I just accepted amendments. I understand that advice, having just gone through a two-hour debate on the previous group.

A number of noble Lords referred to how these amendments relate to our previous debate on inequalities. I point out that that is sometimes not quite in the way that we would expect. We might think there is a direct connection, but sometimes the green agenda can be seen to be for those who can afford it—as I explained before, for the white, middle-class, patronising people who tell immigrant working-class communities what to do and push up their costs. Anti-car policies push up costs for those in rural areas, and there are higher fuel costs as we replace gas boilers with potentially more expensive heat pumps. We have to be aware of those issues. In the long term, I am optimistic. I look forward to the day when we have solar power and wind power, with storage capacity, which will reduce costs.

Care Workers: Professional Register

Debate between Baroness Wheeler and Lord Kamall

Monday 10th January 2022 Lords Chamber

[Lord Kamall (Con)]

Only last week we opened a consultation on whether or not to make registration mandatory and to move towards it. When I spoke to people in the department about why it is currently voluntary and not mandatory, they said it was because they did not want to inadvertently put people off registering. They were worried that some people might leave the sector if registration was mandatory now. The noble Lord can shake his head, but this is a very real concern. We want to make sure it is voluntary first and we are consulting on the steps towards mandatory registration.

[Baroness Wheeler (Lab)]

My Lords, the noble Lord’s Question is timely, with the Government’s consultation on future statutory regulation and the criteria that could form the basis of assessing whether regulation is appropriate. We all want to see care workers given the professional status that they deserve, but, as has been said, this needs a whole suite of key improvements on pay, training, career structure and development. Does the Minister agree that paying staff a wage that truly reflects the importance and value of their work is an essential first step and what action are the Government taking to ensure this?

[Lord Kamall (Con)]

As the noble Baroness will appreciate, many people who work in social care are employed by private care home owners and other bits of the sector. If she looks at the minimum wage, there has been an announcement of 6.6%, effective from 1 April, which means that workers will be paid more, but one of the bases of some of the additional funding that we have announced is to convince local authorities to put pressure on private care home owners and others to make sure that they pay staff more.

Hospital Beds and Social Care

Debate between Baroness Wheeler and Lord Kamall

Thursday 6th January 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, with today’s reports of hundreds of care homes closing their doors to new admissions because of the rapid spread of omicron, adding to the huge pressure on hospitals, can the Minister explain in more detail why urgent priority funding is not being directed to the provision of step-down facilities to address the escalating crisis? We are told that we have new diagnostic units and resurrected Nightingale hospitals, but step-down facilities in local NHS and community settings, where patients medically fit for discharge can be monitored and properly assessed, have been shown to be working very successfully. Would not that provide the right care at the right time, as promised in last month’s social care White Paper?

[Lord Kamall (Con)]

We have been looking at different pathways out of hospitals, and one of the discharge pathways is step-down care. One issue that the task force has looked at is how we improve and increase accessibility to appropriate step-down care when a patient is unable to go straight to their home.

NHS: Elective and Cancer Care Backlog

Debate between Baroness Wheeler and Lord Kamall

Tuesday 7th December 2021 Lords Chamber

[Lord Kamall (Con)]

One thing that the Government are doing is looking at a number of different ways in which we can think outside the box and be multifaceted to make sure that, for example, instead of patients going directly to A&E they can be dealt with by 111 or other services. In addition, we are committed to delivering 50,000 more nurses, growing the workforce and making sure that we have a trained workforce not only in healthcare but in social care.

[Baroness Wheeler (Lab)]

My Lords, the NAO report clearly showed that performance against NHS waiting times had been steadily deteriorating prior to the pandemic, and that during the pandemic there were between 24,000 and 74,000 missing urgent GP referrals for suspected cancer. For the most common cancer in the UK—breast cancer—it is estimated that the disruption in screening services during Covid means that 12,000 people are living with undiagnosed breast cancer, 10,600 fewer breast cancer patients started treatment and 20,000 fewer people last year were referred for breast checks. What specific action is being taken to address this deeply worrying situation?

[Lord Kamall (Con)]

Even before the pandemic there was a growing number of referrals across elective and cancer care. This had been driven by a number of different factors, including people’s awareness of cancer, the symptoms associated with it and media campaigns. In addition, one of successes of having an ageing population is that people face a number of different issues. For example, over half of cancers are diagnosed in patients over 65. We know that we have to tackle this issue. That is why we have published the long-term plan with a £33.9 billion budget.

Dementia: Art and Music-based Interventions

Debate between Baroness Wheeler and Lord Kamall

Monday 22nd November 2021 Lords Chamber

[Lord Kamall (Con)]

I pay tribute to the noble Baroness for all her work raising awareness of dementia, in this House and outside of it. The Government understand the importance of non-medical and lifestyle factors in supporting people’s health and well-being, including brain health. This is why we are continuing to roll out social prescribing across the NHS, in line with the NHS Long Term Plan commitment to have at least 900,000 people referred to social prescribing by 2023-24. The Department of Health and Social Care is working closely with NHS England and NHS Improvement to incorporate social prescribing into the guidance to integrated care systems. Some of this guidance has already been included in the document implementation guidance on partnerships with the voluntary, community and social enterprise sector that was published in September 2021.

