NHS: Elective and Cancer Care Backlog

Lord Kamall Excerpts

Tuesday 7th December 2021 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government what assessment they have made of the reasons for the backlog of NHS elective and cancer care work that pre-dated the COVID-19 pandemic.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

The backlog in elective and cancer care before Covid-19 was caused by a range of factors including a mismatch in demand and activity, which drove waiting lists’ growth. To address this, the Government have provided additional investment of £33.9 billion by 2023-24 for the NHS long-term plan to grow the amount of planned surgery, cut long waits and reduce the waiting list.

[Lord Rooker (Lab)]

That answer comes nowhere near responding to the NAO report on the NHS backlog published last week. When will we be able to return to Labour’s legal legacy of 92% of patients getting treatment in 18 weeks, instead of the miserable figure under the Tories of 83% because they are running down the NHS, which has led to hundreds of thousands extra on the waiting list?

[Lord Kamall (Con)]

I thank the noble Lord for this Question on an otherwise quiet day for me. There was growing demand on the NHS before the Covid-19 pandemic, with growing referrals across elective and cancer care. This is driven by an ageing, more affluent population. On what we do about it, we set out our ambitions in the NHS long-term plan. I do not call a £33.9 billion budget increase by 2023-24 an abandonment of the principles. We are looking at the waiting lists and are looking to get them down.

[Lord Clark of Windermere (Lab)]

One of the reasons for the backlog is poor patient flow. The key exit block is from hospitals into care homes, and the problem is the lack of staff being attracted into those homes. Will the Government look at some unexpected ways of dealing with this issue—possibly even offering a bonus to members of staff of care homes and the NHS who spend several months working for their service?

[Lord Kamall (Con)]

The noble Lord raises an important point about making sure that patients are released earlier from hospital into care homes, and into their own homes as well. I have answered questions previously on what is being done to make sure that it is as joined-up as possible. Some 75% of patients on the waiting list do not actually require surgical treatment but are waiting for diagnostics. The Government have invested in rolling out 100 new diagnostic centres. Some 80% of patients who require surgical treatment do not actually require an overnight stay in hospital, while 20% of people waiting for surgery are waiting for musculoskeletal or eye-related surgery. In many ways we know what the issue is—it is targeting.

[Baroness Stuart of Edgbaston (CB)]

My Lords, the waiting lists are clearly too long. Will the Government undertake a comparative analysis of whether the backlog pre Covid was better handled in Scotland and Wales than in England?

[Lord Kamall (Con)]

As the noble Baroness will recognise, health is a devolved matter. It is important that we look at international comparisons, so not just among the devolved Administrations but internationally. That is one of the things we are doing to make sure that we focus, improve and tackle the backlog.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, of the many millions of people in the growing waiting lists, how many are waiting for surgery and how many for appointments?

[Lord Kamall (Con)]

Seventy-five per cent of patients do not require surgical treatment, and 80% of those requiring it can be treated without an overnight stay in hospital. One of the ways of addressing that is to make sure that we roll out diagnostic activity. We have allocated £2.3 billion to make sure that we roll out at least 100 community diagnostic centres by 2024-25, not only on NHS properties but in places such as shopping centres.

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, this week the Royal College of Emergency Medicine reports that 40 hospitals have cancelled at least 13,000 operations over the last two months because of the surge in demand, as well as the high number of Covid patients in hospitals. The Government winter plan says that there will be extra beds and staff to help, but there are no beds or spare staff right now, so what are the Government proposing to do before many of these patients end up back in A&E because of their delayed surgery?

[Lord Kamall (Con)]

One thing that the Government are doing is looking at a number of different ways in which we can think outside the box and be multifaceted to make sure that, for example, instead of patients going directly to A&E they can be dealt with by 111 or other services. In addition, we are committed to delivering 50,000 more nurses, growing the workforce and making sure that we have a trained workforce not only in healthcare but in social care.

[Baroness Wheeler (Lab)]

My Lords, the NAO report clearly showed that performance against NHS waiting times had been steadily deteriorating prior to the pandemic, and that during the pandemic there were between 24,000 and 74,000 missing urgent GP referrals for suspected cancer. For the most common cancer in the UK—breast cancer—it is estimated that the disruption in screening services during Covid means that 12,000 people are living with undiagnosed breast cancer, 10,600 fewer breast cancer patients started treatment and 20,000 fewer people last year were referred for breast checks. What specific action is being taken to address this deeply worrying situation?

[Lord Kamall (Con)]

Even before the pandemic there was a growing number of referrals across elective and cancer care. This had been driven by a number of different factors, including people’s awareness of cancer, the symptoms associated with it and media campaigns. In addition, one of successes of having an ageing population is that people face a number of different issues. For example, over half of cancers are diagnosed in patients over 65. We know that we have to tackle this issue. That is why we have published the long-term plan with a £33.9 billion budget.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Is the Minister content that the NHS has a workforce strategy sufficiently robust to ensure that the extra funds provided can be effectively deployed?

[Lord Kamall (Con)]

In June 2019 the NHS published a people plan that would improve the NHS workforce, including a dedication to recruit more nurses. We continue to work hard to deliver that commitment. Latest workforce figures show that there are 5,100 more doctors and more than 9,700 more nurses.

[Lord Hamilton of Epsom (Con)]

My Lords, I will follow on from the question from the noble Lord, Lord Kakkar. Unlike the noble Lord, Lord Rooker, I believe that the Government have ploughed ever increasing amounts of taxpayers’ money into the NHS. Does the Minister think that the Government have got good value for money?

[Lord Kamall (Con)]

My noble friend makes an important point. What matters is not just the amount that you put in but the way that you spend it. This is why the Government announced the NHS long-term plan to look at where we should tackle issues and the nature of waiting lists and, given that much of the waiting list is for diagnostics, roll out diagnostic centres to meet that challenge.

[Lord Stirrup (CB)]

My Lords, an exacerbating factor in the size of waiting lists more generally is the number of patients referred unnecessarily to secondary care specialists. One way of addressing this problem is to make more time available to GPs to investigate patients’ symptoms more carefully. Does the Minister agree that, in looking at the overall issue of waiting lists, we have to take into account the needs of primary care as well and not just secondary care?

[Lord Kamall (Con)]

The noble and gallant Lord makes the very important point that we have to look at the whole way we configure our system of healthcare in this country. Many things that were previously done in secondary care can be done in primary. In fact, some of the things that were done in GP surgeries can now be done in the community in diagnostics centres or even in pharmacies, as many people who have had their booster recently will acknowledge.

[Lord Watts (Lab)]

My Lords, coming back to the point made by my noble friend Lord Rooker, when will the Government get back to Labour’s figure so that people who are waiting in pain will know when they will get treatment? When will he get back to those historic levels?

[Lord Kamall (Con)]

The Government have announced the NHS long-term plan. We have had a budget increase. We are focusing on a number of different issues. One of the challenges over recent years has been the ageing population. That should be a positive thing and we want to make sure that we look at the new health challenges that we face for the future.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that one-fifth of patients with cancer are diagnosed in emergency departments across the country? When patients are diagnosed late, the nature of cancer and its progressive metastasising behaviour means that, by the time they are diagnosed, the treatment burden is greater and the cost to the NHS goes up. Early diagnosis becomes the only way to tackle the overall problem.

[Lord Kamall (Con)]

The noble Baroness makes a very important point—as did the noble and gallant Lord—about how we reconfigure our healthcare system to make sure that we catch these diseases much earlier in the system rather than waiting for secondary referral. This is not only in primary care but lots more self-diagnosis with more technology now in the home and elsewhere.

Health and Care Bill

Lord Kamall Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Bill be now read a second time.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, over the pandemic the NHS has worked wonders. Throughout the greatest challenge that our health and care system has ever faced, the extraordinary dedication, care and skill of the people who work in our communities and hospitals have been unwavering, and I am sure that the whole House would want to put on record our thanks and admiration for staff across the health and care system.

The Government believe that part of that thanks must be in the form of giving the NHS the Bill that it wants, the Bill that it has asked for and the Bill that it needs to take better care of all of us. Some may say that this is the wrong time for this legislation. The Government and, more importantly, the NHS disagree. The Bill builds on the progress that the NHS made during the pandemic. Under crisis conditions, the NHS evolved, finding new reserves of incredible creativity, innovation and collaboration. It rolled out an extraordinarily successful vaccine programme, it drew on our collective strengths to deliver a programme reaching every corner of the United Kingdom and it has continued to deliver.

But the NHS has told us that the current legislation contains barriers to innovation that the Government feel duty-bound to remove. The NHS has asked for more flexibility to enable local leaders to try out new things—not as a free for all but in ways that best suit local needs and ensure that the system can evolve. The NHS has asked us to protect and nurture the innovation and hard-won lessons of the pandemic, as we begin to build back better.

Much of the Bill is not new: it builds on years of work on the ground to integrate care, on the work outlined in the NHS Long Term Plan and on years of experience, effort and learning, and of the system pushing the legislation to its limits to do what is best. It also builds on the Integration and Innovation White Paper that we published in February 2021, and on the many consultations that we have held on different aspects of the Bill. The NHS asked for legislation to make it fit for the future, and we are delivering. The Government believe that this is the right Bill at the right time, with wide support for the principles of embedding integration, cutting bureaucracy and boosting accountability.

I am sure that noble Lords will agree that one of the biggest challenges facing the NHS is the workforce. The Bill proposes a duty on the Secretary of State to report on the workforce “once every five years”. The Government are asking the NHS to develop a 15-year strategic framework for workforce planning, and we are looking to merge NHS England and Health Education England to deliver this. We are on track to deliver on our promise of 50,000 more nurses by March 2024.

The Government believe that this Bill will also help to deliver adult social care reform. In September, we announced plans to invest an additional £5.4 billion to begin a comprehensive programme of reform. Last week, we published our reform White Paper, People at the Heart of Care. This sets out our vision for adult social care and our priorities for investment, with measures including a new £300 million investment in housing and a £500 million investment in the workforce, to bring tangible benefits to people’s lives.

The Government recognise that their amendment to the adult social care charging system was considered controversial. However, it is necessary, fair and responsible. Everybody, no matter where they live in the country, no matter their level of starting wealth, will have the contribution they have to make to the cost of their care capped at £86,000. Those with lower levels of wealth will be far less likely to have to spend this amount, thanks to a far more generous means-testing regime that we will introduce. To be clear, the Government believe that nobody will be worse off in any circumstances than they are in the current system, and many people will be better off.

Furthermore, without this change, two people with the same level of wealth, contributing the same amount towards the cost of their care, could reach the cap at very different times. This is not considered fair. A fairer system is to have the same cap for everybody, and then provide additional means-tested support so that people with less are unlikely ever to spend that amount.

At its heart, this Bill is about integration. It builds on the lessons of the pandemic, when the NHS and local authorities came together as one system and not as individual organisations. New integrated care boards and integrated care partnerships will build on the progress made so far to plan, to join up services and to deliver integrated care. We are grateful for the work done to develop these clauses by both the NHS and the Local Government Association.

We have listened throughout the Bill’s passage in the Commons to concerns that we are enabling privatisation. Nothing could be further from the truth. To put this beyond doubt, we amended the Bill in the other place to make it clear that that no one may be appointed to an ICB who would undermine the independence of the NHS, either as a result of their interests in the private healthcare sector or otherwise.

Many noble Lords will be aware of the integration White Paper announced in September and currently in development. I can assure the House that this will build on the integration measures in the Bill, to go further and faster and to deliver person-centred care. We expect to publish it in early 2022.

As I have mentioned, a key aspect of this Bill is removing bureaucracy where it gets in the way. While bureaucracy often ensures that there are processes and procedures in place, we all know how excessive bureaucracy can make sensible decision-making harder. We believe that health and care staff are able to deliver better when they are trusted and given space to innovate, with barriers removed. Every NHS reform has claimed to reduce bureaucracy, with varied degrees of success, but such reforms have often been top-down. These reforms come not from the top down but from the bottom up, giving the NHS what it has asked for. This includes introducing a new, more flexible provider selection regime that balances transparency, reducing bureaucracy and fair and open decision-making.

It is right that the day-to-day decisions about how the NHS is run, both locally and nationally, are free from political interference. However, it is also right that there is democratic oversight and strong accountability in a national health system that receives £140 billion of taxpayers’ money every year. The public deserve to know how their local health system is being run. Integrated care boards will hold meetings publicly and transparently, and the Care Quality Commission will have a role in reviewing integrated care systems.

The Bill also ensures greater accountability from healthcare services to government, to Parliament and, ultimately, to the public. Through new powers of direction, the Government will be able to hold NHS England to account for its performance and take action to ensure that the public receive high-quality services and value for taxpayer money. Equally, we must ensure that there are safeguards and transparency mechanisms in place. That is why the Bill is clear that the new power of direction cannot be used to intervene in individual clinical decisions or appointments. The public also expect Ministers to ensure that the system conducts reconfiguration processes effectively and in the interests of the NHS and, where necessary, to intervene. In such instances, the Bill provides a mechanism for the Secretary of State to intervene, subject to the advice of the independent reconfiguration panel.

