NHS: Dentistry Provision
Lord Fowler Excerpts(1 month ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
My Lords, the Government are investing around £3 billion in dentistry each year. As the noble Lord will be aware, I cannot yet confirm 2025-26 dentistry budgets, but they will be confirmed in planning guidance published by NHS England in due course. I know that the noble Lord will be aware that, despite the tough fiscal circumstances the Government have inherited, the Budget set out a big increase in day-to-day spending for health and social care. Regarding the process, and our planning, it is entirely normal that we set out matters in planning guidance. We are, of course, keen to reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. That work is immediately under way.
Lord Fowler (CB)
My Lords, no one fought harder for the elimination of dental deserts than Lord Colwyn, who died recently and whom most of us in this House remember. Would not the best memorial to Lord Colwyn be to place a new priority on dental services particularly for children? As well as making that a priority, and to show that it is, should we not allocate it a budget?
Baroness Merron (Lab)
I would like to associate these Benches with the comments made by the noble Lord about the late Lord Colwyn, whose contribution was indeed considerable. I agree that that would be a very appropriate legacy to his memory. The fact is that we are in the position that the previous Government’s dentistry recovery plan did not go far enough and, as we all know, there are too many people struggling to find an NHS appointment. As part of our 10-year plan we are working to assess the need for more dental trainees in areas including the east of England, which the previous noble Lord referred to, because many people continue to struggle. This cannot go on, not least because prevention is absolutely crucial as we move towards making an NHS fit for the future.
NHS: Independent Investigation
Lord Fowler Excerpts(2 months, 3 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
I do not recognise the description of taking autonomy away; I appreciate that that is the noble Lord’s opinion. The National Health Service is so key to not just our health and well-being but the economic health of this country. In my opinion, it is something of a backbone of the country. It is right that the Government have made this an absolute priority and have commissioned a very honest report—I hear his criticisms of the report; they are not ones that I share—and that the Government are held accountable. That does not mean taking away autonomy from the NHS. I accept the noble Lord’s point that it is outcomes that matter, and perhaps I should have put that better because by output I mean things not just being done but actually being effective. I thank him for that point.
On frameworks and meeting obligations, one of the points made not just in the Darzi report but elsewhere is on how many of the standards are not being met. We will return to a number of the standards to ensure that people can feel that they know what they are going to get and within what timeframe, and that that will be absolutely possible. We are interested only in what works. We are not interested in scoring points; we are interested in improving the health and well-being of the nation, and I hope noble Lords will want to join with that.
Lord Fowler (CB)
My Lords, I say straightaway that I entirely support the concept of an independent inquiry into the National Health Service. Indeed, it was something I advocated to the previous Government —not with notable success. I also pay tribute to the excellent National Health Service treatment and care I received when recovering from a recent heart attack. It was excellent in every way, from the ambulance service right through to the hospital treatment itself. In that context, does the Minister agree that the Government’s description of the National Health Service as “broken” is both unjust to the staff and an altogether false generalisation? It takes the language of the recent election into healthcare, and I would have thought that was one of the things we needed to avoid now.
Baroness Merron (Lab)
I am very pleased to see the noble Lord in the rudest of health and to hear of his positive experience. Of course, there are many positive experiences every single day, and the noble Lord is quite right to remind us of that and of the need to thank the whole NHS staff team who make that happen.
On the point about the NHS being broken, I understand the noble Lord’s view. However, I think it is important that we lay it bare and say what we have found. Having read the report by the noble Lord, Lord Darzi, I find it hard not to conclude that there are fundamental points within the National Health Service that are just not working. Of course there is good practice and there are brilliant outcomes in some areas, but it is not universal and that is what drives us to make that point. I hear what the noble Lord says. However, it is important to be honest, and that is what we have said we will be, uncomfortable though it might be at times.
HIV Care: Access
Lord Fowler Excerpts(3 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
My Lords, Ministers have already commissioned officials for advice on how to progress the development of a new HIV action plan. On the very tragic case that the noble Lord refers to, he will be aware that since April 2022, NHS England has funded emergency departments in London, and in areas of very high diagnosed HIV prevalence, to provide routine blood-borne virus testing for HIV as well as for hepatitis B and hepatitis C in everyone aged over 16. That attention at the point of contact is crucial in this area.
