Defibrillators

Baroness Merron Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Kamall (Con)]

All I can say is that I hope so. I will try to find out and commit to write to my noble friend.

[Baroness Merron (Lab)]

My Lords, with Travelodge, Tesco and Royal Mail all announcing that they will participate in the British Heart Foundation use training pilot, will the Minister undertake to look at the potential impact of this training on saving lives and work with his ministerial colleagues across government to encourage such training on defibrillator use by other companies, the public sector and other organisations?

[Lord Kamall (Con)]

If noble Lords will excuse the pun, one of the heartening things in answering this is that, when I received briefing on this, it is really important and interesting how we are working across government. It is not only in the Department of Health; we are working with the Department for Transport on transport locations, DCMS on sports grounds, the Department for Education on education settings and other departments. This is really a cross-government initiative.

Personal Protective Equipment: Waste

Baroness Merron Excerpts

Tuesday 14th June 2022 Lords Chamber

Asked by

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the expenditure on unusable and excess Personal Protective Equipment (PPE), and the reasons for the waste.

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

We have delivered over 19.8 billion items of PPE to keep front-line staff safe. Facing a dangerous virus, and against the background of no vaccine, as well as rising demand, market disruption and panic buying, we procured as much PPE as possible rather than too little. Only around 3% of PPE that the department purchased is unusable, and we are working with waste providers to dispose of unusable stock in the most environmentally friendly and energy-effective way.

[Baroness Merron (Lab)]

My Lords, £9 billion was wasted on PPE due to obscenely inflated prices, irregular payments to intermediaries and faulty kit which is now poised to go up in smoke, along with nearly one in four of the contracts in dispute around products which are not fit for purpose or where allegations of slavery have been made. We know that the Government were responding to an unfolding crisis, but how was this shameful episode allowed to go unchecked and why has the department been allowed to establish a track record for not following public spending rules?

[Lord Kamall (Con)]

We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.

Health and Social Care Leadership Review

Baroness Merron Excerpts

Thursday 9th June 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank everyone who works in the NHS for their continued dedication and skill. We owe them our gratitude. I also put on record my thanks to General Sir Gordon Messenger and Dame Linda Pollard for leading this very important review.

We know that we are at the foothills of a huge programme of NHS reform and reorganisation, which your Lordships’ House carefully scrutinised during the passage of the Health and Care Act. It came through loud and clear that the healthcare system requires proper leadership and a workforce that has enough staff to do the job, something that we know is not the case at present nor is suitably in the pipeline.

I confirm that these Benches support the review’s seven recommendations and welcome that the Secretary of State has already agreed to implement them. However, the critical thing will be to see whether, when and how the proposals are implemented and we will keep a close eye on this. Regrettably, we have too often seen the commissioning of a review by Ministers only to see those same Ministers drag their feet on implementing the recommendations or shelve them completely. Will the Minister give us today a firm date for when he intends to publish the plan to implement the seven recommendations?

The social care survey from the Association of Directors of Adult Social Services shows that more than 500,000 people are waiting for a social care assessment in England, and we need swift action to alleviate this. Will the Minister explain why the review has not covered leadership in social care or primary care in sufficient detail? Is not this a missed opportunity?

Of course, this review is just one part of dealing with the crisis that the NHS faces. New staff getting an induction when they first join the NHS is sensible, but that is just a basic requirement of any organisation worth its salt. We all know that there are bigger, real mountains to climb. Waiting lists are at a record high: 6.4 million in the queue for treatment—nearly one in 10 people—patient satisfaction is at its lowest since 1997, and there have been longer waiting times for cancer treatment in every year since 2010. So it goes on.

There are currently 106,000 vacancies in the NHS, and staff are leaving in droves. In many specialities, they are leaving faster than they can be recruited to those vacancies. It remains to be seen how a shake-up for management will help our health outcomes and alleviate pain and suffering when there are not enough front-line staff. This has to be the Government’s focus.

Yesterday, the Secretary of State talked about the 15-year workforce strategy that he has commissioned. When can we expect it? It would be much appreciated if the Minister could put more flesh on the bones of this brief reference yesterday. Who will be leading this and what will be its terms of reference?

It would be negligent not to mention the role that managers played in the North East Ambulance Service cover-up. The Government are still considering whether to launch a review. Will the Minister provide an update? Surely, if management is to be improved, there is a need to learn from the times when it fails. The incidents at the North East Ambulance Service are a clear case in point.

