Children’s Health: Sugar

Lord Allan of Hallam Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

Many noble Lords will recall the Question we had on this before. It is the actual ingredients that are the problem. Ultra-processed foods, in and of themselves, are not a good definition because bread is an example of an ultra-processed food. The problem is that many of these are high in fat, sugar and salt, and that is what we need to be tackling. That is what we are going after, not the definition of ultra-processed foods per se.

[Lord Allan of Hallam (LD)]

My Lords, the Minister has told us previously that the Government are going slow on their ban on junk food advertising because they want to give time to manufacturers to reformulate their products. For many of us, this is disappointing because, as long as the food continues to be advertised, there will be excessive consumption. Could the Minister give us a progress update, so that we can get to the point where these foods, which are bad for health, will no longer be promoted—particularly in front of children?

Countess of Chester Hospital Inquiry

Lord Allan of Hallam Excerpts

Tuesday 5th September 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Statement that we consider today reminds us of acts that were so cruel that it is hard to make sense of them. Our thoughts must be with the families who have suffered the worst of ordeals and with the children who were so brutally taken from them. It can only be hoped that the conviction and the sentencing have helped bring some closure, even though the murderer dared not face up to them in person in court. More than this, the extent of the crimes committed by Lucy Letby may not yet be fully known, as Cheshire police have widened the investigation to now cover her entire clinical career.

There are heroes in this story—the doctors who fought to sound the alarm in the face of a hard-headed and stubborn refusal to even consider the evidence that was brought forward. I am sure that the whole House would wish to join me in recognising the courage of Dr Stephen Brearey and Dr Ravi Jayaram.

This killer should and could have been stopped months before. If it had not been for the persistent bravery of the staff who finally forced the hospital to call in the Cheshire police, the lives of even more babies would have been put at risk. The refusal to listen, the failure to approach the unexplained deaths of infants with an open mind, and the failure to properly investigate when the evidence appeared to be so clear, are absolutely unforgivable. There was then the insult of ordering concerned medics to write a letter of apology to a serial killer. It is clear that the allegations that were made and the evidence produced were not met with any respect or regard.

This is a tragic and true story, where events came together and flags were raised and ignored. It is to this point that I would like to take the Minister. I start by saying that we very much welcome that the inquiry has been put on a statutory footing, and it is welcome that the full force of the law will be behind it. However, can the Minister tell your Lordships’ House why it took so long to get to that correct decision? It is right that families have now been listened to, but why were they not consulted before the initial announcement? Will they be consulted ahead of any future decisions?

This is not the first time that whistleblowers in the National Health Service have been ignored. On all the occasions such as these where they have not been listened to, there has been a missed opportunity to save lives. The reality is that nobody thinks that the system of accountability, professional standards and regulation of NHS managers and leaders is good enough. Why were senior leaders at the hospital still employed after the conviction? Regarding the absence of serious regulation, which enables a revolving door of those with records of poor performance or misconduct, does the Minister agree that this is unacceptable, particularly when lives are at stake?

I refer the Minister to the duty of candour. It is 10 years since Sir Robert Francis’s report was published in which he put forward the duty of candour, and yet the duty of candour of a number of consultants was ignored and overridden in this case. As a result of that, will the Minister ensure that there is an independent external route through which concerns can be raised in future? Will he look at the accountability, scrutiny and supervision of clinicians throughout the National Health Service, because the pressures on the service at the moment mean that, sometimes, these vital double-checks can be missed? What review has been conducted into the effectiveness of the duty of candour? What is the conclusion of any review that has taken place about what has gone wrong over the past 10 years?

The terrible events at the Countess of Chester Hospital shine a clear light on a lack of consistent standards. Therefore, it is welcome that the Government are considering a register of NHS executives and the power to disbar, which was recommended by 2019 Kark review. However, the Government should go further. Will they begin the process of bringing in a regulatory system for managers, and standards and quality training, as was recommended by the 2022 Messenger review? Can the Minister indicate how and when there will be progress on bringing together a single set of unified core leadership and management standards for managers, and training and development to meet these standards? What is being done to promote excellence in leadership and to ensure patient support when things go wrong?

I am sure we can all agree—I know that the Minister will join with this—that we owe it to the children who lost their lives and to the families who grieve their loss to do what we can to prevent anything like this ever happening again.

