National Insurance Contributions: Healthcare

Lord Bishop of St Albans Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

[The Lord Bishop of St Albans]

Can the noble Baroness help us understand the huge impact this is having on the hospice movement, which is an extraordinary sector? We get an incredible service from it but, ironically, while we are having a national debate on assisted dying—some of us prefer to call it assisted suicide—this will make it even more difficult to provide this much-valued service. Is there not a case to be made for special support for those independent hospices which have to raise massive amounts of money from charitable sources, so that we are not penalising them?

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

Pharmacies: Rural Areas

Lord Bishop of St Albans Excerpts

Tuesday 10th September 2024 Lords Chamber

Asked by

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to ensure that pharmacies are accessible to those living in rural areas.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, pharmacies are key to our plans to make healthcare fit for the future, as we shift healthcare out of hospitals and into the community. We will expand the role of pharmacies, including the introduction of prescribing services. People’s experiences of accessing pharmacies differ across the country; we will look closely at this. There are dispensing doctors in areas where pharmacies are not viable, and online pharmacies delivering medicines free of charge to patients.

[The Lord Bishop of St Albans]

I thank the noble Baroness for her response. However, analysis by the Independent Pharmacies Association has identified a £1.2 billion funding gap in this sector, which is leaving, in particular, pharmacies in rural and deprived areas very vulnerable indeed, at the very point when, as she said, we are looking for them to deliver more services. Given that 90% of their income comes from the NHS contracts and that most are unable to fill the funding gap through a retail outlet, what else can His Majesty’s Government do to ensure that we have adequate coverage in rural areas?

[Baroness Merron (Lab)]

I take on board the point that the right reverend Prelate makes. The analysis to which he refers shines a light on the fact that funding for community pharmacies was either cut or held flat over the last eight years, which amounted to a funding cut in real terms of some 28%. We are seeing the result of that. It is also worth saying that the consultation with Community Pharmacy England on the national funding and contractual framework arrangements for 2024-25 was not concluded by the previous Government, so I can say to your Lordships’ House that we are looking at this as a matter of urgency. We look forward, through my colleague Minister Kinnock, to how community pharmacy can be best set to deliver on the ambitions that I have already outlined.

Immunisation: Children

Lord Bishop of St Albans Excerpts

Wednesday 8th May 2024 Lords Chamber

Asked by

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to address the decline in uptake of childhood immunisations.

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

NHS England’s 2023 vaccination strategy set a range of ambitions, including to improve uptake of children’s vaccines across the board. On mumps, measles and rubella in particular, between January and March the NHS and partners administered around four times as many MMR vaccinations to those aged five to 25 as last year and focused on engaging groups with historically lower vaccination rates. We intend to build on these experiences to further improve uptake.

[The Lord Bishop of St Albans]

I thank the Minister for his reply and pay tribute to the NHS for its sterling work in this area. I have a couple of points. First, I wonder what consideration His Majesty’s Government have given to working with leaders of harder-to-reach groups, some of the smaller groups and some of the faith groups, where messaging can be more powerful when it is done by a local leader. Secondly, there is a worrying increase in the level of whooping cough. Indeed, I believe there has been a childhood death recently. Can the Minister update us on what is being done about this worrying development?

[Lord Markham (Con)]

I thank the right reverend Prelate. First, I completely agree that using faith leaders is often a very good way to reach hard-to-reach communities, particularly as it is often ethnic-minority communities that have lower rates of vaccine uptake. Whooping cough has been a concern; we had about 850 cases in January 2024 compared with about 550 for the whole of 2023. We are deploying a number of strategies that have been proven to work in areas such as MMR: using outreach groups, having leaflets in 15 languages and having recall programmes. In the case of whooping cough, if we can get pregnant mothers vaccinated, that is 97% effective.

National Health Service: Key Targets

Lord Bishop of St Albans Excerpts

Tuesday 16th January 2024 Lords Chamber

Asked by

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have in place to ensure the National Health Service meets its key targets.

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

The NHS has made progress against its targets, especially given the challenges of recovering from Covid-19, the changing demography and winter pressures. The Government recognise that there is still a way to go and are working non-stop to support the NHS to do better. I take this opportunity to thank all NHS staff for their hard work to improve performance this winter.

