NHS: End-of-life Care

Debate between Lord Balfe and Lord Kamall

Thursday 8th September 2022 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what assessment they have made of the provision of end-of-life care by the NHS, particularly in respect of Archie Battersbee.

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

The Government are committed to providing high-quality end-of-life care, working closely with the NHS and other stakeholders. The Government are commissioning an independent review into the causes of disputes between those with parental responsibility and those responsible for the care or medical treatment of critically ill children such as Archie Battersbee. The requirement was specified in Section 177 of the Health and Care Act 2022 to lay a report before Parliament by 1 October 2023.

[Lord Balfe (Con)]

I thank the Minister for his Answer and for our meeting earlier this week. I stress that what I am looking for is a review, not an inquiry. We are not trying to pin blame and I hope that the review will have a wide range of disciplines and not be dominated by doctors and lawyers. Because although they say they acted in the best interests of the child—I am prepared to agree that—the parental grief will last for the next 50 years, for the rest of their lives, and we need to get this right. I hope the Minister will be able to reassure me that this will be a wide-ranging review that will involve all the disciplines involved in care.

[Lord Kamall (Con)]

I return the favour by thanking my noble friend for the meeting, but also for the frequent conversations we have had about mediation, for example. I know my noble friend is a qualified and experienced mediator. We are quite clear that the review has to attach no blame. We want to hear from as many people as possible. It will investigate the causes of disagreements in the cases of critically ill children between providers of care and persons with parental responsibility. It will look at whether and how these disagreements can be avoided, how we can sensitively handle their resolution, provide strong evidence and inform future recommendations to support end-of-life healthcare environments in the NHS. As much as possible, it will promote collaborative relationships between families, carers and healthcare. We can see it from both sides: as a parent, just put yourself in the shoes of someone who has to make these difficult decisions. Sometimes they feel that the medical profession acts like God; on the other side, there are medical professionals who believe that the parents do not really understand all the details. Let us make sure that we get this right.

NHS: Pre-pandemic Facility Levels

Debate between Lord Balfe and Lord Kamall

Tuesday 29th March 2022 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government when they expect the full range of NHS facilities, such as hospital visiting and booking GP appointments, to return to pre-pandemic levels.

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

My Lords, NHS services are open to patients and numbers of general practice appointments have returned, or are returning, to pre-pandemic levels. As before the pandemic, hospital visiting is currently at the discretion of NHS trusts. Hospitals are expected to accommodate at least one hour of visiting per day, and preferably more. The department is working closely with the NHS to tackle the Covid-19 backlog and restore pre-pandemic activity and performance as soon as possible.

[Lord Balfe (Con)]

I thank the Minister for that Answer, but in our local hospital there are very big signs saying that visiting is still not permitted, while it seems to be quite in order for staff who are unvaccinated to go in and out of the hospital at will. What steps are being taken to test unvaccinated staff to ensure that they are not carrying Covid, and can the Minister remind me whether we have repealed the bit of legislation that restricted the number of people who can be in a GP’s surgery?

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer as many of them as I can. We are aware that this idea of returning to normal is patchy in different parts of the country. Some people have told me that visiting their GP or a hospital is fine, while others have had real trouble. Therefore, when these issues come up, I hope that noble Lords and others make us aware, so that we can ask the NHS what is happening. It is clearly an issue of capacity, but also, some people are trying to get face-to-face appointments with their GPs, while some practices are trying to move towards a technology-based service offering. I am aware of that. GP appointments are up to 60% of what they were pre-pandemic, but we understand that there is progress to be made in other areas.

New Hospitals

Debate between Lord Balfe and Lord Kamall

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness will recognise that we need not only to build new hospitals but to upgrade existing infrastructure and this is all part of the capital programme. The decisions on individual hospitals and upgrades will be taken in local communities in consultation with clinicians and local ICSs.

[Lord Balfe (Con)]

My Lords, will the Minister avoid getting caught in a numbers game? We need an adequate number of beds in a good geographical spread to deal with the needs of the whole population. I hope that he will see this as part of an integrated expansion of the health service and that we will not get tied up with the numbers, as we did years ago—how many hospitals, how many this, how many that. We need an improved health service. This is a vital part of it, but it is only a part.

[Lord Kamall (Con)]

I completely agree with the sentiments expressed by my noble friend. Surely what we should focus on is output; surely what we need is the best healthcare system across the country. We need up-to-date healthcare with the best information from patients to make sure that we can diagnose and give them appropriate treatment, working with the very latest technology such as artificial intelligence to spot patterns, to make sure that we can also build in prevention when we look at tackling health issues in the future. I welcome my noble friend saying that we have to focus on output—modern digital infrastructure and modern digital hospitals fit for the future.