As we all know, the health challenges that we face are not static, so the NHS must continue to be dynamic. As the noble Lord, Lord Darzi, once said:

“To believe in the NHS is to believe in its reform”.—[Official Report, 11/10/11; col. 1492.]


The Government believe that this Bill allows the NHS to meet the challenges of today and adapt to those of tomorrow. With this Bill, we can look beyond treating disease and focus on prevention with measures to promote good health, such as tackling obesity and stopping the advertising of less healthy products to children. This Bill includes a range of important additional measures, including the establishment of the Health Services Safety Investigations Body, or HSSIB—a world-leading innovation in patient safety—and legislation to ban virginity testing to fulfil the Government’s commitment to the most vulnerable.

The Government believe that the founding principles of the NHS—taxpayer-funded healthcare available to all, cradle to grave and free at the point of delivery—remain as relevant now as they were in 1948. To protect these values, we must back those who make them a reality every day of their lives by building and constantly renewing a culture of co-operation and collaboration. I commend this Bill to the House.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I put on record my thanks and gratitude for this excellent and wide-ranging debate. I hope noble Lords will understand that I may not be able to answer every point in the time available—unless they are prepared to stay here all night. I am grateful for the constructive and thoughtful contributions of noble Lords from all sides of the House. When I first entered this House, a noble friend who was a Minister here and in the other place said that, in the other place, you are probably one of the few experts on the Bill you are taking through, but in this place there will be at least one other expert. I disagree: there are many experts who will know far more about this than I do, but I look forward to learning from noble Lords across the House and listening to their expertise.

I echo those who praised the excellent maiden speech of the noble Lord, Lord Stevens. He will be a valuable addition to the House. I caution against describing him as a treasure, because the problem with treasures is that people want to lock them away, put them behind a glass case, or bury them.

The noble Baroness, Lady Merron, asked how the Bill would be different from previous reorganisations. I make it clear that this is not a reorganisation that comes from my office or my right honourable friend the Secretary of State’s office in Victoria Street. Instead, the Bill builds on the evolution up and down the country over the last decade led by the noble Lord, Lord Stevens of Birmingham, to deliver joined-up care.

This is the right Bill at the right time, as the noble Lord, Lord Adebowale, said. I was extremely struck by the contributions of the noble Lords, Lord Kakkar, Lord Adebowale, Lord Stevens, and my noble friends Lady Harding and Lord Hunt of Wirral, in support of the principles underlined in the Bill. I am grateful for their support. As the noble Lord, Lord Stevens, said, the Bill is not a cure-all; no Act of Parliament could ever be. However, it can set the framework for people to find solutions that work; that approach has been the guiding light.

I will now address some of the issues raised across the House. As the noble Lord, Lord Mawson, said, integrating services around people is the only sustainable way of delivering high-quality health and care systems and, more importantly, delivering improved outcomes for everyone. This has been a goal of health systems across the world, and it is at the heart of the provisions in this Bill, including putting new integrated care systems on a statutory footing. To meet that challenge, a key principle of the Bill is to ensure that the legislative framework is flexible and responsive to local population needs. It is right that local areas should be able to determine the arrangements that work best for them. Frimley is not Cumbria; we should not try to create a one-size-fits-all single model for both.

To protect this flexibility, I ask noble Lords to consider whether it is appropriate to add additional prescriptions on membership and duties for integrated care boards and integrated care partnerships, although we will, of course, be happy to consider suggestions for additional guidance and support for the system. In that spirit, I hope that I can reassure the noble Baronesses, Lady Tyler, Lady Walmsley, Lady Masham, and other noble Lords who raised this, that we are working with NHS England and the Department for Education on bespoke guidance in relation to children, including the vital issues of safeguarding, special educational needs and disabilities.

I thank my noble friend Lord Farmer for raising the role of family hubs, and for his sustained work in advocating for the family hub model. I assure him that this Government have committed to championing family hubs and we are working to roll them out. I also assure the noble Baroness, Lady Pitkeathley, and other noble Lords that we are fully committed to supporting carers, including consulting them in the development of services. I reassure the noble Baronesses, Lady Finlay and Lady Meacher, and my noble friend Lady Hodgson that integrated care boards will be responsible for commissioning palliative care services as part of a comprehensive healthcare service.

This may be a convenient moment to consider the question of parity of esteem, as raised by a number of noble Lords, including the noble Baronesses, Lady Thornton and Lady Watkins, my noble friend Lady Morgan of Cotes, the noble Lord, Lord Bradley, and others. References to health in the Bill will already apply to mental, as well as physical, health. Likewise, I hope that I can reassure many noble Lords, including the noble Lords, Lord Patel and Lord Desai, and the noble Baroness, Lady Walmsley, that tackling inequalities is deeply embedded in the Bill. Given the backgrounds of both my right honourable friend the Secretary of State and myself, we believe very strongly in tackling inequalities. At the same time, I remind noble Lords of the establishment of the Office for Health Improvement and Disparities, with the focus on disparities and tackling inequalities. It is important that we give our support in tackling disparities right across our nation.

Integrated care partnerships will plan to address local needs, including the wider determinants of health, and the triple aim places new duties on NHS bodies to consider the health and well-being of the people of England when discharging all their functions. I listened carefully to the concerns raised by the noble Lord, Lord Mawson, and the noble Baronesses, Lady Merron and Lady Pinnock, on the principle of subsidiarity—the role of place. We want to empower local leaders to support integrated and person-centred care at place level.

The noble Baroness, Lady Brinton, my noble friend Lord Lansley, the noble Lord, Lord Bradley, and others raised the question of why we are putting forward a two-board approach. This approach recognises the importance of integration, both within the NHS and between the NHS and its wider partners. I reiterate that this was co-designed with both the NHS and the Local Government Association. I hope that I can reassure the noble Lords, Lord Howarth and Lord Crisp, that ICPs—integrated care partnerships—will have flexibility to draw members from a wide range of sources including organisations with a wider interest in local priorities, such as housing providers and education, as well as art and culture organisations.

The noble Lord, Lord Kakkar, asked why the Bill provides for CQC assessment of integrated care systems. It is important that members of the public can understand how well their health and care system is collaborating and that their local hospital is providing a safe, high-quality service.

My noble friend Lady Blackwood and other noble Lords raised the importance of research. I assure the House that we share the objective of wanting to see research embedded in the health and care system, not only to improve healthcare outcomes but to contribute to the goal of making the UK a hub for life sciences globally.

To address the contributions from the noble Baronesses, Lady Bakewell and Lady Chakrabarti, I assure the House that we have no intention of opening the door to privatisation. As the King’s Fund has said, there is nothing in the Bill that is likely to drive more NHS funding towards private companies—a sentiment echoed by the noble Lord, Lord Adebowale. I also remind noble Lords that successive Labour and Conservative Governments have seen the value of collaboration between the voluntary sector, the private sector, social enterprises —as mentioned by the noble Baroness, Lady Thornton, and the noble Lord, Lord Kerr—and the state.

On integrated care boards, the right reverend Prelate the Bishop of Carlisle and the noble Baroness, Lady Walmsley, asked about transparency. Integrated care boards are covered by the Public Bodies (Admissions to Meetings) Act and will be bound by the principles of openness and proper public engagement.

I listened to my noble friend Lord Bethell with great interest. I agree that data sharing is essential to true integration. I know that many other noble Lords support this but they also, rightly, raised some concerns. The information provisions in this Bill are part of a wider range of commitments set out in the draft data strategy. We will ensure that the system has the ability and competence to share and use data appropriately and effectively to benefit individuals, populations and the health and social care system.

I listened carefully to the many contributions on social care from the noble Baronesses, Lady Thornton and Lady Campbell, and many others. Social care reform is a challenge ducked by generations. Successive Governments have commissioned reports on social care only to see them gather dust on bookshelves and never be enacted. This is the first attempt for many years to tackle a long-standing issue. Many noble Lords have spoken about it being ignored for 10, 20, 30 or 40 years. Anyone who has looked at the history of demographics and economic history will know that this challenge was coming a long time ago, yet successive Governments have kicked it down the road. We hope that this Bill, alongside the upcoming integration White Paper and the recently published social care White Paper, will go towards meeting that challenge. The social care White Paper sets out a 10-year reform vision that puts people at the centre of social care. It will ensure greater choice, control and support to lead an independent life with fair and accessible care.

We are backing that vision with investment. The Prime Minister has announced an additional £5.4 billion to begin a comprehensive programme of reform, including an extra £3.6 billion to reform the social care charging system, an extra £300 million of investment in housing, £150 million of additional funding to improve technology and increase digitalisation across social care, and £500 million of investment in the workforce. As technology improves, we hope that the nature of social care will change, enabling many more people to spend longer lives in their own homes with adaptations and better technology. Would it not be great if the United Kingdom were at the forefront of those technological developments?

I recognise the strength of feeling in relation to Clause 140, but I remind the House that it is absolutely essential that noble Lords look at the package of social care reforms as a whole. Our reforms will stop unpredictable and unlimited care costs, significantly increase the means test to help those with the least wealth and help people to plan for the future.

I hope that noble Lords will recognise that, as my right honourable friend the Secretary of State said in the other place, nobody will be worse off in any circumstances than they are in the current system and many people will be better off. The reforms mean that the Government will now support an extra 90,000 older care users at any given time. Comparisons have been made to previous proposals for reforms to the charging system. I remind noble Lords that many of these were not in fact acted on, partly due to concerns over unaffordable costs. Unlike previous proposals, our reform package is credible, deliverable and affordable.

There has rightly been much discussion of workforce planning for the NHS and adult social care. I have listened carefully to the contributions on this very important subject made by many noble Lords, including my noble friends Lady Harding and Lady Cumberlege, the noble Lord, Lord Patel, and the noble Baronesses, Lady Cavendish and Lady Thornton. Ensuring that we have the health and care workforce that this country needs is a priority for this Government, and the most recent figures show that there are record numbers of staff working in the NHS, including record numbers of doctors and nurses.

The Bill builds on this work. Clause 35 will bring greater clarity and accountability to this area. The department has also commissioned Health Education England to work with partners to develop a long-term 15-year strategic framework for the health and regulated social care workforce. For the first time, this will include regulated professionals in adult social care. That work will look at the key drivers of workforce supply and demand over the longer term and set out their impact on the future workforce. We anticipate publication in spring 2022. Supporting all this work is our recent announcement of our intention to formally merge Health Education England with NHS England. Such a merger will help to ensure that workforce is placed at the centre of NHS strategy.

I now turn to some of the wider issues raised during this excellent debate. I beg your Lordships’ indulgence, as time may not permit me to answer every point raised, and I commit to write to noble Lords whose points I do not address. I hope noble Lords will forgive me for the time I may take to write some of those letters.

On the power of direction for the Secretary of State, I am afraid I cannot agree with the characterisation suggested by some noble Lords. Instead, I would echo the former shadow Minister in the other place who said that

“the public think that the politicians they elect are accountable for the decisions taken in the interests of their health”.—[Official Report, Commons, Health and Care Bill Committee, 21/9/21; col. 393.]

We agree. I would also like to assure the noble Lord, Lord Stevens, that Ministers have no intention of requiring hospitals to report on the movement of a broom cupboard. I am afraid that is a mischaracterisation, albeit a witty one, of how Ministers intend to use their power.

We anticipate that Ministers will be involved only where decisions become particularly complex or a significant cause of public concern, or if they cannot be resolved at a local level. Local NHS commissioners will continue to be accountable to NHS England and for developing, consulting on and delivering service change proposals. However, we believe that strengthening democratic oversight will make it more likely that the right decisions will be taken. Any decisions will be based on the evidence and consultations that have taken place, and where the Secretary of State chooses to intervene they will, rightly, be accountable to Parliament and the public.

I welcome support for the establishment of the Health Service Safety Investigations Body and agree with the noble Baronesses, Lady Merron and Lady Walmsley, and others that it is essential that the HSSIB is an independent body and a safe space. This is what the Bill delivers. It was always difficult to achieve the right balance between openness and getting people to come forward so that we can make sure that we improve and learn lessons.

As raised by the noble Baroness, Lady Meacher, the Bill contains a number of delegated powers. Many of these are not new but simply reflect the replacement of clinical commissioning groups with the new integrated care boards. Far from a power grab by the Secretary of State, many of these powers will be exercised by the NHS.

The noble Baronesses, Lady Pinnock and Lady Jones, and my noble friend Lord Reay raised the question of fluoridation. I gently remind noble Lords that although tooth decay can be prevented or minimised by adherence to a healthy diet, water fluoridation is seen to be the only intervention to improve dental health that does not require sustained behavioural change over many years. It also disproportionately benefits poorer or more disadvantaged groups.