[The Lord Bishop of St Albans]

My Lords, I would like to join in thanking NHS staff, who are doing a fantastic job. There are some structural problems here. In particular, I am concerned about ambulance response times, which are causing a great deal of concern despite the Government having increased the category 2 call response times from 18 minutes to 30 minutes. Category 2 calls deal with such life-threatening events as strokes and heart attacks, so this is deeply worrying. What are His Majesty’s Government doing to reduce the response time? Will they consider returning to the 18-minute response time for category 2 calls?

[Lord Markham (Con)]

I agree with the basic point, as I am sure all noble Lords will, that ambulances are on the front line and are the most important service in all of this. That is why we have invested in 800 new ambulances, with over £200 million of funding. It is early days, but that is starting to take effect. Regarding the category 2 issue, we have managed to halve the time it takes since last year, but it is still too long and we absolutely need to make more progress in this area.

Mental Health: Children and Young People

Lord Bishop of St Albans Excerpts

Thursday 23rd November 2023 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I too congratulate the noble and learned Baroness, Lady Hale, on her excellent maiden speech, and the noble Earl, Lord Russell, on securing this debate on an area of huge importance for all of us. As has been noted by many noble Lords already, and raised in the Question asked in the House by the noble Lord, Lord Bradley, on Tuesday, the omission of the mental health Bill from the King’s Speech has caused a great deal of worry and concern. It seems that we have time to debate pedicabs but not the urgent need for this review of our mental health provision.

With the number of children and young people being referred to mental health services increasing, alongside increasing waiting times for treatment, it is clear how urgent and pressing the reform of the Mental Health Act is. The Government have said that the Bill would be published when parliamentary time allows. I would argue that this is of the highest priority. Improved mental health in our young people and children—and the rest of the population, more broadly—would not only decrease the huge levels of suffering and anguish but bring immense economic benefits, saving taxpayers’ money and bringing more people into the workforce.

Mental Health Foundation research shows higher levels of unemployment and in-patient stays and a higher likelihood of contact with criminal justice for those with mental health problems. The annual mean cost to the public purse is 16 times greater for those with mental health problems. We on these Benches and Members in the other place can all agree that mental ill health is extremely costly for our nation. At the end of August 2023, 414,550 children and young people were in contact with children and young people’s mental health services and waiting times have increased, as have the number of children referred who do not end up ever receiving treatment. The scale of the problem is not the only concern. The quality of care, and the conditions under which our children and young people are being detained, urgently need to be rethought, according to the recommendations set out in the Health and Social Care Committee’s report, many of which the Government have accepted but which have not yet been implemented.

Given that over 50,000 people were detained under the Mental Health Act last year, there are clear arguments that reforming the Act needs to be a government priority. Concerns that the report raised included inappropriate use of restrictive practices and many children and young people facing long stays in adult wards, or, as we already heard from the noble Lord, Lord Allan, in wards far away from their homes where they are not being visited. I ask the Government to consider how traumatising these conditions must be for children and young people who are already mentally unwell enough to be admitted to a mental health care ward.

The Commons Health and Social Care Committee report comments:

“The use of restraint against children and young people can be humiliating and cause unnecessary distress”.


This is the case for any child or young person, let alone a child who is already extremely distressed and suffering from a mental health condition. I am sure that His Majesty’s Government are aware, having responded to this report, that the use of restrictive practices remains very high in children and young people’s mental health services, with the use of restraint on children and young people being on average five times the level of the adult equivalent. This is deeply worrying.

There are also deep injustices embedded in the implementation of the Mental Health Act, with black people four times more likely to be detained, and, in 2021-22, girls making up 71% of all children detained. We desperately need to address these problems to ensure that our staff and services are educated in trauma-informed practice and to ensure that we are not retraumatising these children and young people during their treatment.

Many of these issues could be addressed, as was recommended, by expanding the legal right to support from an independent mental health advocate to all children and young people. The Government accepted this recommendation in their 2021 mental health White Paper, but even then this was subject to future funding availability. Children’s rights expert, Kamena Dorling, highlights how serious these current conditions are. As it stands, we have mentally unwell children as in-patients who do not have the right to advocacy, and many of whom do not understand their rights and worry that they must do as they are told or they may end up being sectioned. She writes:

“There is a real question about whether we have a section of children who are unlawfully deprived of their liberty”.


This is a very serious and deeply worrying situation, and one that I hope the Minister will reflect on.