[Lord Allan of Hallam (LD)]

My Lords, we have all been appalled at what happened at the Countess of Chester Hospital, and we would also like to extend our sympathy to all those affected, especially those parents of children who were taken from them. Those were losses that we now know that could, and should, have been prevented. I echo the comments of the noble Baroness, Lady Merron, in praise of those doctors who did raise concerns and fought to have them taken seriously. The accounts that we have seen of legitimate concerns either being ignored, or in some cases being actively suppressed, are truly shocking and represent a call to action that we must heed.

The inquiry is welcome, and will cover a lot of important ground, and I will not try to pre-empt their work today. Instead, I want to focus on one aspect where the department could act now without cutting across the work of the inquiry, and that is the role of NHS trust non-executive directors. This is something which the patient safety commissioner also highlighted in her statement on the Letby case. She said of NHS non-executive directors that

“it is vital that they are able to ask the right questions and escalate concerns where needed.”

The relationship between non-executive directors on a board and senior management teams in any organisation involves the delicate balance of responsibilities. Would the Minister agree that NHS trust non-executive directors should see patient safety as a priority responsibility—perhaps the single most important among their broad set of duties? Would he also agree that it is a healthy and positive situation if trust managers feel that they are under scrutiny from their non-executive directors on safety issues and believe that they will be pulled up if they are not fully open with them? We saw in this case claims of management not presenting the full sets of facts to their boards. They must be entirely candid with their non-executive directors and must expect to be challenged; that is the culture we want to see on trust boards, not one of cover-up and misleading.

In this context, could the Minister confirm whether the department will take steps now to reinforce with trust boards the importance of non-executive directors being able to raise safety issues? Importantly, will they be providing non-executive directors with training on how to perform this function effectively, so that they understand the best ways in which to challenge executives where necessary?

As I said at the outset, we welcome the inquiry from these benches, but I hope that the Government will not wait until the inquiry has completed its work to start making changes, and that they will be equally committed to making changes now where these would improve governance, and that the Minister can confirm that they are looking at strengthening the role of non-executive directors on NHS trust boards.

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

I would like to thank the comments, and the spirit of the comments, made by noble Lords. I start by adding my condolences to the parents and families in question. As we all know as parents, it is the most horrible thing we could ever imagine happening to us.

Clearly, the inquiry will find out the full facts of the matter, but at the same time it is important that lessons are learned quickly. To the point of the noble Baroness, Lady Merron, the families will continue to be consulted throughout this time. We would all agree that what happened is unforgivable, and we should praise the doctors for the work that they did and the courage that it took to bring it forward. I am convinced, as mentioned by the noble Lord, Lord Allan, that we need to make sure that we are doing sensible things in the meantime to ensure that we learn those lessons quickly. The foremost responsibility—the first line of defence as I like to call it—is the role of the board and the NEDs.

Speaking to colleagues about this, Chris Whitty was just saying that any sensible statistician and someone with sound common sense should have been able to say that there is something seriously awry here. We must all ensure that the boards are equipped to be able to challenge in the right way. That does take training, but it is important to make very clear to them that their primary duty must, beyond anything else, be the safety of the patients in that hospital. That has to be the first line of defence. There are things that we need to do to help them, including training—and to the noble Baroness’s point, that they are equipped with the records of those people so that it is known whether they are fit and proper people. One of the questions that I have asked, and got answered, is that I know there is a list so that, when you are looking to employ people, you know now whether a person is not a fit and proper person. As happened in this case, people moved on to other trusts in intervening periods, and there must be a mechanism where the trust can annually review, or review even more frequently, whether they are fit and proper through past cases that have just come to light, so that they have the ability to act.

It is our role to arm those boards, and give them the information and training to be that first line of defence. Tragically, we know in this case that first line of defence failed. These actions should bolster that first line of defence, but we also need to look at some of the second lines of defence. Medical examiners are a good way forward. From April 2024, they will now oversee all deaths that have not been put to coroners. I am told that this happens quite regularly already in the hospital setting; the challenge is more in the primary care setting. Along with other lines of defence, there is the duty of candour, allied with the freedom to speak up, so that we are gaining knowledge from the staff and people on the front line. Again, it is clear in this case that, while doctors were very brave in bringing it up, a lid was kept on it for too long. Clearly, we need to do more in terms of that whole approach of them feeling emboldened to speak up.

