National Insurance Contributions: Healthcare

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, unintended consequences have plagued policymakers and Governments for many years. I am interested in whether the impact on primary care providers, hospices and care homes was a deliberate or unintended consequence of the recent rise in employers’ national insurance. Did the Government conduct an impact analysis of the cost to primary care providers, hospices and care homes before the Budget? If not, have they conducted one since or do they intend to do so? Can the Minister assure non-state providers of primary care, hospices and care homes that this was not a deliberate measure to squeeze them out of the health and care space and that the Government will consider appropriate measures to ensure that they can continue to be financially viable and invest in facilities, staff and front-line services?

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

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

National Carers Strategy

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend, who is a very impressive campaigner on the rights of carers, is right to talk about recognition. Of course, if one does not understand that one is a carer, it is hard to access support. I certainly agree on that point. There is guidance, for example, to support GPs in recording which of their patients are unpaid carers, to ensure that they get access to the support they need. Importantly—this has been raised a number of times in this House—in respect of young carers, there is guidance for GPs and it has recently been added to the school census, so young carers can be identified in order that there can be an assessment of needs. So it is true that we need to identify in order to support. Part of that is people recognising themselves as carers.

[Lord Kamall (Con)]

My Lords, I also pay tribute to the work of the noble Baroness, Lady Pitkeathley. I learned much from her when I was the Minister. The Minister may recall that, in April 2023, the previous Government set out the better care fund framework. This included £100 million to accelerate digitisation in the social care sector. This would enable the Government and NHS England to collect valuable data about the state of social care and identify gaps if the Government decide to deliver a national strategy. What plans do the Government have to continue and expand this vital process of digitisation across the care sector, hopefully in delivering a national strategy?

[Baroness Merron (Lab)]

It is indeed the case that using technology and digital advance is key in all the areas where we are working, and the noble Lord will know that in the 10-year plan one of the three pillars will be, for example, going from analogue to digital. On that point, plans for going forward in dealing with social care, which is much needed in this country, will be set out in due course. I assure your Lordships’ House that it will be done through a cross-party approach, involving those with lived experience and the many voices and organisations that are part of the social care sector. We are keen that it is something that we can all get behind.

Cancer: Older People

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.

[Lord Kamall (Con)]

My Lords, I will carry on the thread of questioning that the noble Lord, Lord Patel, started about early diagnosis. As the Minister said, it is very important that we look at early diagnosis. Noble Lords who are interested in diagnosis were looking forward to a follow-up report to the 2020 community diagnostic centre review by Sir Mike Richards. That was due to be published before the Budget, yet the Health Service Journal has reported that it has been shelved. Is this true? If so, can she explain why?

[Baroness Merron (Lab)]

It is important that we concentrate on the biggest ever NHS consultation, because that will lead us to the 10-year plan, and all that we are doing will sit within that. As the noble Lord will know, we are committed to getting the NHS to diagnose cancer earlier, treat it faster and improve waiting times. One of the announcements in the recent Budget, which also shifts the dial, is that we will deliver an extra 40,000 scan appointments and operations every week. The 10-year health plan will set out our approach for shifting healthcare from sickness to prevention, including reducing the incidence of cancer.

Type 2 Diabetes: Continuous Glucose Monitors

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I hear what the noble Baroness says and I am glad to report that I met the Northern Ireland Health Minister recently, along with colleague Peers, to discuss a range of matters including differences across the nations. I will consider the point that she makes.

[Lord Kamall (Con)]

My Lords, while the original Question was about type 2 diabetes—as the noble Lord, Lord Patel, said, type 2 diabetes can be due to lifestyle and can sometimes be reversed—I want to ask the Minister about type 1 diabetes. Its exact cause is unknown and people can get it at any time of their life, yet there is no cure, so in some ways the need for CGM is more critical. The charity Breakthrough T1D, which represents type 1 diabetics, finds that black, Asian and minority ethnic groups in England and Wales and lower socioeconomic communities are much less likely to get access to or use these technologies. Closing that gap was one of the issues that we grappled with in government, so can the Minister tell the House what plans there are to ensure that as many type 1 diabetes patients as possible across England receive access to continuous glucose monitoring?

