Health: Pancreatic Cancer

Lord Kakkar Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree that screening programmes are, without doubt, the way forward. I mentioned earlier the 73 different pancreatic cancer research studies, of which screening is a very important element, so I totally agree that that should be our top priority.

[Lord Kakkar (CB)]

My Lords, I declare my interests in the register. Clinical research is fundamental to ensuring the evaluation and rapid adoption of new therapeutic interventions that could improve survival rates in diseases such as pancreatic cancer, but operational pressures in the NHS are having an impact on the ability to conduct that clinical research. Is the Minister content that there is sufficient emphasis and support to maintain the infrastructure for clinical research and the capacity to deliver translational, early-stage and later-stage trials in pancreatic cancer?

Long Covid

Lord Kakkar Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking the noble Baroness, Lady Thornton, for having secured this important debate and for the very thoughtful way in which she introduced it. I declare my own interests as chair of King’s Health Partners, chairman of UK Biobank and an active researcher in the field of thrombosis, a particular pathophysiology that has both impacted acutely on Covid and may have some role in long Covid symptoms.

We have heard that some 2.1 million people—some 3.3% of our population—have self-reported, as part of the ONS data collection programme, symptoms attributable to long Covid. It is striking that some 500,000 of those individuals reported having had Covid some two years previously. This represents a substantial, ongoing, chronic burden of disease. We should all be conscious of its potential impact on the way in which we are able to deliver healthcare through the National Health Service.

As we have heard, little is known about the etiology of long Covid. There is a suggestion that part of it may be attributable in some individuals to a failure to properly clear the virus from their bodies. It is also possible that there are genetic determinants that drive individual immune response and that this dysfunction is part of the explanation for long Covid symptoms. There is a now well-established phenomenon of dysfunction in the microvascular and endothelial cells that line blood vessels, which may be responsible for some of the long Covid symptoms. Indeed, a profound hypercoagulable state—a tendency to a risk of thrombosis and blood clots—manifests itself in an important number of long Covid patients.

We have heard of the importance of research in trying to understand more about the etiology of long Covid and to better understand its history. This is critically important if we are to be able not only to research and develop new therapies but to address the question of long Covid through the mechanisms underlying its development and sustained impact. This research is also critically important in understanding how we should properly develop services to manage patients. At the moment, His Majesty’s Government have committed some £194 million to the provision of clinics and services to manage Covid patients—some £90 million of which is to be spent in the financial year 2022-23. However, when one looks at the burden, this resource is only able to provide services for some 5,000 patients a month. The substantial demographic of long Covid is running into many hundreds of thousands, if not millions, of people. We clearly need to understand from prospective research not only what volume of services is needed but how those services should be constructed, based on our knowledge of the natural history of the disease, in order to adequately and properly manage the requirements of those patients beyond symptom control.

Is the Minister content that the approach to research is sufficient? As we have heard, some £50 million has been committed by the Chief Medical Officer to a variety of research programmes. Is he able to address the question, raised by the noble Baroness, Lady Thornton, of why a national cohort has not been established to allow us to marshal the current clinical burden of long Covid in our country and then to apply an appropriate methodology and protocols to the evaluation of these individuals? Research undertaken in this systematic fashion is not only highly efficient but provides the best opportunity for us rapidly to understand and start addressing the questions that need to be addressed if we are to be able to develop these new therapies and organise and deliver services in the most appropriate way for these patients.

Beyond the financial commitment to the development of a long Covid research cohort, there is also the need to ensure that the data collected through routine exposure of these patients to NHS services can be marshalled to inform the research effort. Those data should be able to link with other datasets whose huge value in addressing acute Covid and in the post-infection period has been established. I reiterate my interest as chairman of UK Biobank, which has been used in this regard. It is a unique resource, available to the country, where half a million of our fellow citizens have provided their biological material. The genome in those individuals has now been mapped and the opportunity exists to interrogate the dataset, using that biological material, to assess novel biomarkers and the prevalence of disease. The deep phenotyping and repeat imaging give the capacity to understand structural end organ dysfunction in Covid. All this requires an approach from His Majesty’s Government with regard to data sharing, within and across datasets, between researchers in different institutions and, as we have heard, with those outside the public sector wishing to support this research. Is the Minister able to provide some reassurance on this?

