Alcohol Duties

Lord Kamall Excerpts

Tuesday 2nd November 2021 Lords Chamber

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

The reform of alcohol duties will simplify duty rules and tax drinks in proportion to their alcohol content. This should create a financial incentive for manufacturers to reformulate their products, therefore giving consumers a greater choice of lower-strength products. This would support individuals to drink within the Chief Medical Officer’s guidelines. The Office for Health Improvement and Disparities plans to make an assessment of the potential impact of these proposals on consumption and associated harms.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I regret that the Minister has not actually answered the Question. All the evidence indicates that if the price of alcohol goes up, people drink less and are healthier. If the price of alcohol goes down or the duty goes down, people in fact drink more. More people go into hospital and more people die. Instead of relying on the industry to decide whether manufacturers will reformulate their drinks, as the Minister just indicated, the Government should take a firm lead and put the health of the nation first. They should not be handing out a £3 billion cut in this way. Will the Minister please go back to the Chancellor and tell him that we need a policy that will lead to better health, not worse?

[Lord Kamall (Con)]

Many public health officials, for many years, have criticised the system of alcohol taxation, particularly the EU’s system of taxation. Now that we have left the EU, we are free to set our own law in this area. Given the criticisms from the World Health Organization and many other think tanks, we can now set taxation based on the volume of alcohol.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I welcome that the duty will be related to the strength of alcohol. However, the Budget included a dozen references to wine, just as the Government were boasting that the biggest benefit of the New Zealand trade deal was cheaper New Zealand wine. This duty freeze, as we have heard, will cost £3 billion to the Exchequer over five years—money that could have been used for treatment services and for public health, since we know that deaths and illnesses will go up. It seems to me that the Government have an alcohol problem. They are scared to increase prices for the sake of all our health and are uncaring about the problems that this measure brings in its wake. Can this Health Minister go to his colleagues in the Treasury and try to educate them as to what they should be doing?

[Lord Kamall (Con)]

The noble Baroness is being a little unfair in her comments. These reforms were based on the advice of many public health officials, including the World Health Organization as well as a number of think tanks, which said that it was about time that we linked taxation to the volume of alcohol in drinks in the hope that we can encourage and incentivise manufacturers to lower alcohol content and to produce more low-alcohol and alcohol-free drinks. I am not sure whether noble Lords would accept such reformulated drinks, but it is important that we push this from a public health perspective.

[Baroness Randerson (LD)]

My Lords, real-term cuts in the price of alcohol send the wrong message also about drink-driving. We have one of the highest drink-drive limits in the world, set more than 50 years ago and well out of date. Around 2,000 people are killed and seriously injured on the roads every year, and that figure rose by 8% in 2019 alone. The British attitudes survey reveals that 77% of people support lower limits. Do the Government intend to catch up with the rest of the world and adopt this popular policy, saving lives on the road?

[Lord Kamall (Con)]

Noble Lords will know that alcohol-related deaths are not due purely to sclerosis of the liver and other direct impacts; we also know that alcohol plays a large role in, for example, drownings, 30% of which have some alcohol connection. We know that a number of murders and cases of domestic abuse are also connected to alcohol. The most important thing is to try to incentivise drinkers to drink low-alcohol or no-alcohol products in the hope that we can do that. This is why we have reformed the taxation system in a way that is linked to the volume of alcohol in drinks.

[Lord Smith of Hindhead (Con)]

My Lords, I refer to my interests as set out in the register. While the duty freeze and 5% cut on duty on draft beer was welcomed by the industry, in reality prices that consumers will experience are likely only to increase due to production and distribution costs. I do not think that measures in the Budget will lead to overconsumption since, in the highly unlikely event of the duty cut being passed on, a person would need to drink 183 pints before they got a free one. Does my noble friend the Minister agree that we should encourage people to go out, have a couple a modest drinks if they want to, support our fantastic hospitality industry and enjoy themselves?

[Lord Kamall (Con)]

The noble Lord makes an important point in looking at the various factors that have to be balanced up. Clearly, we want to encourage consumers or drinkers to move towards low-alcohol and no-alcohol products, while balancing that against the wider economic climate and the hard two years that the hospitality sector has faced, which is why we announced the freeze to some alcohol duties. On encouraging people to go out and drink alcohol, I am afraid I am the wrong person, because I am teetotal.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest, having chaired the Commission on Alcohol Harm. Our report published last year cited the data, then 10 years old, which showed that the cost from alcohol to the NHS was £3.5 billion a year, while the Home Office’s own estimates were that the cost to society was £21 billion a year. In the decade since then, the number of alcohol-related hospital admissions has risen by 19%, and there has been a rise, too, in alcohol-related hospital admissions and deaths, which increased by 20% last year alone. Given the rising cost to the NHS, what contingency plans have the Government made should this drop in duty fail to decrease alcohol harms, and what other methods do the Government plan to use to decrease alcohol consumption?