[Baroness Merron (Lab)]

It is probably important to say at the outset that type 1 diabetes, as the noble Lord knows, is not related to lifestyle issues, and at this point cannot be prevented, so it is a case of management. The technology that is available now is quite remarkable— not just the CGMs that the noble Lord, Lord Rennard, inquired about, but also hybrid closed loop systems, where the CGM is paired with an insulin pump, so it is administered automatically without the person having to calculate. I think that is incredibly helpful. It is only available to those eligible, with type 1 diabetes, but the rollout began in April 2024. The noble Lord makes a good point, as did the noble Lord, Lord Rennard, about access and inequality in access. That is something we continue to work on, ensuring that everybody can fairly access these wonderful technology advancements.

Diets: Fat

Lord Kamall Excerpts

Thursday 31st October 2024 Grand Committee

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lord McColl for securing this debate on a timely and important matter, but I also thank all noble Lords in this debate for their contributions. I warn the Minister that I tend to take a rather Socratic approach, so I will have lots of questions. The noble Baroness may not be able to answer all of them but I am happy for her to write to all of us.

The noble Earl, Lord Caithness, and the noble Lord, Lord McColl, have shared some interesting statistics: an NHS survey estimated that 28% of the population are obese, and a further 38% are classified as overweight. As other noble Lords said, this is not only a health issue but an economic problem. The question is: how do we as a society encourage people to lose weight—to help them live healthier lives but also to reduce the cost to taxpayers of the NHS treating obesity, be that through medication or lifestyle changes?

As someone who believes in personal freedom, I would not oppose anyone who decided to take Ozempic, as long as it was safe for them to do so and they were aware of the risks, as the noble Lords, Lord Mitchell and Lord Rennard, testified. However, there have been reports that the popularity of such drugs has led to a market for dangerous counterfeit drugs that mimic these effects. Can the Minister confirm whether the Government are aware of the proliferation of cheaper alternatives? Have the Government made any assessment of the safety of these alternatives and of whether some are in fact counterfeits?

While medical advancements such as Ozempic can help to manage someone’s weight, surely it is important that we explore and promote alternative approaches, as the noble Lords, Lord Brooke and Lord Krebs, said. As my noble friend Lord McColl and the noble Earl, Lord Caithness, suggested, research shows that diets with enough healthy fat content, especially unsaturated fats, can be effective in making people feel that they have eaten enough and reducing their appetite. These diets can also stabilise blood sugar levels, which is critical for weight management and overall health.

Education and prevention are just as important. Many people may not understand the impact of their dietary choices on their long-term health; they may not realise that better diets will not necessarily cost more; and they may not be aware that a small increase in physical activity can contribute to better physical health and mental well-being—although it is not a panacea, as the noble Lord, Lord Krebs, and the noble Earl, Lord Caithness, said.

Can the Minister reveal whether the NHS is prioritising cost-effective lifestyle approaches, rather than focusing on weight-loss drugs as some sort of magic bullet? I urge the NHS and the Office for Health Improvement and Disparities, as well as the department, to ensure that accessible support is available to those from all backgrounds. Often, those from the most disadvantaged backgrounds face the greatest challenges in accessing healthy food and exercise facilities, leading to higher incidences of obesity within those communities.

Noble Lords may have seen daytime television programmes—I know they work very hard, but in their rare moments of relaxation they might switch on the TV—where families are taught to cook healthier meals, which can often be cheaper than ready meals from the freezer section of a supermarket. When I was a Minister, I often wondered how you transfer these daytime TV lessons into people’s homes. I know that my noble friend Lady Jenkin has taken an interest in this issue for many years.

One of my students recently wrote an assignment on Brite Box, a fantastic project in Kingston upon Thames that provides families with ingredients and an illustrated recipe guide so that they can cook a healthy meal on a budget together. What happens is that cooking together leads to meals being family occasions rather than one parent being stuck in the kitchen. Can the Minister tell us how the NHS, the Department of Health and OHID are working with similar local community projects across the country to encourage families in poorer communities to eat healthier diets? What steps are being taken to enhance dietary and health education in our schools, workplaces and community spaces?

Finally, as weight-loss drugs such as Ozempic gain popularity and we start to see the results of the trial of tirzepatide in Manchester, we have to recognise the psychological aspect of obesity. Can the Minister tell us about how weight-management initiatives will consider the link between poor weight management and the mental health of individuals? What mental health support is available to overweight individuals with underlying mental health conditions, and how do we avoid the unintended consequences of those who suffer from eating disorders such as anorexia or bulimia?