Menopause

Lord Kakkar Excerpts

Tuesday 18th October 2022 Lords Chamber

[Lord Markham (Con)]

With constraints on the public purse, I like many others believe that targeted support is probably the best form of support, and 60% of women receive it free. At the same time, as I am sure the noble Baroness is aware, to prevent it being a barrier to the others, next year we are introducing a fixed cap so that the costs should be a maximum of only £19 per year, which I believe will not act as a disincentive to the 40% who can afford to pay.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The menopause is associated with an increased risk of heart attacks and strokes as a result of falling oestrogen levels. Despite this, women are consistently less well represented in cardiovascular clinical research than men. Is the Minister content that the ongoing publicly funded research effort in cardiovascular disease will be able adequately to address the challenge of postmenopausal heart disease?

[Lord Markham (Con)]

I will not pretend to be able to give a detailed answer at this point. I am aware that part of the funding through the health and wellbeing fund is to make sure that women’s reproductive health is included in some of those research programmes, but I will look specifically at the cardiovascular point and respond in writing.

Pharmaceutical Research and Development Spending

Lord Kakkar Excerpts

Thursday 13th October 2022 Grand Committee

[Lord Kakkar (CB)]

My Lords, I apologise for not having added my name to the list. I was responsible for chairing a meeting elsewhere and did not anticipate finishing on time. I am grateful for the indulgence of noble Lords in permitting me to intervene in the gap. In so doing, I declare my interests as chairman of King’s Health Partners and of the Office for Strategic Coordination of Health Research and as an active researcher with studies in the national research portfolio.

I, too, thank the noble Baroness, Lady Wheeler, for introducing this debate so thoughtfully, building, of course, on the immense contributions the noble Lord, Lord Hunt, has made over many years in debates on this question.

I shall confine my comments to the increasing problem that the deteriorating performance in clinical research in our country is having on the capacity to invite inward investment in research and development, as we have heard in this debate.

The National Institute for Health and Care Research is responsible for the application of public funds to ensure that there is infrastructure and capacity available within the clinical research network to deliver our national research portfolio. Is the Minister content that the public funding made available to NIHR to establish that infrastructure and create that capacity in the CRN is appropriately applied? Of course, the NIHR has recognised that there are currently important problems in the delivery of clinical research and is trying to take steps to ensure that the rather bloated national portfolio of approved studies is reduced in some way by the removal of studies that are identified to be underperforming or poorly performing. But this action itself has a profound impact on the perception of the standing of our country as a suitable location for inward investment of research funding to undertake clinical trials. Are His Majesty’s Government content that the approach being taken with regard to management of the portfolio and the problems associated with the size of the portfolio that predate Covid are the appropriate steps? Are appropriate measures being taken to ensure that there is no perceptional impact in terms of reducing the attractiveness of the United Kingdom for overseas funding for clinical research in such a way that it undermines the overall life sciences vision and strategy?

It is important to try to understand where the application of funding to drive the clinical research effort nationally is being directed. Again, can the Minister confirm that there is an appropriate mapping of the populations where the research effort and opportunity might be achieved against where the infrastructure funding to deliver that research is being applied, so that there is a targeted approach that ensures that maximum capacity is delivered, particularly in the medium term, to overcome these particular clinical research problems?

Primary and Community Care: Improving Patient Outcomes

Lord Kakkar Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking my noble friend Lord Patel for the very thoughtful way in which he introduced this important debate. In so doing, I remind noble Lords of my own interests. In particular, I am chairman of the King’s Fund and King’s Health Partners.

In opening this debate, my noble friend described—and many other noble Lords added to his description—the substantial challenges that the NHS faces in general and in particular in primary and community care. So far in the debate, there has been a consensus and recognition that failure to address those challenges will ultimately lead to the NHS, in general, becoming totally unsustainable. We see the manifestations of this every day in the crisis to ensure that patients in an acute situation can be delivered to hospital through the ambulance service; in the substantial waits and, quite frankly, clinically unsafe environment that now represents many accident and emergency departments; in the tremendous pressures demonstrated in the acute management of patients in medical, surgical and other disciplines in our hospitals; and, most importantly, in the failure to discharge patients from hospital back into the community. The result of all that is an NHS that is considered, regrettably, now to be failing in many aspects. That failure is attended by an increasing loss of confidence among our fellow citizens.

