Health and Care Bill

Lord Kakkar Excerpts

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Patel, on the term “nurse”, which is protected in law at the moment only for those who are a “registered nurse”. This means that anyone can describe themselves as a nurse, as the noble Baroness, Lady Wheeler, outlined. They can even describe themselves as a nurse if they have no qualifications or experience—or, perhaps more seriously, have just been struck off the register. As somebody who was a member of the forerunner to the Nursing and Midwifery Council, I can say that we do not strike people off the register lightly, so the risks of such people being at large and describing themselves as nurses are serious. For this reason, a petition was created calling for the title “nurse” to be protected further in UK law.

In the initial response by the Government to the petition, recognition was given that the protection of professional titles

“provides assurance to the public that someone using that title is competent and safe to practise.”

The response references a consultation by the Department of Health and Social Care on professional regulation, Regulating Healthcare Professionals, Protecting the Public. In the Nursing and Midwifery Council response to this consultation, the nursing regulator recognised issues around the limitations of “nurse” not being a protected title and said it did not think that its current powers are sufficient,

“given that they are primarily based around titles that are not widely understood by the public or used by the professions.”

This amendment is designed to ensure that there are sufficient regulatory levers to be able to protect the public in the future.

Nurses on the NMC register find it difficult to understand why the Government are reluctant to protect the title. As part of the statutory regulations of the Health and Social Care Act 2012, it was mandated that registered nurses would be part of the clinical commissioning group governing body. In Regulation 11 of the National Health Service (Clinical Commissioning Groups) Regulations 2012, the CCG governing body is required to include at least one registered nurse within its membership. This created a statutory commissioning role for nursing leaders in England that will be lost should this not be required within integrated care boards’ executive membership. Please can the Minister explain whether guidance will include a recommendation that there should be a registered nurse as part of the executive team on integrated care boards?

[Lord Kakkar (CB)]

My Lords, I support Amendment 264, in the name of the noble Lord, Lord Hunt of Kings Heath, to which I have added my name. In so doing, I remind noble Lords of my own interests, particularly as a fellow of the Royal College of Surgeons of England, a fellow of the Royal College of Physicians of London and an honorary fellow of the Royal College of Surgeons of Edinburgh.

This is a critical amendment, as the noble Lord, Lord Hunt of Kings Heath, indicated, strongly supported by my noble friend Lord Patel. Currently, the National Health Service (Appointment of Consultants) Regulations 1996, with additional guidance provided by the department in 2005, restricts membership of advisory appointments committees for consultants to certain royal colleges, as we have heard with the appointment of surgeons by the Royal College of Surgeons of England alone—and, indeed, for physicians by the Royal College of Physicians of London. This is an anomaly. The medical royal colleges across the United Kingdom are recognised in terms of the postgraduate training that they are able to supervise, the continuing professional development they are able to provide and, indeed, collaborate with regard to postgraduate examination which is required for provision of the certificate for the completion of specialist training. However, when it comes to the question of consultant appointment, there is this restriction.

Noble Lords might ask why it is important that this matter be dealt with. The provision by a medical royal college of a professional member to serve as part of the appointment process for a new consultant is critical. Those representatives provide expertise and insight with regard to the nature of the job description, the requirements for the individual post, and the assessment of individual candidates as part of the selection process on the day.

Health and Care Bill

Lord Kakkar Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Harding of Winscombe (Con)]

My Lords, I also rise to support the noble Lord, Lord Mawson, in his amendment, and congratulate him and his colleagues on the extraordinary work they have done.

I support the Bill precisely because integration will be key to delivering the health outcomes that we all seek. But I worry that, if the Bill is just rearranging the organisational deckchairs, with exactly the same people in different organisations with different three-letter acronyms, we will not change anything at all.

