Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Baroness Merron Excerpts

Tuesday 21st March 2023 Lords Chamber

Moved by

[Baroness Merron]

At end insert “but that this House regrets that the explanatory memorandum to the Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023 does not offer sufficient evidence to support the change; that the information provided on the potential costs and savings from this reorganisation are unspecified and vague; that the Regulations have not been published alongside His Majesty’s Government’s promised NHS Workforce Plan; and that they do not guarantee that NHS England will give long-term workforce issues sufficient priority”.

[Baroness Merron (Lab)]

My Lords, I am grateful to the Minister for introducing this draft statutory instrument, which facilitates the merger of the body responsible for the education and training of the health workforce, Health Education England, with NHS England, with the purpose of improving long-term workforce planning and strategy for the recruitment of NHS staff. I would also like to express my appreciation of the work of Health Education England and acknowledge the contribution of staff who have worked within that organisation. I am also grateful to the Minister for his initial response to the points raised in the amendment standing in my name on the Order Paper.

As noble Lords will know, on these Benches we are very committed to long-term workforce planning for the NHS and for social care, which requires independent workforce projections. Once again, I have to say, it is staggering that the NHS has not had a workforce plan since 2003—and still we wait. In answer to the much-asked question about the publication of the workforce plan, your Lordships’ House and the other place have been told that it would be “soon”. The meaning of the word “soon”, I do feel, has been somewhat overstretched, and I know the Minister understands that point. So, to repeat the question: when will the workforce plan be published? And can the Minister indicate what will be the role of NHS England within the workforce plan?

In earlier debates about the merger of NHS Digital and NHS England, the point was rightly made that talented expertise has to be retained. Given that, in this case, we are looking at an estimated cut of up to 40% in workforce numbers, this point bears repeating. Could the Minister provide an update on how the work on retaining talent and expertise is progressing? What assurances can he give to your Lordships’ House that the staff are being treated fairly throughout this process? Could the Minister also set out what specific service improvements are anticipated because of the merger and what metrics the department will use to judge NHS England’s performance, given its new remit?

I am grateful to the BMA for its contribution, which highlights areas of concern it has picked up from practitioners. I hope the Minister can assist with allaying those concerns, which I will now set out. Doctors are anxious that these changes could devalue the importance of supporting education and training, compared with the desire to increase service delivery during an ongoing workforce crisis. How will this be guarded against?

There are also concerns that the reduced size of the new NHS England will damage its ability to deliver support to junior doctors and negatively affect the day-to-day running of postgraduate training programmes, which are currently supported by the local offices of Health Education England. Can the Minister give reassurance on this point?

Finally, there is a question about NHS England’s ability to adhere to the minimum standards set out in the code of practice on the provision of information for postgraduate training. I hope the Minister can also assist by responding on this point.

Although we on these Benches will not oppose these regulations, I now turn to the substance of my amendment and draw the attention of your Lordships’ House to the report of the Secondary Legislation Scrutiny Committee, which says:

“The Explanatory Memorandum describes what the instrument does in quite legal terms but does not offer evidence to support the policy by setting out the costs and benefits anticipated from this transition. We have received further information from the Department … which is published in Appendix 1 but despite our enquiries the information on the costs and savings from this reorganisation remains quite vague.”


In addition to these points, my amendment notes that

“the Regulations have not been published alongside His Majesty’s Government’s promised NHS Workforce Plan; and that they do not guarantee that NHS England will give long-term workforce issues sufficient priority”.

I heard the Minister’s initial response, but I feel he has spoken of promises of delivery in the future, so could he explain how the shortcomings, which have been criticised by the committee and in the context of the amendment, have arisen and how he will seek to address them in full?

Although there is no fundamental problem with the general policy of abolishing Health Education England and transferring its responsibilities to NHS England, once again the presentation, content and communication has been somewhat lacking. The SLSC has been damning of the regulations’ Explanatory Memorandum, which, as the committee says, does not provide sufficient evidence to support the policy, or set out the costs or savings clearly enough. This is clearly unacceptable, so could the Minister—this, again, is a repeat question for him—confirm what steps he has taken to ensure that important regulations such as these are properly and thoroughly brought before the House?