Lord Fowler (CB)
My Lords, I declare an interest as an ambassador for UNAIDS. Is it not a fact that we have been extremely successful in developing the means to combat HIV and AIDS, but we still face the obstacle of stigma around the whole subject, which is a serious deterrent for treatment and continuing treatment, as the noble Lord, Lord Black, suggested? Will the Government make the fighting of stigma around HIV a priority, so that we can become one of the first countries to be absolutely AIDS free?
Baroness Merron (Lab)
The noble Lord’s campaign in this area is very well regarded, and for good reason; I certainly agree with him. The fact is that engagement in care is strongly affected by a number of factors, including a person’s well-being and quality of life, discrimination and, as the noble Lord says, stigma. That, alongside accessibility of service, will define how successful we are. I am keen that our new plan will absolutely take account of stigma.
Sexually Transmitted Infections
Lord Fowler Excerpts(1 year ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Fowler (CB)
Does the Minister remember reports on the AIDS campaign in the 1980s, which showed not just a reduction in AIDS but a fall in all other sexually transmitted diseases generally? How much is now being spent on such public education campaigns in this area? Is this spending increasing or decreasing?
Lord Markham (Con)
Overall, we spend £3.5 billion on public health. I do not have the breakdown of the advertising within that, but I will happily follow up with that. That is a small increase over the last year. Education is key to all this. Part of the reason for the increase in sexually transmitted diseases is that people used to use condoms because they were scared about two things: pregnancy and HIV infection. As both those risks have gone down, so has the use of condoms, which has resulted in the higher level of sexually transmitted diseases—so education is key.
Times Health Commission
Lord Fowler Excerpts(1 year, 11 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Markham (Con)
I thank the noble Lord and firmly agree that we should look to implement anything that is a good idea. I know that there are many things we can learn and that I am still to set up the meeting I talked to him about. I apologise that it has taken a while but we have had a few things on. In a word, yes, I will always look to work on a cross-party basis. One thing that I want to bring to Parliament soon is the new hospital programme I am working on, which I believe needs to go on for ever in terms of the way we are going to build new hospitals. It is something I would like to take forward as a cross-party action. Most of the things in this space are not political; they are all about getting good and effective treatment to our population, so I am very happy to work in a collaborative fashion.
Lord Fowler (CB)
Should not the Minister go a little further than what he has said? Should not the Government follow the example of the Times and set up a full-scale royal commission, with adequate financial support and powers of investigation, so that it can take through an independent look at the state of the health service today? Surely the Minister will agree that no one can be happy with where we are at the moment.
Lord Markham (Con)
No, we are working very intensively. We have some very good minds involved in this. I know from my work with my colleagues that we work hard on developing our own plans, some of which were announced just last week. We are facing a challenge, as we all know, from the setbacks around Covid but we are tackling it. What I am saying is that there is an absolute openness to new ideas, which is why I welcome any ideas that come to the table—but, believe me, we are working on a lot of our own ideas.
Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021
Lord Fowler Excerpts(3 years ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Fowler (CB)
My Lords, perhaps I may intervene briefly as the last Secretary of State who had responsibility for a major epidemic, that of AIDS.
It is in no way exceptional that there should be profound differences in view among politicians and others of the way in which an epidemic or pandemic should be handled. In my day, we had chief constables openly attacking the patients and the Government. We had religious leaders, I regret to say, arguing that it was not a public health issue at all, but one of morality. We had Ministers, particularly Scottish Ministers, arguing that giving free needles to drug addicts was condoning crime, although there was absolutely no evidence that crime increased, and the example of our Government was followed worldwide. We had a Treasury which refused to provide extra resources for the pandemic.
Debate, controversy and difficulties on the way forward are absolutely nothing new in debates of this kind. The crucial question is: what advice do we follow? My view now, as then, is that we should follow the advice of the public health experts inside the Department of Health who work on these issues year after year, in particular the Chief Medical Officer. I pay particular tribute to my old CMO, Donald Acheson, and the new CMO, Chris Whitty. Chris Whitty and the Chief Scientific Adviser have done a remarkable job for this country over the last months and deserve full credit for that.
It is said that this is a question of freedom; obviously, I do not discount that argument, but surely the exercise of that freedom should not put others at risk. That seems to be a matter of common sense. It should not lead to infection being spread or hospitals having to prioritise which patients they treat because some have decided to remain unvaccinated and then become dangerously ill.