Finally, it is regrettable that NHS senior leadership still does not represent the diversity of the population that it serves. How will the Government drastically improve equality, diversity and inclusion? And how will the best leaders—whether or not they have a so-called good network—be encouraged, prepared and brought into the most challenging roles where we need to see them?

These Benches welcome the review and its recommendations, but there are many outstanding questions while the NHS is in dire need of support and a workforce able to meet the demands and serve the people who need it.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely and I now invite her to speak.

Children: Cancer

Baroness Merron Excerpts

Thursday 26th May 2022 Lords Chamber

[Lord Kamall (Con)]

I completely apologise to all noble Lords. It is important that we look at this issue; I am afraid I will have to write to the noble and gallant Lord with more detail.

[Baroness Merron (Lab)]

Following on from the question of the noble and gallant Lord about the matter of significant improvements being made in the lives of children with cancer by detecting cancer early and avoiding delays in care, there are of course three components to early diagnosis, with the first being awareness of symptoms by families and primary caregivers. Can the Minister tell your Lordships’ House what assessment has been made of the level of awareness and what is being done to promote that awareness among families and primary caregivers?

[Lord Kamall (Con)]

The noble Baroness raises an important point about how we raise awareness, and that goes right across not only the population but patients themselves. NHS England and NHS Improvement are developing plans for future phases of their Help Us Help You campaign to raise awareness of key cancer symptoms. To date, the campaign has contributed to the record high levels of urgent cancer referrals that the NHS has seen since March 2021.

Perhaps I may take the opportunity to address the question from the noble and gallant Lord. Covid clearly affected the backlog. One of the things about the waiting list is that now 80% of people on it are waiting for diagnosis. One of the issues we are looking at is how you push out more community diagnosis centres around the country, not only in hospitals but in shopping centres and sports arenas, so that effectively we go to the patient and detect as early as possible. We hope that all that, in conjunction with things such as blood testing and genomic sequencing, will lead to earlier diagnosis.

Sugar Reduction Programme: Bread

Baroness Merron Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Kamall (Con)]

Right. I begin by thanking my noble friend for that very comprehensive question. As I said earlier, some sugar is needed in the process, but he makes an important point about how we reduce the unneeded additional sugar that is added. I have already given the reasons why there is some sugar, and no doubt the chemical processes will be improved over time: as mankind’s innovation and ingenuity increase, we will see more substitutes for sugar. I was also interested in the point made by the noble Lord about chapatis; next time I go to a restaurant I will ask about their sugar content.

[Baroness Merron (Lab)]

My Lords, with the UK attending the 75th World Health Assembly in Geneva as we speak, it is concerning that the Government have delayed their planned measures to encourage a move away from foods that are high in fat, sugar and salt. To compensate for this, particularly for those who are experiencing higher levels of deprivation, can the Minister tell your Lordships’ House in what specific ways the Government intend to show the leadership that is so urgently needed?

[Lord Kamall (Con)]

I thank the noble Baroness for raising that point. Part of my role is in international health diplomacy, where other countries come to the UK wanting to learn from us. It is very interesting that a number of other countries are asking to learn from our sugar and salt reduction programmes, our alcohol and anti-tobacco programmes and our campaigns for healthy eating—not just telling people they should not do things but encouraging them to have a healthier lifestyle

NHS Dental Services

Baroness Merron Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

[Baroness Merron (Lab)]

My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?

[Lord Kamall (Con)]

I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

Long Covid

Baroness Merron Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

The NICE guidelines start with the definitions as I have laid out previously, and the NICE definitions are aligned with the World Health Organization. On the noble Lord’s specific question, I will have to write to him.

[Baroness Merron (Lab)]

My Lords, the Equality and Human Rights Commission made an announcement on Twitter that it recommended that long Covid should not be treated as a disability. That would mean that those suffering from the condition would have to take their employer to a tribunal if they felt that they were being discriminated against. Can the Minister tell your Lordships’ House what his view is on how reasonable or not this is? What steps are being taken to promote understanding by employers of this debilitating condition and to encourage and guide them to be open to making changes in the workplace to support sufferers in continuing to work?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are learning more about the different types of long Covid, how to treat them and what interventions they need. People will not always need to go to a primary or secondary care centre for their treatment; in fact, there is an app to help people who can be supported at home. In terms of general advice about disability or to employers, we are working across government as we learn more about this in order to give appropriate advice to employers.