More broadly, and to return to where I started, these regulations are before us without reference to the broader NHS workforce plan, and it is this for which we still wait. Absorbing Health Education England into NHS England before knowing the number of health workers it will need to educate and train really does feel like putting the cart before the horse. The NHS is nothing without its workforce, yet we are still unsighted on how many doctors, nurses, care staff and allied health professionals we will need in five, 10 or 20 years’ time. Can the Minister set out the reasons behind this delay? Is it a matter of cost, or is it some kind of disagreement within government as to what the NHS needs and what the Government are prepared to commit to? I beg to move.

--- Later in debate ---

[Lord Markham (Con)]

I think that is probably one element I need to come back to the noble Lord on in writing.

As I said, I will try to follow up the questions in detail. I welcome the contributions of various noble Lords and their understanding of what we are trying to do here. I understand the arguments, as an ex-management consultant, regarding centralisation versus decentralisation and how they go in and out of fashion. This is a slightly different case because it is about bringing a core function in house. To me, that is the key change and the key thing we will be seeking to measure. As well as setting out clinical needs, the key role of the NHS at its centre is making sure that it is recruiting, training and retaining talent to meet the workforce plan needs. On that note, I thank noble Lords for their contributions and hope that my follow-up answers any questions that I missed.

[Baroness Merron (Lab)]

My Lords, I am grateful to the Minister for his response, and to the noble Lords who have spoken in this debate: the noble Lords, Lord Scriven and Lord Allan, and the noble Baroness, Lady Watkins. I did smile when the noble Baroness gave us an update on the workforce plan, which I am sure was helpful to the Minister, and I also wish her well in her new role.

As the Minister and your Lordships’ House will have equally understood, this is not about the actual steps that are being taken. We have had a useful debate to pull out some aspects, but the regret Motion is about the workforce and, in particular, the failure to have produced a workforce plan. This is not something recent from the last year or so. We have to remind ourselves that this Government have been in government for 13 years, and still we wait. For every day we wait, we lose an opportunity—as noble Lords have said—to plan for the future, as well as to deal with the immediate, and that is what motivated me to put forward this amendment.

We are all in agreement today that a workforce plan has to be for health and social care, which are inextricably linked, and has to not sit on the fence—well, it may; we will see. The plan has to not sit on a shelf but be fully resourced and do the job it is intended to do. We will look forward to holding the Minister to account on that point, as I know he expects.

Regrettably, I do not believe that in this debate the Minister has addressed the shortcomings of the regulations before us. Those shortcomings are somewhat unnecessary, which is a great shame because overall the statutory instrument is one that will be beneficial. It is a shame that we have had to debate it in this fashion. With that, I beg leave to withdraw the amendment.

Amendment to the Motion withdrawn.

Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2023

Baroness Merron Excerpts

Monday 20th March 2023 Grand Committee

With those questions, including the nerdier questions on the designation of agencies, I hope that the Minister will be able to clarify some of those points. In principle, we do not oppose the idea that there needs to be a properly funded approval process—and I hope that it is one that works consistently and to a high quality.

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing the SI and the important provisions within it. As my noble friend Lord Jones said, it is an important SI, and we acknowledge the role that the MHRA plays and the need to increase the fees that it charges for regulating medicines and related products.

I appreciate that the Minister said that the MHRA has not increased its fees to this extent since 2016-17, which was in an effort to provide the industry with certainty and stability through the EU exit period and the challenges of the pandemic.

The noble Lord, Lord Allan, asked some questions the responses to which I would also be interested to hear. The consultation process was important, and I am glad that it took place and has guided the SI and its provisions, because the views of relevant stakeholders are key in making sure that we get things in the right place.

There is a clear acknowledgement from noble Lords that the MHRA needs to be financially stable, because it needs to be able to deliver regulatory services that protect and improve patient safety with high-quality, safe, effective and innovative medical products. I certainly welcome the greater clarity that the SI provides on the increased costs of providing quality care in our health services. However, I have a question for the Minister specifically on the SI. Where the increased costs of the fee simply cannot be absorbed by the NHS, which is already facing the worst of crises, could the Minister outline how the Government will ensure that the increase will be accommodated without affecting the stability of NHS finances and without impacting patient care? In other words, how will it be done?