At the same time, the steps being taken in terms of the Getting It Right First Time programme and the health and safety investigations board and CQC are all good steps in that direction. But what is vital is that we do not, by putting in those central measures, somehow give boards the feeling that the first responsibility does not lie with them. It is the most important job that they can do, and the last thing that any of us would want is the feeling that they do not have to worry so much about that, because there are these other bodies looking into it. Absolutely fundamental to all of this is that they realise that it is their primary duty and that we in the centre are arming them to do that properly.

I hope that gives a good sense of the direction of travel we are going in, and I hope it accords very much with the points made. As to whether we should be going further in terms of registers to make that regulatory, we are absolutely open to that. It is just about trying to work out the practicalities and where the right level is. There are, however, some things, such as making sure this fit and proper persons list is up and running. That is something that we can do very quickly and are doing tomorrow. Clearly, there will be other opportunities for questions that I am taking in a moment. As ever, I will follow up all of this with a detailed reply. Most of all, I want to give a moment’s pause.

Folic Acid Fortification

Lord Allan of Hallam Excerpts

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend, and I agree. I hate the words “in due course” because they mean “whenever”. While I freely admit to using words such as “soon” and “imminent”, “in due course” is not a term I use, and I understand the point being made. The consultation will be published late in the summer. It is a complex area, and I have said that I want to get personally involved now; I want to make sure that we get the balance right between the many competing interests. The legislation is planned for early 2024. All I can do on my side is to undertake to push that forward as much as possible.

[Lord Allan of Hallam (LD)]

My Lords, the Minister said in reply to a previous question that a lot of the industry is already voluntarily adding folic acid to bread and other foodstuffs. Of course, “a lot” is a well-known scientific term for “more than a little”. I invite the Minister to offer us a more precise figure. Does the department know what percentage of bread and similar products are currently fortified on a voluntary basis? If not, could it carry out a survey so that we can have that number?

[Lord Markham (Con)]

Probably the best thing to do is for me to give the noble Lord the detailed information we do have and try to find out more. I am told that “a lot” means the majority of bread products, but I will give the noble Lord a more precise answer.

Stroke Care

Lord Allan of Hallam Excerpts

Monday 24th July 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we are fortunate to have the Sentinel Stroke National Audit Programme—SSNAP—to help us monitor compliance with the national guideline. In its very good easy access report for the first quarter of this year, it tells us that three out of five stroke patients are not taken to a stroke unit immediately and it calls for urgent action in this area. What are the Government doing to make sure that stroke patients are immediately admitted to stroke units in line with that guideline?

[Lord Markham (Con)]

The noble Lord is absolutely correct. As mentioned, speed to the right place is vital; videos in ambulances are one way of communicating ahead and speaking to the paramedics so that they are ready to receive them, which is really important. The latest data I have seen is that 92% of people are now sent straight to the stroke ward on arrival, which sounds promising but is somewhat at odds with the Sentinel figure he mentioned. I will find out more about that and get back to the noble Lord.

Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023

Lord Allan of Hallam Excerpts

Monday 24th July 2023 Grand Committee

[Lord Dodds of Duncairn (DUP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Ritchie. Like her, I declare that I am neither a smoker nor a user of vapes.

Despite their technical-sounding name, these regulations are important in their own terms for what they do in this area. However, they are also important in the wider political sense because they are a manifestation of the direct application of European Union law to Northern Ireland as opposed to the decision being made by anyone who has been elected in Northern Ireland, either in the Stormont Assembly or in this Parliament. It is therefore a good illustration, whatever your views may be on the subject, of the issue that is at the heart of the problem now facing Northern Ireland politically and that is causing so many problems in getting the institutions back up and running.

I would have thought that an issue such as this would be something that elected representatives of the people of Northern Ireland would wish to consult on, discuss, debate, come to a conclusion on and eventually pass, either at Stormont or at Westminster. However, under the Windsor Framework, which is a version of the original protocol, they are not allowed to do that. This decision, as the papers make clear, is a decision that has been made by the European Union.

