Covid-19 Vaccination: Coronary Disease

Lord Davies of Brixton Excerpts

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

The main thing that the vaccine did was prevent any bad effects if you did get Covid. While it might not have reduced transmission much, its main benefit was that it reduced the effects if you had it, as well as hospitalisations and deaths. Making Covid a less serious disease, basically, enabled us to open up the country and we were one of the first to get going again because we knew that the disease no longer posed the high risk that it did before we had the vaccines.

[Lord Davies of Brixton (Lab)]

My Lords, I have some personal experience here. One week after I had my first course of Covid vaccination, I had an attack of pericarditis and ended up in St Thomas’ Hospital. I am convinced that there is a link, but it is important to look at the longer-term effects—having an attack of Covid causes more heart problems, as well as having a long-term impact on your general health.

[Lord Markham (Con)]

The noble Lord is absolutely correct. The MHRA study on heart inflammation, which he mentioned, said that there is that side-effect for one to two people per 100,000—unfortunately, the noble Lord seems to have been one of them. However, if you get Covid it affects 150 people per 100,000. On balance, if you have not had the vaccination, your risk is 22 per 100,000. The statistics are very clear.

NHS: Long-term Sustainability

Lord Davies of Brixton Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, it is a pleasure and an honour to have been able to listen to this debate. I am happy to come in at this late stage with some additional thoughts. I thank the noble Lord, Lord Patel, for initiating the debate, and all the other speakers. In particular, I congratulate my noble friend Lady Ramsey of Wall Heath.

Putting your name down to speak in this sort of debate means getting a large number of briefing notes. I cannot claim to have read them all. Perhaps the Minister should commit himself to reading all the briefing notes and acknowledge the contribution they have made to our debate. A consolidated version of the notes would be a useful document.

Given the volume of material, there was obviously bound to be much that was missed from our discussions. I will focus my remarks on good mental health. I urge noble Lords to read the briefing notes from both the Royal College of Psychiatrists and the Mental Health Foundation. In the time available, I can touch on only some of the points arising from their submissions, but I think they are important and should be read.

I want to make three points. First, there is a considerable cost of poor mental health. I emphasise that measures are available that can tackle those problems. Providing healthcare is not just about the financial return, but when we can spend relatively limited amounts and get huge benefit, we clearly need to take that into account. Secondly, the focus in this area has to be on prevention. The value of measures aimed at prevention is considerable and will be effective across the whole health service. Thirdly, I mention the importance of undertaking more research in the area of mental health.

I take the opportunity to stress again the importance of getting a mental health Act through the House. Presumably, we will now wait for the next Session. An incoming Labour Government, if we have one, are committed to doing that. The problem is that the problems assessed by Sir Simon Wessely six years ago are still there. The Act is a symbol of the intention to deal with the problems he identified.

What measures could we adopt? What measures do we need to think through? They are all set out in the submissions and there is not enough time to go through them all. Poor mental health among the workforce has been touched on already. According to the research we have been provided with, that is where £1 of expenditure provides £13.62 in improvements. This bears directly on the overall health of our economy. Individual health is very much the health of the economy as a whole. The £118 billion that poor mental health is costing us—that is 5% of GDP—is an obvious and clear target for work across the important area of poor mental health.

National Health Service: 75th Anniversary

Lord Davies of Brixton Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I join other speakers in thanking my noble friend Lord Hunt of Kings Heath for initiating this debate. I am going to focus on the issue of mental health and I declare as an interest my involvement with the Money and Mental Health Policy Institute. My remarks depend a lot on the excellent briefing note produced by the Royal College of Psychiatrists, and there is also the continued information provided by the BMA about the pressures on mental health services in England.

Looking back over the last 75 years, we have seen massive changes in this area. It has improved significantly since the NHS was launched. Treatment options have increased and access to treatment has improved. Most notably, of course, there was the closure of the large institutions—the asylums—and the welcome shift to emphasise treatment in the community. Attitudes have also changed. Social barriers are being broken down, mental health is being talked about more openly and positively than before, and in particular, as has been noted by NICE, young people have a different attitude and will drive the process of achieving progressive change.