As many noble Lords have commented, prevention is in many ways better than cure. That is why we are so concerned about childhood obesity, a concern shared by noble Lords across this House. It is one of the biggest health problems this nation faces, and I am grateful to many noble Lords for the support that related measures have received today. We want to be quite clear that, as these measures are taken forward by local integrated boards and commissioners, we must rely on evidence, learn lessons and, when something does not work, try something else. We have to use the power of discovery to make sure that we are finally able to put obesity to bed or to reduce it on a significant scale.

I was also grateful for the intervention of the noble Baroness, Lady Brinton, in relation to reciprocal healthcare agreements. I hope I can assure her that such arrangements will be entered into only when they are in the best interests of the people of the UK and the NHS. The NHS is not, and never will be, for sale to the private sector, whether overseas or domestic.

I thank my noble friend Lady Cumberlege for her remarks and for her tireless work in championing patients, ensuring that the voices of patients and their families were heard in her First Do No Harm report. My noble friend continues to be a voice in the House for patients in general, and for the women and their families who have been so terribly affected by matters covered in her review. She continues to champion their cause and their calls for redress. We are committed to making rapid progress in all areas set out in our response, and we aim to publish an implementation report in the summer of 2022.

Finally, I welcome those, including my noble friend Lady Hodgson, who raised the issue of hymenoplasty. The Government agree that this is a repressive and repulsive procedure. We have convened an independent expert panel to make a recommendation on whether it should be banned. That recommendation will be published before Christmas.

This Bill is the product of extensive engagement with stakeholders across the health and care system, including partners in local government as well as the NHS. It will provide a platform that empowers local leaders across health and care to build back better and to continue to deliver a world-class service, fit for the 21st century and beyond. I urge noble Lords across the House to trust the judgment of our health and care staff as much as we value their commitment and their care. I know that noble Lords will work together to make this Bill better during the coming weeks and I commend the Bill to the House.

Bill read a second time and committed to a Committee of the Whole House.

Coronavirus Act 2020 (Early Expiry) (No. 2) Regulations 2021

Lord Kamall Excerpts

Monday 6th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 27 October be approved. Considered in Grand Committee on 30 November.

Relevant document: 18th Report from the Secondary Legislation Scrutiny Committee.

Motion agreed.

Health and Social Care

Lord Kamall Excerpts

Monday 6th December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

I, too, thank the Minister for the Statement and I start by thanking all our NHS and social care staff, at all levels—back room or front line—for all they are doing to keep the NHS and social care going while under the most extraordinary, sustained pressure.

Like others, I am struggling to see what is new in the Statement, which admits that the funding mentioned is not new. Although there is marginally more detail on how some of it will be spent, it is very light on by when the extremely urgent investment will deliver the help that our NHS and the public who use it desperately need.

Repeatedly, the Statement, and the accompanying so-called policy paper, The Health and Social Care Approach to Winter, refer to the urgent need to recruit more staff for both the NHS and the social care sector. However, it reports that currently, the NHS has an 8% vacancy rate at all job levels, and the social care sector, which has had more than 100,000 vacancies for some time, has had a further 3% reduction in staff since March this year.

Although there are proposals to increase staffing, can the Minister please explain where those staff will come from if they have not been able to be recruited over the past few months? How long will it take to recruit them? It is good that money is being put into the workforce, but I struggle with any suggestion that that will help to deal with the current winter crisis. When will the staff who are desperately needed in health and social care be available to join the teams out in the wards?

Both the Statement and the report talk about using locum services for doctors and agencies for nurses and social care staff, but health and social care employers tell the public daily that the extra qualified people are just not there. One of the problems in social care at the moment is that the NHS is poaching nurses from care homes. Please can the Minister explain who is going to fill those roles, given that training those skilled personnel takes a lot longer than a few months?

I echo the comments of the noble Baroness, Lady Thornton, about delayed discharges. We have all been asking the Minister and his predecessor about specific plans to help the social care sector overcome its problems in the workforce, not just for months but for years. The high level of staff vacancies continues to worsen. Can the Government help in the short term? For example, NHS Providers made the very helpful suggestion today that the Government help to fund a winter retention bonus for social care staff. NHS Providers understands that we must get the log-jam moving, and if the only way to do that is for the Government to help, please will they consider that proposal very seriously?

The Statement says that the NHS needs to be able to offer more appointments, operations and treatments, which is absolutely right, including with the NHS itself. However, the capacity to change to innovative ways of working, with a heavy load of staff vacancies and the current sustained 20 months of intense pressure, seems to be extraordinary. To illustrate this, in the second week of November, there were 966,406 more GP appointments in England compared with the same week last year—and we were not in lockdown at that point last year.

The Statement talks about the transformation funding for elective recovery, announced in September. The plan lists the hospitals that have been successful in getting their schemes approved. I know, from experience in my local area in Watford, that some of the modular ward proposals can move ahead very quickly. Can the Minister tell us the likely earliest delivery date for any one of these projects? Once the buildings are there, when will extra staff be available to make these new wards work? We certainly do not want to see a repeat of the Nightingale hospitals.

The plan says that NHS Test and Trace will be carrying out contact tracing, so will the Minister say whether local test and trace will continue? It is noticeable that this was not mentioned at all, yet only two months ago Ministers were saying that this was where the focus of contact tracing would be. May I repeat the questions that I have asked on at least two occasions to the Minister? What is happening to the funding for the local resilience teams for Covid tracing and other pandemic work from April, given that, at the moment, there is no money in the budget whatever for the next financial year?

Last week, the Minister wrote to my noble friend Lady Thomas of Winchester about the delivery of vaccines to the vulnerable housebound who cannot go out either to their GP’s surgery or to vaccination centres. He wrote to her after the Question, confirming that GPs have a duty to offer vaccines to the housebound. He went on to say:

“If there are no GP practices signed up to phase 3, the CCG will make these alternative arrangements instead.”


Today’s Daily Telegraph talks about more than 300,000 people—more than two-thirds of the housebound—having yet to receive their booster doses. This is not hesitancy in people coming forward; it is clear that there is a problem. With many GP surgeries having withdrawn from delivering booster jabs because of their increased workload, can the Minister tell me when CCGs will be setting up these new systems and, most importantly, contacting and reassuring this vulnerable group of people about when they will get a visit from the mobile vaccination team? Putting the booster programme on steroids for all adults is of no use if the most vulnerable are not even being contacted. I look forward to hearing from the Minister. If he does not have the answers at his fingertips, I ask him to write to me.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank both noble Baronesses for their questions and for acknowledging that I may not have all the answers immediately; I will commit to write to them if I do not.

I will start with the questions on hospital beds and discharge. We are very aware that we have put in £478 million to get patients out of hospitals, freeing up beds. The NHS is also giving ambulance trusts an extra £55 million to boost numbers. It is our priority to ensure that people are discharged safely from hospital to the most appropriate place, and that they receive the care and support that they need. Our guidance sets out how the health and social care system is continuing to support the safe and timely discharge of people in hospital. People who are clinically ready are supported to return to their place of residence where possible, where an assessment of longer-term needs takes place using the discharge-to-assess Home First model.

New or extended health and care support is funded for up to four weeks, until the end of March 2022. During this period, a comprehensive care and health assessment for any ongoing care needs, including determining funding eligibility, should take place. Since March 2020, we have made nearly £3.3 billion available via the NHS to support enhanced discharge processes and implementation of the discharge-to-assess model. This approach means that people who are clinically ready and no longer need to be in hospital are supported to return to their place of residence. We are also reviewing the way that we look at this scheme and how it works. We are very much aware of the issues raised about how we make sure that people are discharged in the most appropriate manner.

On the issue of investment, a number of trusts were asked to bid for funding, very much on the basis of which of those schemes could be delivered immediately and which were longer-term. Trusts have now been informed that their bids have been approved, and they are beginning to work to deliver them. NHS England and NHS Improvement will be monitoring the programme closely. Schemes were selected that could deliver immediate solutions that will support elective recovery this winter, as well as over the next three and a half years and beyond. This is just one element of how we are looking to make sure that we are dealing with things in the short term.

As the noble Baroness, Lady Brinton, acknowledges, some of these modular systems can come up to speed quickly, and that was considered in the bids that were put forward. Funding was allocated on a regional basis, based on the number of people living in each area, to ensure that funding is equally spread across the country. NHS regional teams identified and prioritised individual schemes and DHSC evaluated and approved them to ensure that the schemes that had the highest potential to help us reduce waiting lists for elective care were selected.

We have looked at a number of areas and, looking at the regional breakdown, we have had about £112 million in the north-east and Yorkshire; £97 million in the north-west; £131 million in the Midlands; £78 million in the east of England; £105 million in the south-east; £69 million in the south-west; and £109 million in London. There are a number of different schemes at various hospitals, on which I would be very happy to go into more detail if asked.

Turning to waiting lists, we need to recognise that 75% of people waiting do not require surgical treatment; 80% of those requiring surgical treatment can be treated without an overnight stay; and 20% of patients are waiting for ophthalmology treatment for eyes, or orthopaedics for bones, muscles and joints. So we are looking at how, on a targeted basis, we can address that backlog. We hope that, with the new diagnostic centres rolling out, we should be able to tackle a lot of that backlog.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare my interest in relation to medicine, the BMA and the Royal College of Emergency Medicine, and I would like to ask about emergency medicine. The winter flow data from the Royal College of Emergency Medicine has data from 40 sites across the UK. They are reporting that, in November, there were 275,596 attendances. Their long hospital stays had increased by 13% to more than 48,000 patients. Their 12-hour stays in emergency departments were twice as high as they had been in the previous year, and that was equivalent to 7.3% of all attendees. Their four-hour performance is incredibly low, at 62%. I know from one department that was built for 28 patients that, on a Monday in November, it had 108 patients in. This becomes unsustainable, and the overcrowding is a danger in terms of Covid and infection. It is also a danger to the welfare of staff because, in this particular department, even the staff toilets were not flushing, so the staff had to leave the department just to excuse themselves.

The estate takes time to rebuild and be repaired. What is being done with projects now to create additional space for emergency departments to manage this overcrowding? Is there targeted money going to make sure that the departments are in a good condition of maintenance for the staff? Separate, but related, to that, is the pension block, which has stopped doctors from returning from retirement and has pushed some doctors into early retirement, being addressed in the long term? It is important that doctors who have retired because their pension pot has reached its limit can be incentivised to come back to take pressure off in GP surgeries and in hospital departments, particularly out-patient departments, by seeing patients where their long-term experience and wisdom can contribute to the clinical services.

[Lord Kamall (Con)]

I thank the noble Baroness for the points she makes. We are doing what we can to support the dedicated NHS staff in healthcare services. This year alone, we have invested over £15 billion on top of the existing NHS annual budget, and that includes funding to help get patients out of hospital, freeing up beds and supporting hospitals to manage Covid-19. In addition, we are looking at how we can tackle capacity issues on NHS 111 and A&E. We are giving NHS 111 £98 million to boost capacity, help people avoid unnecessary ambulance trips to A&E and take pressure off hospitals. We realise that NHS 111 is often the first port of call to provide urgent medical advice quickly and book time slots for people at their local A&E or appointments at alternative services. We are also delivering the largest ever seasonal flu vaccination programme, so we hope to tackle it on that basis. A number of CCGs and others are having conversations about how we can tackle the pressures on A&E.

The noble Baroness makes the point about staff who, during Covid, went way beyond the call of duty, and we managed temporarily to address those concerns. We are very grateful to staff who had retired and returned, and we are looking at whether that can be a long-term solution. We need to make sure that no one who is willing to come back is disincentivised. I do not have the details at the moment but I commit to write to her.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the first paragraph of this Statement says that it outlines

“the preparations we are making so that health and social care services remain resilient … and available to patients”.

How does that square with the fate of the residents of Berkeley House in Kent, which was home to adults with severe learning difficulties and autism, who were told at 7.30 in the morning that they would have to leave by 5 that evening? Among them was one resident who had to be sedated to ensure he could safely be moved. Berkeley House is owned by Achieve Together, one of a chain of companies registered through the tax haven of Jersey that ultimately appears to be owned by AMP Capital, a global investment firm based in Australia. How does providing a “resilient … and available” social care system line up with homes such as this being run for profit, not for the public or the residents’ good?

[Lord Kamall (Con)]

We have to recognise that if we look at the social care system, there are an awful lot of private providers. Quite often, when we look at private providers, it is private patients who subsidise their ability to provide places for state-funded patients. In our health system overall, there will always be a mixed economy, including state provision. Lots of our GPs, for example, are partnerships—they are not state-run, some of them are co-operatives, some are even for profit. When we look at the overall health system, there will be a general balance. I am not aware of the particular case, so I thank the noble Baroness for raising it, but one of the things we are committed to is making sure that we improve services, whether they are state-funded or private, as part of the overall system of healthcare that we have in this country. Clearly, where providers are not providing a service, there will be CQC and other assessments to see whether they are fit.