I think that, over the course of the nearly three days we have spent in Committee and on Second Reading, there is cross-party agreement on the nature of the problem we are trying to solve. In each debate we have had over the last two and a half days, whether on health inequalities, mental health, the social determinants of health, or person-centred digitally enabled care, there has been extraordinary cross-party agreement on the nature of the problem. As the noble Lord, Lord Clement-Jones, said, we are debating and disagreeing more on the means to the ends than anything else.

One of the means to the ends is local—genuine local ownership and leadership. Like many in your Lordships’ House, I have made the pilgrimage to Bromley by Bow and I have also been to St Paul’s Way. When I first joined the NHS, about five years ago, I was told to go to Bromley by Bow, and I was told by a number of NHS insiders how brilliant it was, but how impossible it was to replicate anywhere else. “Go and have a look at it, Dido,” they said, “because you’ll be amazed and impressed, but no one’s worked out how to spread it”.

What I have actually discovered, as we have heard today from people with far more experience of place-based leadership than I have, is that brilliant though Bromley by Bow is, it is not alone. There are fantastic place-based leaders in communities across the country. It is those local groups and leaders who we owe the exit from Covid to more than anyone else, I suspect.

I have had the privilege of working alongside them. I have been to north-west Surrey with the noble Lord, Lord Mawson, but also to Wolverhampton, to the Guru Nanak Sikh gurdwara, one of the first local testing sites for NHS Test and Trace. I have been to Gloucester and spent time with Gloucester FM, a local community radio station that for the first time in its existence got funding to run an advertising campaign to encourage people to come and get vaccinated in the local community. That was the first time it had succeeded in working collaboratively with the local NHS.

I have been across the country in the last two years talking to people from groups who feel excluded. Whether it is the Roma Gypsy community, Travellers, refugees, taxi drivers or faith leaders from a whole host of communities, all have told me—in both my previous role as chair of NHS Improvement and as executive chair of NHS Test and Trace—how in different ways they felt excluded not just from the NHS but from society in general. They also said, generally to a man and a woman, how hard the NHS is to work with when you are from a small, outside local group, as those of us who have worked in the NHS know.

It is with that knowledge base that I wholeheartedly endorse the spirit of the amendment of the noble Lord, Lord Mawson—but with a “but”. I have been consistent in the last two and a half days of Committee in being nervous about adding specific roles and experiences to what is now a growing list of characteristics and past experience we would all like to see in this new three-letter acronym NHS entity, the integrated care board.

I would like to post a question to the Minister. It is clear that we need these local voices—the grit in the oyster, as my noble friend Lady Cumberlege described it; the difference that the noble Lord, Lord Crisp, is referencing; people from outside the system—if this new reorganisation is going to be anything more than a rearranging of the deck chairs. How will we ensure that those local voices are genuinely heard in an integrated care board?

[Lord Kakkar (CB)]

My Lords, I rise to support the amendment in the name of my noble friend Mawson and others, and in so doing congratulate him on his thoughtful introduction. It is clear that one of the most important aspects, and the purpose, of this Bill is to ensure integration at a local level. But the purpose of that integration must surely be—as has been confirmed by the Minister—to improve health outcomes for the entire population. It is well recognised that that can happen only if the social determinants of health in local communities are addressed appropriately and effectively, in a way that our health system has not been able to do to date.

If we accept that to be the purpose, then local integration—that focus on and understanding of the social determinants of health—and responding to local needs must be secured in the organisation of the integrated care systems and their boards. As we have heard from the noble Lord, Lord Mawson, and others, to achieve that, one must not only understand, appreciate and hear the local voice, but be clear that the culture that is established in these systems is responsive to those voices and is determined to act on them and the understanding of the local situation—particularly those social determinants that extend far beyond what has been and can be delivered through healthcare alone—and focus on other issues such as housing, education and employment. It would be most helpful if the Minister, in answering this debate, could explain how that is going to be achieved in the proposed construction of the integrated care boards.