I want to explore with the Minister—if he cannot answer these questions today, I would obviously be happy to receive a letter setting out some of the answers in detail—first, what consultation was carried out by the Government, in bringing forward these regulations to implement European Union laws, with anyone in the Department of Health or any other department in the Northern Ireland Executive. This instrument says that it applies changes “to Northern Ireland only”. What is the position in Great Britain and in the rest of the United Kingdom? The committee on which the noble Baroness, Lady Ritchie, serves and to which she referred in this debate references the general restrictions that apply to the market in Great Britain for vaping machines and products but there is nothing there about the actual issue of characterising flavourings, which is the subject of this piece of legislation for Northern Ireland. What consultations have been carried out in Great Britain thus far on whether to go down the same route as the European Union? If it is decided that the rest of Great Britain will not go down that route, what implications does that have for regulatory divergence with the rest of the United Kingdom—namely, Northern Ireland?

For instance, what will happen to somebody who buys or gets a vaping product in England, Scotland or Wales, brings it back to Northern Ireland and uses it, hands it over or sells it to friends? Under the term “supply”, I would have thought that that would be illegal. How will that be enforced—or will it? I have a further question for the Minister. Will there be checks carried out at any point to determine whether people have such products and are bringing them back as an individual for use or for distribution among friends, or even as a small business to sell them? How will that be implemented? If it is to be implemented by surveillance in market, why cannot that happen in relation to a whole lot of other products that are subject to green and red lane checks under the Windsor Framework? Again, I would like the Minister to deal with that question.

We have here before us a statutory instrument that is UK law but applies only to Northern Ireland. However, it has been brought forward at the behest of the requirement under the Windsor Framework to implement EU law. The noble Baroness, Lady Ritchie, serves on the protocol Select Committee with me; we are honoured to do so. We have many examples of legislation from the European Union, applied under the Windsor Framework, which are just applied directly and do not require any UK legislation at all. Again, I would be grateful if the Minister could explain why it is that this case requires UK-implementing legislation whereas, in many cases, it does not. It sometimes seems hard to rationalise what the difference is, although I accept that that is a wider question than the Minister be here at this Committee armed to answer. If that could be explained to your Lordships, I would be very grateful, as I would be if the Minister could explain where we might find the list of the statutory instruments that are being brought forward and the Explanatory Memorandum in the case where they are not being brought forward by the Government but are being brought forward by the EU directly.

The noble Baroness, Lady Ritchie, mentioned the district councils that are required to enforce these regulations. An impact assessment has not been carried out. I would therefore like to know what consultations there have been with the district councils in Northern Ireland, which are under severe pressure at present. What is the estimated cost in terms of enforcement of this and other requirements under the Windsor Framework, given that they have presumably had no consultation from anyone at the Stormont level or, indeed, at the Whitehall level? I would be grateful if the Minister could answer that one.

On the requirement to decide whether a tobacco product has a characterising flavour, the regulation of the European Union sets out the procedures for determining that. It also lays down the procedure for the establishment and operation of an independent advisory panel to assist in this determination. It seems quite convoluted but there you have it: it is in EU law. We are told that, in accordance with the Windsor Framework, both pieces of EU tertiary legislation apply in Northern Ireland. Again, what exactly does that mean in terms? Where is this legislation and will it be brought forward by statutory instrument or directly by the European Union? Will there be a chance to consult on it? If there are to be people appointed to an independent advisory panel, how will we find out how that is done? Questions around that would be deserving of an answer.

Small businesses and retailers in Northern Ireland—small shopkeepers and so on—will have to be aware that, after 23 October this year, they will no longer be able to sell heated tobacco products with a characterising flavour. So where do they get their supplies from? Has anyone talked to the retailers and small shopkeepers? Has anyone sat down with them to say what the impact of this on their businesses will be? Whether or not you agree that this is a good idea—I am not making any pronouncement on that; I have a lot of sympathy with everything that the noble Baroness, Lady Ritchie, said on the issue, particularly around young people—it is an issue of process and proper accountability. Who has actually sat down with wholesalers, retailers and shopkeepers and discussed this matter with them? What guarantee is there that these people will be aware of this change in law?

I am aware that I have asked a number of questions and that they are perhaps not all capable of being answered today. However, when they are answered, either here today or by letter, I hope that they will provide some clarity to people on this issue. As I say, it illustrates the issues that we have with a form of legislation for part of the United Kingdom when the people who make the law are not accountable to anyone in that part of it and nobody elected as a representative of the people in that part of the United Kingdom has any opportunity to have a vote or bring forward legislation in this area.