[Baroness Walmsley (LD)]

My Lords, Covid-19 is absolutely rife in our schools, both primary and secondary. Teachers are in the front line. There are whole classes and even whole year groups being sent home because the teachers are off sick and they cannot even get supply teachers. A lot of teachers are under 40. Why can they not get boosters? If vaccines really are the answer, during this winter period, that would help more children to be able to stay in school and avoid disrupting their education. Will the Minister tell us about that?

Secondly, I go back to what both noble Baronesses on the Front Bench raised. Where are the social care staff going to come from? When I looked at the paper that sat behind this Statement, I noticed that there was nothing in it about changing the salary level at which visas can be offered to social care workers coming from abroad. Why not? We are desperate for social care workers. Can the Minister tell me—and if he cannot, perhaps he will write to me—what proportion of vacant posts fall below the salary level required for a visa?

[Lord Kamall (Con)]

In terms of tackling the social care workforce, there are a couple of things: £162.5 million is going on a number of different schemes to make the social care sector an attractive place to work and we are looking, longer term, at professionalisation, so that people feel valued. At the same time, the minimum wage will help lift the pay of many people in social care work, but in the longer term we want to make sure that social care is not seen as the poor relation of other parts of the health service. We want to make sure that we have professionalisation and that it is all joined up. Some of these things will not be tackled in the short term, but we have a short-term programme called Made with Care, which is aimed at targeting and recruiting people to come and work in the social care sector. We realise that we have to do the long-term things, but also to promote short-term measures to tackle the issues we have at the moment. On specific statistics, as I am sure the noble Baroness can imagine, I do not have the details at hand but I commit to write to her.

[Baroness Pinnock (LD)]

My Lords, I draw the attention of the House to my registered interests as vice-president of the Local Government Association and as a member of Kirklees Council. I want to pick up on issues raised already by the noble Baroness, Lady Thornton, and my noble friend Lady Brinton, and the point that the Minister himself has just made about professionalising the workers in social care. On one hand, as the noble Baroness, Lady Thornton, said, there are no spaces in social care for older people to be discharged into, because of a lack of availability of staffing, and we have heard already about some care homes being closed. The issue at the heart of all this is the great chasm of funding being made available for social care.

In my own council area in West Yorkshire, the pandemic has resulted in a 36% rise in demand for social care by adults in the last year, yet the funding from the Government is nowhere near going to meet that demand. What we have then, as a consequence, is older folk who have first gone into hospital because of ill health, and there is then nowhere available for them to be discharged into to continue their recovery and gain back their independence. The chasm of funding is at the heart of this. Can the Minister confirm that the Government will no longer impose the social care precept on the council tax payer, which, since 2016, has been at either 2% or 3% per annum? This is a totally regressive tax and has cost taxpayers in my part of the world well over £200 a year. What is needed is proper funding from the Government, not the bits and pieces that the Government have announced so far.

[Lord Kamall (Con)]

When you look at our health and social care sector, you see that one of the issues is a lack of joined-up thinking over the years. We have seen report after report about the future of adult social care gathering dust on the shelves—not forgetting that lots of people who are not older are also in the social care system. The White Paper we published last week was a first attempt to try to tackle the problem long term. We recognise that you have to look at the long-term issue—which, frankly, successive Governments have kicked down the road for years, and not really tackled—and we have made an attempt to do that with the 10-year vision we published last week. But we have also committed to the first three years of funding, to realise that vision. We now have a framework against which to judge future progress in adult social care, so that, overall, it is no longer seen as a poor relation of the rest of the health system and is properly joined up on a number of different levels—not only career paths but also the data that can be shared, so that you do not have the drop-off that happens when someone leaves hospital and enters a social care home and you have to find all that data again; the home is prepared to accommodate that patient with all their specific needs at the beginning.

In the longer term, with increases in technology, we hope that, instead of patients leaving hospital to go to a residential home, they will be able to return to their own home with the help of technology. All that will take time, but we have laid out that vision.

In the short term, we have laid out the winter plan, which includes looking at how we tackle some of these social care issues and how we recruit more social workers via the £162.5 million. The Made with Care plan will make sure that social care seems more attractive. For a long time, no one has really “sold” social care as a career. We want to ensure that it is seen to be just as valid a career as any other and offers a real career path. We also want to see a professionalisation of the industry, so that people feel valued.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in responding to my last question, the Minister referred to the mixed economy of ownership of healthcare provision. I am sure that he is aware that 84% of care home beds are provided by for-profit providers. Tonight, the “Panorama” programme is looking at HC-One, which is the biggest care home chain provider, with 321 care homes, formed in 2001 from the collapse of Southern Cross. I will not ask the Minister to watch the programme, since I know that he is a very busy person, but will he undertake to look at a summary of it, particularly the fact of the funding of HC-One, which appears to include a £540 million interest-only loan from a New York-listed property company? A great deal of this has been uncovered by the Centre for International Corporate Tax Accountability & Research.

[Lord Kamall (Con)]

I thank the noble Baroness for sharing all that data with me. The point remains that our system of healthcare will, through CCGs at the moment and integrated care services in the future, continue to commission some from the state and some privately; that is the way it is. What is really important is not who provides it but the care that the patient receives at the end of the day, and the fact that taxpayers are getting value for money. We should judge outcomes, not inputs.

Cigarette Stick Health Warnings Bill [HL]

Lord Kamall Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I add my congratulations to my noble friend on progressing his Private Member’s Bill to this stage and on securing this important debate.

Over the past two decades the UK has introduced a range of public health interventions and a strong regulatory framework to help smokers quit, and to protect future generations from using tobacco. Thanks to these, smoking rates in England are down to a record low of 13.9%, from 19.8% in 2011. If we go back even further, we see that the smoking rate was at 45% in the 1970s. As the noble Baroness, Lady Merron, has said, these reductions have been cross-party; Governments of all colours have tried to tackle this issue.

Those reductions are something we should be very proud of but not complacent about. While we celebrate this success, we recognise that there are still 6 million smokers in England, with smoking remaining one of the biggest causes of preventable mortality and, as a number of noble Lords have acknowledged, one of the largest drivers of health disparities. One of the reasons why I am very pleased that we now have the Office for Health Improvement and Disparities is that there will be a laser-like approach in the attempt to tackle these disparities.

Smoking rates still range from 23.4% in Blackpool to 8% in Richmond upon Thames. In addition, smoking rates vary significantly among certain groups. Nearly one in 10 pregnant women still smoke, increasing the risk of health problems for their babies. The Government are determined to reduce smoking rates in groups that smoke disproportionately, as well as across the board—so, work is going on not just in respect of pregnant women but elsewhere. For example, we know that 23% of routine and manual workers smoke, while the rate among people with long-term mental health conditions is nearly 26%. That is why there is so much to do. We have to make sure that we understand those parts of communities where we can, laser-like, focus our action. That is why the Government have set the bold ambition for England to be smoke free by 2030.

The Government recognise the good intentions behind the Bill. I pay tribute to my noble friend Lord Young of Cookham not only for the Bill but for his long-standing commitment to encouraging smokers to quit. My noble friend himself has told me about his work in the 1970s but also as a Health Minister in the 1980s. Let no one be in any doubt that the Government are clear that we strongly support measures to stop people smoking but also to educate current smokers of its dangers. We have already introduced a number of measures, such as graphic health warnings on tobacco packaging and information on packs giving further advice on how to quit.

While we sympathise with the aims of the Bill, we believe that policy should be evidence-led. It is therefore vital that we conduct further research to build up a strong evidence base to support measures before bringing them forward. To date, sadly, no country has introduced such a measure so there is very little evidence so far on its impact in supporting smokers to quit, compared with other measures we are looking at. Several other measures have been tried in other countries—for example, warnings inside the pack as well as outside—and there are a number of other issues we are examining.

The Government are in the process of developing a new tobacco control plan that will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda. We want to explore a broad range of new regulatory measures to support our ambition to be smoke free by 2030. So, I reassure noble Lords that we will be reviewing this proposal as part of that work.

I turn to some of the specific questions that were asked. A number of noble Lords asked about the tobacco control plan. Rather than implementing blanket measures that may not always reach some of the communities that need to be reached, we want to ensure that the plan has an even sharper focus on disparities and that it supports the Government’s levelling-up agenda. We need bold but impactful proposals. With the establishment of the Office for Health Improvement and Disparities, we are going to draw on its advice on how to address the high levels of smoking among some of these groups, and harness that advice to develop robust and effective proposals that will ensure that our plan delivers the smoke-free 2030 that this country deserves.

We are developing policy for the tobacco control plan and intend to publish it next year. There is a current tobacco control plan, which runs until 2022. We hope to include a number of measures that focus on health disparities and groups where smoking rates are not falling fast enough. I have already mentioned pregnant smokers and smokers with mental health conditions, but that also includes smokers in many deprived parts of the country.

We were asked about the amendments to the Health and Care Bill. We were grateful for the suggested amendments, which show support for strong tobacco control, but once again we need to see the evidence and make sure that such measures are targeted at groups we want to encourage, as well as more generally. At this stage we do not believe we should accept the amendments but, as I have said, next year we will be publishing our new tobacco control plan, since the current one runs until 2022.

Some of these examples include stop smoking services, which we have found produce high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have also protected a public health grant over the course of the spending review to ensure that local authorities can continue to invest in stop smoking services, because they have been seen to be successful. As long as they are successful, they will continue to be part of our armoury.

The noble Lord, Lord Moylan, asked about evidence. The Office for Health Improvement and Disparities continues to monitor developments in tobacco control across the world. We share our knowledge with international partners and draw on their evidence-led experiences to make sure that we are introducing effective measures, rather than just introducing measures we feel might work without evidence.

The noble Lord, Lord Rennard, talked about youth smoking. He is absolutely right, but youth smoking rates continue to decline, and they are currently at their lowest rate on record. In 2018, 5% of 15-year olds were regular smokers, 2% of 11 to 15 year-olds were regular smokers, and 16% had never smoked. While the youth rates are declining, we should not be complacent. We know that smoking remains an addiction largely taken up in childhood, with the majority of smokers starting as teenagers and then becoming addicted. We want to build on that recent success and protect young people from harmful tobacco, and we have an area of focus targeted at that.

My noble friend Lord Naseby talked about the tobacco levy. We recognise that the tobacco industry is already required to make a contribution to the public finances through tobacco duty, VAT and corporation tax—in many ways, it pays our wages. The department will continue to work with HMT regarding tobacco taxation and revenue funding. This includes reviewing options such as the future levy, but we want to make sure that it is an effective way to raise additional funds to support stop smoking services.

The noble Baroness, Lady Uddin, was very honest in her appraisal of her ability to stop smoking in her family. But she made some interesting points, not only about having failed to prevent her family smoking but about whether young people will read the warnings on the cigarettes. I think that is a point we have to look at. Will they be dismissed, just as the effectiveness of the warnings on the outside has waned over time? Will the same thing happen here?

[Lord Naseby (Con)]

As I mentioned, I spent 20-odd years in advertising. The Bill says that the warning has to be in red on blank white paper—quite frankly, that will be very difficult to read. If my noble friend is serious about this, I suggest he takes advice from those who know a little more about printing.

[Lord Kamall (Con)]

I thank my noble friend Lord Naseby for that intervention; I will take account of his advice. In fact, I want to thank him for his advice, given the number of years he spent in the advertising industry. Something we are looking at generally in the public health approach in this country are those experts from the advertising industry who have looked at behavioural studies and behavioural economics to encourage people to buy their products or to smoke, and to attract a number of them—as poachers turned gamekeepers—to help us understand the skills they use to attract smokers and people eating high-fat food, and to turn that around to discourage people from taking up smoking and eating food that might cause obesity.

The noble Baroness, Lady Uddin, also talked about smoking in pregnancy, and we recognise this problem. It is sad that 10% of pregnant women still smoke, and they are not falling in line with other groups. Therefore, we are looking at how we address that at prenatal and neonatal clinics, but also during that whole experience. How do we reach those mothers, and would that really be effective?

One of the questions asked was about a number of different ideas that came up. Basically, we want to follow the evidence. That is really important. There is a tobacco plan already in progress, which will end in 2022. Next year, in 2022, we will publish the new tobacco plan, and we are looking at evidence from around the world and at what works. But we also want to see how we can work across government. For example, we are working closely with the Department for Education to ensure that the harms of smoking are in the curriculum, but many of us will remember being at school and receiving education on a number of different issues related to lifestyle. A number of my friends would say, “I’m never going to smoke or drink”, and two years later, I would see them at parties, smoking and drinking.

Therefore, we have to understand how effective these messages are, how long they work for, and how we can make sure that they continue to work. We understand and accept that we need to continue to take action; we must not be complacent. We want to look at the evidence: some 64,000 people still die each year from smoking; two-thirds of long-term smokers will die from it; it is one of the greatest drivers of health disparities and, as many noble Lords have said, it causes a great, heavy financial burden. In fact, each year smoking costs society £12.5 billion, with a cost to the NHS of around £2.5 billion. We believe that making smoking obsolete would free up £15 billion per year, benefiting especially the most disadvantaged families and the most deprived communities.