As is evident, after my spell on the Woolsack, I am now a Cross-Bencher, so I am not an automatic or whipped supporter of the Government—I am not whipped at all. My days as Conservative Party chairman are behind me—noble Lords might be very grateful for that—and no more than noble Lords in the Labour Party do I automatically follow the lead of the Government Front Bench. However, I must say that I think their case is totally overwhelming. The success of the national vaccination programme has moved us ahead in the race to get people vaccinated in this country and worldwide but, with the new omicron variant, we have to work even harder to stay ahead. That is the lesson of the whole thing.
Last week, we learned two things about this variant. The first is that no variant of Covid-19 has spread this fast—if you want a definition of an emergency or a need for action, surely that is not a bad one. We expect the numbers to increase dramatically in the days and weeks ahead. I do not think that is seriously disputed by anybody so, again, this is an argument for action. As the Prime Minister said—for once, his language is not over the top—
“there is a tidal wave of omicron coming”.
That seems to be the view of the public health experts as well. We know that a third or booster dose provides strong protection, with analysis from the UK Health Security Agency showing that a third dose is 70% effective at preventing symptomatic infection. We expect the booster to take effect more quickly than the second dose. Again, I would have thought that this should provide an incentive to us to do what is not just the best thing in terms of public health but the right thing, as I would term it—and action is the right thing.
What I really wished to say to this House in the few minutes that I have spoken is that we should do our utmost as a House and a Parliament to appear united. It seems it is not the best day to make that case or plea, after the rather dismal vote in the House of Commons yesterday, but I hope that the House of Lords will give support to this struggle. Parliament consists of two Houses—a fact that seems to be conveniently forgotten by much of the media and the press—and this House can give a real lead as far as the handling of this pandemic is concerned.
Like the noble Lord, Lord Cormack, whose speech I enjoyed, I hope that the noble Lord who has proposed a series of amendments will not persist with them. The Government have far more support than I think they realise. Far more people outside this confined area of Parliament are signing up to the case that they are putting. Ministers should persist in their case and fight for it as strongly as they can.
Lord Rooker (Lab)
My Lords, I make two preliminary points before my main point. First, it would be quite contrary to the way in which this House works and to the conventions under which we operate to throw out secondary legislation. This is just not on. We do not do it, and it would be quite wrong to attempt to do so. Secondly, I follow up on what the noble Baroness, Lady Walmsley, who spoke for the Liberal Democrats said. As many other people have done, I tried to order lateral flow tests this morning. They are not available; you cannot order them. Every week for the past two months, I have succeeded in ordering them and the pack has arrived within a couple of days. The Minister must have an answer to this fundamental issue. Now, you cannot just walk into the chemist and collect them, or order them via a QR code, as you could do months ago—at 8.30 am today, it was not possible.
The Minister said that we are doing all this to protect people—which is true—and also to protect the NHS. I make no apology for asking why is it that we need to protect the NHS? It seems self-evident: we need to protect the NHS because it is incredibly vulnerable compared with how it was. In recent years, we have lost 17,000 beds, systematically and deliberately. Why?
I cite two or three examples from the recent NAO report on NHS backlogs pre pandemic. The OECD is the rich countries—or rather, the richer countries— of the world. In the context of the health systems within the OECD, the UK has fewer resources than many of the other rich countries. The UK has 2.4 hospital beds per 1,000 of the population. France has 5.8 and Belgium 5.5—and they are not the highest. Sweden has 2.1, which is less than the UK but, at 2.4, we are way down the list. With 8.5 nurses per 1,000 of the population, the UK is 11th on that list, whichever way you look at it. Ireland has 12.9; Germany 14; and France 11.1. This is all before the pandemic. The UK has three doctors per 1,000 of the population. Sweden has 4.3 and Spain has 4.4. They are not the highest; the highest is much greater. Finally, in 2019, we did 175 CT, MRI and PET examinations per 1,000 of the population. France did 332; Austria 349, and Belgium 313. In other words, the NHS has been deliberately run down since 2010. The other thing that has happened since 2010 is that life expectancy has stalled—read the Marmot reports. Why has life expectancy stalled since 2010? More people are dying earlier as a result of life expectancy stalling. There is something systematically wrong.
Of course, we need to carry these orders for public health reasons. I have no problem with that. I am 100% with the noble Lord, Lord Fowler. When it comes to protecting the NHS, we have to ask ourselves why it is so vulnerable. It is because we have lost out on doctors and nurses and because of the other issues that I have raised. It has been done systematically. I do not know why—a national policy has never been announced on that. We always talk about protecting the NHS. We need to ask why.