Health Incentives Scheme

Debate between Lord Balfe and Lord Kamall

Thursday 28th October 2021 Lords Chamber

[Lord Balfe (Con)]

My Lords, perhaps I may first apologise to the Opposition Front Bench for my confusing an Urgent Question with an Oral Statement. I thought that we had only 10 minutes for all of us.

My reaction is that this system will be quite easy to game. One cannot measure fruit and vegetables, and size of portions, by wearing a wristwatch; one can only use it to input data. That is the same for step counting, which, on a wrist counter, is well known as being not as accurate as elsewhere. I hope that the Minister and his officials will look carefully at the possibilities for gaming the system. If they are collecting the data remotely, they should be able to tell whether it is being gamed.

As a former president of the British Dietetic Association, I ask the department to look carefully particularly into the obese and overweight category. There is evidence that a BMI of around 26 does no harm to people, and I should like to see more medical evidence produced on that. I invite the Minister to ask the department to look at that.

Finally, will the department look at producing an app for all citizens, not with rewards attached but just an app of good practice that could be made available for free through the App Store so that we can all share in the wisdom of the department?

[Lord Kamall (Con)]

I thank my noble friend for those important questions, which are exactly those that I would have asked—and, in fact, did ask the briefing team when I was getting more details on this matter.

Of course, one of the most obvious things that we have to ask is: how do people game the system? Often, when one analyses a scheme, sometimes there are unintended consequences whereby people are able to game it. Someone asked me—I think and hope that it was in jest—“If I ate 75 cream cakes and blamed my metabolism, would I be able to get on to the scheme?” We have to make sure that our data is robust. The pilot will include robust anti-fraud measures in relation to users’ activity and access to incentives.

What is interesting about the scheme is that it is voluntary, but it will also make sure that the users input the data. There has been a lot of research around that, because it has seemed to be a potential weakness, if users were inputting the data, regarding whether they can game the system. We have been assured that measures have been put in place to avoid that sort of gaming but, once again, the evidence will tell. That is why the system is not national but is a pilot to test all these questions to the limit.

The noble Lord mentioned weight loss and obesity, which I shall come to. One of the things that we want to make clear is that the health incentives scheme is not a weight-loss programme; it is a programme for healthy living. It uses an innovative approach to rewards and incentives to help participants to adopt healthier behaviours for physical activity and diet. Of course, it will help those who are overweight. I have been on two diets in my life—no, really I have. What is interesting about this is that, when one looks at these issues, it is not just a question of consuming less but about burning off calories. That is why we want to encourage healthy living as opposed to purely tackling obesity. That is very important.

The other day, I met a young lady who was very slim. She said, “Why do you keep going on about obesity and type-2 diabetes? I am slim and I have type-2 diabetes”. So sometimes we have to make sure that we are clear about these connections.

NHS England Funding: Announcement to Media

Debate between Lord Balfe and Lord Kamall

Tuesday 26th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for that question. It is important that we recognise that this is a public/private partnership and that we make sure that we can rely on expertise and investment from the private sector. On the specific question, I will write to the noble Lord.

[Lord Balfe (Con)]

My Lords, I point out that the NHS has an insatiable capacity to spend money. I put it to the Minister that political control must be re-exerted over the NHS. Nye Bevan did not found the NHS by asking civil servants to do it. I encourage the Minister to bring a Bill to this House PDQ to get political control back into the NHS and into running it.

[Lord Kamall (Con)]

I thank my noble friend for the very important point he has raised. A friend of mine with completely different politics from me—probably closer to that of noble Lords on the Benches opposite—once said to me, “The thing about working in the NHS is that we always want more money and we are always looking at how to balance that when we get more money”. I think it is important for the public, but also for workers, staff and patients, that we remember value for money and ensure that we spend as productively as possible.

GPs: In-person Appointments

Debate between Lord Balfe and Lord Kamall

Tuesday 19th October 2021 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what steps they are taking to ensure all patients can choose to have a telephone or in-person appointment with their GP; and what assessment they have made of the impact of appointments not being in person on the late diagnosis of conditions.

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

We have published a comprehensive new plan to support GPs and make it easier for patients to see or speak to GPs and their teams, based on their choice. The plan is backed up by a new £250 million winter access fund, which will help patients with urgent care needs. As part of this, practices should ensure that they are providing the right proportion of appointments for their registered population that is clinically warranted and takes account of patient preferences.

[Lord Balfe (Con)]

I thank the Minister for his reply but point out that one of the fundamentals of the NHS has been that the patient has decided when they wish to see the doctor. Under Covid, that has been breached many times, with doctors having far more power not to see patients. Can he assure me that the aim of the department will be to get back to a system where the patient decides whether they need to see the doctor?

[Lord Kamall (Con)]

My Lords, I am happy to agree with the sentiment in the question from my noble friend, but it is important to make sure that we are not overly prescriptive. Patients sometimes want face-to-face consultation, but they may also be happy with a telephone call or an online consultation. At the heart of this should be patient choice.