Given the lack of evidence and the other measures being considered, the Government do not feel that the Bill is appropriate at this point in time. However, the Bill’s requirements will be considered as part of the wider range of regulatory proposals to support our smoke-free 2030 ambition. We want to see evidence-based, targeted proposals and to make sure that they are effective.

I once again thank my noble friend Lord Young of Cookham for this important debate and encourage him to continue pressing the Government. I also thank noble Lords for their insightful contributions.

Adult Social Care

Lord Kamall Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for the Statement. It is no exaggeration to say that we on these Benches, along with many other noble Lords, have been repeatedly pushing Ministers to publish this White Paper for years. It is now two and a half years since the Prime Minister announced from the steps of 10 Downing Street:

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care. And so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … that is the work that begins immediately behind that black door.”


We were pushing because it was evident even then that adult social care was already in crisis. High levels of staffing vacancies, and cuts to local government meant that fewer people who had been entitled to state support would receive it, as the criteria for eligibility were repeatedly tightened. Even then, it was common knowledge that private patients were having to subsidise those funded by the state, as the amount given to local authorities did not match the actual costs of that care.

Even allowing for the inevitable delays caused by the pandemic, this Government have insisted on continuing with their structural reforms, rushing through the Health and Care Bill—which NHS leaders are now asking to be delayed because of the continuation of coronavirus and its pressure on all NHS services—as well as the health and social care levy, rushed through your Lordships’ House in one day, six weeks ago, which now requires amendment in the Health and Care Bill, which will mean that house owners outside the greater south-east will end up paying a higher percentage of their assets than those in the greater south-east. So much for protecting them from the fear of having to sell your home to pay for the costs of care—yet another broken promise from this Prime Minister.

In setting the scene, we and others have pushed for the publication of the White Paper prior to the Bill starting its journey in the Lords, because we cannot understand how any Government could restructure integrated care services between the NHS and the care sector without knowing what plans they have for the future of the adult social care sector. Yesterday’s paper was deeply disappointing—but I think the Government know that, which is why Ministers announced yet another White Paper next year on integration. But hang on: was that not why this White Paper was due to be published? If there is to be another White Paper, the timing is important. Can the Minister say when this new White Paper will be published? This one certainly is not the answer.

Allocating some money to developing the workforce in five years’ time will not even start to address the current crisis in social care: with well over 100,000 vacancies; with social care providers still having to pay for expensive PPE that is provided free to the NHS; and with providers handing back state-funded payments to their local authorities because they cannot provide a safe service for those patients. It does not address the current practice, caused by lack of funding, of domiciliary care workers not being paid as they travel between clients. It does nothing to change the experience of unpaid carers. There are lots of great ideas about following best practice and getting people to talk together, but there is no real offer of funding for regular respite care or other benefits and support.

Reading the full White Paper, the truth about the promises in the Statement begin to be revealed. The Minister knows that, from these Benches, we have repeatedly emphasised the importance of housing in relation to care and support for adults of all ages. It was, therefore, perhaps encouraging to read the recurring phrase

“Making every decision about care a decision about housing”,

but closer examination of the funding for disabled facilities grants increases shows that there will be £570 million a year in 2022–23, 2023-24 and 2024–25. The current budget for this year is already £537 million. Although continued funding is welcome news, this is only a £33 million—or 6%—increase, which, given rising costs of labour and materials, will barely keep up with inflation. It is not the transformative grant that the Statement trumpets. On the funding for

“a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe”,

for which most authorities are able to offer only £1,000 to £2,000 per person before they have to look at their assets, no cash amount is specified, but it is hoped that this will give a boost to handyperson services that are so highly valued by older people and provide such a great return on investment.

It is impossible to transform way our social care provision works, keeping people in their homes, unless this White Paper demonstrates the practical support that the Government can give to make that happen. The real difficulty we face is that staff in the sector, providers, the NHS and, above all, the users and their families are severely let down by the White Paper. The word “dignity” is used repeatedly in the Statement. The reality is the opposite: no vision, no real reform and, worst of all, no attempt to deal with the current crisis.

[Lord Kamall (Con)]

My Lords, I thank the noble Baronesses for the points they raise. But let us be clear that for many years—not just five, 10, 15 or 20 years; some noble Lords have said that we knew this issue was coming after the war, in the 1950s—the demographics of the country meant that we were going to have an ageing population, and successive Governments of all colours have not grasped the nettle. They have commissioned a report, it has gathered dust on the shelf and another report has come along. Many noble Lords, including my noble friend Lord Lilley and others, have written papers for various think tanks, but those also gathered dust and nothing has been done. When I have spoken to friends of all political colours, they have said that, frankly, it was too difficult and there were other priorities. So the Government should be given some credit for finally grasping the nettle.

We have set out a vision. Before you set out a strategy, you have to set out a vision, and we have done so. This is a 10-year vision, and we have committed to the first three years. Throughout the White Paper, we have said that we will continue to consult the sector—experts, carers, both paid and unpaid, local authorities and nursing or care home providers—to make sure that we get the right balance and understand the issues. As technology develops—medical technology, information technology and other technology that enables people to live in their own homes—we will see how the vision might adapt, rather than laying out everything from day one. We have laid out the vision and the spending for the first three years, but we will continue to consult to ensure that we are adapting to the changing technology and circumstances.

Compared to the current system, more people will be supported with their social care costs and have greater certainty over what they pay and receive higher-quality care. We think the plans announced represent the best value proposals. As many noble Lords will appreciate, that means balancing many issues: how many people are supported; how much they are supported; and the cost to taxpayers of offering that support. We believe that the plan sets out an appropriate level for the cap and balances that with people’s personal responsibility for planning for their later years. A number of experts have written recently asking why financial advisers advise people to build up ever-larger sums of money but they then leave it to their children at the end of their lives, rather than depleting their assets as they get older to look after themselves. We were clear that the £86,000 would be the amount individuals will need to pay towards the cost of their care, and the amendment to the Health and Social Care Bill reflects the changes. We believe the new system is necessary, fair and responsible.

We admit that the Care Act 2014 was landmark legislation informed by a range of partners, and we want to build on those strong foundations, rather than reinvent the wheel. Many of the provisions in that Bill act as a platform for better, even more joined-up health and social care in future. We are the first Government to announce that we are going to integrate health and social care, and that we will have a system of healthcare all the way through—not social care as a bolt-on afterwards—from your birth all the way through your life.

The Health and Social Care Bill contains several provisions built on the Care Act 2014. We have looked at assurance, with a new duty on the Care Quality Commission, and we have looked at data, to make sure we have the appropriate data on adult social care. People should pass from hospital to social care with no delay and as seamlessly as possible. We have looked at provider payments and the better care fund. The Bill also proposes to put integrated care systems on a statutory footing, which will make sure that, in each area, working with local authorities, account is taken of the needs of social care, joined up with the other parts of the healthcare system.

On 3 November, we published the adult social care winter plan, because we recognise that this is a long-term plan, but we have constantly been listening to stakeholders and have drawn up recommendations with a number of people, including Sir David Pearson, who reviewed last year’s adult social care plan, advisers from SAGE and UKHSA. So we have listened carefully to make sure that we meet some of the short-term issues that we are facing. We have looked at how we can increase spending, where relevant, to make sure that we tackle some of those issues.

Across the House, noble Lords will want to pay tribute to social care workers, both paid and unpaid. We have a track record of responding to workforce pressures—for example, the £162.5 million workforce recruitment and retention fund and the £388 infection control and testing fund. We will continue to keep this situation under control. We are also increasing the rate of the national living wage, which means that many of the lowest-paid care workers will benefit from pay rises. We are also investing at least £0.5 billion in the way we support the development and well-being of our social care workforce—an investment in knowledge, skills, health and well-being, and how we drive the retention of existing staff and boost recruitment. This will set the conditions for professionalisation over a longer period, giving carers recognition. When we look at the social care workforce and how much they are valued, one of the great issues has to be recognition of their skills and giving them a professional development pathway.

In the longer term, as set out in the White Paper, we remain interested in working with commissioners and providers to make that sure care workers have the best terms and conditions possible, including being paid for all the hours possible. This is already set out in our existing market-shaping and commissioning guidance. We will also explore how we can champion best practice and support local authorities, including through the new CQC assurance framework. We acknowledge the prevalence of zero-hours contracts in the social care sector and we are interested in working with commissioners, providers and care workers to understand how those contracts impact this sector.

Chapter 6 of the White Paper sets out three key aims for the workforce strategy over the next three years, backed up by £500 million of investment. We want to create a workforce that is well-trained and well-developed, healthy and supported, sustainable and recognised. We want to make sure that social care is seen as a rewarding career—that it is not only heart- warming but has professional recognition. I should stop there and take some more questions at this point.

[Baroness Thomas of Winchester (LD) [V]]

My Lords, could the Minister say exactly what the Government are doing right now to recruit more carers, in view of the huge shortfall in the workforce? Are they largely leaving it to hard-pressed local authorities?

[Lord Kamall (Con)]

The Government are in conversation with local authorities at the moment to look at the short-term issues. That is why we have announced increases in funding, particularly as part of the winter plan. The White Paper we are talking about today looks at the longer term, but we have also recognised the short-term issues, which is why we have announced these increases in spending.

[Baroness Pitkeathley (Lab)]

My Lords, we have been waiting for four years—sometimes I think I have been waiting 40 years—for a White Paper that contained a vision for social care that would, once and for all, rescue it from its Cinderella role in public services. I did not get that, but I am a glass-half-full person and am relieved by how many times unpaid carers are mentioned and how many warm words there are about identifying, recognising and involving carers. I thank the Government for that.

But family carers are at breaking point now. As my noble friend said, most have not had a single break since the start of the pandemic. They need immediate help, so will the Minister tell the House how the proposals in the White Paper will help stressed carers now? My second question is about integration between health and social care services, which is the only hope for real reform. It is frequently referred to in the White Paper, but there is no vision for how it will be delivered. We understand that another White Paper about integration is being prepared; I wonder why that is necessary when it could have been tackled in this one. Could the Minister update the House on progress and assure me that carers will be consulted as that paper on integration is written?

[Lord Kamall (Con)]

First, I pay tribute to the work that the noble Baroness has done for carers over many years. She has personally raised with me issues with carers, both paid and unpaid, as well. The White Paper clearly raises issues of professionalising, training and recognising carers to help make this a rewarding career for many. At the same time, it looks at unpaid carers and understands that, for a number of reasons, they are not all similar. Sometimes they are school-age children. We have looked at young carers and at elderly carers—for example my mother, who, in her 70s, looks after an 80 year-old sister who suffers from dementia. They have different needs.

We are first trying to look at how we can help make their task easier, for example through technology freeing up time. We are also looking at respite and how we can make sure they have breaks. We hope that those conversations will be had at the local level, between ICSs and health professionals having meetings directly with the individuals concerned to make sure that unpaid carers have the appropriate support.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I feel torn on this. On the one hand, it is irritating that the White Paper has come out but everybody wants to bash it, when I am relieved that somebody has suggested something. On the other hand, it is not satisfactory. To ask some immediate questions, the crisis of care staff has already been referred to, but I am concerned that the White Paper is being used to avoid talking about the real crisis now. There are genuine problems in care homes in the aftermath of Covid. It is not just about staff, but the fact that relatives are still being denied face-to-face visits. There is still a climate of risk aversion and fear from some managements, with lots of people with dementia being locked in their rooms. All sorts of terrible things are happening and people do not know what to do. I do not want this White Paper to be used to bat things away.

That was the first thing. Secondly, in the longer term, can the White Paper create that vision and be used as a platform? To be honest, I think it is visionless and technocratic. We need to get talking and involve the nation in developing the vision we need. Everybody has an investment in improving this.

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[Lord Kamall (Con)]

The noble Baroness, Lady Fox, makes a valid point: we have to look at not only the long-term vision but the short-term issues raised. This is why, on 3 November, we announced the adult social care winter plan for 2021-22. This was developed in conjunction with the NHS and social care stakeholders. We drew on the recommendations of the review of last year’s adult social care winter plan and listened to a number of different stakeholders in setting out the short-term issues.

As the noble Baroness acknowledges, we are the first Government to set out a long-term vision, not just from one electoral cycle to another but for 10 years. We have set out a vision with three years of commitment to specific spending, some of which is a discovery process, because we still have to know what will and will not work, and how to use and integrate technology. By doing that, we have laid down the gauntlet to whatever Government come after us, of whatever political colour, for them to continue to fulfil this vision. It is a vision against which this and future Governments will be measured.