--- Later in debate ---

[Lord Kamall (Con)]

The Office for Health Improvement and Disparities, as well as many other bodies, will continue constantly to review the impact of this change in taxation. In addition, the Government remain committed to supporting those who are most vulnerable and most at risk from alcohol misuse. Alcohol is a cross-cutting issue affecting several government departments. A strong programme of work is under way to address alcohol-related harms and their impact on life chances, including an ambitious programme to establish specialist alcohol care teams in hospitals and support for children of alcohol-dependent parents. There are a number of other alcohol harm reduction strategies that are too numerous to list now, but I am happy to write to the noble Baroness.

[Baroness Merron (Lab)]

My Lords, alcohol-misuse experts have warned that the Government’s reforms of alcohol taxes are undermined by their failure to address the issue that alcohol from high-strength beverages may remain cheaper, in many cases, because the price per unit of alcohol is lower in many of those high-strength beverages. What plans do the Government have to introduce minimum alcohol pricing? Does the Minister share my concern that the Chancellor, in the Budget, appeared to be investing more in Prosecco than in the public health budgets that we need to see to cover the cost to society of alcohol harm.

[Lord Kamall (Con)]

The World Health Organization and a number of other organisations have criticised the current system of taxation of alcohol, and urged the Government—and the EU when we were a member of it—to move toward taxation based upon the volume of alcohol. To answer the noble Baroness’s specific question, there are no current plans to implement minimum unit pricing in England, but the Government continue to monitor the impact of minimum unit pricing as evidence emerges from Scotland and Wales. It has been in place in Scotland for more than three years, and the Scottish Parliament will not consider its extension until April 2024. In all my conversations with various public health experts, one of the things that they make quite clear is that this has to be evidence-led, and we want to look at evidence from elsewhere.

[Baroness McIntosh of Pickering (Con)]

I declare my interest as chairman of the PASS Proof of Age Standards Board. I also chaired the Select Committee on the Licensing Act 2003. Does the Minister agree with the Committee when it said:

“It is in our view unarguable that an increase in the price of alcohol will decrease consumption.”?


Does he further agree that, by increasing the taxation on stronger alcohol as the Budget aims to do, that will have a better chance of reducing alcohol intake and dependency than the minimum unit pricing that we have seen in Scotland?

[Lord Kamall (Con)]

I thank my noble friend for that very important point. This is why the new system of taxation has been introduced. It will more directly align the volume of alcohol with the taxation on it. That will feed through to higher prices for drinks with higher alcohol content.

Smoking Cessation: Prescription of E-cigarettes

Lord Kamall Excerpts

Tuesday 2nd November 2021 Lords Chamber

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

I thank the noble Baroness for her questions. It is really important that we look at how we can reduce smoking in this country. The point about the e-cigarettes and the MHRA’s wish to licence products is that it wants to move smokers on to a pathway away from smoking cigarettes and on to e-cigarettes since they are seen as a safer option. It does not want to encourage people to smoke e-cigarettes, but to move them off cigarettes and on to e-cigarettes. At the moment, the MHRA does not feel comfortable licencing any of the existing products, and therefore wants to have conversations with manufacturers and others to see if there can be a product produced that it feels comfortable licencing so that it can be available for prescription. Moreover, by having that MHRA stamp of approval, it may well encourage others to buy it over the counter.

[Baroness Walmsley (LD)]

My Lords, it is three years since the change of rules that allowed medicinal cannabis to be available on NHS prescription, but there have been only three NHS prescriptions in that time. How confident is the Minister that smokers will be able to benefit from regulatory change when children with intractable epilepsy cannot? Do not both of these situations require further training for doctors to ensure their confidence to prescribe?

[Lord Kamall (Con)]

The hope is that we will be able to move current cigarette smokers to e-cigarettes, but I am afraid that I will have to write to the noble Baroness on her specific question.

[Earl Cathcart (Con)]

My Lords, I used to smoke over 50 cigarettes a day but, in 2014, I transferred to using e-cigarettes. I have not had a puff of tobacco since, and I find that my health and breathing are so much better now. This is surely a very good thing; it should be encouraged.