Of course, one recognises that Her Majesty’s Government are deeply committed to this agenda. But it is clear that if these boards are not constructed in such a way that they can change the culture and drive, in an effective and determined fashion, a recognition of those social determinants and create opportunities at a local level to address them, much of the purpose of this well meant and well accepted proposal for greater integrated care at a local level will fail.

[Lord Lansley (Con)]

My Lords, I did not originally intend to contribute to this debate. However, I would like to thank the noble Lord, Lord Mawson, for his Amendment 41A, which, although modest in scope, has initiated an extremely useful debate and raised a lot of important issues. I do not want to add a lot of material to the debate, but I want to focus on the questions that have emerged from it.

House of Lords: Remote Participation and Hybrid Sittings

Lord Kakkar Excerpts

Thursday 20th May 2021 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking the Minister for the very thoughtful way in which he introduced this debate and in thanking members of staff and the staff authorities for the rapid response to the unprecedented situation last year, when our nation recognised that it was in a pandemic, and the way that this House discharged its responsibilities had to be modified. There is no doubt whatever that we have to recognise that the procedures, processes and indeed the adoption of technology platforms that were necessary at that time were undertaken under considerable pressure. In particular, the technology platforms have a number of important limitations that we need to consider in determining how we should move forward as we come out of the pandemic period.

Noble Lords have rightly recognised our principal constitutional obligations, which are to revise and scrutinise legislation and to hold the Government to account. They have rightly identified the need to weigh the opportunity provided by the processes, procedures and technology platforms we have adopted in this unprecedented period in determining whether those obligations are being properly discharged. We have heard, of course, about the important report of your Lordships’ Constitution Committee and many noble Lords have identified that, regrettably, much of the discharge of those important responsibilities and obligations is less than satisfactory in the way we are currently having to conduct our responsibilities.

That is not to say that there may not be opportunities in the future, as technology advances. Technology may be developed that is bespoke for a parliamentary Chamber rather than adopting platforms that have been developed primarily, as we have heard, for use in other businesses. We may be able to return to this question. As things currently stand, it is clear that the subtlety and nuances afforded by physical presence in parliamentary debate—the capacity to intervene; in particular, to hold Ministers to account; and to ensure the expertise and experience that this remarkable Chamber is able to bring to bear to a specific and often detailed question, sometimes not properly considered in the other place—has been undermined as a result of the current circumstances and our current working practices.

When the Lord Privy Seal comes to wind up this debate, can she say whether there might be opportunities for your Lordships’ House, in returning to practice as prior to the pandemic, to continue to explore technology —with the potential development of bespoke technology —that might help the House overcome some of the limitations we have heard about today? Might we continue to explore processes and procedures, but, as we have heard, in the context of actually returning and functioning as the House should and rightly must expect to do, rather than adopting measures that were applied as a matter of urgency? We have had the opportunity of an impressive experiment; might we look at some of the advantages and disadvantages of those technologies, but not adopt them without proper and due consideration beyond the period of the pandemic?

We have been very fortunate in our own country to benefit from the remarkable vaccination programme. It will soon allow us to take these decisions and return to what we would consider the normal working of your Lordships’ House, but we should not dismiss the opportunity to learn from the experience of the past 15 months. Noble Lords will be well aware of the words of the Writ of Summons, demanding that,

“(waiving all excuses) you be at the said day and place personally present”.

Those words are a very powerful reminder of our individual obligations, as Members of your Lordships’ House, and I very much hope that, in reaching a conclusion about future working, we are cognisant of those important obligations and responsibilities.

His Royal Highness The Prince Philip, Duke of Edinburgh

Lord Kakkar Excerpts

Monday 12th April 2021 Lords Chamber

[Lord Kakkar (CB)]

My Lords, so much has been written and said about the remarkable life of His Royal Highness The Prince Philip, Duke of Edinburgh. It is as director of the Thrombosis Research Institute that I rise to add my tribute to His Royal Highness, who was our patron. His Royal Highness had many scientific and medical patronages, and I suspect that our institute was one of the smallest, yet we were privileged to enjoy His Royal Highness’s support and encouragement, informed by his intellectual curiosity and enthusiasm, which was always reflected in many practical ways. His patronage had an immense impact on our work over the past 30 years.