[Lord Allan of Hallam (LD)]

My Lords, it does rather feel like the old days to be transposing EU directives into UK law—the good old days, from my political perspective—but I certainly recognise some of the political challenge that the noble Lord, Lord Dodds, has outlined around the agreement that the former Prime Minister, Boris Johnson, signed up to, as confirmed by the current Prime Minister. This is one of the anomalous situations that they have created made real for us because we have to transpose certain elements of EU law specifically into regulations that have an impact on Northern Ireland but not on Great Britain.

The substance of the change seems to us to be entirely sensible from a health perspective. My questions relate to similar areas to those raised by the noble Lord, Lord Dodds, around the relationship with Great Britain, but they come from perhaps a slightly different perspective.

My primary question as a health spokesperson is: why not Great Britain? If we are seeking to limit flavoured heated tobacco products today, why are we not limiting them across the entirety of the United Kingdom? Why are we doing it for Northern Ireland only? I have a concern that there may be a “not invented here” syndrome going on. While we have to implement this for Northern Ireland, we have a choice in Great Britain; there is nothing to stop us imposing similar limitations on Great Britain. I would be concerned if the position of His Majesty’s Government is almost that we are aiming to be awkward and are somehow deliberately misaligning with something that has a public health benefit.

Human Medicines (Amendment Relating to Original Pack Dispensing) (England and Wales and Scotland) Regulations 2023

Lord Allan of Hallam Excerpts

Monday 24th July 2023 Grand Committee

[Lord Dodds of Duncairn (DUP)]

My Lords, I rise very briefly to raise a point. I was intrigued when reading the title of these regulations that they are for England, Wales and Scotland, but they do not include Northern Ireland. While the regulations are designed to increase patient safety and create efficiencies in the pharmacy sector—I agree with all that and think we can all subscribe to it—I would be grateful if the Minister could tell the Committee whether a decision has been made not to apply them to Northern Ireland, whether is it the case that we have no power in this Parliament to apply them to Northern Ireland, whether the Northern Ireland Assembly has any power in this area, or whether, despite what the Minister said in outlining potently and clearly the reasons for these changes, this is something that no elected representative in Northern Ireland, here or in Stormont, has any power over. I would be grateful for clarification.

[Lord Allan of Hallam (LD)]

My Lords, I start with the point made by the noble Lord, Lord Dodds. Reading the Explanatory Memorandum, it was curious that in paragraph 10.2 we are told that the consultation was carried out by all the United Kingdom authorities, including

“the Department of Health in Northern Ireland”

yet the regulations clearly state

“England and Wales and Scotland”.

This does not surprise me. We are dealing with two instruments on the same day, one of them Northern Ireland-only and one England, Wales and Scotland-only.

I was curious about the answer on the Northern Ireland instrument, which is that we would need primary legislation, so it is easier to regulate tobacco products in Northern Ireland than it is in England, Wales and Scotland. I hope the reverse does not apply here, and that Northern Ireland is not included because some kind of legislative barrier means that they would find it harder than we would to regulate something which, on the substance of it, seems eminently sensible. Many people outside here might be surprised that pharmacists did not already have some discretion over how they dispense, given that packs are quite often in odd numbers. Having dealt with the scope point, again, the substance of it seems entirely sensible.

This must be a pre-recess present, as it is rare that people bring before us regulations which are good for patients, pharmacists and GPs. It is not only that everybody wins from the change being promoted; the Government have managed to get a “two for the price of one” by incorporating another change, which I know has come up. The noble Baroness, Lady Cumberlege, and others have campaigned for some time to improve the information given to women who are prescribed sodium valproate. So here we are: we are making two sensible changes in one instrument, and the Government should be congratulated on that.

For once, we have an impact assessment. We have four pages of regulation and 40 pages of impact assessment. My heart always sinks when I see a huge impact assessment but this one was really good. Whoever prepared it should be congratulated. There are lots of really good facts and figures about how prescribing works in the United Kingdom to help support the case, so I thought it was very well worked out. The fact that savings were identified independently for patients, GPs and pharmacists was extremely helpful in trying to assess the impact of the regulations. It highlighted that there is a potential increase in drug costs but that that is far outweighed by the savings that all those other constituencies make.