North East Ambulance Service

Baroness Merron Excerpts

Monday 23rd May 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, human tragedy permeates this scandal, which has seen up to 90 unnecessary deaths, gross negligence, cover-ups and public money buying the silence of staff. Quinn Beadle, who was just 17 when she tragically committed suicide, died because an ambulance worker failed to perform proper resuscitation. In the report that was then made to the coroner, North East Ambulance Service managers removed this detail. The Secretary of State said today that this and dozens more injustices will be investigated more fully. Will the Minister confirm that this will take the form of a formal inquiry, as it surely must? Will questions be asked of the Care Quality Commission, which, despite being tipped off two years ago, failed to flag or even spot this outrage?

[Lord Kamall (Con)]

I thank the noble Baroness for raising those concerns. I completely agree with the sentiments she expressed; this is completely uncalled for. As I said previously, my honourable friend Maria Caulfield pledged that there would be an investigation into this. As to whether it will be a formal inquiry, it is too early for me to give a direct answer, but I will go back to the department and as soon as I have more information I will write to the noble Baroness. I understand that these are historic incidents and that the CQC has said that its service is improving, but as more information is still coming out—even today when I had the briefing, not all the information was there—I will of course commit to write to the noble Baroness.

Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Baroness Merron Excerpts

Monday 23rd May 2022 Grand Committee

May I also ask about the introduction of the statutory term of “chief pharmacist” with professional standards set by the GPhC? As I read the order, a defence for inadvertent dispensing errors cannot be called in aid if the service where it happened did not have a chief pharmacist responsible for the safe running of that service. Does that mean that if a service did not identify a chief pharmacist, or if he or she were not on the spot, the staff would be more exposed to discipline over errors than those working at a site where the work was supervised by a chief pharmacist? Will the Minister please explain?

[Baroness Merron (Lab)]

My Lords, I welcome the Minister’s helpful introduction and his acknowledgment of the delay in bringing this statutory instrument before us. These Benches welcomed the initial preparation and dispensing errors instrument when it came before Parliament in 2017. That welcome was in line with that of a number of organisations, including the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. Today, we are very happy again to give that welcome to this statutory instrument, not least because it is entirely focused on patient safety and on improving safety for patients. It also brings parity across the pharmacy profession, something that has been much called for.

There were some 1 billion prescriptions dispensed last year. At this volume, it is, of course, impossible to avoid all errors, and it is certainly a credit to the pharmacy profession that they are statistically very few and far between. Most professional groups in the health service do not face criminal conviction and potential imprisonment for an inadvertent dispensing error, and therefore it would be quite wrong for pharmacists to be the only ones who do. It is therefore very welcome that this SI extends legal protections to pharmacists working in a range of locations, such as prisons, hospitals and care homes.

Those working in these settings are often under increased stress, and this has been exacerbated by the challenges of the pandemic. The Pharmaceutical Journal has found an approximate doubling of pharmacists reporting that they feel extremely stressed compared with recent years. In often very pressured circumstances, it is right that we, in the way we are discussing today, protect pharmacists—who are often people’s first point of contact with the healthcare system and too often victims of abuse—from unintended mistakes. Ensuring the right to legal defence against prosecution in cases relating to inadvertent error will undoubtedly remove some of the fear these clinicians feel when it comes to admitting errors. It will help to prevent and reduce patient harm through taking the wrong medication or dosage.

It will also assist in promoting a culture of transparency, as has been referred to already. That will help to inform future learning and improve protocols for the dispensing and preparation of medicines. I agree that this is very much a helpful step towards cultural change and towards a more positive and candid workforce, which, as we have already referred to, can only serve to make patients safer.

Of course, again, it is right that this SI extends only to inadvertent errors. Where they are wilfully negligent or intent on causing deliberate harm, those who are responsible will continue to face criminal prosecution. This is critically important and we certainly support that.

I move on to my outstanding questions on the SI. I am concerned that, of the 523,000 dispensing errors that occur each year, only 5% are reported. Does this not suggest that the 2017 legislation increasing protection for inadvertent errors has been largely unsuccessful in encouraging honesty? What more are the Government doing to increase that number? How will the Government further encourage individual pharmacists to feel safe to come forward if they have dispensed the wrong medication? I should like to understand further how the professionals affected by this legislation, especially those who are more isolated than those who have the benefit of a network of pharmacists easily accessible to them, are informed about these changes.