I will make some more general points about the work of the MHRA. Innovative companies in this field often say that a key block to their progress—a key block to getting their work through the MHRA—is the speed, or the lack of speed, with which it can be processed. Can the Minister indicate how he will ensure that the MHRA stays up to speed with the latest advances and is able to process them as quickly as possible?

It would also be helpful to know how the department scrutinises and assesses the work of the MHRA. For example, what is the formal matrix for success and the speed at which it processes new devices? How well does the MHRA communicate with other organisations in the sector? What engagement does the department have with the MHRA, both to hold it to account and to improve its practices?

In drawing my more general points to a close, I note and welcome the recent announcement of the extra £10 million of funding for the MHRA. Can the Minister outline the blocks to quick approval to which this money will be targeted? How will the impact of this additional money be measured, and is it sufficient to deliver the service we need to ensure that UK patients have faster access to the most cutting-edge medical products in the world? As part of the additional money, the Chancellor announced last week that treatments already approved by “trusted” regulators internationally would be nearly automatically approved. Which countries are counted as “trusted”? Has an impact assessment been carried out for this change and, if so, can it be published?

We are always looking forward and looking to make further strides in patient safety, it is certainly my opinion that this statutory instrument takes us further along this route, and we welcome it.

[Lord Markham (Con)]

I thank noble Lords for their contributions today and, as ever, will try to reply and follow up in writing where necessary. I shall try to take them in order, for ease. The noble Lord, Lord Jones, asked who is working on the bloods, for want of a better word. We have qualified professionals who are working to WHO standards, such as phlebotomists. Related to this was the question of who is in receipt of these fees. It is twofold. Obviously, a lot of fees go to fund MHRA itself, but a lot of the cost base is when it is hiring in subject-matter experts. In that case, they get the fees.

The general point raised by all noble Lords was the basis of this. As I said, it is a cost-recovery model. There are swings and roundabouts there, but it has tried to ensure that where there are bigger increases, it is only because that is the legitimate cost, but on average it comes to about 12% to 13%. I think that we would all accept that, for something that has not increased since 2016-17, that is reasonable. It is quite a bit behind inflation. That notwithstanding, I am very alive to the impact on SMEs, having been, as I said, in a similar space myself in the past. There are easements and waivers that can be applied, if that is the case.

To the general point about how we are trying to keep up with the speed of advances in the industry, it is very much the understanding that the industry is providing a service. Of course, safety must always be paramount, but it is a service to bring in innovation and attract new people into the sector. It has a transformation programme to ensure speedy replies—but I was pleased to hear that it is also looking to introduce a consulting service to help companies get into the field. That will be different from the regulatory side—obviously, we need a Chinese wall between the two. But it is recognised, especially for a small company, which does not have a regulatory team in place, that being guided and hand-held through the process, and having someone to tell them that this is what they need to do to get in, is very important. That is something that it is committed to doing.

As for holding the MHRA to account, to be candid, I see that very much as my job. That is obviously for officials as well, but I have the brief for the ALBs, and I set up regular meetings with them. As I said, I am very much alive to the fact that that is needed to make sure that it really is serving the industry properly. Part of holding it to account is about making sure that it is providing a decent service level. That is something that I will look for it to carry on doing. Consultation is useful as a formal process, but it should always talk to its customers and get that sort of feedback.

I have to fess up that I probably cannot answer some of the nerdy questions right now, particularly on the reclassification of the agency. I will have to phone a friend or get my colleagues to reply on that point. Likewise, I think we would all agree that the extra £10 million is welcome in this space. How the MHRA will go about that distribution and how it will measure that effectiveness is something I will follow up in the detailed letter that I will send.

Similarly, on which countries are counted as “trusted”, my understanding is that often the MHRA looks at the processes that are in place—again, I will come back in detail on this. Rather than a country being trusted, per se, it is more about the scrutiny process that it undertook. Obviously a regulator would be accepted as good in a place, but again, I have some personal experience. If you can see that the CDC or the FDA has gone through a very similar process, does it really make sense to do that all again? Clearly, it is felt that I have not quite answered the question—but I mentioned the waivers.

At this point, I hope I have covered most of the questions that I can right now, but I will follow up in detail. I appreciate that noble Lords are generally supportive of what we are trying to do here, and that we all agree that the MHRA has an important part to play and that the cost recovery is a reasonable approach, particularly with some of the price increases in recent years. As I said, I will happily follow up in writing. On that, I commend the regulations to the Committee.