I would be interested in the Minister’s reaction to one number in it that surprised me. The impact assessment said that the cost of an e-consultation that would be saved—I assume it is for some sort of repeat prescribing —was £1.40. That is a very precise amount, but less than the saving from a patient going to the pharmacist to pick up their drugs. That figure surprised me because it felt low. I would expect a greater saving from reducing the number of e-consultations for people being represcribed drugs. Again, I am curious about where that came from.

I thought the model of trying to price out where the savings are, in a sort of piecework way, was extremely helpful, down to the 45p that will be saved by assistants in pharmacies not spending 90 seconds on splitting packs. That is super precise, but it is the kind of data that we want, and which can be tested to really understand how you are making savings all through the chain.

The other numbers that came out, that were just fascinating, were on the spread of prescriptions of paracetamol. There were two prescriptions for 10,000 paracetamol in there that were checked and found to be correct, which did surprise me. Even more surprising than the two prescriptions for 10,000 were two prescriptions for 1,009 paracetamol each. 1,009 is a very large prime number, so there is no “so many per day”; you cannot divide it by anything to get anything else. I assume that is a mistake, and that they meant to write 1,000 or 100 and stuck a nine on the end, because that is the only way I can think of that any GP would ever prescribe a large prime number of paracetamol.

I welcome more impact assessments like this with fun numbers in them, as they are extraordinarily helpful on a Monday before we head off for our break. More substantively, I genuinely hope that we will see more innovation such as this around prescribing and dispensing, because this is one of the areas that we have talked about a lot with the Minister. If we are to see improvements in primary care, we have to look for the kinds of efficiencies that benefit patients and make everything quicker and easier for the patient, but also make it more cost-efficient, because there are savings to be made that can in turn be ploughed back into the new enhanced services that we want to get from our pharmacists.

Again, as a substantive point, the general sustainability of community pharmacies is a problem. They are not getting the kind of income they need to continue to be present in all our communities. We see that in the closure rates; there are hundreds closing every year. As we look at changes such as this—the Minister talked about things such as the hub and spoke model—we have to bear in mind all the time that if we are making savings and are able to put those savings back into community pharmacies, that will be essential if we are to continue to have the kind of network that we need for the Minister’s ambitious plans.

This is a very welcome development. It is great to get two for the price of one; reducing the risks to pregnant women from sodium valproate is very welcome, but in terms of the scale of the dispensing operation, it is the 10% change that will potentially have a significant impact. As I say, I hope the Minister can commit that savings made through this will go back into that community pharmacy network that we all depend on.

[Baroness Merron (Lab)]

My Lords, as the Minister said in his introduction, this is an important issue. I too express my enthusiasm for this SI. We do not have a lot of SIs for which we have a lot of enthusiasm, so I hope the Minister and his team will be very happy with that. The reason for that is that this is common-sense and practical, and provides savings that can be diverted to benefit elsewhere, but also increases patient safety and is a better service to patients. It also allows pharmacists and their teams to do the job they are there for. That, in itself, is somewhat liberating for members of the healthcare team, so it is very welcome.

I also felt that the Minister had given an extremely detailed and welcome introduction, so I will just focus on a few questions in that regard. The first is about pharmacists. Given the changes and the impetus on pharmacists’ professional judgments, will there be any extra training, checks, reviews or similar put in place? I talk about the review not just to ensure that it is doing the job; are there other innovations that we can welcome in SIs in the future? That would be a very positive outcome.

MMR Vaccine

Lord Allan of Hallam Excerpts

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

There are two main approaches. If a child is under 11, we would prefer to have a parent present, for obvious reasons—because it involves a vaccination—so that is normally done through the primary care system, through nurses. Post 11, because you do not need the parent there, that is where schools really come into effect. In particular, there is a school-age assisted immunisation providers programme that goes into every school in a particular area, targets it and speaks to every child to see whether they have had their vaccination—and they can give it on the spot if they have not.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that the experience of both the MMR and Covid vaccination programmes shows that vaccine hesitancy is actually a very complex problem with multiple factors? Given the importance of high vaccination rates for public health, are the Government commissioning any research from academic experts in misinformation and disinformation so that we can understand what kinds of government campaigns will work and which ones will not and will only reinforce vaccine hesitancy?