[Lord Kamall (Con)]

I thank my noble friend. He is indeed looking incredibly healthy and is a living advert for the path away from cigarettes to e-cigarettes. Noble Lords across the House are keen for this to happen. The MHRA has advised that it is 18 to 20 months away from approving a medicinal licence for e-cigarettes in the UK. However, I take the points of many noble Lords; I will push the MHRA, and I hope that they will too.

[Lord Patel (CB)]

My Lords, it is correct that only MHRA-approved e-cigarettes should be available on prescription. The reason for that is that many e-cigarettes currently sold on the market contain dangerous products; there have been reports of deaths occurring due to lung complications. So is it not right that the sale of e-cigarettes not approved by the MHRA should be banned?

[Lord Kamall (Con)]

E-cigarettes are a pathway out of cigarettes; these e-cigarette products exist now, even before we have one approved via the MHRA. It is important not to ban existing products because we need to make sure that people move along that pathway. The hope is that, once there is an MHRA-licensed product, people will be encouraged to buy it, both on prescription and over the counter.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the MHRA a considerable number of times, which is a great tribute to the work that it is doing. Can he tell us why it is facing budget cuts at a time when we need our independent regulator in this country to be doing all it can to regulate and encourage new innovative products, including pharmaceutical products, to the market?

[Lord Kamall (Con)]

As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.

[Lord Naseby (Con)]

My Lords, is the Minister aware that, as I understand it, there is a problem with the MHRA budget? This is important work. Furthermore, is it not a fact that the industry itself is supporting this work?

[Lord Kamall (Con)]

It is very important that we get the MHRA to approve these e-cigarette products. The MHRA is seen as a jewel, to which many experts from other countries look. One of my roles is international health diplomacy, and many people I talk to from other countries are very impressed with the work of both NICE and the MHRA. We can use that in our international health diplomacy.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, does the noble Lord believe that encouraging and giving the green light to e-cigarettes may well send a signal to youngsters who might think it is cool to start inhaling foreign gases into lungs which are not designed for them?

[Lord Kamall (Con)]

The noble Lord raises a very important concern about e-cigarettes. From conversations I have had with the MHRA and others, I understand that, at the moment, there is no evidence in the UK that young non-smokers are adopting or taking up smoking e-cigarettes. Most users of e-cigarettes use them as a pathway away from cigarettes.

[Lord Vaux of Harrowden (CB)]

My Lords, to follow up on that point, e-cigarettes are sold using flavours such as dragon berry, bubblegum, gummy bears and unicorn juice, in colourful packaging with cartoon characters—all clearly aimed at children. If we are considering licensing e-cigarettes, could this also be an opportunity to tighten up the packaging and branding rules to ensure that that stops?

[Lord Kamall (Con)]

There are a number of factors that will be looked at when licensing e-cigarettes, including incentives to customers—flavours, et cetera—to take up these products. I will have a discussion with the MHRA to ask that question in more detail, if the noble Lord would like to write to me.

[Lord Rennard (LD)]

My Lords, e-cigarettes are undoubtedly part of the way forward to achieving a smoke-free Britain. But why has it taken so long to get to this point and to begin fulfilling what was in the 2017 tobacco control plan and to adopt the recommendations of the 2018 Select Committee, chaired by Sir Norman Lamb, which highlighted the significant benefits of having medicinally licensed e-cigarettes which could be prescribed? How do we know that licensing will now proceed in a timely manner?

[Lord Kamall (Con)]

The MHRA has been quite clear that it wants to be in a position to license a product as soon as possible—it says 18 to 24 months. Noble Lords may well want to push the MHRA on that, and that is part of your Lordships’ role. But it is important that we make sure that, when we license a product, both consumers and public health experts can have faith in it.

[Lord Cormack (Con)]

My Lords, I understand from my noble friend Lord Patel that some of the devices and products to which he referred do not bear health warnings on their packaging. Why is that so? Surely that at least should be on all of them.

[Lord Kamall (Con)]

I thank my noble friend for pointing that out, and I will investigate. Not being a user of e-cigarettes or cigarettes, or of any sort of narcotics or alcohol, I am afraid that I am not really an expert myself. I will look into that and write to my noble friend.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that the nicotine levels will be looked at, given that the nicotine level in some e-cigarette products is very high and that nicotine is the addictive substance both in cigarettes and in the continued use of e-cigarettes? The commercial incentive for tobacco producers to produce flavoured, palatable and highly addictive products should not be pandered to.