Patient Deaths: Ambulance Waiting Times

Baroness Merron Excerpts

Tuesday 14th March 2023 Lords Chamber

Asked by

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of reports that over 500 seriously ill patients died in England last year after long waits for an ambulance; and what steps they are taking in response.

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

We recognise the pressures facing the NHS and the need to recover performance following the impact of the pandemic. We are working hard to make sure that no one waits longer than necessary, given how important response times are for patient care and outcomes. We are backing the NHS to meet these challenges and our emergency care plan will deliver one of the fastest and longest-sustained improvements in waiting times in history, backed by £1 billion in funding and up to 800 new ambulances.

[Baroness Merron (Lab)]

My Lords, it is alarming that last year, the number of deaths of patients waiting for an ambulance for up to 15 hours more than doubled from the previous year. What action will the Government urgently take, co-ordinated across the whole of health and social care services, to reverse this tragic tide? Can the Minister also explain the lack of a government plan over the years for getting to hospital in time those who have had a stroke or a heart attack, whose breathing has stopped, or who have been in an accident?

[Lord Markham (Con)]

I thank the noble Baroness for that question. As I said, we are providing 800 new ambulances, but there is a flow issue, as she rightly points out. To resolve the issue at the back end, so to speak, £500 million will be provided for new adult social care places, which is a vital part of unblocking 13% of the beds that are blocked and creating space throughout the system. At the same time, providing ambulance hubs will create offloading space so that ambulances can quickly get back on the road again. These are all key aspects. Fortunately, we are starting to see an improvement but there is a lot more that needs to be done.

Communications Act 2003 (Restrictions on the Advertising of Less Healthy Food) (Effective Date) (Amendment) Regulations 2022

Baroness Merron Excerpts

Monday 27th February 2023 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the noble Lord, Lord Allan, for his Motion to Regret and for the excellent way in which he presented it, and to all other speakers who have contributed. I feel sorry for the Minister. He is one of several Ministers we have seen since 2015, since the Conservatives have been totally in charge of government, and, during that period, of course, we have seen obesity grow—it is the one area in which we have seen growth, growth, growth. It is an area that has now worryingly spread down, particularly to children. We can say what we will say today, but I know the Government are not changing their mind; they are kicking this ball into the long grass, into the next election and beyond. Really, I think we in this Chamber should start addressing ourselves to who will be in power next time around, and what we might try to do in persuading them to have policies that will effect changes, because the one thing that the Government should have learned is that relying on voluntary conversations and a voluntary response from the private sector and the businesses in the food and drinks industry rarely produces a response.

Yesterday, I had experience of where the Government have taken some action. I went out for lunch and I had a choice on the menu: I saw the number of calories available to me with the various foods that were in front of me. I chose to have food with 1,000 calories, as opposed to 1,500, which I might have chosen had they not got that legislation through—with our support. Where they failed, of course—we pointed this out at the time the legislation was going through—was when my colleagues sat down, my friends and family, and had the bottles of wine, the gin and tonics before and the rest of it. They had no idea what they were consuming. I have been talking about labelling on alcohol for years, and the Government have done nothing at all. They have relied on the private sector to try to effect changes; there have been some marginal ones, but we still do not have any knowledge of what people are consuming when they come to take alcoholic drinks. Often, they can be consuming far more calories in the form of drink than in food.

So, looking at a menu with calories on does work. Leaving it to the private sector to do it voluntarily does not. I am hoping that the next Government in power will recognise fairly early on that we have to take the action, do the research, get it on the statute book and then implement it and not fiddle around. Because we see that we now have type 2 diabetes emerging among children as young as nine, 10 and 11, and that was not the case back in 2010 when the Labour Government went out of power. It was not the case even in 2014. If we look at what is happening in America with type 2 diabetes, the projections of the numbers of citizens who will have it in the future are quite frightening. They are saying that there could be up to 90% with type 2 diabetes unless people start to address basic food and drink properly. Yet we are letting it slip through our fingers here today. I am hoping the Minister will sensibly recognise—he does endeavour to bring a business attitude to bear—that we need to get law and not rely on a voluntary approach.