Other politicians from other parties have known about this for many years. The noble Baroness, Lady Pitkeathley, mentioned waiting for 40 years and others have known about our post-war demographic challenge. We have finally grasped the nettle. We are not going to get everything right, which is why we have not laid out a detailed, prescriptive plan for 10 years. We have laid out a vision of integration, making sure that we use the best technology to support people in their own homes, as much as possible. At the same time, we have committed for the next three years. After that, the challenge is for us to work with all stakeholders to deliver that vision.

[Baroness Watkins of Tavistock (CB)]

My Lords, I am particularly delighted to see this White Paper and congratulate the Government on publishing it in this timeframe. However, we need to look closely at workforce needs, at the same time as we look at workforce needs for the Health and Care Bill, because there is a real mismatch between the vision we now have and the staffing for that vision. I welcome this opportunity to hear how the Government think we can tackle that and give young unemployed people good opportunities to come into a proper caring profession.

[Lord Kamall (Con)]

I thank the noble Baroness for the conversations that we have had about this, and a number of other issues, as I got to grips with my brief. She makes a very important point. We have to make sure that social care is seen as an attractive career path and not just something unskilled; we know that there are skills involved, such as empathy. There will also be an increased need for digital skills, and people management skills will be handy in other areas. For far too long, social care has been seen as the poor relation of other parts of the health system. By bringing health and social care together, we are sending a signal that our vision is to put them on an equal footing. We are also explaining how we intend to spend over the next three years. We challenge everyone—stakeholders, local authorities, everyone—to come forward and help us develop that vision for the long term, and to hold future Governments to account against that vision.

[Baroness Walmsley (LD)]

I wish the Minister good luck with his nettle grasping—I think he is going to need it. He will know that the right housing is key to enabling people to remain safely and happily in their home, yet only £300 million, a very small amount, is being promised in the White Paper to integrate housing into health and care strategies. Take, as an example, the so-called extra care units, where people can live in a flat with appropriate on-site support; that will mean only about 3,000 such units across England. Can the Minister say over what period that money is being offered? Is it three years or a different period? How many units of supported housing can be provided for that amount of money?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this issue. We want to ensure that people can live in their own home for longer. We have committed a sum of money and been quite clear that practical changes can be made, such as installing stairlifts, level-access showers, wet rooms, sensors, et cetera. New technology is constantly being developed to meet people’s needs in their own home. To this end, we have committed a further £573 million per year to the disabled facilities grant, from 2022-23 to 2024-25. We are also talking to local authorities and others, looking at whether we need to increase the subsidy amount per adaptation and reconsider funding allocation to better align with local needs, as well as funding a new service to enable minor repairs and changes to people’s homes. We need to know what needs to be done, and local authorities and others can come back to us on the adaptations that they need and the best way to achieve them. We must look at best practice to make sure that, as technology develops, people can stay in their own home for longer.

[Lord Dubs (Lab)]

My Lords, I declare an interest; my daughter-in-law is a full-time unpaid carer. First, the report says that unpaid carers’ money will go up to £69.70 a week. That is fine if you also have a job, but quite a few unpaid carers have given up their jobs to be unpaid carers, so that is all that they have got, other than the benefit that the person they are caring for may get. That is a pretty tough situation. Secondly, unpaid carers get very few breaks—some get no breaks at all. We must devise a way of looking after the 10 million or 11 million people who keep everything going. Although there are aspirations in this document, I would like to see them translated into something absolutely practical, so that I can go to an unpaid carer and say, “You’re full time, and something will happen to help you and take off the pressure.” It is a lonely business working full time, on virtually no money, looking after somebody. If the paid carers who come in the mornings or evenings do not turn up, it is the unpaid carers who keep things going. I hope that the Minister will pay attention to that. There is a whole agenda there which many of us will be pushing very hard on.

[Lord Kamall (Con)]

I know that the noble Lord has been a champion in this area. We have been quite clear that, as we go forward, a number of issues have to be understood. For example, you cannot say that all unpaid carers are the same. They all have different needs: some can work and some cannot work; some can spend a couple of hours working and share their care duties with others; there are sole carers; some are elderly and some are younger. We want all the different partners to come together to discuss individual needs—including respite for carers, to rest and recharge—and to look at their financial situations. We have laid out that those who are not working may be eligible for other benefits on top of the care allowance that they get. We are exploring this. It is a process of discovery and we want to ensure that it works. We have therefore set out the vision and the three-year commitment.

[Baroness Tyler of Enfield (LD)]

My Lords, I would like to pursue the points that were raised a minute ago by the noble Baronesses, Lady Fox and Lady Watkins. Despite the welcome long-term aspirations in the White Paper, the reality is that the chronic workforce shortages in social care are getting worse, with uncompetitive pay being the main culprit. If Covid surges this winter because of the new variant, these workforce problems will be magnified, with potentially disastrous consequences. There are similar concerns with unpaid carers, as the noble Lord, Lord Dubs, has just said. With no new resources from the new levy coming on stream until October 2023, and all the fragilities that I have just described, what are the Government going to do to address the pay and retention issues now, over this winter?

[Lord Kamall (Con)]

The Government have been listening to the workforce and understand its pressures. We recognise that this is the vision, and that we need to look also at the short-term issues. We announced £162.5 million for the workforce recruitment retention fund, and the new Made with Care scheme to recruit social workers and to send a message that social work can be a rewarding career. We are talking to different bodies, including the Department for Education, about how we increase professionalisation. We have also increased the national living wage, meaning that many of the lowest-paid workers will be paid more. We are investing at least half a billion pounds in supporting the development and well-being of the social care workforce, including an investment in knowledge, skills, and well-being. We will work with partners to set the conditions for the professionalisation over a longer period. We cannot do this immediately; we want to consult the education sector and care and social care experts, to give recognition. That will be a precursor to making progress on pay.

[Lord Lilley (Con)]

Does my noble friend agree that the primary obligation of a Government is to provide decent care for those who cannot finance their own care, and that the lowest priority is to provide taxpayers’ funds to enable those who own valuable assets to pass them on to their offspring? If it is possible to enable people to insure against the risk of having to use the value of their home to pay for their own social care, possibly through a state-aided scheme, would that not be desirable? Is he not astonished that the Labour Party, normally the champion of public sector provision and the enemy of channelling public money to the rich, should advocate channelling money to the rich and not a state-funded insurance scheme?

--- Later in debate ---

[Lord Kamall (Con)]

I thank my noble friend for his question and pay tribute to him as one of the authors of a paper on funding social care, which had a number of interesting ideas. I am also very grateful to noble Lords across the House who have approached me with different ideas, including from the Labour Benches, these Benches and the Cross Benches. The Government have looked at a number of plans and have decided on this, but we are in conversation with the private insurance industry, including the ABI and others, to discuss what financial products it can offer in response to the changes. Some people are quite happy to take out insurance policies, but it depends on individual wealth levels and circumstances, and a number of different matters. We hope that there will be a development of the private market, and we are in conversations with the insurance industry. It has told this and successive Governments that, at the moment, there is no private sector solution for social care insurance. I regret that and wish that there was. My noble friend’s idea of the state underwriting it is interesting, but many reports have been written. I know that the noble Baroness, Lady Walmsley, will writhe in pain at this, but we have drafted that letter. Whatever we do, we will be criticised for it, but we will do this. We have set the vision for the first three years and have set the challenge for all of us to come together to provide the best possible social care for the future.

[Lord Desai (Non-Afl)]

My Lords, I want to reinforce something that the noble Lord, Lord Dubs, said: the distinction between unpaid and paid care workers is very unfair because people who have to care do not have a choice whether to do so—they just do not get paid. The noble Lord mentioned his mother looking after her sister—there is no choice in that matter. Something ought to be done to redefine the category of unpaid social worker, perhaps by making such people part of universal credit so that they will get a statutory payment as of right—because they are relieving the state of some expenditure on care and, of course, performing a very useful social function.

[Lord Kamall (Con)]

The noble Lord makes the very important point that unpaid carers save the state billions of pounds a year with all the work that they do and the love and attention that they give. Sometimes, they do have a choice, but they choose to be carers because they are worried about putting their relative into a home and are not quite sure about that—I understand that. But the fact is that, if they are unpaid, we are looking at how we can support them better. Unpaid carers are very different, and you cannot lump them all into one group: they have different needs and are at different stages of their lives. I emphasise the importance of making sure that we understand how we can personalise that journey for everyone—the cared- for person and the carer. But, if you have given up work, a range of other benefits may be available, and we want to make sure that unpaid carers are equally valued and not penalised for looking after a loved one.

[Lord Hamilton of Epsom (Con)]

My Lords, following on from my noble friend Lord Lilley’s remark, what percentage of people in need of care will be covered by the £86,000 cap?

--- Later in debate ---

[Lord Kamall (Con)]

I am afraid that I do not have the details of that, but I will write to my noble friend.

Ambulance Response Times

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what assessment they have made of current ambulance response times; and what steps they are taking to reduce them.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

We recognise the unprecedented pressures that the ambulance service is facing, and strong support is in place. A £55 million investment by NHS England and NHS Improvement will provide 700 additional staff in control rooms and on the front line to improve response times. This is alongside £4.4 million to keep an additional 154 ambulances on the road this winter. NHS 111 is recruiting an additional 1,100 staff, alongside a £250 million winter GP capacity fund to avoid unnecessary ambulance calls and visits to A&E.

[Baroness Brinton (LD) [V]]

Last week, the BBC reported that Shropshire had run out of ambulances, as every ambulance was queueing outside hospitals. Yesterday, the Shropshire Star reported that the West Midlands Ambulance Service had apologised that ambulance-hospital handover times were now four hours. This is happening all over the country, and people are dying waiting for paramedics. This is before the expected winter surge starts, so what is the Government’s emergency plan right now?

[Lord Kamall (Con)]

The Government understand that the reason for a number of these waits is related to the Covid pandemic and increased callouts, and we have stats for that. Ministers are in regular contact with NHS England and NHS Improvement about the performance of the emergency service care system, including the ambulance service. One Minister of State has meetings that track the improvement effort at all times, including in ambulance trusts. In addition, there is investment of £55 million to boost ambulance staff by more than 700 and £4.4 million to keep an additional 154 ambulances on the road. Also, we are looking at ways to stop people calling out an ambulance when they do not need to—when their calls could be handled without the need to call out an ambulance.

[Baroness Thornton (Lab)]

My Lords, it seems clear that the problem is a symptom of system pressures and will require a whole-system approach to resolve it once and for all—Covid, social care packages to help with discharges and local factors, and the fragility of the NHS infrastructure going in to the pandemic. The Minister has explained some of the short-term emergency plans literally to save lives, but in the absence of an NHS workforce strategy, how will the Government produce a system-wide resolution of this matter?

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we should be looking at this in a systemic way. In fact, I did my PhD in a department of system science, where you look at problems in a holistic way—rather than analysing individual problems, you look at the whole system. We found odd unintended consequences. For example, a friend forgot his inhaler, could not get one from the chemist, could not get one from the A&E and, in the end, had to call out an ambulance. There are a number of times when ambulances are called out needlessly, and that is on top of the pressures we are already facing due to Covid. We are tackling the backlog, which, hopefully, will also reduce ambulance waiting times.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that every ambulance service in the country is currently on black alert? The problem goes both upstream, into the community, and downstream, into the hospitals and social care. What are the Government doing to decrease the number of older people being blue-lighted into A&E because they cannot get the social care services to keep them safe in their own homes?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are all aware of the difficulties in different parts of the system. We have invested £450 million to upgrade A&E facilities in more than 120 separate NHS hospitals ahead of last winter, and this is being used to boost the physical capacity of A&E through expanded waiting areas, increasing the number of treatment cubicles, reducing overcrowding, et cetera. This is alongside an additional £1.8 million to place more hospital ambulance liaison officers at the most challenging acute trusts to help address the long delays, to reduce ambulance queueing and to get crews back on the road quickly.

[Lord Rogan (UUP)]

My Lords, the Northern Ireland Ambulance Service and its personnel hold a special place in the hearts of the people there because of their bravery, selflessness and professionalism during 30 years of terrorist violence. With Northern Ireland currently registering the highest Covid infection rate in the UK, the ambulance service is now facing a new challenge, with waiting times trebling and some patients having to wait for up to six hours outside emergency departments to be admitted to hospital. What assurance can the Minister offer the people of Northern Ireland that Her Majesty’s Government are aware of this problem and will offer all possible support to local Ministers to help solve it?

--- Later in debate ---

[Lord Kamall (Con)]

I thank the noble Lord for raising that point and making people aware of the challenges in Northern Ireland. As he will be aware, health is a devolved issue, but we are very much aware of the challenges in all four of the devolved Administrations. If he would write to me with extra information, I should be happy to pass it on.

[Baroness Tyler of Enfield (LD)]

My Lords, it is estimated that nationally, a quarter of patients in beds are clinically ready to leave hospital but cannot do so due to problems of discharge—particularly a lack of available care in the community. With fewer available beds, ambulances cannot discharge patients to a bed, leading to a lack of ambulances and paramedics available to deal with other emergencies. What plans do the Government have to deal urgently with the problem of discharge to help the NHS get through the winter?