I strongly support my noble friend Lord Patel’s proposal to establish an ad hoc Select Committee of your Lordships’ House to examine in more detail the challenges and opportunities for reform in primary and community care. In proceeding along that line and in having identified the many challenges faced, the issue is to understand how we might address them. To do that, first, we must deal with a major problem, which is the discordant perception and expectation among some important groups, with regard to what should be delivered by primary and community care services in the NHS. The expectations are those of politicians, of the public, and of health and care professionals. Those expectations are starting to differ widely when we look at the reality of what can be provided through a model of primary and community care established at the birth of the NHS.

That model, having at its heart family doctors well versed with the needs of their patients in broadly small communities in small practice settings, was fine some 70 years ago, but the demographic changes in our country, and the nature of chronic diseases that now attend so many citizens, which have a profound impact on their quality of life and their need to avail themselves of health services, are quite different from 70 years ago.

In addition to that, advances in medical and clinical practice provide important opportunities to impact on many of these conditions, but those advances require changes in the way we deliver care, pathways of care and an important emerging recognition that the hospital cannot be the place where the majority of patients with chronic conditions are managed. They must be managed in the community. Indeed, many must be managed in their home. That requires a different approach to understanding how professionals in primary care and community care settings need to be trained and the skill sets required. It also requires a confidence in understanding that what clinicians might have done previously should be done by other professionals.

Therefore, a professional workforce must be developed, with a recognition that skill sets will have to be developed differentially and that those who might previously not have been involved in delivering direct care—more specialist nurses, community nurses and practitioners—will now need to be encouraged and developed to do so. It also requires the adoption of innovation and technology to ensure that this care can be delivered safely in the community. Patients and their relatives need to be confident that they can understand and have confidence in the digital and technological solutions provided in their own homes and in community hubs and community settings.

Regrettably, none of this seems to be being addressed cohesively, so we rightly welcomed the opportunity provided in the most recent Health and Care Bill for the development of more broadly integrated community care settings and integrated care partnerships and boards to supervise the delivery of that care and bring different elements of the healthcare system together. But we need to go far beyond that. The Minister will be aware that in the debates on that Bill, which he so ably took through your Lordships’ House, there were suggestions, which we have heard from other noble Lords, regarding ensuring that workforce planning, a better understanding of the methodology used in planning, and the parameters considered in terms of demographic change, emerging technologies, advances in our understanding of pathophysiology and the capacity to deliver care should be included in very sophisticated workforce planning that will help us understand not only the number of healthcare professionals required but their potential disposition by way of discipline and specialty, and the capacity, with emerging understanding, knowledge and technology, to train different groups of healthcare professionals so that, as we have heard, they can work more cohesively together as a team, delivering so much more of the care in the community and at home so that patients never need to come to the hospital.

Indeed, other European countries have been able to achieve these ambitions. They have much lower levels of bed occupancy in their acute hospitals. Therefore, they see no particular anxiety about times such as winter, when acute admissions will inevitably increase. We have failed to achieve that. This failure is now taking us to a place where the system will, as I said, become entirely unsustainable.

In closing, I urge Her Majesty’s Government to have the courage to start addressing the problems we face and to start establishing a narrative and communication to bring together professionals, politicians, the public and patients to help understand and develop a consensus around the very important, serious and far-reaching decisions that now need to be taken to ensure that we strengthen primary and community care with new models; to ensure that those models are properly co-ordinated with the changes that need to occur in secondary and tertiary care; and, attending all that, to ensure that we have appropriate workforce planning across those different environments and care settings, attended by a proper review of the regulatory framework in which those professionals will deliver care and a better understanding of how we will ensure proper adoption of innovation through funding innovation streams beyond the recurrent funding for day-to-day delivery of care.