[Lord Markham (Con)]

The noble Lord is correct about trying to make sure that we learn the lessons from all these areas. The approach that they have been responding to so far is very much “horses for courses”. In the last six months alone, they have had four different types of campaign. We do not have the results from those campaigns yet, but the point is a very good one and I will make sure that we get those results from the research and share them.

Emergency Healthcare (Public Services Committee Report)

Lord Allan of Hallam Excerpts

Thursday 20th July 2023 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, we are all grateful to the members and staff of the Public Services Committee for producing this excellent report and to the noble Baroness, Lady Armstrong, for introducing it. I want to explore five issues that arise from it.

First, I was very much struck by the comments in the report that the waiting times that we get for accident and emergency are calculated using a “dishonest” method. I recognise that the committee was quoting one of the people who had spoken to it. It seems to me that these statistics are so fundamental to our understanding of what is happening with emergency care that I hope the Minister can respond more fully on what is collected and how the data should and should not be used. I note that the noble Lord, Lord Harlech, is here; we have been together sitting through many days’ consideration of the Online Safety Bill and discussing the kind of transparency that we want from online companies. There, the maxim is “more is more”. The more data that we get about their performance, the better. The same should apply here. Certainly, we should be given as much data as possible about all the different aspects of waiting times as one goes through the health emergency care treatment path—the ambulance times, the wait times before you see a doctor in A&E, the wait times from seeing a doctor to being admitted and so on. Then we can make our minds up about whether it is effective. Today, I think we often get statistics that could accurately be described as misleading in the impression that they give.

The second issue that I picked up, which was absolutely fascinating, was a reference to the Frequent Caller National Network, which looks at people who make five or more emergency calls in a month or 12 or more over three months. I also remember an article from the Times Health Commission on 10 June. The journalist Rachel Sylvester had been out with the London Ambulance Service and reported that, in London, 4% of patients account for 22% of demand. The Frequent Caller National Network pointed to a number of reasons why we seem to be getting these frequent callers regularly and the numbers are not coming down. It talked about the lack of mental health support—something that has already come up in the debate and seems fundamental—the lack of primary care support and the lack of NHS system integration. The people manning 999 and emergency care professionals do not necessarily have access to the NHS systems—never mind any other systems—that they would need to direct someone to something more appropriate for them.

I am interested in the Minister’s response to the issues that were identified. Again, we have waited a while to debate the report—the committee produced its evidence last year—but it is very compelling, and I hope the Minister will be able to talk about some actions that have been taken.

Of course, for frequent callers, the real answer is that they can be helped to navigate to the most appropriate care for them. The right reverend Prelate the Bishop of St Albans made an important point about rural services, where, again, we must ensure that services of all kinds, whether mental health support, social care support or primary healthcare support, are available everywhere, otherwise people will default to calling 999 if the service is not there for them.

The noble Baroness, Lady Morris of Yardley, made a critical point about risk aversion. It has been pointed out to me that even if you, as the 999 caller, know— because you have the record—that you are 99% sure that an individual does not need an ambulance, the 1% stops you from directing that person to the service that is the most appropriate. We must have a grown-up discussion about this, otherwise everyone will call 999 and always get an ambulance and always go to A&E, and the service will break down. There must be a better way of thinking about risk than this.

Thirdly, it would be extremely helpful to have a progress report on the emergency care plan announced with great fanfare back in January. I note that Health Service Journal this week carried a quote from someone who said that the approach of NHS England in trying to deliver this care plan by reaching out to integrated care boards and others was like

“whipping the dead horse harder”,

which does not suggest that all is going well in the relationship between NHS England and those who have to deliver the plan. How would the Minister characterise progress on the plan and how confident is he that the capacity will be there for the winter of 2023-24 so that we do not see a repeat of last year’s meltdown?

Again, the noble Baroness, Lady Morris of Yardley, helpfully used the word “intolerable”, which is good because it reflects the public mood. The public in the United Kingdom are generally extraordinarily patient and respectful of the NHS because they believe that it is trying to do its best, but sometimes their experiences mean that even the most tolerant person feels that there is failure. That is certainly the situation we have got to with a number of areas of NHS care, but particularly around emergency care. Even the person most tolerant and respectful of the NHS feels at times that the service offered is intolerable and unacceptable.