Another approach linked to this—I hope my noble friend on the Front Bench might pick this up—is that we see increasingly that advertising is not so much influencing young people on television, but it is online, and these regulations do not touch on online advertising one iota. There may be a saving grace, in that there is a delay: whoever deals with it next will sweep up online advertising as well. Linked to that, there is a requirement to look at the whole advertising industry and see how it is operating and whether we should not contemplate introducing health taxes into advertising, so that those who are advertising the most harmful food and drinks should be paying taxes on their advertising, and those who are advertising good food should have encouragement and support. That is the kind of change that we may be looking for with a new Government—a different approach from the one we have had so far. So, I look forward with interest, as others do, to the defence the Minister is going to mount—a defence which will be about nothing changing while they are still in power.

[Baroness Merron (Lab)]

My Lords, the Children’s Minister recently admitted that the nation had a problem with childhood obesity that should not be ignored. I am sure that noble Lords who have spoken today, and I am grateful to them, will share that view, not least because children with obesity are five times more likely to become adults with obesity, increasing the risk of developing conditions including type 2 diabetes, cancer and heart and liver disease. This is an extremely serious and pressing matter, as the Minister has been reminded yet again.

Two in five children in England are above healthy weight when they leave primary school and we now see the fastest increase in childhood obesity on record, as my noble friend Lord Brooke highlighted in his remarks. But it gets worse. Children starting school in the most deprived areas are three times as likely to be severely obese as those in the wealthiest, while NHS data shows that almost half of boys in England’s poorest areas are overweight or obese when they leave primary school. Last year, there were 3,400 severely obese children aged four or five in the most deprived parts of the country, as compared with 630 in the richest. So will the Minister give some indication as to what account is being taken of this great disparity between those who have more and those who have less in the Levelling-up and Regeneration Bill currently being considered in your Lordships’ House?

As we have heard today, it is absolutely right that we make informed choices about what we eat and drink, but choice can only really be choice if there is no distortion, and if those who are making the decisions have all the information they need and are able to interpret it. As the noble Baroness, Lady Bull, said, we actually need an integrated health approach to tackle the complexities of achieving a healthy weight. So the question for the Minister that has run throughout this debate is: how will the statutory instrument support this integrated health approach to tackle the complexities we know we have?

In the Government’s original analysis, they suggested a watershed on advertising, saying that introducing restrictions to prevent adverts for products high in salt, fat and sugar being shown before 9 pm could lead to 20,000 fewer obese children. I took it that this was, as others have said in the debate today, about shifting the environment, shifting the power of influences, in order to manage the challenges that we all face in supporting our wish to secure good health. So, will the Minister tell your Lordships’ House what will be the change in opportunity to tackle children’s obesity because of this regulation and the change it brings about? I refer in particular to page 33 of the Secondary Legislation Scrutiny Committee report. The noble Baroness, Lady Walmsley, referred to the figures. The report states:

“Analysis conducted to inform the Government’s Impact Assessment of the advertising restrictions found that under current restrictions children were exposed to 2.9 billion less healthy food and drink TV impacts and 11 billion less healthy food and drink impressions online in 2019”.


The committee observes that the effect of the delays means that, presumably, this level of advertising will continue and asks for an explanation as to why this is acceptable given the harms stated. Perhaps the Minister could refer to an answer on this point. The committee also asks for an explanation as to how the Government anticipate that they will still achieve the target of halving childhood obesity by 2030 if various elements of the strategy are delayed. Again, perhaps the Minister can tell your Lordships’ House his view on this.

Of course, there is a difficult balance to strike when seeking to improve public health and also when working with broadcast and online and the advertising industries. The Government have produced a regulation that has been drawn to the attention of the Secondary Legislation Scrutiny Committee once again, and this clearly does not assist the striking of that balance. It is not acceptable that the Explanatory Memorandum is described as “poor”, and that it fails to evaluate the effects on public health and the NHS from this delay. Nor is it acceptable that it fails to explain the use of a different definition from previous legislation. This refers to the unexplained shift from “high-fat, sugar and salt” to “less healthy foods”. The committee rightly asks whether the Government’s intended scope of products that they want to regulations to cover have been changed. Perhaps the Minister could respond on this point.