Having said that, I endorse the remark made by my noble friend that it is deeply disappointing that we are still waiting for the Mental Health Bill which was first proposed six years ago. Despite all the work that has been done, the issues that prompted the reform process remain unaddressed. Detention rates continue to rise and the detention of black and racialised communities remains hugely disproportionate. I am pleased, therefore, that the Labour Front Bench in the Commons has given a commitment to introduce the Bill in its first King’s Speech, were it to win the next election. I call on the Minister to make a similar commitment. What goes in the manifesto is possibly above his pay grade, but perhaps he can assure us that he will urge it on his colleagues as a priority should we get another term from the Conservatives.

It is worth emphasising that, even without this major legislation, there is much that can still be done to protect people’s dignity, autonomy and human rights when they are subject to the Act. I hope that the Minister will give an assurance that active steps are being taken, failing the Act achieving this objective.

I turn now to where we are and waiting lists, which are highlighted in the Motion. There are a record 1.9 million people currently on waiting lists for NHS mental health services and record numbers of children with a mental illness. One of the main reasons for this is the shortage of staff. We have a workforce plan, but we still lack the ambitious and measurable commitments to expand the mental health workforce, in both hospitals and the community. There are also significant retention challenges affecting the mental health workforce, with professionals reporting high workloads, time pressures and poor work/life balance. Especially, there is the need to address racism and discrimination in the workplace, as well as recruitment.

The problems with staffing result, inevitably, in long waits in A&E, reflecting the difficulties that people have in accessing in-patient provision or community-based crisis alternatives. On top of this, adult acute bed occupancy has not fallen below 95% since May last year. Unfortunately, one of the reasons for this is that more than one in 10 people occupying an adult acute in-patient bed are clinically ready for discharge, but, due to a lack of social care and housing support, they remain in hospital. It also means there is still an unacceptable level of inappropriate out-of-area placements, so perhaps the Minister could say something about that.

There is a special problem with children’s mental health. Over the last few years, we have seen record numbers of children and young people with mental illness. To tackle this problem, it must be recognised that the first five years of life are crucial to a child’s development and to protecting them from future mental health conditions. The Government must invest in early intervention for children and young people—that is widely recognised. The mental health of under-fives should be a priority. The Royal College has identified the need for the urgent introduction of a national network of early support hubs.

Finally, there is the need to address the long-term disinvestment in mental health estates. The mental health sector has some of the oldest buildings across the NHS, with 15% of mental health and learning disability sites built pre-1948—older than the NHS itself—compared to about half of that in the acute sector. Despite this age, and more than 50 bids from mental health trusts for the Government’s “40 new hospitals scheme”, only two were allocated to a mental health trust. Mental health faces the most substantial shortfall in capital investment in cash and percentage terms across all trust types, which is part of a sustained trend in recent years. I hope that the Minister can give us some reassurance in his reply that capital will be put where needed.

Suicide Prevention Strategy

Lord Davies of Brixton Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, on the suicide prevention strategy more generally, does the Minister share my concern at the figures published today by the ONS showing that the suicide rate among offenders in the community is six times that of the general population and the suicide rate among female offenders in the community is 11 times that of the general population? Surely this points to the need for priority action.

[Lord Markham (Con)]

The noble Lord is absolutely correct. The priority groups identified include people in the justice system for exactly that reason; likewise, as I mentioned, middle-aged men, who are three times more likely to commit suicide. There is a strategy behind each priority group—people with poor mental health, people on the autistic spectrum, pregnant women, people who self-harm, children and young people, as well as people in the justice system—in terms of how we help and support them.

Adult Social Care (Adult Social Care Committee Report)

Lord Davies of Brixton Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, it is a pleasure to take part in this debate and I very much appreciate the work of my noble friend Lady Andrews and the committee in producing such an excellent and helpful report.