Fourthly, we know that a key plank of the recovery plan is to deliver 5,000 more beds. There remain concerns that when the Government said that they would deliver more beds, that was all about surge beds in corridors and other spaces that are in fact unsuitable. I hope that the Minister can update us on the plan for beds so that when we reach the next winter surge they are there. Of course, the long-term solution is for there to be brand new and replacement hospitals but, yet again, we saw from the National Audit Office that the hospital-building programme is falling behind and will not deliver what was promised. I am interested in the Minister’s response to that report, which I think came out since we last debated the hospital programme. It says in terms that only 32 of the 40 hospitals will be delivered by 2030, and even getting to that 32 depends on everything going right in the programme. Sadly, as experience tells us, there is many a slip ’twixt cup and lip, and it will be extraordinary if this hospital programme does not also encounter issues along the way.

Finally, I wanted to raise again the issue of management capacity, which I flagged when responding to the workforce plan. It is an area that we do not talk about as often as we talk about doctors and nurses. I was going to suggest that I had an interest in this area as I once worked as a health service manager, but rather than using “interest” for these things that we once did years ago, the word “affinity” might be better. I have an affinity for people who work in health service data and health service management, who are trying to make the resources that we already have stretch further. This is one area where there seems to be significant scope for that.

However, this depends both on data being turned into information and on information being turned into action. It is very interesting to have a dashboard that shows you how bad things are, but the real value comes in taking that information and feeding it into process improvement. The noble Baroness, Lady Morris of Yardley, reminded us how difficult that can be when you have disjointed services. Somebody sitting there with a police, social services or health dashboard is fine, but the improvement process requires police, local authorities and health all to work together. I would be really interested to hear from the Minister where that capacity is coming from. It is hard work convening people and making cross-service improvements. I would like to hear from the Minister how capacity is being built into data analytics and change management to improve emergency and urgent care.

Finally, I will reflect on a point made by the noble Baronesses, Lady Morris and Lady Bennett, about “pilotitis”; we are good at creating examples of best practice but the real challenge is how to scale it once you have created it. I repeat a call we have made previously to the Minister that he should visit the laggards as well as the leaders and reflect on how we get those bits of the health service that are not so good up to the standards of the really good bits, which I suspect are where his officials mainly take him.

Food: Two-For-One Offers

Lord Allan of Hallam Excerpts

Wednesday 19th July 2023 Lords Chamber

[Lord Markham (Con)]

We are trying to educate, inform and nudge. The best example of all is encouraging the industry to reformulate its foods to be healthier. At this point, I am glad to say that, since we introduced these restrictions, Mars, Galaxy, Bounty and Snickers have reformulated, and even Mr Kipling’s Deliciously Good cakes are compliant.

[Lord Allan of Hallam (LD)]

My Lords, next week it will be three years since the Government committed to legislate to end the promotion of high-fat, salt and sugar foods by volume. Would a reasonable person think that this commitment has been met when the legislation has been passed but not implemented, and will not be for another couple of years?

[Lord Markham (Con)]

As I mentioned, the key is giving industry time to adjust so that it can reformulate. We would all agree that, if you can get the same taste but it is a lot healthier, with less fat, salt and sugar, that must be a good outcome. The examples that I just gave show that, and it is working.

Ultra-processed Food

Lord Allan of Hallam Excerpts

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. That is why we are at the highest level of free school meals for children ever. More than a third of children are now receiving free school meals, including all infant schoolchildren. The noble Lord is correct that a healthy start to life is vital, and if we can make sure that children are getting a good, nutritionally balanced school meal, that is a good start to life.

[Lord Allan of Hallam (LD)]

My Lords, as the Online Safety Bill works its way through this House, we see how interventionist the Government can be in the interests of public health and well-being when they put their mind to it. Learning from that effort, does the Minister agree that the phrase “legal but harmful” is quite an accurate description of some of the kinds of ultra-processed food that are sold and marketed in the UK?

[Lord Markham (Con)]

Absolutely. Some of the foods are not healthy at all, and we totally want to discourage them. We have taken a lot of steps in that space. The whole product positioning strategy, whereby you cannot now put such foods in places where there will be so called pester-power influences, is beginning to have an effect. We are already seeing healthier foods outgrowing non-healthy foods from that. Those sorts of actions were modelled to show that they were effective for 96% of the things that we are trying to target to reduce in terms of calories.