[Baroness Wheeler (Lab)]

Around 25,000 people with dementia are from BAME communities and this is expected to double by 2026. The Alzheimer’s Society report, The Fog of Support, found that people from these communities, and those with English as an additional language, were more likely to use BAME-led groups. The report also found that there is generally a need for interventions to be much more culturally sensitive. What action are the Government taking to ensure that people with dementia can access culturally appropriate care, including art and music-based interventions, which reflect a wide range of cultures and languages?

[Lord Kamall (Con)]

The Office for Health Improvement and Disparities is looking at areas where there are clear disparities. As part of developing the dementia strategy, the Government are consulting with a wide range of stakeholders and ensuring that a diverse range of views from different communities is heard and that it is not targeted just at one particularly community.

Clinical Negligence Claims

Debate between Baroness Wheeler and Lord Kamall

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

My noble friend raises an important point. The Government remain committed to continuous safety improvement, particularly on developing learning cultures in our health system and tackling the issues of denial and delay. While we strive towards this goal, we have seen that the cost of clinical negligence claims has quadrupled in the last 15 years, and there is no guarantee that reducing harm would necessarily result in fewer claims. In many cases, the overall costs are being driven by increases in the average cost per claim. Indeed, claims have recently levelled out, falling from £2.26 billion to £2.17 billion but this is largely due, in least in part, to the coronavirus pandemic.

[Baroness Wheeler (Lab)]

My Lords, the annual cost of clinical negligence has risen from £1 million in 1975 to £2.2 billion last year, as we have just heard. The Medical Defence Union’s evidence to the Health and Social Care committee’s inquiry into NHS litigation reform predicted that any money raised by the new health and social care levy would be entirely swallowed up by the amounts being paid out each year in NHS clinical negligence claims. What assessment have the Government made of this claim, how does it impact their plans to reduce the huge NHS waiting lists for treatments, and what money will be left for social care?

[Lord Kamall (Con)]

The noble Baroness raises an important point that spending more on compensation means less money for the care of patients. That is why we are committed to looking at various ways of reducing this and are working with the Ministry of Justice. Issues include the role the royal colleges play and the training they give to their medical staff, while needing to instil a culture of more openness when things go wrong. When things go right, we are ready to praise but when things go wrong, they have to stop hiding, delaying and denying, and be open.

Health Care and Adult Social Care

Debate between Baroness Wheeler and Lord Kamall

Wednesday 27th October 2021 Lords Chamber

[A noble Lord]

Round three!

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I am on a hat trick. The department welcomes the report by the CQC and recognises the challenges that providers and local authorities are currently experiencing in recruiting and retaining staff, especially social care staff. While local government has a key role to play in tackling staff shortages, the department has been monitoring the situation closely. We have already put in place a range of measures, including funding to help local authorities and care providers address workforce capacity pressures.

[Baroness Wheeler (Lab)]

My Lords, the CQC’s concern about the desperate social care staff shortages this winter and warning about a tsunami of unmet need unless urgent action is taken is very worrying. It is clear that the health and social care levy will not provide any real means of dealing with chronic staff shortages for at least two years. The recent £162.5 million for the workforce retention and recruitment fund gives less than £100 per social care worker, according to this week’s analysis from the Homecare Association of care providers. The CQC has echoed the Commons Health and Social Care Committee’s call in May for an urgent total overhaul of workforce planning in light of workforce burnout after dealing with Covid; a people plan for social care; and an annual independent report with workforce projections. Can the Minister tell the House what progress is being made on this and when we can expect a fully costed and funded workforce plan for this key sector?

[Lord Kamall (Con)]

I thank the noble Baroness for her reference to the £162.5 million of funding for social care through the workforce retention and recruitment fund to help boost staff numbers and support existing care workers through the winter. This is on top of the third infection control and testing fund, introduced in October 2021, which is providing a further £388.3 million of adult social care Covid-19 support until March 2022. This means that, during the pandemic, we have made available more than £2.5 billion in funding specifically for adult social care. We are also taking action to support adult social care providers through a national recruitment campaign.

Social Care

Debate between Baroness Wheeler and Lord Kamall

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that important point. We have listened to the sector and prioritised the adult social care workforce. The investment of at least £500 million over three years will deliver new qualifications, progression pathways, and well-being and mental health support. This workforce package is unprecedented investment, which will support the development and well-being of the care workforce. It will enable a fivefold increase in public spending on the skills and training of our care workers and registered managers, as well as on their well-being.

[Baroness Wheeler (Lab)]

My Lords, the Secretary of State, Sajid Javid, has admitted that the Government cannot commit to clearing the NHS treatment backlog generated by Covid within three years. This is despite the fact that £12 billion a year raised from the levy will mostly go to fund this work and that he is also announcing another £6 billion in capital funding for the same purpose. Does this recognition of the scale of the NHS challenge mean that social care will have to wait even longer than three years for any levy funding? Can the Minister confirm, as he failed to do last week, that the £162.5 million announced for the social care workforce and recruitment fund was new money and not part of previous repackaging, as we have seen with the Chancellor’s pre-spending review announcements so far?

[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.