The big issue, of course, is paying for sufficient care—we have been playing with that issue for 20, 30 or more years—but, short of a grand plan, we can leave that on one side for the purposes of this debate, because, in any event, much can be done. What I would like to stress is the need to take better care of the carers. There is a paid social care service on which there are recommendations that it should be properly funded and properly staffed with appropriate status and skills, but I am very pleased that the emphasis in this debate has been on unpaid carers.

The report sets out excellent proposals and I am sure we have all been sent additional proposals from Carers UK, with an emphasis on issues such as an improved carer’s allowance related directly to the national living wage and—an issue that is extremely important to those concerned directly—some form of carer’s leave.

I want, however, to add an extra point about carers and their pensions. This arises because the unpaid carers are all too often, all too frequently, poor. They are poor because they are unable to work, or have to work limited hours, because of the care they are providing. It affects them directly during the period when they are providing care, but it also lingers on throughout their lives because they have missed opportunities for promotion and career development. The inevitable result is that they end up poor. The problem with their pensions is that, in our current pension system, you get a reasonable pension only if you have had a reasonable income while at work; because of the gap in your employment income, you have a gap in your pension.

There must be some way of improving the pensions provided for carers who have no, or limited, employment income. In one way or another, this will require providing them with credits for additional pension. My favoured approach is that they should get additional national insurance pension on top of their basic pension to make up for the gap arising from their inability to earn while providing care; so, these carers should get some additional credits for their state pension.

This is very much an issue for all carers—male, female, sons, daughters, parents. They are all affected in the same way but, as most care is provided by women, it impacts far more significantly on women. Hence, the main reason for the gender pensions gap, which should get more attention, is that women provide the care. The way to solve that problem is to provide them with some pension entitlements for the period when they were providing that care.

It is not mentioned in the report but I will now be pressing this issue as often as I can. Clearly, it is relevant here: care for carers means providing them with decent pensions.

NHS Procurement: Palantir Contract

Lord Davies of Brixton Excerpts

Thursday 22nd June 2023 Lords Chamber

[Lord Markham (Con)]

Yes. I really appreciate having this opportunity to state categorically that the NHS will remain the data user here. The data controller will remain in place for each individual institution; sometimes it is the GP and sometimes it is the hospital. Fundamentally, everyone’s data will be allowed to be used only by the NHS in these circumstances. There are no circumstances in which Palantir—or any other supplier should it win—will have access to see individuals’ data.

[Lord Davies of Brixton (Lab)]

My Lords, health service data is incredibly valuable. The Minister should, and probably does, understand the sensitivity of Palantir in this context. The Minister said that the quality of the contract was the only criterion. Where does price come into it? How can we build in protections against predatory pricing by the sitting tenants of contracts, who create an effective monopoly?

[Lord Markham (Con)]

I think I said that we wanted the best supplier to win; I will check and correct the record if I mentioned quality only. Quality is very important because the contract has to be good, of course, but the price has to be right as well. There are a number of criteria. Again, we will hold a session so will be able to take noble Lords through the whole process. I am confident that, at the end of that process, people will feel confident that we have reached a decision on the best supplier across all the criteria.

--- Later in debate ---

[Lord Markham (Con)]

Round about autumn time. Currently, we think that the contract will be awarded in September and then finalised. The new database should in place by April. Having this transition arrangement until June gives us a safety net to make sure that everything is in place.

[Lord Davies of Brixton (Lab)]

My Lords, I welcome the opportunity of a meeting to discuss data security. Can the Minister say whether it is anticipated that that security will go beyond what is currently being established in legislation going through Parliament? If it will be stronger, why are the other protections not stronger?

[Lord Markham (Con)]

I am sorry; I am not sure that I completely followed the question. It is fundamental here that everyone’s data is strongly protected in the best possible terms. As I say, we will arrange in the next few weeks a meeting where we can answer all the questions that noble Lords have and have the experts in the room as well.

Hospitals: Maintenance

Lord Davies of Brixton Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, we want to give each trust the freedom to spend where it needs to. Obviously, there are overall Treasury rules but the main thing is the increased allocation we have made available in this space. We have spent £1.4 billion in the past year, which is a 57% increase, recognising that it is a good thing to put preventive maintenance in place to get on top of the backlog.