His Royal Highness was always remarkably well informed in discussion, with a keen interest in and understanding of the science underpinning our work and a fascination with the innovation derived from it. Most of all, he was always demanding that there be meaningful impact from our work for others. To talk about the science and its implications and learn from His Royal Highness, who was always so well and widely informed, was a great privilege, but my abiding memory of His Royal Highness, as it is for so many others, is of his profound kindness. At the time that my father, who founded the institute, died, His Royal Highness wrote to me in his own hand. His letter was one of such kindness and comfort, for which I shall always be grateful. I join noble Lords in adding my deepest condolences to Her Majesty and to members of the Royal Family.

Covid 19: Winter Plan

Lord Kakkar Excerpts

Tuesday 24th November 2020 Lords Chamber

[Lord Kakkar (CB) [V]]

My Lords, I draw attention to my declared interests. In his Statement in the other place, the Prime Minister made reference to the imminent initiation of a mass vaccination programme for the UK population. Have Her Majesty’s Government considered creating a prospective research cohort from among the millions of citizens who will be vaccinated in the early months of this programme? This would facilitate individual follow-up and invaluable data collection, better inform our understanding of pandemic epidemiology and provide invaluable insights into the future development of novel vaccine platforms.

[Baroness Evans of Bowes Park (Con)]

I thank the noble Lord for his question, and I also pay tribute to all the fantastic work that has been done in relation to the vaccinations. Indeed, obviously a lot of research and testing has been done to develop the vaccines. We will certainly learn from that as we roll out the vaccination programme, and from his very useful comments and observations about things we may consider. I am very happy to take that back to the department of health, which I am sure will be considering these things and talking to experts, such as himself, throughout the industry to make sure that we roll out this programme as effectively as possible.

Covid-19 Update

Lord Kakkar Excerpts

Tuesday 3rd November 2020 Lords Chamber

[Lord Ashton of Hyde (Con)]

My Lords, I remind noble Lords that this time is meant for questions not statements, which will allow all noble Lords who want to to get in.

[Lord Kakkar (CB) [V]]

My Lords, I draw attention to my registered interests. The lockdown for the coming month in England must achieve a substantial reduction in coronavirus circulation in the community so that hospitals are not overwhelmed by Covid-19 admissions and are able to continue to admit Covid-19 and non-Covid patients requiring urgent and elective care in future. How will Her Majesty’s Government use this one-month period better to prepare our National Health Service and our public health systems to secure these objectives so that further lockdowns will not be necessary?

[Baroness Evans of Bowes Park (Con)]

The noble Lord is absolutely right. Concerns about pressure on the NHS were one of the key drivers behind the decision made as well as the fact that, unfortunately, we are seeing in some areas of the country a small number of non-elective procedures having to be cancelled, and we absolutely do not want that to happen. That is why during this time opticians, pharmacies and GPs will stay open, and we will continue to urge people who need any type of medical opinion, attention or treatment to continue to attend appointments and see professionals. We are ramping up testing capacity. We are providing millions of items of PPE, £3 billion of funding to make sure the Nightingales can provide surge capacity and £300 million to make sure that departments have the funding they need to upgrade ahead of the winter and ensure that the NHS is not overwhelmed.