Once again, I thank my noble friend Lord McColl for securing this debate and all noble Lords for their contributions. I look forward to the Minister’s responses.

Food and Drink Industry: Processed Sugar

Lord Kamall Excerpts

Monday 14th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for that point. It is one of a number of things that is discussed with industry. It is important to draw on the fact that the location restrictions—in other words, where things are located—that came into force in October 2022 have actually turned out to be extremely impactful. There is a whole range of measures that we need to look at, and we will continue to work with industry. As I said in response to my noble friend, we will look at the balance between what is mandatory and what is voluntary, because that will be our best way forward.

[Lord Kamall (Con)]

My Lords, I pay tribute to the noble Lord, Lord Brooke, for his persistence on this issue. As a Minister, I received many similar Questions. The noble Lord asked about natural sweeteners, but can I ask the Minister about artificial sweeteners? The world-renowned Mayo Clinic suggests that artificial sweeteners, while reducing sugar intake, might also have negative side-effects, and that food labelled as having no sugar or being low in sugar may give the impression of being healthy but actually contain high levels of saturated fat, trans-fat, sodium and other cholesterol-raising ingredients. Can the Minister tell the House, first, whether the Government are aware of any negative side-effects of natural sweeteners and, secondly, what the current thinking is on informing consumers on how reformulating food with less sugar does not necessarily make it healthy?

[Baroness Merron (Lab)]

The noble Lord makes some very good points. I can give the assurance that all sweeteners have undergone a rigorous safety assessment before being authorised for use. It is also worth drawing the attention of your Lordships’ House to the fact that the Scientific Advisory Committee on Nutrition is currently considering the recent World Health Organization guideline, Use of Non-sugar Sweeteners, which has particularly suggested that achieving weight control may not necessarily be about replacing sugar with sweeteners. It is about acknowledging that sweeteners are more difficult—to use a non-technical term—to use in the reformulation of food than they are in drinks. There has been success in drinks, which has not been exactly mirrored in food, but there are technical and practical reasons for that.

Bread and Flour Regulations 1998

Lord Kamall Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord raises an extremely good point. Before we speak about the groups to which the noble Lord referred, I want to point out that fortification will not be enough in any case. We need to continue our encouragement for women to take daily folic acid supplements before conception and in the first 12 weeks of pregnancy, because doing so can prevent up to seven out of 10 cases of neural tube defects—I want to emphasise that. I will take on board the noble Lord’s very important point and ensure that it is part of our considerations.

[Lord Kamall (Con)]

My Lords, I start by paying tribute to the noble Lord, Lord Rooker, for his persistence in this matter. When I was a Minister, I found it rather frustrating to be told that the consultation process could not be speeded up, so I pay tribute to the Minister for the progress she has made. However, I want to ask about a possible unintended consequence. The NHS website says that folic acid is not suitable for some people: those who are allergic to folic acid, obviously; those who have low vitamin B12 levels; those who have cancer, unless they have folate deficiency anaemia; and to those who are having a course of haemodialysis or who have a stent in their heart. Given these warnings on the NHS website, can the Minister assure the House that she is confident that those who suffer from those conditions will not be harmed unintentionally by increasing the volume of folic acid in our bread and flour?

[Baroness Merron (Lab)]

I thank the noble Lord for his support in this area; I know that he also worked hard to make progress in it. I can give the assurance he asked for, and I would say to people that if they are concerned, they should seek expert advice about their own personal circumstances. All of the expert advice and relevant committees are content that this is the right way forward.

HIV Care: Access

Lord Kamall Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

Yes, and I thank the noble Baroness for making those points, which I certainly agree with. The challenge for us now is to reduce the number of people who live with undiagnosed HIV, but also to reduce the number not seeking care and treatment. For the first time, the latter has exceeded the former, which suggests that we have a challenge we must focus on in the new plan, and we will do so.

[Lord Kamall (Con)]

My Lords, I pay tribute to my noble friend Lord Black for his consistent campaigning on this issue, and especially for helping those with HIV. What has been learned from previous initiatives? We know that in recent years, the NHS and the previous Government looked at ways to address issues such as vaccine hesitancy, and the reluctance of some to seek tests and treatment at any time. What lessons have been learned from these previous initiatives for the HIV action plan—for example, by working with local communities and the charities that a number of noble Lords have mentioned to encourage more patients with HIV to seek treatment, especially in communities such as black and Asian communities, where there may also be a stigma, as the noble Lord, Lord Fowler, mentioned, around admitting that they have HIV?