[Lord Davies of Brixton (Lab)]

My Lords, I may not be doing the Minister much justice but I admire his ability to give straight answers. I also admire his ability to maintain the fiction of 40 new hospitals. Does he accept that the Nuffield Trust puts the number of hospitals that any person in the street would recognise as new at three?

[Lord Markham (Con)]

I know that it is a lot more than that. The number of cohort 1 and cohort 2 hospitals being built at the moment is substantially more. This is a real programme; in fact, I invite all my colleagues here to a parliamentary open day, which I think will happen in the next month or so, when we plan to exhibit exactly what we are doing. We will have virtual reality glasses so that noble Lords can see the hospital of the future. Please come along and see for yourselves how real this programme is.

National Health Service Pension Schemes (Member Contributions etc.) (Amendment) (No. 3) Regulations 2022

Lord Davies of Brixton Excerpts

Wednesday 11th January 2023 Lords Chamber

Moved by

[Lord Davies of Brixton]

That this House regrets that the measures proposed by His Majesty’s Government in the National Health Service Pension Schemes (Member Contributions etc.) (Amendment) (No. 3) Regulations 2022 (SI 2022/ 1028) are insufficient to address fully the problems with staff retention in the NHS arising from the NHS pension arrangements.

Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee

[Lord Davies of Brixton (Lab)]

My Lords, to a certain extent the burden of this Motion is uncontestable; the Government themselves accept that the measures proposed are insufficient because they have put down some further changes that will come before us in due course. I look forward to a further debate. This is an important issue, and I welcome the opportunity for a discussion.

Yesterday, on the winter crisis Statement, the Minister said that

“we should be learning all lessons. I like to think that, three months into my role, I am learning some of those lessons.”—[Official Report, 10/1/23; col. 1316.]

I am pleased to provide the opportunity for the Minister to learn more about the impact that the pension tax rules—the lifetime allowance and the annual allowance—are having on the work that he is undertaking to get our NHS back into shape. I did not seek to intervene yesterday when the Minister made the Statement, as I knew we had today’s debate. Of course, the crisis is not the product of short-term problems but the result of 12 years of political choices—but we are not going to debate that again.

The taxation issues, however, are still highly relevant. It is no good promising extra beds and shorter waiting times if you do not have the staff to provide the care, and there is no doubt that the rules are having an adverse effect on staff retention at senior levels, as well as—possibly even more important—on the morale of the staff whom we depend on. We are all agreed: for example, the last Prime Minister promised to

“stem the exodus of doctors from the NHS”,

and the Prime Minister before that promised to fix the pension tax relief rules. The current Chancellor, albeit before he took up that role, called the situation a national scandal. He also tweeted on 4 August that, among the actions needed to get the NHS back on its feet, the Government should:

“Grant an immediate exemption for doctors to public sector pension rules which are currently forcing them to retire in their fifties in alarming numbers”.


Even the current Health and Social Care Secretary, Steve Barclay MP, has said that the NHS Pension Scheme

“is one of the best in the country, but it’s not working as it should for everyone”,

so I am pleased that the Minister is here and ready to learn lessons. The problem, as he might be the first to acknowledge, is that the real solutions are not in his hands or those of his department. The solutions lie in the hands of the Treasury, which sets the pension tax rules and effectively controls the rules of public service pension schemes. Of course, this is a general problem which I could speak at great length about, but given the crisis we face in the NHS it is right that in this debate we should focus on what can be done in this area for the NHS.

As I have said, my Motion is indisputable. These provisions were inadequate and we have further changes, which are currently the subject of discussion. The Secretary of State has said:

“We need a system where our most experienced clinicians don’t feel they have to reduce their workload or take early retirement because of financial worries”.


This suggests that he understands the problem but, unfortunately, the further proposals currently out for consultation tell us that he does not, and that what has been proposed so far is insufficient. This is where it starts to get technical and the current forum, where slides and spreadsheet presentations are out of order, is not really conducive to a full explanation. Possibly it might be useful to have a meeting, but let us have a go at outlining the issues.