The SLSC also says that it

“provides insufficient information to gain a clear understanding about the instrument’s policy objective and intended implementation.”

It also says that, worryingly:

“The views of the NHS are not addressed or explained.”


This, I believe, is quite remarkable and suggests a breath-taking lack of engagement with those who should be engaged with. Once again, poor policy-making and poor administration have come together to leave your Lordships’ House unable to properly scrutinise what the Government are doing and why, even though it is the job of your Lordships’ House to do this. Perhaps the Minister could address these points of concern.

The Minister will recall that I have raised many times before the point about his department’s approach to legislation and the criticism that it has attracted. He kindly gave an undertaking that he would look into this with a view of doing better in future. Can the Minister could update the House of progress in this regard? Finally, I hope that the Government will not be diverted from measures that will have an impact on the health and weight of the nation.

[Lord Markham (Con)]

My Lords, I congratulate the noble Lord, Lord Allan—despite his wish to invite people to kick our balls—and the noble Baroness, Lady Merron, for securing the debate to discuss these regulations. I also thank the Secondary Legislation Scrutiny Committee for its report on this, and I thank all noble Lords for their constructive discussion on how to tackle the pressing challenge on obesity. I thank the noble Baroness, Lady Bull, in particular, for her thoughtful contribution showing the complexities of the subject with regard to the impact on eating disorders, as well as obesity.

I like to think that we are all agreed on the scale and the gravity of the issue at hand. Data from the latest child measurement programme, as mentioned by others, shows that 38% of children leaving primary school were either overweight or living with obesity. One in four were living with obesity. This, as we know, is fuelled by the regular overconsumption of food and drink that is high in calories, sugar and fat—or HFSS food and drink for short. As the noble Baroness, Lady Merron, mentioned, we know that being overweight or living with obesity at a young age increases the risk of being overweight as an adult which, in turn, significantly increases the risk of diabetes, coronary heart disease, musculoskeletal issues and certain cancers. This impacts on both the individual’s well-being and wider society. As we all know, it comes at a very high cost. Not only does it cost the NHS £6.5 billion a year in the latest estimates—there is an economic cost estimated to be as much as £58 billion. For all those reasons, this Government are committed to tackling obesity: it is the morally and fiscally responsible thing to do.

GP Appointments

Baroness Merron Excerpts

Thursday 23rd February 2023 Lords Chamber

Asked by

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of (1) the impact that the logistical difficulties of getting a GP appointment has on patient outcomes, and (2) the extent to which the needs and choice of individual patients are being met in making healthcare appointments.

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

We recognise that some people have struggled to access timely care from their general practice. We are taking action to expand general practice times to increase the availability of appointments, upgrade practice telephone systems, and publish data about how practices are performing so that patients can make informed choices when registering and commissioners can help the service to improve. In 2022, nine out 10 patients felt that their needs were met at their last general practice appointment.

[Baroness Merron (Lab)]

My Lords, the latest GP Patient Survey shows that more than one in four of those needing an appointment actually avoid making one because it is just too difficult. So does the Minister accept that practices such as being made to ring at 8 am, long phone queues, waiting hours for a call back and no online booking, all stack up more serious problems for the patient and the National Health Service? What are the Government doing to tackle these very basic practices, so that people can get to their GP in a way that suits them?

[Lord Markham (Con)]

Absolutely. One of the things I am very proud to be leading on the NHS side is our whole digital way of addressing access to the health service. This will be fundamental to how people make their hospital appointments and take control of their own health, so it will be the main thing that will help with the 8 am appointments, alongside the increased telephony services and everything else. Just as every walk of life is coming down to being able, at your fingertips, to make appointments and bookings and get your own records, this will also be the case with GP surgeries and I think it will fundamentally change the way that we address our whole health.

Hospitals: Maintenance

Baroness Merron Excerpts

Thursday 9th February 2023 Lords Chamber

Asked by

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the NHS’s Estate Returns Information Collection data, which show that the cost of maintenance work on hospitals in England exceeded £1 billion in 2021–22.

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

Patient and staff safety is our top priority: that is why the Government are providing £12 billion in operational capital to the NHS over the next three years for trusts to maintain and improve the estate. We support the increasing levels of investment by trusts to ensure that facilities are safe and maintained to a high standard.