St George’s Hospital: Patient Deaths

Lord Kakkar Excerpts

Wednesday 18th May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important question, and it was one of the questions I asked when I was being briefed on this. Unfortunately, when HSIB was established, it did not investigate to historical cases. The future HSSIB will also not be able to investigate such cases; it will undertake only cases that are brought to it in the future.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identifies that the NHS, and indeed all healthcare systems, must be committed to ensuring the best clinical outcomes and securing patient safety. Clinical failings are subjected currently to a number of different potential investigations, such as local employer investigation, professional regulatory investigation, systems regulator investigation, civil litigation and potential criminal prosecution and interrogation. How do Her Majesty’s Government ensure that these multiple routes for investigating a clinical failing are properly co-ordinated to ensure that immediate learnings from such failings are applied to drive system improvement?

NHS Mental Health Patients in Private Hospitals

Lord Kakkar Excerpts

Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord clearly discusses an important point: we have to have the appropriate workforce. The Government have begun a register of social care to work out who is in the workforce, what qualifications they have and what improvements we have to make to social care. We should also remember that social care providers are a mixture of private homes and state provision. At the same time, we have to make sure that we have the right people, locally trained. For example, the visa system encourages people to come and work in our social care system as well.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my declared interests. In view of recent press reports about a young patient who absconded from a private sector mental health unit and subsequently died, and the subsequent coroner’s inquest findings, is the Minister able to confirm that the Department of Health and Social Care will be able to provide guidance on the safety and security arrangements that should attend outside areas at mental health units and subsequently might be used as the basis for CQC inspection?

Health and Care Bill

Lord Kakkar Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

If we want a sustainable health and care system in the decades ahead, we need an independent office of health and care sustainability to do the long-term planning. History has shown that we cannot rely on the departments and their political heads, who are busy doing the day-to-day stuff, to take the time to plan for the future far ahead to sustain our health, our NHS and our adult social care system. I beg to move.

[Lord Kakkar (CB)]

My Lords, I declare an interest as a member of your Lordships’ ad hoc Select Committee on the Long-term Sustainability of the NHS. My noble friend Lord Warner has very clearly introduced the arguments summarised at that time, when your Lordships’ committee made its report, strongly supporting the establishment of an independent office for the sustainability of health and care, and I shall not repeat those arguments.

What was striking was Her Majesty’s Government’s response to that report and, indeed, to recommendations 32 to 34 in that report, which dealt with that specific question. To summarise, Her Majesty’s Government felt that that office was unnecessary and that the Office for National Statistics had much of the data publicly available to assist in this long-term planning activity. Clearly, that is not the case; it has not happened, and it is unlikely to happen.

It is essential, as we have heard, that such an office is established not only to deal with questions of workforce—my noble friend has identified the interview given by the right honourable Jeremy Hunt on the question of an independent office for questions of workforce—as sustainability of health and care goes far beyond workforce. A very careful and appropriately defined methodology and expertise needs to be brought together to ensure that we can plan on a definite basis and achieve the sustainability that every Member of your Lordships’ House clearly regards to be essential. I therefore hope that Her Majesty’s Government accept this amendment.

[Baroness Merron (Lab)]

My Lords, five years have passed since the ad hoc Select Committee on the Long-term Sustainability of the NHS, under the chairpersonship of the noble Lord, Lord Patel, recommended an office for health and care sustainability. I thank the noble Lord, Lord Warner, for bringing this amendment before your Lordships’ House. This is a clear direction to put sustainability at the heart of planning and is long overdue. So we on these Benches support the amendment, and I hope the Minister will accept this amendment as a way forward.

Health and Care Bill

Lord Kakkar Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Earl Howe (Con)]

My Lords, in moving Amendment 3 I will speak also to the other government amendments in this group, in the name of my noble friend Lord Kamall. Of the many critical topics we discussed in Committee, our debate on health inequalities stands out as one that prompted unanimous and emphatic agreement from all Benches on the need for us to recognise in the Bill the centrality of the inequalities issue. My noble friend Lord Kamall and I took it as our mission to respond to the compelling points raised by noble Lords by bringing forward government amendments on Report, which I now do. These are issues and points of principle about which the Government—not least my noble friend the Minister—feel very strongly.

As the House will know, we think it important to empower local health and care leaders to pursue new and innovative ways to tackle disparities in the most appropriate way for their area. However, we should not miss the opportunity to ensure that this Bill reinforces those intentions in other ways. The amendments are designed to ensure that the Bill fully reflects the strength of the Government’s ambition to address disparities by levelling up every area of the country.