There are a number of problems, not least the lifetime allowance, but I want to focus in this debate on two issues that arise from the annual allowance: the limit on how much extra pension National Health Service employees can accrue each year, tax free. If you exceed the limit, there is a penal tax rate involved on the portion of growth of a member’s pension rights in excess of a defined amount, currently £40,000. It is a penal rate because tax is levied on the money as it goes into the scheme and then again when it is paid out as benefits. Effectively, that is a tax rate on pensions savings of up to 70%. While I am not against high earners paying more in income tax, it still needs to be applied equitably and fairly, and certainly not when people are doing the right thing by providing themselves with an adequate pension.

The growth in pension savings during a tax year, which is limited by the annual allowance, is referred to as the pension input amount. This is the increase in the value of the individual’s pension rights, starting from an opening value immediately before the beginning of the tax year and going to the closing value at its end. It consists of two parts: the increase in the pension that they had previously accrued and the additional pension that they earned during the current year. If, after allowing for inflation, an individual’s pension input amount is more than the annual allowance of £40,000, the individual is liable to pay tax on the excess, so the clear intention is that the pension input amount should consider only growth in pension savings above inflation. There are two major problems with how this works in practice. First, there is an index mismatch; secondly, there is the problem of negative pensions growth.

--- Later in debate ---

[Lord Davies of Brixton (Lab)]

My Lords, I thank the Minister for his response. I am sure everyone will be relieved that I am not going to push the Motion to a vote and say that my main intention this evening was to ensure that we took this opportunity for the relevant department and the Minister to understand the issues involved. The solution has to be one which is acceptable to the doctors. It goes without saying, really, that we can discuss this as much as we like, but it is the doctors who have to say, ultimately, “Yes, this solves the problem; we are not being forced to retire.” In that light, I beg leave to withdraw.

Motion withdrawn.

Excess Deaths in Private Homes

Lord Davies of Brixton Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

This whole area is all about the number of beds and the occupancy. This analysis was done around the October plan for patients, where we said that we were going to put in 7,000 beds and a £500 million discharge fund. What was clear, as per the announcement yesterday, was that the high level of Covid beds—9,500—and the over 5,000 flu beds were far more than any of us estimated. That increased bed occupancy means that we have had to look to increase supply again and at the number of discharges to social care. That is the root cause of the problem. That is why we acted again yesterday to provide even more care in those places.

[Lord Davies of Brixton (Lab)]

My Lords, although my noble friend quite rightly emphasised the particularly concerning figures in a particular week, this is a reflection of a longer-term trend that has taken place. Does he accept that a particular concern is the high number of non-Covid-related deaths during the last summer? Normally, you expect to see a dip during the summer, and it simply did not take place this time. Is he seized with the urgency of dealing with this issue?

[Lord Markham (Con)]

I am definitely seized with the urgency. I was able to speak to Sir Chris Whitty about a number of those, including last summer. The heatwave was a factor then: we had over 2,500 excess deaths caused by the heatwave over those couple of weeks. There were multiple factors. You have heard me say, again from Sir Chris Whitty, that cardiovascular disease is a real concern: for those three years that people missed going to their primary care appointments, they did not get their blood pressure checked in the same way, and we did not get the early warning indicators. That is another thing that you will hear me talk further about, so that we can get ahead of the curve, because those are the areas of excess death that we risk in future.

NHS and Social Care Workers

Lord Davies of Brixton Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I thank the noble Lord, Lord Allan of Hallam, for raising this issue today. As he says, this debate is extremely timely. I have to say that I am a bit surprised and disappointed that so few speakers have signed up for this debate. It is obviously for noble Lords to make their own decisions about which issues they wish to raise, but this one is crucial. You only have to look at the front pages of today’s newspapers to realise how important this is.