[Baroness Merron (Lab)]

My Lords, while the cost of replacing crumbling wards and operating theatres soars, only 10 of the 40 proposed hospital construction projects have full planning permission and the National Audit Office is investigating the programme. Can the Minister confirm how many of the 40 promised new hospitals will actually have been built by 2030? Can he also confirm that they really will be hospitals and not extensions or refurbishments?

[Lord Markham (Con)]

Twenty-one outline or full planning permissions have been given, which is totally on track with the target. Clearly, if some of those hospitals are not being built until, say, 2027, there would be no detailed planning permission yet. So those statistics are not representative of the situation, which shows that the programme of planning applications is on track. I am committed, as are my colleagues, to ensuring that we deliver the 40 by 2030.

Maternity Services

Baroness Merron Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

The figure for the number of midwives has been roughly constant over the last few years at about 23,000. We want to increase that, which is why we have made a commitment to increase the number of graduate places to more than 1,000 each year. This year, as I say, we have 1,200 places, so we are making good progress.

[Baroness Merron (Lab)]

My Lords, there is an almost twofold difference in maternity mortality rates between women from Asian ethnic groups and white women, while black women are now 40% more likely to experience a miscarriage than white women. When will there be a report from the Maternity Disparities Taskforce? Could the Minister confirm that Parliament will have a full opportunity to examine its findings and review the progress that has been made?

[Lord Markham (Con)]

The noble Baroness is quite right to point out those figures, and they are something that none of us is happy with. That is exactly what the Maternity Disparities Taskforce was set up to deal with, so I am happy to make a commitment to talk through with the noble Baroness the progress of that.

NHS Staff: Food Banks

Baroness Merron Excerpts

Tuesday 7th February 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, a survey by the Cavell Nurses’ Trust found that 14% of nurses and health workers are using food banks to feed themselves and their families, and nearly 70% are either unprepared or very unprepared for a financial emergency. What assessment have the Government made of the effect this is having on the health and well-being of staff? Does the Minister feel that this ought to provide a greater incentive to the Government to resolve the long- running pay dispute?

[Lord Markham (Con)]

That is a concern; we want to resolve the pay dispute. I know personally how much time and energy are being put into this from our side as well. Clearly, more needs to be done. We are not there yet, but I am hopeful that we will get there. At the same time, we did try to protect those on the lowest incomes, as I mentioned earlier. Everyone received a minimum of £1,400, which is 9.3%. Clearly, we will need to do more for the next year, but we are trying to protect those in the most difficult circumstances.

Urgent and Emergency Care Recovery Plan

Baroness Merron Excerpts

Thursday 2nd February 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, this plan, interesting in parts though it is, misses the point. We find ourselves in yet another debate over another short-term cash injection to deal with a continuing acute crisis in the health service. It would certainly be helpful if, in replying, the Minister could indicate to your Lordships’ House whether this is in fact new money and, if not, where it is coming from. Furthermore, can the Minister say in his response whether he feels, from his experience, that the better way forward would in fact have been to have a sustainable and long-term plan for the NHS and social care with a laser-like focus on having the necessary workforce in place? The absolutely core point here is this: do we have the staff with which to provide the right level of service? At present, we do not.

We know that more than 7 million people are waiting for NHS treatment; that the four-hour A&E waiting time target has not been met since 2015; and that heart attack and stroke victims and others are waiting inordinate amounts of time for an ambulance. Similarly, we know that those waiting for more than five hours in A&E are more likely to lose their lives, as are heart attack and stroke victims waiting more than 18 minutes for an ambulance.

I am concerned that this plan waters down standards for patients rather than trying to recover the baseline services that are needed to meet them. For example, while the target is for 95% of patients to be seen within four hours at A&E, the Secretary of State has said that the best that can be managed is 76%. Yet outcomes are poorer if patients wait longer than five hours, so can the Minister say what plan there is to return to this all-important target? More generally, can the Minister indicate when patients will see a return to safe waiting times throughout all services?