First, we will put beyond doubt that tackling disparities should be an integral factor when making decisions across the NHS. This was something that NHS England’s four purposes for ICSs made clear. The triple aim duty was always intended to support achieving those purposes, and these amendments strengthen the duty on NHS England, NHS trusts and ICBs so that, when decisions are made by NHS bodies, consideration will always be given to the effect of those decisions on disparities. What does that mean? It means that NHS bodies should consider the wider effects of their decisions on the inequalities that exist between the people of England with respect to their health and well-being and the quality of the services that they receive.

We are also going further by strengthening the more specific duties that complement the triple aim. Disparities are not limited just to health outcomes or access; they relate also to the experience of the care that is received. For example, the independent Commission on Race and Ethnic Disparities reported that Asian patients are more likely to report being less satisfied with GP services than their white, black African and black Caribbean counterparts. These amendments seek to strengthen existing duties as to reducing health inequalities on NHS England and ICBs by explicitly including patients’ experience of care, the safety of services and the effectiveness of services to create a more holistic duty that addresses how disparities manifest themselves in health and care.

When it comes to inequalities in access to health services, we can go further. The duties currently focus only on people who are already using or accessing health services. This fails to address those who do not or cannot access health services—and, as we powerfully heard in Committee, these include many socially excluded and marginalised persons, who are more likely to have preventable health conditions. The point is fully taken, and we have therefore tabled an amendment to ensure that the duties placed on NHS England and integrated care boards as regards reducing health inequalities require the consideration of inequalities in access for “persons”, rather than simply “patients”. The intention here is to improve outreach, as well as access by socially excluded and marginalised groups.

Lastly, we recognise the crucial importance of information on which to base targeted action. The Covid vaccination campaign was unprecedented in the way that it focused activity on every community across the nation, especially where there were disparities in the uptake of the vaccine. Fundamental to that success was the ability to collect and analyse data from across the system so as to target resources in the most effective way.

Our amendment will require NHS England to publish a statement describing certain NHS bodies’ powers to collect, analyse and publish information relating to disparities in health, together with NHS England’s view on how these powers should be exercised. Those bodies will be required annually to review and publish the extent of their compliance with that view. We hope and believe that this will power the evidence-based drive to reduce disparities in health across the country.

I hope that, together, these amendments provide the reassurances that noble Lords sought from their various amendments tabled in Committee. In conjunction, these changes will strengthen the ability and the resolve of the health and care system to take meaningful and impactful action. I commend them to the House and beg to move.

[Lord Kakkar (CB)]

My Lords, in thanking the Minister for having introduced so thoughtfully and elegantly this important suite of government amendments that address the question of inequalities, I would like to pass to the Minister and the Front-Bench team the thanks of my noble friend Lord Patel, who regrettably is unwell, recovering from Covid-19, but who of course spoke with great insight and passion in Committee on this matter, and indeed has engaged actively with the Front-Bench team subsequently in ongoing discussions.

The noble Earl has done something quite remarkable and absolutely essential. There is no need to rehearse the very strong arguments that were made in Committee around the necessity at this particular time to ensure that every element of the National Health Service is able not only to focus its resource and thought quite clearly at the elements of the triple aim but to ensure that, in a tension with those important pan-NHS objectives, the system is never allowed to forget the importance of addressing the inequalities and disparities that regrettably continue to be an abject failure of the delivery of the healthcare system.

Her Majesty’s Government, in proposing these amendments, deal not only with questions of access and outcomes but ensure that data is appropriately collected and all NHS organisations are obliged to pay attention to those data and to act accordingly; that is a very powerful statement and a powerful act of leadership. But beyond that, in ensuring that the patient’s voice and the public’s voice is heard in these matters, this will set a new tone and new direction for the delivery of healthcare in our country, and Her Majesty’s Government are to be strongly congratulated.

[Lord Shipley (LD)]

My Lords—

--- Later in debate ---

[Lord Sharkey (LD)]

My Lords, like the noble Lords, Lord Patel and Lord Kakkar, I have added my name to the government amendments in this group. These amendments directly address the criticisms which we made in Committee that, as things stood, a duty to promote research lacked any real force. Since we made these criticisms, we have met with the Minister and his officials to try to strengthen this research duty and make it more meaningful and concrete. These amendments, and the others in the next group, are the result of our discussions.