Covid-19 Update

Lord Kakkar Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

My noble friend is absolutely right to talk about care homes, and I can certainly reassure him that no care homes should be forced to admit residents they do not feel they can provide appropriate care for. Also, all individuals must be tested before discharge from hospital into a care home. I hope I can reassure him by letting him know that we have provided over 208 million items of PPE and are giving every care home free PPE until at least the end of March. We are also piloting weekly testing for professionals who visit care homes regularly and come within one metre of residents when carrying out their roles, so that we can do everything we can to ensure that infection rates do not rise exponentially within that sector.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The noble Baroness the Leader of the House made reference to Nightingale hospitals. Is she in a position to advise your Lordships on what measures were taken and how the Nightingale hospitals have been prepared during the summer months, with specific reference to the provision of protective equipment, clinical equipment, advanced therapeutics and, most importantly, human resource staff, so that they are now immediately able to make a contribution to the management of this second wave of Covid-19? In particular, I ask if, and how, a clinical protocol has been established to ensure that the Nightingale hospitals can be deployed for the management of not only Covid-19 but other diseases, in such a way that the NHS can continue to deliver?

[Baroness Evans of Bowes Park (Con)]

As I mentioned in reference to a comment by the noble Lord, Lord Newby, CT scanners have been made available—for instance, in Harrogate and Exeter—to provide safer, faster access for people with a range of conditions, including cancer, so that we can continue to try to ensure that routine appointments and operations can still take place. As I also mentioned, three other hospitals are now on alert in areas of high prevalence in order that they can come on stream. Obviously work is going on between the Department of Health and NHS England, but they will be staffed from the local area. We will of course keep all of this under review because we know that capacity is important, and the Nightingale hospitals will, I am sure, once again play an important part in our response as we go forward.

Covid-19

Lord Kakkar Excerpts

Wednesday 23rd September 2020 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join others in thanking the noble Baroness for taking questions on the Prime Minister’s Statement, and in so doing draw your Lordships’ attention to my declared interests.

The first wave of Covid-19 earlier this year saw major challenges for the NHS, in being able to treat patients with non-Covid conditions, such as cancer and cardiovascular disease, while dealing with the large numbers of patients needing admission for acute Covid conditions. How will Her Majesty’s Government determine whether the measures now in place are having sufficient impact to be confident that the NHS will be able to manage not only patients requiring Covid-19 admissions but those with non-Covid conditions requiring urgent treatment during the winter? This is a critically important issue. Do they have modelling available? How will they determine if these measures are going to have the desired impact and, if not, how will they act to ensure that the NHS will be able to look after all patients, both Covid and non-Covid?

[Baroness Evans of Bowes Park (Con)]

I assure the noble Lord that the department is working extremely hard with the NHS to ensure an absolute minimum of disruption to other treatments. It was thanks only to the incredible work of staff that, even at the peak of demand earlier this year, hospitals were still able to look after two non-Covid patients for every Covid patient. A similar picture was seen in primary, community and mental health services. The most effective way to ensure that other treatments are not disrupted is to make sure we tackle this disease and try to make sure we do not have huge numbers of hospitalisations of patients with Covid. We are working towards that. We are also working on the principle that the most urgent treatments, including mental health support, should be brought back first. I assure the noble Lord that is a priority for the department.

Covid-19 Update

Lord Kakkar Excerpts

Thursday 25th June 2020 Lords Chamber

[Lord Kakkar (CB) [V]]

I thank the Leader of the House for taking questions on this Statement. Although testing of symptomatic individuals and tracing their contacts represents an important approach to controlling the spread of Covid-19 disease in the community as lockdown restrictions are lifted, there may be an alternative approach: mass population testing to identify both symptomatic and asymptomatic individuals carrying the SARS-CoV-2 virus in the community, with them being isolated if they test positive. Such a testing strategy would need to be delivered locally and to provide the results in real time to facilitate maximum workplace participation and consumer confidence. What assessment have Her Majesty’s Government made of the emergent technologies that could facilitate this population approach? What provision has been made for the necessary logistical arrangements that would need to be adopted to test the entire population on a repeated and regular basis?