There is a whole range of issues that could be raised in discussing these issues; I will focus on just two. That is in no way intended to diminish the importance of other issues. As a veteran of the long-lost and unlamented healthcare Bill, I am glad mention was made of the workforce plan. There was a whole debate then in which the Government were resistant to introducing a workforce plan, but it has suddenly become a priority for them. Maybe there is a case there that they need to listen.

The first of the two issues I will focus on is pay in general, and because today is today, I will talk about nurses’ pay. Secondly, I am going to take this opportunity to talk about pensions in the National Health Service and, in particular, the impact of taxation rules, particularly the annual allowance and the lifetime allowance, on employment in the NHS. When I first thought of contributing to this debate, I thought I would have less time and would focus on just that issue. However, now I have the luxury of 10 minutes, I have expanded my remarks.

First, pay is an issue across the whole service. All workers within the National Health Service have seen problems with their pay and the need for action to be taken to overcome the clear requirement to sort out the problems that we face. I do not think there is any question that there are big problems and that sorting out pay is a crucial element in resolving them. It is not the only answer, but it is the one I am focusing on today.

In particular, I am focusing on nursing, where we have compelling figures: there are 47,496 nursing vacancies. No doubt the Government will tell us that they have increased the number of nurses, but there is still a horrendous level of nursing vacancies. Over 7 million people are waiting for treatment in the National Health Service, and there are 363,000 people who are out of work because of long-term illness. So, pay is one of the direct measures to address those issues. I hope the Minister will say that he recognises that, even though the Government believe that they are under various constraints. The issue, therefore, is not about whether we can afford to meet the demands that have been made for improved pay; the issue is, with the problems faced by the health service, can we afford not to sort out pay?

To be clear, I support the nurses’ demand for a significant pay rise, achieved through collective bargaining. The Government cannot hide behind the independent pay review process because it is clearly broken. I will not undertake a full analysis of the pay review process today, but sticking the word “independent” into a phrase does not make it independent. The Government appoint the members of the pay review body and issue a remit letter that sets out what they can do. It is no criticism of the members of the pay review body to say that this is not a truly independent process: they have to play the cards that they are dealt.

The nurses’ action today—the fact that they are on strike—is a clear indication of the gravity of the problem. CPIH, the agreed appropriate prices index, has increased by about 33% since 2010. Private sector earnings have gone up faster than that, by something like 40%, providing a real-terms increase. Public sector pay in general has gone up by a lesser amount: it has gone up by only 28%, which is a 5% real reduction. Within that, the nurses have done particularly badly, with an increase of under 20%. So there has been a real-terms reduction of over 10% over the last 12 years. One can only admire their moderation in seeking to recover only half of that fall in real terms. A similar case can be made for other groups of employees within the health service, but the Government have to recognise that the way to see this issue resolved is to accept the RCN’s request for direct negotiations. The so-called independent pay review process is just not working any more.

On pensions, a consultation is of course currently under way, and the Government say that this will

“retain more experienced NHS clinicians and remove barriers to staff returning from retirement.”

This is actually the Government’s second go at this issue: some regulations have already gone through, but we will have a debate, which I am looking forward to, with the Minister early in the new year on the previous set of regulation changes—and now we are going to get a different set, following a period of consultation. Unfortunately, my regret Motion on the first set still stands. They will be insufficient to address fully the problems with staff retention in the NHS arising from the NHS pension arrangements that the House of Commons Health and Social Care Committee described in its report last autumn as a “national scandal”. The committee was of course chaired by the current Chancellor of the Exchequer.

Given that we will have another debate, and probably further debates on further regulations, I will spare the House a full discussion of this issue—I do not have enough time for that in any event. The issues are complicated, but they are explained on the BMA website, and I invite noble Lords and noble Baronesses to see what the issues are. I admit that, in the regulations currently under consultation, the Government do address one particular issue about the mismatch of the CPI on various indices—but that was not the only problem, and they do not propose to address one of the worst problems. So I am using this opportunity to focus the Minister’s mind on this issue, which we will return to. I hope that he will perhaps give us a commitment today that he will take the issue seriously and take part in further discussions.