[Baroness Merron (Lab)]

There is what I call a three-pronged approach to interventions to reduce the number of people not being seen for care, which is so important, as I know the noble Lord is aware: identifying people who have not been seen for care; contacting them and re-engaging them; and addressing the barriers to engagement, which a number of noble Lords have referred to. This means sustaining engagement with care in the long term and supporting people with HIV.

We will review what lessons we are learning from the HIV action plan for England, which runs to 2025, and that means we will be able properly to inform the development of the new plan. I look forward to updating your Lordships’ House on this.

Pharmacies: Rural Areas

Lord Kamall Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

On the point that the noble Lord correctly raises, it is worth reflecting that there has already been a reduction in the number of pharmacies since 2017. There are now some 1,200 fewer pharmacies than we had in 2017 and 600 fewer than there were two years ago. This is a trajectory that we would rather was not the case. Support is available—for example, through the Pharmacy Access Scheme, which provides financial support to pharmacies in areas where there are fewer pharmacies. I can say that we are monitoring access to pharmacies. While it is the case that four in five people live within a 20-minute walk from a community pharmacy, we absolutely recognise that the experiences of patients differ. If we are to see pharmacies as key to future plans for the health services, we will have to address that.

[Lord Kamall (Con)]

My Lords, we recognise that the current access to healthcare is based on an outdated model, where far too many patients are unable to book GP appointments online or by telephone in advance. They have to join the 8 am lottery to try to get an appointment by phone, only to be referred later to a pharmacist or hospital. The Pharmacy First reforms introduced by the last Government attempt to unblock the GP surgery bottleneck by allowing patients to access treatment for common health conditions without the need for a GP appointment. To ensure that patients in rural communities equally benefit from the Pharmacy First initiative, is the Minister able to give the House a firm commitment that the Government will continue the Pharmacy First approach and look at how this could be accessed by more patients in rural areas?

[Baroness Merron (Lab)]

I am pleased to say that, as I am sure the noble Lord is aware, prescribing pilots are going on in NHS England. These will look at what more pharmacies could do in this regard, in particular asking whether more minor illnesses could be dealt with, and whether the long-term management of conditions could be better managed through pharmacies. We will be very interested in what those pilots come up with. They are across the entire country, so will of course include rural areas. This is something that we will want to ensure is available in rural and urban environments.

Government Policy on Health

Lord Kamall Excerpts

Tuesday 10th September 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, the Minister will know that there have been concerns over Labour’s appointment of donors and party apparatchiks with little or no experience to senior Civil Service positions, which have led the Civil Service regulator to launch a review into Labour appointments.

I accept that this case is different. We understand that the Secretary of State is new to the role and inexperienced. We also know that Alan Milburn brings a huge wealth of experience in healthcare both in government and from personal consultancy, advising one of the largest providers of residential care for older people. I have also seen reports that he is a senior adviser on health for a major consultancy firm. I want to be clear, this is valuable experience and I applaud the Government for seeking such experience in the same way that noble Lords welcomed the appointment of the noble Lord, Lord Robertson, to review defence capabilities.

However, I am sure the Minister will also recognise the issue of real or perceived conflicts of interest—something that Labour Peers rightly questioned Ministers on when we were in government. So, in that spirit, I will ask the Minister a few questions about how the Government can look at potential perceived conflicts of interest and how they will be managed. Given Mr Milburn’s consultancy interests, can the Minister tell us what his formal role is? Is it a paid role and, if so, how much does he earn? Which meetings does he attend? Does he attend meetings without Ministers being present? Are notes taken for these meetings? How do the department and the Government ensure that he does not have access to commercially sensitive documents that could be of interest to his clients?

If the Minister cannot answer all these questions, I ask her to write to me and other noble Lords with answers and place a copy in the Library. Let me be clear, I completely understand why the Secretary of State appointed Mr Milburn—due to his experience in government and the private sector. It is valuable experience, from which a new Government could learn. I hope the Minister will accept my questions in the spirit of ensuring that the conflicts of interest are managed and there is real accountability, so that the Government can get the best out of Mr Milburn in his new role.

[Lord Kennedy of Southwark (Lab Co-op)]

Before the Minister responds, I make it clear that these should be questions, not speeches.