[Baroness Evans of Bowes Park]

The noble Lord obviously knows a lot about this area. He is right that a series of strategies will need to be used for us to continue to make progress in combating this virus. The Department of Health is looking at an array of issues with SAGE and the medical advisers, so work is ongoing in the area that he suggested, as well as in developing track and trace, because we are going to need all these different strands to come together to beat this virus and make sure that all areas are able to clamp down if we start to see a sudden resurgence in any area. I am sure we all want to avoid going into a national lockdown again if the virus were to start to reappear.

House of Lords: Lord Speaker’s Committee Report

Lord Kakkar Excerpts

Tuesday 19th December 2017 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join noble Lords in thanking the noble Lord, Lord Burns, for the thoughtful way in which he introduced his important report. In doing so, I declare my interests as chairman of the House of Lords Appointments Commission and of the Judicial Appointments Commission.

The task taken on by the noble Lord, Lord Burns, and his colleagues—looking at the size of this House—was inevitably going to be a very difficult, complicated and fraught matter. Yet it was vital for them to come to a practical solution that would deliver what was required: achieving a size for your Lordships’ House that would meet the important challenge of public perception—an issue touched on by many of those who have already contributed. Having initiated this process in a debate last year and having supported the establishment of the Lord Speaker’s committee to look at these matters, the reality is that there would be tremendous harm to the standing of your Lordships’ House if your Lordships were not able to reach a conclusion in supporting an essentially irrefutable argument: this House is too large and does not enjoy the respect of the public more generally. Whether or not that is fair, it is the held perception.

I will deal with issues in the report that touch on the work of the House of Lords Appointments Commission. I remind noble Lords that the commission was established in 2000 as an advisory body to the Prime Minister. As a non-departmental advisory body, it has continued its work since then with two principal remits: to make nominations to your Lordships’ House for independent Cross-Bench Peers—undertaking both an assessment of candidates’ suitability for service in your Lordships’ House and vetting checks—and to undertake vetting responsibility for all other nominations. In that regard, some 10% of party-political nominations made to the commission since 2015 failed to meet the vetting test and have not proceeded.

The Burns report suggests that we enhance the responsibilities of the House of Lords Appointments Commission in a number of respects. The first is that, beyond continuing our current nomination function for independent Cross-Bench Peers, the commission should facilitate the extended leave of absence that will be available to Peers nominated under the new scheme. The second is that it should, for want of a better description, keep the spreadsheet generated after every election, looking at the size of the House of Commons and the proportion of votes, and therefore the size of the political Benches for the forthcoming Parliament.

The third, as we have heard, is to provide a clear understanding for all those nominated to serve in the House of Lords of the commitment that would be required and the obligations that attend membership of your Lordships’ House. This is something that the commission pays special attention to with regard to Cross-Bench nominations. An analysis undertaken between October 2016 and January 2017 identified that of the 67 nominations by HOLAC since 2000, 90% participated in some way in that period, either through voting, contributions in the Chamber or work in committees.

Clearly, the commission would be happy to assist as requested in providing the narrative of the expectation of contribution and service once appointed to the House of Lords, but it would be vital that the political parties heard the response of each candidate to that description because, ultimately, so as not to fetter the Prime Minister or party-political leaders’ opportunity to make political nominations, they would have to be clear that the response received was suitable to those political parties.

Ultimately, under the scheme, beyond hereditary elections, there will be three routes to the Cross Benches: the independent nomination rate through the House Of Lords Appointments Commission, the appointment of Prime Minister’s exceptions—10 in any given five-year period—and a new judicial appointments route for Supreme Court justices on appointment to the Supreme Court. It would be essential to understand how the balance between those three routes will be achieved over any given Parliament.

One of the important duties of the House of Lords Appointments Commission has been to try to achieve greater diversity in this House. Of the 67 nominations made since 2000, 37% have been of female candidates and 19% of members of ethnic minorities. It is essential that that ability to look more broadly at the membership of the House is not lost as we look at the different routes to contribute to Cross-Bench membership in future.