There is always so much more to do when it comes to patient safety, but this is a very welcome step forward. I look forward to the Minister bringing forward further improvements in due course.

[Lord Kamall (Con)]

I begin by thanking noble Lords for their questions. I shall try to answer as many as I can and, in the usual way, if I have missed any of them, I will go through Hansard and make sure I respond in more detail. The noble Baroness, Lady Walmsley, asked about deterrence. I have some statistics here. In 2021, a survey of community pharmacists found that 95% of pharmacists said that they report errors to improve practice and 80% to learn from mistakes. In response to her specific question about fear of prosecution as a reason not to report an error, it dropped from 40% in 2016 to 18% in 2021, largely attributed to the 2018 change in law. Therefore, we expect a similar drop in the fear of being prosecuted for the pharmacists covered by this order.

The noble Baroness also asked about the chief pharmacist. This is a statutory role that mirrors the statutory role of the superintendent pharmacist in registered retail pharmacies. This aims to strengthen the governance of pharmacy services by incentivising the creation of this role, if a hospital, prison or care home does not already have one, in order to benefit from these defences. However, to reflect the diverse arrangements in different health settings, organisations do not necessarily need a specific chief pharmacist role, but should ensure that the statutory functions of a chief pharmacist are included in the relevant individual’s job responsibilities if they want to benefit from the defences.

There was a specific question about where there is no chief pharmacist officer. I understand that, at the moment, existing pharmacists can have that duty extended to them, but I shall have to write to the noble Baroness with more detail. What is really important, as she acknowledged, is the duty of candour. We want to encourage an environment where people do not feel afraid to come forward in order to learn. Of course, there is always the right balance between those who have acted maliciously compared to those who have made a mistake. As the noble Baroness, Lady Merron, rightly said, when you are dispensing this number of prescriptions, statistically and probability-wise, there is probably bound to be some error.

To go back to the point about the chief pharmacist officer, given the flexibility, people do not need to adopt the statutory term of chief pharmacist as a job title; they can have the role of chief pharmacist assigned them. I just wanted to clarify that; if I have not been clear, I shall write to the noble Baroness.

I just want quickly to give a bit of a flavour of the errors to show how something might not necessarily be malicious but could be an error. A medicine intended for another patient could be dispensed to the wrong patient. The wrong medicine could be dispensed. An ingredient could have inadvertently been omitted or added when making up a medicine. A medicine could be dispensed at the wrong strength or in the wrong dosage form. These things happen, not intentionally but unintentionally, which is why we want to make sure that we learn from such mistakes.

Given that we have already introduced these offences for the majority of pharmacy professionals in the retail sector, it is right that we extend them to colleagues working in hospitals. By introducing this order, we are not only removing the fear factor for pharmacy professionals but helping to protect the patient under their care. We know from patients that it is important for them to know that, when an error is made, responsibility is taken and the service learns lessons. This legislation supports and incentivises that principle.

I am not clear whether I have answered every question, but I will check and write to the noble Baronesses as appropriate. I thank noble Lords for their interest and the positive debate today. I commend this draft order to the Committee.

International Healthcare Outcomes

Baroness Merron Excerpts

Thursday 19th May 2022 Lords Chamber

Asked by

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the report by Civitas International Health Care Outcomes Index 2022, published in April; and in particular, the factors that ranked the UK healthcare system 18th in a league table of 19 comparable countries.

[Baroness Merron (Lab)]

My Lords, the recent Civitas report—

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

I shall start again. I beg to leave to ask the Question standing in my name on the Order Paper.

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

I assure the noble Baroness that I am only too happy to answer the Question standing in her name.

The Government value the use of robust international comparisons to help improve and reform health services, and work closely with the OECD in compiling such statistics. The Civitas report is based on data already known to the Department of Health and Social Care, which highlights both where the NHS is world-beating as well as where it needs to improve.

[Baroness Merron (Lab)]

My Lords, the recent Civitas report on international health outcomes does not make pretty reading, showing the UK to be the worst for stroke and heart attack survival. With the NHS and patients facing record waiting times and soaring turnover and vacancy rates in the workforce, and no corresponding social care proposals in the Queen’s Speech to alleviate pressure, will the Government finally commit to a proper workforce plan with projections of future need and a proper plan to meet those requirements?

[Lord Kamall (Con)]

I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.

I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.