Finally, I will stray into a related area which no one has mentioned so far but on which I have been campaigning for a number of years. I want to comment briefly on some of the problems encountered due to the lack of regulation of online gambling and gaming. Some 60,000 to 62,000 young people in this country are classified as having a gambling disorder—according to law they should not even be gambling. If 60,000 to 62,000 young people have been diagnosed with these problems, how many are gambling? Presumably hundreds and hundreds of thousands, which shows the level of the problem that we are facing.

Of the 15 gambling clinics that have now been opened, funded by the NHS, at a time of huge financial constraints, 12 are facing huge waiting lists for people to get specialist treatment—they simply cannot access this treatment. Fortunately, the Government are now moving on the need for better regulation, but this really is needed to protect vulnerable young people. We have evidence that there are aspects of the gambling industry taking advice on how to produce games that are very addictive and encourage people to keep returning to them. If you talk to a family who have a teenager with a gambling addiction, they will tell you it can ruin the whole family. It is so compulsive that children can be stealing and lying to feed this devastating addiction.

I turn briefly to gaming. The WHO has classified gaming disorder as a mental health disorder. In 2019, the National Centre for Gaming Disorders opened a clinic in London, again funded by the very hard-pressed NHS, and 70% of the patients are under 18 years old. Noble Lords will have seen, as I have, a series of stories in the papers about the devastating damage that this is causing in families, where children really cannot tear themselves away from these, in some cases, highly addictive games. We need to support our world-leading, brilliant gaming industry—it brings a lot of pleasure which many people enjoy, so I am told—but there is, nevertheless, a downside, which urgently need regulation. Surely the gambling and gaming industry needs to pay a compulsory levy on the principle that the polluter pays. The industry has brilliantly privatised the profits and nationalised the costs. We as taxpayers are picking up the problem, and although this is a much smaller and niche problem, it is growing and we need to attend to it.

Polling shows that the population now ranks mental health as a more important issue than unemployment, industrial action and Brexit. Those under 40 rank it as more important even than climate change. I believe this shows that the public are telling the Government what their priorities are, and I hope His Majesty’s Government will listen. I look forward to hearing the Minister’s reply on many of these complex but deeply worrying issues.

Stroke Care

Lord Bishop of St Albans Excerpts

Monday 24th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. The NHS delivery plan set out in January 2023 was trying to set out the best practice in this area. It is then the job of the SQuIRe managers to make sure that that is implemented in each area. One example is that they are trialling having videos in ambulances in certain areas so that paramedics can speak to stroke experts. We all know that getting patients to the right place quickly is vital, so I hope that that is another example of best practice that we can roll out.

[The Lord Bishop of St Albans]

My Lords, these guidelines are very encouraging, and all who work on them should be congratulated. As we keep hearing, the essence is speed if we are to treat effectively, yet this is particularly difficult in rural areas, especially remote rural areas. What additional help is being given to integrated care boards’ care systems to ensure that our rural integrated care boards can deliver these guidelines, which are so vital?

[Lord Markham (Con)]

The job of each integrated care board and the regional SQuIRe managers within it is to make sure that they are catering for the needs of their area. Clearly, rural areas present more challenges in terms of speed of access to the relevant stroke services. At the same time, there has been a rollout of the integrated stroke networks that can perform the clot-busting treatments to make sure that we have more of them located in the right places.

Emergency Healthcare (Public Services Committee Report)

Lord Bishop of St Albans Excerpts

Thursday 20th July 2023 Grand Committee

[The Lord Bishop of St Albans]

My Lords, I thank the noble Baroness, Lady Armstrong of Hill Top, not only for chairing this committee and producing an excellent report but on now bringing it to your Lordships’ committee for us to debate. I declare my interest as president of the Rural Coalition and a vice-president of the LGA.

I associate myself with the noble Baroness’s concerns that a subject of such huge importance has so few people speaking on it. I understand the problems, but I encourage His Majesty’s Government, the Whips and so on to look at how we can give such topics the time they deserve.

I have long expressed my concern about healthcare in England, particularly in rural areas, so I read this report with great interest. I have seen the strain on emergency care in my own diocese of St Albans, which covers Hertfordshire and Bedfordshire. In Hertfordshire, category 1 ambulance calls—those reserved for the most life-threatening injuries—were responded to in just under 12 minutes, on average, well above the national average of seven minutes.