[Lord Kamall (Con)]

All noble Lords have raised important points about the pressures on different parts of the system. In taking a systemic overall view, the Secretary of State is holding regular “pressure” meetings and looking at the key metrics in getting those pressures down. He is also looking at how we can tackle things systemically from within, including discharge issues. We are looking at how to improve on discharges to make sure that there is enough space, thereby continuing to ensure not only that elderly patients are back in their homes as quickly as possible, but that we reduce the length of time that others have to wait for ambulances.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, that concludes Oral Questions for today.

HIV and AIDS

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

[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.

[Lord Cashman (Non-Afl)]

My Lords, the Global Fund to Fight AIDS, Tuberculosis and Malaria has saved 44 million lives since being founded 20 years ago. It is estimated that more than 3 million of those were thanks to UK aid. Therefore, will the Minister confirm that continued close partnership with the Global Fund will remain a central pillar of the UK Government’s planned international development and global health strategies?

[Lord Kamall (Con)]

I thank the noble Lord for his question and pay tribute to his work during our many years together in the European Parliament, where he was probably one of the strongest champions for LGBTQ+ issues, and AIDS and HIV awareness. My only regret is that I was not able to champion as strongly as I wanted to on ethnic diversity and the lack of it in the EU. Of course, we remain committed to the Global Fund and to other partners, including UNAIDS and the global financing facility. It is important that we all work together on this issue, not only in our own countries but particularly in countries where the situation is difficult and people have challenging health systems, and in countries where, unfortunately, gay people or those suffering from HIV are discriminated against or even stigmatised. One of the things that we can be proud of in the UK is that we stand up for those people.

[Baroness Barker (LD)]

My Lords, over the past 40 years, this country has led the international efforts to overcome HIV and AIDS. We have done so by leveraging our contributions to international funds. Unfortunately, in 2021, those were significantly cut, jeopardising world-leading research at a point when we were very close to some game-changing treatments and diagnostics. Will the FCDO review look, as a matter of urgency, at restoring the funding for UNAIDS and Unitaid?

[Lord Kamall (Con)]

I am sure that noble Lords understand the reasons for some of those cuts in terms of the pandemic and needing to redirect resources, but we are committed to continuing with funding and working at an international level. In fact, this issue has come up at a number of G7 international health meetings attended by UK representatives. The UK is seen on the diplomatic circuit as one of the leaders standing up for the rights of both gay people and people with HIV/AIDS.

[Lord Lexden (Con)]

Does the Government’s welcome new commitment, announced today, to ensure that home testing is available throughout the country mean that anyone who wants a test will be able to get one throughout the year?

[Lord Kamall (Con)]

I thank my noble friend for his question. I am pretty sure that the answer is yes.

[Baroness Chakrabarti (Lab)]

My Lords, generic drugs were crucial to the global response to HIV/AIDS; I see the Minister nodding. In that case, will we learn that lesson for this pandemic and stop blocking the TRIPS waiver so that we can better vaccinate the global south and protect ourselves from new variants?

[Lord Kamall (Con)]

One of the best ways to help to vaccinate people across the world is through multilateral, bilateral and plurilateral partnerships. We will have donated 100 million coronavirus vaccine doses by next June. We are committed to working internationally. This issue comes up at the G7 where, once again, we are seen as leaders on the COVAX programme and other such programmes. It is important that we focus on what is effective and how we can get vaccines to those who really need them.

[Baroness Bennett of Manor Castle (GP)]

My Lords, following on from the noble Baroness’s question, the UK Government played a leading role in establishing the Medicines Patent Pool, which is a means of simplifying and accelerating the generic production of HIV medicines by sharing patents. Does the Minister agree that a global pooling mechanism for Covid-19 would support countries’ ability to access the vaccine and the drugs required to control Covid-19 infections? Will the Government give their full support to the Covid-19 Technology Access Pool and encourage UK pharmaceutical companies to license through it?

[Lord Kamall (Con)]

In tackling coronavirus and helping those who cannot access even a first dose of the vaccine while people in this country are now going for their third—even fourth—injection, it is really important that we act internationally. This issue comes up at international meetings. We are seen to be leaders in co-ordinating; we are doing much of that via the international COVAX programme and by talking to pharmaceutical companies about what more they can do.

[Baroness Manzoor (Con)]

My Lords, more than 40% of people who are diagnosed are diagnosed later in life. Can my noble friend say what the Government are doing in relation to this so that the stigma is removed and people come for testing much earlier? I welcome the government strategy as it currently stands.

--- Later in debate ---

[Lord Kamall (Con)]

I thank my noble friend for making that point. I am afraid that I do not have specific details on the older population, but I will make sure that I write to her.

[Lord Collins of Highbury (Lab)]

My Lords, the Minister mentioned stigmatised communities. UK civil society organisations have raised concerns that previous global health strategies have failed to address the gender-specific aspects of HIV, in particular the priorities of marginalised women. Can the Minister tell us how the FCDO’s planned global health strategy will address the underlying structural inequalities that contribute to the vulnerability of girls and women?

[Lord Kamall (Con)]

The Government have made more money available for the funds, particularly in helping young girls and young ladies in different countries. At the same time, we must work out what we can do, as donors or as an international community, to help address some of the structural inequalities in particular countries. We can name it, we can draw awareness to it, but how much deeper can we go? Quite often, one of the best ways to do this is to support the NGOs who are right at the heart of the community, understanding these issues and understanding the structural inequalities on a daily basis.

[Lord Hayward (Con)]

My Lords, following on from the question asked by the noble Lord, Lord Collins, but bringing it to this country, there is still a general perception that HIV/AIDS is a gay disease. There is a growing proportion of the population that are infected who are heterosexual. Can my noble friend ensure that the messaging is directed at heterosexuals as well as the gay community?

[Lord Kamall (Con)]

I thank my noble friend for making that very important point and for stressing that this should be seen not just as a gay disease but as a disease that heterosexual and other people also suffer from. One of the issues in the HIV plan has been to ensure that those communities which maybe have a macho approach to a number of these issues are addressed, particularly at the local community level. It is very difficult, and we have to tread carefully, particularly with some of the ethnic minority communities, so that we are not seen to be stigmatising that community or blaming them but getting the right balance. The fundamental point that my noble friend makes is very important and we should repeat it: HIV does not affect only gay people—it also affects heterosexual people and younger communities.

[Lord Laming (CB)]

When coronavirus struck us, within a year, remarkably, a number of vaccines had been produced, to huge effect. Does that not stand in marked contrast to what has happened with HIV/AIDS? Is it not amazing that 20 years after the noble Lord, Lord Fowler, did so much to establish a proper response to HIV/AIDS, we still have do not have the medical support that we need for it? Can the Minister take this back to the department and see what more can be done to improve the situation?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord makes an incredible point. Not many people are aware that there is no cure as such yet. It is about ensuring that you reduce the risk of transmission and that those who contract HIV can live longer, as opposed to the beginning of the 1980s, when this epidemic hit us, and sadly many people lost friends, loved ones and others prematurely. On looking for a cure, I assure the noble Lord that the department is very aware of that. In my briefing for this I asked how come we still do not have a cure after so long—a question that continues to be asked. Let us pay credit to the pharmaceutical industry and the medical profession. They have tried.

[Lord Brooke of Alverthorpe (Lab)]

What steps are being taken with those members of the Commonwealth who have difficulties accepting or supporting the gay community?

[Lord Kamall (Con)]

The noble Lord makes a very important point that we should be aware of and address. We are aware of certain countries—I have been warned not to name and shame them, sadly—which stigmatise, discriminate, or have some other explanation. One of the best ways to deal with this sometimes is not via government-to-government help but by ensuring that we get to NGOs that are working with people on the ground. Also, at the macro level, in international forums, we can raise this issue. The UK, to its credit, is seen as a world leader when raising these issues at different diplomatic forums.

[Baroness Hussein-Ece (LD)]

My Lords, we heard earlier that HIV/AIDS has always been perceived as a gay problem, which is of course a fallacy; it is also perceived as something that young people are more likely to contract. The facts show that the over-50s have, for the past decade, been the fastest growing group contracting HIV/AIDS and living with it to quite a senior age. What is being done to target that particular group? It is not just young people who are affected by this, but they should also be vigilant in protecting themselves against HIV/AIDS.

[Lord Kamall (Con)]

The noble Baroness makes a very important point of which we should all be aware. It is great that we are all living longer and, as I am sure noble Lords agree, that we are being sexually active for longer. The HIV plan sets out how we look at different—for want of a better word—segments or parts of different communities where there are issues, and how we target messaging there. That is the most important thing, rather than trying to have a one size fits all that others could ignore.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, there has been a huge amount of progress in the last 30 years since—I think I may say my noble friend—my noble friend Lord Fowler did his good work. But there is still work to do in this country. I noted that the Minister proudly referred to there being perhaps less stigma in this country than elsewhere. It is true that we have no room for complacency in this regard and that this is still one of the main reasons why people who should be tested are not being tested. Can the Minister tell the House the Government’s current assessment of the infected but untested rate of HIV/AIDS in this country?

[Lord Kamall (Con)]

I am afraid I do not have a specific figure for the noble Baroness, but the action plan sets out how we are going to increase access to and scale up HIV testing, by focusing on populations and settings where testing rates have not been high to ensure that we tackle them, that new infections are identified rapidly and that people receive the necessary treatment faster to prevent complications. We will operate the annual HIV Testing Week between 7 and 11 February 2022, and the campaign will be called “It starts with me”. During that week we will open self-sampling HIV testing services for all residents of England, and we want to make sure that lots of different programmes are raising awareness. I know that a number of noble Lords across the House take this issue seriously and I would welcome their advice.

Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 29 November be approved.

Relevant documents: 22nd Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, in moving these regulations, I will also speak to the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 4) Regulations 2021.

We have always known that a worrying new variant could pose a threat to the progress that we have made as a nation. On Friday 26 November, the World Health Organization designated variant B.1.1.529, now known as omicron, as a variant of concern. I thank the Government of South Africa for their rapid identification of this variant and exemplary transparency in alerting the world. Yesterday, the Secretary of State spoke with Minister Phaahla to convey this unanimous message from G7 Health Ministers and reaffirm our commitment to working together to address the global impact of the omicron variant.

Some 22 cases have been confirmed in England and Scotland, but we expect that number to rise over the coming days. Omicron has been spreading across numerous countries. Early indications show that it may be more transmissible than the delta variant, and that current vaccines may be less effective against it. It may also have an impact on the effectiveness of one of our major treatments, Ronapreve. We are therefore concerned that omicron may pose a substantial risk to public health. That is why we are taking decisive action against it to buy ourselves time and strengthen our defences while our world-leading scientists learn more about this potential threat.

Our test, trace and self-isolate system continues to be one of the key ways in which we can manage and contain the virus and protect the nation. The self-isolation regulations that we are debating today were introduced to provide a legal requirement to self-isolate for individuals who have been notified that they have tested positive for Covid-19 or are a close contact of a positive case. On 16 August, thanks to the success of the vaccine rollout, we were able to introduce a number of exemptions to self-isolation for close contacts, including for those who are fully vaccinated or under the age of 18.

Given the greater threat that may be posed by the omicron variant, we have reviewed the application of these exemptions. This latest amendment to the self-isolation regulations is targeted at helping to slow its spread. Since 4 am yesterday, all individuals notified by NHS Test and Trace or a public health official that they are a close contact of a confirmed or suspected case of the Covid-19 omicron variant will be legally required to self-isolate, regardless of their age or vaccination status. Anyone who has been notified as testing positive for Covid-19, regardless of the variant, will continue to be legally required to self-isolate.

We have also reintroduced the requirement to wear face coverings in shops, including supermarkets, banks, and close contact services such as hairdressers, on public transport, and in transport hubs. Some noble Lords may ask why face coverings are not required in hospitality venues such as cafes and pubs. I would respond that this is part of a targeted and proportionate intervention. We recognise that not everyone is able to wear a face covering. That is why health and disability exemptions will continue to apply. However, those who are able to must continue to follow the rules so that we might slow the spread of this new variant.

I stress that these measures are temporary and precautionary, and will be reviewed in three weeks, which is the period scientists say is required before it is known how the variant impacts on the effectiveness of vaccines. Ultimately, the vaccination programme, and the test, trace and isolate system continue to be our most effective way of reducing transmission, along with continuing to practise good hygiene, keeping spaces well ventilated, and wearing a face covering in enclosed or crowded spaces.

--- Later in debate ---

[Baroness Chisholm of Owlpen (Con)]

No, let the Minister finish first.