It is important to see this in the round because too many people find it impossible to get a GP appointment so they end up in A&E, putting more pressure on the service. At the same time, the right care is not available in the community; patients find themselves kept in hospitals, sometimes for months, when they should not be there. As I have said, the gaping hole in this Statement and the Government’s plans is the lack of any sustainable solution to having the right workforce in place, both now and in future. After all, good care in the community, in people’s homes or in hospital cannot be provided without the staff to care for people. As we have lost two in five district nurses since 2010, can the Minister say how more “hospital at home” services will be delivered for patients if there are not the staff to visit them?

As I raised this in a recent question to the Minister, I wonder whether he is now in a position to comment on why the Universities Minister wrote to medical schools telling them not to train any more doctors. It would be helpful to have some light shed on this action.

With regard to virtual wards, NHS providers have rightly pointed out that progress will be dependent on NHS staff continuing to go above and beyond. Does the Minister share my view that this is not what exhausted health and care staff need to hear? Rather, they will want to know when they can expect to have a more sustainable job to go to and when there will be further support from the extended workforce.

In the other place, the former Health Secretary, Sajid Javid, pointed out that successive Governments have not focused enough on prevention, which would take much of the pressure off more expensive emergency care. This intervention came in the context of the Government’s latest announcement that they will not be publishing individual cancer, dementia and mental health plans, which has troubled many patients and stakeholder groups. Can the Minister assure your Lordships’ House that the Government’s new major conditions strategy will give prevention the focus it deserves? When can we expect this strategy? Also, the plan does involve more mental health ambulances, but can the Minister say how we can look forward to a plan that will prevent those with mental ill-health needing an ambulance in the first place?

Lastly, on children, the Royal College of Paediatrics and Child Health has heard how footfall in paediatric emergency departments has doubled across the country, with some children waiting more than 10 hours to be seen by a doctor and surgeries cancelled to free up beds on paediatric wards. As children can deteriorate very quickly, a timely assessment and response is absolutely essential to providing safe and effective care. Will the Minister commit to ensuring that a proportion of the dedicated fund will be used for paediatric services? Will he also commit to writing to every local area to remind them of the solutions that are included in this plan in order to improve urgent and emergency paediatric care?

I look forward to hearing the Minister’s response, in particular with regard to the need for a workforce plan. Perhaps he might also be able to tell us today when we can look forward to the strategy being put before your Lordships’ House.

[Lord Allan of Hallam (LD)]

My Lords, as is usual for this kind of Statement, it is peppered with promises of more of everything. I hope the Minister will help us to dig into the numbers we have been given to see how much lies behind them. First, on the new hospital beds, this seems to come from a process of making winter surge beds permanent. For a real long-term increase in capacity, we need the promised 40 new hospitals. How many of these will be on stream by next winter?

The Statement also tells us that there will be 800 new ambulances, which I think most people would interpret as fully staffed, blue-light vehicles. Can the Minister offer a more detailed breakdown of the different types and capabilities of what is being offered here? The Statement itself said that, for example, 100 of these will be mental health emergency vehicles rather than classic blue-light ambulances.

Of course, staffing these beds and ambulances and the other measures in the Statement will depend on good workforce planning. Here, I echo the comments made by the noble Baroness, Lady Merron, and by these Benches over many months. The Statement tells us that the plan will come this year; can the Minister offer any more precision on when this year we might expect it?

The Statement also talks about data and transparency. We are told that integrated care boards will now have to focus much more on data about patient flow. Can the Minister commit to making more of those statistics public, as well as the ambulance wait time statistics?

Finally, the promised new care hubs can add value only if care services are actually there. This brings us back to workforce limitations. I end with three questions for the Minister: where is the staffing for the beds, where is the staffing for the ambulances, and where is the staffing for the care services?

Mental Health Act Reform

Baroness Merron Excerpts

Thursday 26th January 2023 Lords Chamber

[Baroness Merron (Lab)]

I congratulate the Joint Committee on its excellent work and refer to a report in the Times yesterday that the Government have written to universities to ask them to limit the number of medical school places they offer or risk fines. Can the Minister shed any light on what I regard as a baffling move? Can he explain to the House how the Government will address the concerns of the Joint Committee about getting the right workforce in place if they are planning to reduce the number of doctors in training?

[Lord Markham (Con)]

Again, I agree that workforce is key to this. I am not aware of the report; I will look it up. I am somewhat surprised, because I know that we all accept that we need to invest in this space to recruit doctors, nurses and mental health professionals.