Rural areas have always faced unique challenges in providing care and recruiting and retaining healthcare professionals to care for a predominantly older population. Of course, people who live in rural areas accept that geographical factors mean that it will be more difficult. However, a number of issues particularly associated with rurality make the problem more complex, not least connectivity. In many areas where people rely on mobile phones and there is no coverage, delivering emergency healthcare is even more challenging. I hope the Minister appreciates the profound emergency healthcare challenges faced by rural areas such as those in my diocese.

As the report highlights, it is important for us to recognise that pressures on emergency healthcare are both a cause and effect of the strain on health services across the board. They are a cause because we know that the longer people remain on waiting lists, the more likely they are to acquire co-morbidities that compound the original underlying health issue, often making treatment more complex; and they are an effect because patients often access emergency healthcare because they feel they now have no other avenues to treatment. The squeeze on healthcare services across the board, including preventive and community healthcare, manifests itself in the kind of pressures on emergency services outlined so accurately and precisely in this report.

The Government have rightly recognised the severity of the problem in the NHS Long Term Workforce Plan, which refers to the need to increase training and retention of staff rather than relying on international temporary recruitment. Statistics from the British Medical Association show that 40% of junior doctors are actively planning to leave the NHS as soon as they can find another job, and many are planning to work abroad within the next 12 months. We see a similar story for nurses: more than 40,000 left the NHS last year. With an ever-increasing workload and stagnating salaries, there is no doubting the reason why so many professionals are leaving our health service. We hear regular reports that British junior doctors are being offered packages in places such as Australia that pay more than double what they can achieve if they stay in this country.

Given the profoundly challenging circumstances in rural areas—an ageing population and problems such as connectivity for emergency workers—it is essential that the Government’s response helps to tackle them. Will the Minister assure us that the Government’s response will be properly and fully rural-proofed as we look at how we respond to it? The Government need to increase investment in people. The report rightly notes the immense difficulty and stress faced by those in the emergency care profession, compounded by shortages across the entire health service. If we cannot encourage our healthcare professionals to stay, then it seems that, unfortunately, they will vote with their feet, as so many are doing. How do the Government plan to compete with the generous packages being offered from overseas?

Then, there is the question of how we can do more joined-up thinking. I was particularly interested to hear what the noble Baroness, Lady Armstrong, said about seeing through the whole process from start to finish and trying to work out how people move through the system, so that it can be done efficiently and effectively. Allied to that is the question of how the NHS and others are going to work with the third sector, with so many churches, community groups and medical charities being capable of offering non-urgent care support. We need to think about how we can relieve the pressure on emergency care described in the report, in order to ensure that patients get not just focused medical treatment but all the social support, friendship, follow-up and other things that add to the holistic approach to health. What discussions are His Majesty’s Government having with the third sector in this important area?

To conclude, I thank the noble Baroness and all those who worked on this committee and this report for this excellent and timely debate on emergency healthcare.

NHS: Allocation of Financial Resources

Lord Bishop of St Albans Excerpts

Thursday 11th May 2023 Lords Chamber

[Lord Markham (Con)]

We are putting in record investment. Right now, we are spending about 12% of our GDP on health services; a few years ago, the figure was more like 7% or 8%, so there is record investment. I think the whole House would agree that how we use that investment is the most important thing. We have seen that certain hospitals have a 13% lower cost per patient treatment than others because of effective use of technology. That is where I want to see investment take place.

[The Lord Bishop of St Albans]

My Lords, I welcome what His Majesty’s Government are doing to try to get on top of this very difficult problem. Will the Minister give us a little more information, particularly about ambulance services? In Hertfordshire, which is in my diocese, category 2 call-outs, for strokes and hearts attacks, should have an 18-minute response but the response is averaging two hours and six minutes at the moment. There is a great deal of anxiety among ordinary people when these things happen. When do we think that the money going to the ambulance service is going to bring response times down?

[Lord Markham (Con)]

I am pleased to say that the figures announced today show that response times are coming down. For category 1, the most serious, we achieved the 15-minute target for 90% of calls. We are moving in the right direction, albeit there is a lot more that needs to happen in this space. That is what the investment in 800 new ambulances is about, as well as the £200 million of funding. Most importantly, it is about making sure we have the right services in place. Some 50% of ambulance calls do not result in a trip to the hospital. There are fall services, which are often best placed to help, which will pick people up in their home.