The Minister has explained, and given some examples, how they would help. The importance lies on what new things the amendments put in place. They require the NHS to explain, in its business plans and annual report, how it proposes to discharge, or has discharged, its research obligations. They also require a performance assessment of ICBs, which includes how well they have discharged their research duty and their duty to facilitate and promote the use of evidence in research. I thank the Minister and his team for their extensive engagement on the question of research in the NHS. I am pleased that we have strengthened the research duties of the Secretary of State and the ICBs. I am particularly pleased that progress will now be formally reported and assessed.

I should also mention that, in his letter of yesterday, the Minister listed a number of non-legislative measures either being taken or developed for facilitating or fostering a culture of research within the NHS, and for holding to account the people responsible for delivering this.

Finally, the noble Lord, Lord Patel, has asked me to say how sorry he is that he cannot be here today. He wanted the House to know that he supports the Government’s research amendments and is grateful for their co-operation in generating more research in the NHS. As the noble Lord, Lord Kakkar, has said, he is at home recovering from Covid, and I am sure that the House wishes him a speedy recovery.

[Lord Kakkar (CB)]

My Lords, I remind noble Lords of my own declarations of interests made in Committee: I am chairman of the Office for Strategic Coordination of Health Research, chairman of the King’s Fund and chairman of King’s Health Partners. In so doing, I make particular reference to the King’s Fund, since the Minister, in closing the last group of amendments, indicated the contribution to discussion which the fund has made with regard to the questions of inequalities.

I strongly support the amendments on the question of research that have been put by Her Majesty’s Government, and so ably and thoughtfully presented and introduced to your Lordships’ House by the Minister. The noble Lord, Lord Sharkey, has summarised why this is so very important. Ultimately, a research culture needs to be promoted at the heart of the NHS, and these amendments go a long way to achieving that clear objective.

There is so much by way of other initiatives that Her Majesty’s Government promote on the funding of research and support to bring together different parties to drive the broader life sciences agenda. However, ultimately, this all depends upon an NHS which is strongly supportive of, and facilitated to deliver, that research. Without this commitment, there was a very real risk that, with the other priorities that the NHS is inevitably required to pay attention to, the need to promote and facilitate research would be lost.

In facilitating research, NHS organisations, the Secretary of State, the NHS board and integrated care boards will have to pay attention to not only the facilities provided but the attendant workforce questions, ensuring that a workforce is properly prepared and able to engage in the research agenda, that progress in that regard is properly reported and that the full benefits of a research culture and the output of research are available to patients throughout our country.

Elective Care Recovery

Lord Kakkar Excerpts

Monday 7th February 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord rightly raises the issue of our brilliant workforce, who are at the heart of our plans for recovering services. The NHS’s delivery plans are focused on how we can transform these services and do things differently, not just asking staff to do more of the same. The monthly workforce statistics for November 2021 show that a record number of staff are working in the NHS, with over 1.2 million full-time-equivalent staff, which is over 1.3 million in headcount. This includes record numbers of doctors and nurses. In addition, we are recruiting new staff and focusing on different recruitment programmes and on retention, which many noble Lords have raised. We want to make sure that the excellent staff in our health system are happy and kept happy.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of King’s Health Partners. The Minister rightly identified that an important proportion of this increased waiting list is those requiring elective surgical intervention. How does he propose that the additional capacity will be created to address this important demand, beyond the question on an appropriate workforce just raised by the noble Lord, Lord Hunt of Kings Heath, as well as infrastructure and, beyond that, the development of novel models of care that ensure that elective surgery can be delivered safely and to a high standard?

[Lord Kamall (Con)]

We hope that the funding will deliver around 9 million more checks, scans and procedures, and we hope to support our aim for the NHS to deliver around 30% more elective activity by 2024-25, compared to pre-pandemic levels. As part of that, we have allocated £2.3 billion to increase the volume of diagnostic activity, and we are rolling out at least 100 further community diagnostic centres by 2024-25 to help with the backlogs of people waiting for clinical tests such as MRIs, ultrasounds and CT scans. These increases will allow the NHS to carry out 4.5 million additional scans by 2024-25, increasing capacity and enabling earlier diagnosis.