[Lord Kamall (Con)]

The UK Health Security Agency continues to monitor the situation closely in partnership with scientific and public health organisations across the world. Covid-19 is not going away and so we are likely to keep seeing new variants emerge. If we want to learn to live with the virus, we must follow the scientific evidence and advice and act in a proportionate and responsible way if a variant has the potential to thwart our progress. As we do this, we are taking a well-rounded view, looking not just at the impact of these measures on the virus, but on the economy, education, and non-Covid health, especially mental health. I am confident that the responses we set out today are balanced and responsible steps that are proportionate to the threat we face.

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

I call the noble Baroness, Lady Brinton. No? I call the noble Baroness, Lady Thornton.

--- Later in debate ---

[Noble Lords]

You’re on!

[Lord Kamall (Con)]

I apologise to noble Lords— I was looking forward to so many more contributions. I hope noble Lords will forgive me for enjoying the debate rather too much. I apologise to my noble friend Lord Greenhalgh, who has been waiting for ages, and to my noble friend behind me who says he has to go to the theatre. I hope he will wear his mask when he goes to the theatre.

I thank all noble Lords for their contributions to today’s debate. What is really important and what it shows is that we are still debating issues and contesting the science. Clearly there is a range of views across the House on the issues raised. There is no consensus on this. That is really interesting in the way it shows that we can debate these issues and question the statistics. I will turn to some of the points noble Lords made, particularly about some of the statistics but also on the regulations.

I hope noble Lords will forgive me if I do not answer every single question and refer to every single noble Lord who asked them—unless noble Lords want to stay here a bit longer and my noble friend Lord Greenhalgh can go and have another teacake or something while he is waiting.

[Lord Robathan (Con)]

That’s a bit much!

[Lord Kamall (Con)]

Sorry, was that offensive? I apologise for any offence caused to my noble friend. I just assumed that because I like teacakes, my noble friend also does.

I will start with some of the questions. On the question of how many people have been helped by some of these financial services, as of 17 November 2021, local authorities have reported 362,573 successful claims since the start of the scheme, totalling £181 million in test and trace support systems.

Despite the easing of the restrictions at step 4 of the road map, the Government have continued to recommend that face coverings are worn in crowded and enclosed spaces. We accept that there is wide support for reintroducing mandatory face coverings, but we have always tried to balance these issues. As I said in previous debates, we look at a number of factors, not only medical but economic and social. Also, within health itself, many mental health experts are very concerned that we might go for more lockdowns and about some of the measures that a number of noble Lords have mentioned.

As we saw in the debate, there are noble Lords who believe that we have gone too far and noble Lords who feel that we have not gone far enough unless we effectively enter a second lockdown. That shows the range of views here and the difficulty, as my noble friend, Lady Altmann, said, that the Government are damned if they do, damned if they do not, but we accept that.

So, do face masks actually work? This is where there is still a debate. I thank my noble friend Lady Noakes for pointing out the article by Professor Simon Wood, who is professor of statistics at the University of Edinburgh, in which he analysed the BMJ paper. It is in effect a meta-analysis. A number of newspapers have taken a line saying that wearing a mask cuts Covid by 53%. I encourage noble Lords to read the article, in which he takes apart the statistics as a statistician and looks at, as those who have done statistics will understand, whether we have a significant number of samples to make it statistically sound. In addition, Professor Naismith of Oxford University has been quoted as saying that

“the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to delta.”

Once again we see that there is a whole range of views, but we have listened to those views. Because we do not yet know enough about this variant, we will continue to review the data. For example, some say that it is very mild in South Africa so we should not be overly concerned about it, but we also have to remember that South Africa has a different demographic in terms of younger people. We know that when the virus first struck it disproportionately affected older people—as my noble friend Lord Robathan said, people aged over 85. On the balance of the data at the moment, we believe that wearing face masks works but we have always been very careful to make sure that it is proportionate where we do it.

On the expiry of some of these measures, as the Prime Minister said on Saturday, all the provisions that have been voted on will be reviewed in three weeks. They are necessary and proportionate while we learn more. I refer to the economics Nobel laureate Friedrich Hayek, who talked about humans having limited knowledge. He talked about the conceit of knowledge. The way to understand a lot of complex problems is to allow the discovery process to take hold and to look at what we can learn from that process. We should be very careful not to imagine that we have total knowledge. What we have to do is assess it proportionately.

It is our hope that these regulations will no longer be necessary in three weeks’ time and that we can return to the system that we lived under last week, but in the event that we need more time to understand the effect of the variant, or that the data shows that we need to take a different approach that requires new regulations, the House will return to Parliament ahead of the Christmas Recess for a debate and vote on the regulations ahead of their coming into force.

On regulations expiring, the international travel regulations will expire at the end of 16 May 2022. The face covering regulations will expire, unless extended, at the end of 20 December 2021. The self-isolation regulations at the moment expire at the end of 24 March 2022, but we will continue to review the data. Almost daily the data is being reviewed and conversations are going on. We will also continue to review the data on the new variant and we hope to update Parliament on the review in the week commencing 13 December.

A number of noble Lords asked about facilities. We are told that setting up dedicated testing facilities at border entry points such as airports is logistically difficult at the moment, and risks delays to passenger journeys and operations. Given the turnaround for a PCR test, passengers would still have to travel to their home or the place they are staying and isolate there before receiving a result. The Government are taking a measured and proportionate response. We want to try to protect the UK from omicron while allowing continued safe travel.

A number of references were made to points made by Dr Jenny Harries. As the Prime Minster said, the guidance remains the same as the measures that were in place to fight delta. We have now brought in tougher measures, but we continue to take advice from a number of experts. Individual experts are free to give their viewpoint but we look at the balance—some of it medical, some of it clinical, but also economic and social factors—and getting that proportionate.

[Baroness Thornton (Lab)]

I need to ask the Minister about the fact that our most senior adviser on these matters gave advice that was then completely denied by No. 10 and the Government. That will at least cause confusion. It is not a question of balancing this and that; Jenny Harries was very clear in her advice about what she thought should happen. It was quite the opposite to what the Prime Minister said should happen. The Minister needs to acknowledge that that will cause confusion.

[Lord Kamall (Con)]

I thank the noble Baroness for raising the point, but it depends on how it is reported. The real issue here is that a number of different experts are advising. Of course, you can pick and choose which expert you decide to listen to. A few weeks ago, noble Lords were picking up on comments made by the NHS Confederation. That is not a scientific body, but noble Lords claimed that it showed that we need to lock down. It is very easy to pick and choose your experts, but we continue to listen to a wide range of experts.

One of the great things about science that we should remember is that there is no such thing as “the science says”. Science should remain contestable. Can you imagine if science was not contestable? We would still be saying, “You can’t challenge the notion that the solar system revolves around the earth.” Scientists challenged that, and that is how we advance knowledge. It is really important that we continue to contest. Scepticism is one of the most important factors in science to make sure we make progress. We will listen to a range of experts.

I ask those noble Lords who really want to lock down more, and who say that we not only have not done enough but should do more and lock people down, to look at the impact that has on people’s mental health and on our economy. I ask them to think about the wider impact and to remember that we are not in the same place we were a year ago. We have been absolutely clear that vaccines work and that the best thing we can do to get through this is to get vaccinated. It is not too late to get your first or second vaccine. I am grateful to noble Lords who have asked questions—

[Baroness Thornton (Lab)]

The Minister is now saying that there is absolutely no doubt about the science behind vaccinations. That is not a matter of opinion; there is no doubt about the need for vaccinations. He is straying into dangerous territory when he says that there is science on this side and science on that, because the Government have rightly said that vaccination is the way forward.

[Lord Kamall (Con)]

I thank the noble Baroness for agreeing with the Government’s line that vaccination is the most important way forward.

[Baroness Thornton (Lab)]

The Minister is being patronising. We have always—always—supported the Government on vaccination; I am sorry that the Minister feels he needs to be sarcastic about that.

[Lord Kamall (Con)]

I apologise to the noble Baroness if I came across as sarcastic.

In terms of hospitality settings, quite rightly, as a number of noble Lords have said, even though we have mandated it in certain settings, it is being left to settings to decide. This is in line with property rights, but also something that people have been asking for—a number of noble Lords have asked “Why not just let the establishments themselves decide, so people can make a decision whether they go to somewhere where masks are mandated or somewhere where they are not mandated?” We are looking really hard at this and we want to make sure that we are proportionate. It could be that we find out that omicron is not that dangerous, but we have to make sure that we have the data and that we sequence it all. It could be that it affects us more in the UK that it would in South Africa because of the change in demographics. That is a really important point.

In terms of who is responsible for enforcement, the police and Transport for London officers have powers to issue fixed penalty notices for non-compliance with the regulations. They are using the four E’s in a proportionate way: engaging, explaining and encouraging before enforcement, just to remind people, if they can, to make sure that they wear a face mask.

The Health Secretary has also asked the JCVI to consider giving boosters to as wide a range of people as possible. If you are boosted, your response is likely to be stronger, so it is more vital than ever that we get our jabs.

On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We are also extremely grateful to the South African Government; we have been talking to a number of partners, including South Africa directly, to make sure that we do not disincentivise other countries for doing the right thing by reporting the outbreak in the first place. We are doing all that we can.

I am trying to make sure that I answer all the questions; I apologise if I am not able to. My noble friend Lady Neville-Rolfe asked about exemptions for children under the age of 11 and those unable to wear a face covering due to health, age, equality or disability reasons. In terms of the impact to the economy, we do not know the extent to which the variant escapes the vaccine, but as soon as we do, we will be able to make a better measure. We do not at the moment expect there to be significant economic disruption. We have said that we believe face coverings are effective at reducing transmission indoors. The recent UKHSA study suggests that all types of face coverings are, to some extent, effective, but we also welcome challenges to that data. The advice remains the same: we believe that, on balance, it is better to wear a face mask. Many noble Lords have agreed and disagreed with that, but we have to balance these things.

Proportionate measures remain in place in schools. Face coverings should now be worn in communal areas by older students and teachers. The Department for Education is looking at how we make sure that there are clear guidelines on that. We advise staff, visitors and pupils to wear face coverings in communal areas.

I turn to the point from the noble Baroness, Lady Tyler, and that very personal case; it highlights—this should sober us up—those very powerful words that this is not over. We have said that consistently. It is not over. If we believed it was over, we would have removed all restrictions. It is highly likely, but not definite, that we may have to continue to get boosters. Just as we have an annual flu vaccine, we may in the future end up with an annual Covid vaccine, including looking at other strains.

We have said who is responsible. In answer to a point made by my noble friend Lord Cormack, may I suggest that he takes his point about continuous committees up with the Lord Speaker? That is not really in my remit as Minister for Health. My initial reaction is that it seems a good idea, but let us see what the Lord Speaker says.

I again thank all noble Lords for their contributions and for continuing to challenge. That is really important. I can assure my noble friend Lord Cormack that today I asked my department for a list of potential or forthcoming regulations so that we can lay them as early as possible, as my noble friend and other noble Lords suggested. I am grateful for the acknowledgement that we laid these regulations as quickly as we could, and I pledge that we will try to improve that as much as we can, I too, believe very strongly in procedure and the Government and the Executive being held to account. It is really important.

[Baroness Neville-Rolfe (Con)]

Before my noble friend sits down, I thank him for mentioning the economy. His assessment is that the impact on the economy should not be great, but of course there has already been an impact on the economy from this new strain. I think I mentioned in particular the transport industry, which has been affected. Would he be able to come back to me on this business of economic assessment—in fact, not only economic, as I am also worried about the impact of the measures being taken on things like cancer deaths. There is no time to discuss that now, but I would really like to have a further discussion, perhaps bilaterally. We will of course have my noble friend Lady’s Noakes’s regret amendment in due course, but that may be months away. It really is very important to understand the implications of what we are doing. We are doing it for the right reason, but it has a wider impact.

[Lord Kamall (Con)]

My noble friend raises an important point. We also have to clear about unintended consequences and the costs of what we have been doing. I read an interesting article from the leading behavioural economist Paul Ormerod, who asked where have all the economists been when it came to this debate, as economics is about considering trade-offs.

I again thank the Government of South Africa for their rapid identification of the variant and their transparency in alerting the global community. I commend our scientific and public health experts who continue to monitor the situation closely alongside our scientific and public health partnership organisations across the world. We are continuing to collaborate in order to understand the virus, including the data and the different demographics that our countries have and whether a study in one place is relevant to a study in another place.

I also thank the House for its valuable scrutiny today. The Government hope that the temporary and precautionary measures laid in these regulations will enable us to slow down the spread of the omicron variant while we gather more information on how best to deal with it and how infectious it is. The Secretary of State assured Members in the other place that if it emerges that the omicron variant is no more dangerous than the delta variant, we will not keep these measures in place for a day longer than is necessary. I hope that that is the case, but we must take precautions and act decisively until we have a fuller understanding of the omicron variant. I commend these regulations to the House.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 4) Regulations 2021

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 29 November be approved.

Relevant documents: 22nd Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments

Motion agreed.