NHS: Gambling Treatment Services

Lord Bishop of St Albans Excerpts

Monday 28th March 2022 Lords Chamber

Asked by

[The Lord Bishop of St Albans]

To ask Her Majesty’s Government, further to the announcements that the NHS (1) will no longer accept money from GambleAware, and (2) is establishing two additional NHS gambling clinics to meet demand, what plans they have to agree a long-term independent funding settlement for NHS gambling treatment services.

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

In 2019, the NHS committed to establishing 15 specialist gambling clinics by 2023-24. Five clinics are now operational across England, with a further two to open by May. This rollout carries a budget of £15 million, including £6 million allocated for 2023-24. After this, NHS England will provide recurrent annual funding of £6 million. The Department of Health and Social Care and NHS England and NHS Improvement are currently undertaking a review to ensure there is a coherent pathway of advice and treatment for those experiencing gambling-related harm.

[The Lord Bishop of St Albans]

I thank the Minister for his reply, but it is quite extraordinary that, at a time when the NHS is in such dire straits, with such financial pressures, we are picking up the costs incurred by an industry. This announcement has shown that far more resources are needed to deal with the outcome of problem gambling, and that the current voluntary levy is simply inadequate to provide the level of independent research, education and treatment that we need. Will the Government commit to introducing a compulsory levy of, say, 1% of gross gambling yield on the polluter pays principle, so that taxpayers are not picking up the huge bills being created by this problem that exists right across society?

[Lord Kamall (Con)]

I thank the right reverend Prelate for his follow-up question and for raising the issue in the first place. He is absolutely right that we must think about this across government; DCMS leads the policy, but the Department of Health and Social Care is co-operating with it to look at the health issues. Gambling used to be considered a syndrome, but it is now recognised as an addiction. We are committing resources to it through our long-term plan, and will open 15 NHS specialist gambling clinics by 2023-24, with £15 million of funding over the period.

Integration White Paper

Lord Bishop of St Albans Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her clarification and for notifying me earlier about the issue that she apologised for. One of the issues for us is that we want to make sure that if all the parts of the healthcare and social care systems are talking to each other, and there are accountable people, we hope that people will not fall through the cracks and that there is a multi-agency approach. It will be difficult to be overly prescriptive here, because what would work in one area might not work in another.

The point that the noble Baroness makes about training is critical. In many debates in this House, we have understood that we need to take the social care workforce seriously and give support to unpaid carers of whatever age, whether they are children or family members. Sometimes they are doing it because they do not want their loved ones to go into a home and sometimes they just need a bit of respite. We are looking at a number of issues around carers—first, unpaid carers but, secondly, making sure that being a carer is a rewarding career and is not seen as being at a lower level than, say, a nurse in the health service.

One reason for having a voluntary register, for example, is to understand the landscape and then put in place proper and different educational pathways, and other pathways, into care. Having national qualifications at levels 4, 5 and 6 and so on will show parity of esteem and that this is a worthwhile career. We have the Made with Care campaign to start to encourage more people back. We are looking at a number of different ways to make sure that carers are not just forgotten. If they work in care homes, that is fine, but we want to make sure that there is a real career structure for them, and also that they can move between health and social care, both ways. There may well be nurses or doctors who want to move across. We have to make sure that going from one place to another is not seen as disadvantageous in any way and that the system is truly joined up.

Of course, this is all top level and shows our ambition to integrate. We do not want to be overly prescriptive; decisions have to be made at place level.

[The Lord Bishop of St Albans]

My Lords, I declare my interests as a vice-president of the Local Government Association and president of the Rural Coalition. I want to pick up very briefly on what the noble Baroness, Lady Brinton, said about rural issues. It is disappointing that there are no explicit references to rural health. One of the concerns of the APPG on Rural Health and Social Care parliamentary inquiry was the way in which inappropriate data, metrics and funding formulas can disadvantage rural areas. National programmes are one thing, but when they are delegated to local areas how are we going to ensure that they are properly rural-proofed and will integrate both health and care?

[Lord Kamall (Con)]

It is important to stress once again that the key to this is that we cannot overly prescribe from here in Westminster and Whitehall. We must make sure that at whatever place, whether it is rural or urban, the people and patients who are cared for in the system are being understood. One reason why we want one person to be accountable, whether in urban or rural areas, is the fact that they must take responsibility for ensuring that all these things are joined up—not only health and social care as we understand them but technology, housing and all those other issues. I know that the right reverend Prelate and my noble friend Lady McIntosh have often raised this issue. We think that the proposal is flexible enough, whether in an urban or a rural area, to make sure that one person really understands the local area of integration.