I hope that the noble Lord will not push this to a vote. He would be breaching the conventions of the way in which this House is run. I presume he is only pushing for a vote because he wants to win—you do not push for a vote if you do not want to win. Throwing out the regulations would breach the conventions and the elected House would be after us pretty damn quick—and rightly so.
HIV and AIDS
Lord Fowler Excerpts(3 years ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Fowler
To ask Her Majesty’s Government what assessment they have made of the progress that has been made in the UK and globally in reducing HIV and AIDS, since World AIDS Day in 2020.
Lord Fowler (CB)
My Lords, I beg leave to ask a Question of which I have given private notice. I declare my interest as an ambassador for UNAIDS.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Perhaps I may start by paying tribute to the noble Lord, Lord Fowler, for his work as the ambassador for UNAIDS and for following this issue ever since the 1980s, when he was Secretary of State. We should recognise his commitment to this issue.
We believe that the UK can be proud of its efforts. Since last World AIDS Day, the UK signed up to the progressive and ambitious political declaration at the UN high-level meeting in June and declared our commitment to delivering a new global AIDS strategy so that the world has the best chance of meeting the 2030 goal of ending AIDS altogether. Noble Lords will be aware that, domestically, we have published a new HIV action plan.
Lord Fowler (CB)
My Lords, this is World AIDS Day and the international position is anything but encouraging. Has the Minister seen the reports of the serious setbacks in the fight against AIDS over the past year, with testing figures down by 40% and an annual death toll of over 660,000? Will he join me in paying tribute to the many non-governmental organisations and volunteers around the world whose efforts have prevented the toll from AIDS becoming even more catastrophic?
Lord Kamall (Con)
I am sure that all noble Lords would like to join the noble Lord, Lord Fowler, in celebrating the work of the NGOs. A lot of aid is government to government, which can sometimes be a barrier in reaching those it needs to help, especially in countries where the people who are suffering from HIV are discriminated against or stigmatised. Often, the best way to reach them is not via government but via those NGOs, so of course, I pay tribute to them, as I am sure all noble Lords do.
HIV Action Plan
Lord Fowler Excerpts(3 years, 2 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
I start by paying tribute to the noble Lord, Lord Cashman. We served in the European Parliament together for many years, where he was always a champion of LGBTQ+ issues and made sure that people were aware of the issue of tackling HIV. Funding for HIV treatment and care services is provided by NHS England and NHS Improvement through specialised commissioning. HIV testing and prevention is funded by local government through the ring-fenced public health grant. In March 2020, the Government announced that the HIV prevention drug PrEP would be routinely available across England. The public health grant in 2021-22 includes £23 million to cover local authority costs of routine commissioning, in addition to the £11 million made available in 2021. I give the noble Lord that statement.
Lord Fowler (CB)
Is not one of the chief challenges for the Government to combat the stigma and prejudice that still surround HIV and AIDS? Is it not therefore important that there should be a strong public education campaign, run by the Government, to improve public understanding and dispel the myths? Surely, countering stigma must be a key to ending the HIV epidemic.
Lord Kamall (Con)
As noble Lords will have seen, there is agreement with the noble Lord’s point. As part of the Government’s commitment to reaching zero new HIV transmissions in England by 2030, the department is currently developing a new sexual and reproductive health strategy and an HIV action plan. Officials will continue to engage in discussions with the Department for Education during the development of these publications to relate them to how HIV is covered in the statutory curriculum in schools and as part of the intimate and sexual relationships lessons under personal health and social education.
Office for Health Promotion
Lord Fowler Excerpts(3 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Bethell (Con)
I completely take the point of the noble Baroness. We are extremely conscious of the challenge presented by social media in particular to identity and sense of body image. I know that there is much liaison between Public Health England and obesity and anorexia charities about its marketing to ensure that it hits the right note. We are investing in digital technology to try to get people moving and change their lifestyles; I pay tribute to the team behind Couch to 5K, who have used apps and digital engagement to encourage millions of people to take important steps towards a more active lifestyle.
The Lord Speaker (Lord Fowler)
My Lords, the time allowed for this Question has elapsed. We now come to the fourth Oral Question.
Folic Acid
Lord Fowler Excerpts(3 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Bethell (Con)
My Lords, I take on board the point that it is time to act. That is why we are working hard on the matter. As I said, I hope to return to the House on this soon.
The Lord Speaker (Lord Fowler)
My Lords, all supplementary questions have been asked; congratulations to the Minister. We now move to the third Oral Question.