[Lord Kamall (Con)]

The noble Baroness raises an important point about nicotine itself being a very addictive substance. I am sure that the MHRA will be looking at the guidance, but if the noble Baroness would like to write to me, I can confirm that.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021

Lord Kamall Excerpts

Tuesday 2nd November 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 22 September be approved.

Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 26 October.

Motion agreed.

Health Incentives Scheme

Lord Kamall Excerpts

Thursday 28th October 2021 Lords Chamber

[Lord Scriven (LD)]

My Lords, from these Benches I thank the Minister for coming to answer questions on the Statement. These Benches welcome anything, including innovation, that targets the poor health and loss of life years that obesity brings. However, this is really the emperor’s new clothes, because it has to be set in the wider context of the detriment of poor health, public health budgets and poverty. Public health budgets have been decimated, so that many issues connected to the determinants of health cannot be dealt with. Low pay has become the norm for so many in our country. School budgets for extra activities, such as physical activity, and timetabling have caused problems, and food and drinks industry standards also have to be addressed. Tackling obesity is about tackling the lack of opportunity and tackling poverty. Innovation with a wristband is like asking somebody to learn the Green Cross Code they have a motorway to get across. It is not going to be successful.

As a country, we have to start early: we have the second-largest child obesity problem in the whole of Europe. So what are the Government doing to ensure that daily sport as an activity is available in every state school, so that every child has some daily activity? What is the Government’s response to the report by the Association for Physical Education with regard to children’s health and, in particular, with regard to swimming?

Diet at home and in school is important. The Jamie Oliver Foundation Bite Back report basically found that healthy options in schools were more expensive. What are the Government doing to ensure that fresh, healthy food is available at an affordable price in every school in the country? How are the pilots being chosen? The correct areas are the areas of deprivation, because that is where the highest incidences of obesity are. What are the criteria? How are they being selected? How are areas being offered the chance to become part of the pilot? This must be seen as a healthy eating and exercise approach, and not a weight-loss problem. There are far too many citizens in our country who suffer with eating disorder issues. So what are the Government doing to ensure that it is this framework of healthy eating and healthy lifestyles, rather than being seen purely as weight loss?

With regard to the wristband and the data, who will have access to the data? Where will it be stored? What precisely will the data be used for? Will any private sector organisation have access to the data and its interpretation, and, if so, what conditions are in place to ensure that we do not have the problem that we had with DeepMind, where it was used for purposes over and above what was anticipated?

Finally, talking of the private sector, HeadUp Systems is noted in the Statement. This is a company that has a £30,000 turnover and made an £11,000 loss last year. So how, and on what criteria, was HeadUp Systems chosen? What role will it have? Which other private sector organisations were asked to provide the support that HeadUp Systems is doing? What Ministers or officials did members of HeadUp Systems approach or have access to? If there is a contract, what is its value and on what basis was it given to HeadUp Systems?

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

My Lords, I start by thanking the noble Baroness and the noble Lord for their questions. This is a good story in terms of how we tackle health in the modern day. The noble Baroness mentioned the IPPR. I am not sure how well the name “Tony Blair” goes down on the Benches opposite these days—

[A Noble Lord]

Very well.

[Lord Kamall]

I am pleased to hear that, because the Tony Blair Institute has actually recommended more of these schemes using wearable tech to ensure that we have a healthier population. So this is not politically motivated in any way; it is led by a desire to do the right thing, and to learn lessons from previous schemes about what works and what does not work. One problem, as many noble Lords have said in the past, is that some of these schemes have not worked. We need to make sure that we have evidence, and that anything that we roll out is evidence-based. On that basis, it is absolutely right that we pilot a scheme rather than do a one-size-fits-all scheme, only to find where the errors are.

Also, as Hayek has said, we have limited knowledge. Some people express the conceit of knowledge and think they know everything, and sometimes—in economics and in politics—quite often we become aware of consequences, both intended and unintended. It is important that, when piloting a scheme such as this, we are able to identify potential unintended consequences that would not have been foreseen. I know that the noble Lord, Lord Scriven, can already predict the outcome and has infinite knowledge, but what is really important is that we see what works and what does not work, rather than predicting in advance that something will fail—and I acknowledge that the noble Lord, Lord Scriven, was asking a question, as he is entitled to do.

I will try to answer a few of the specific questions. One of the things that we are seeing is that obesity is costing our health service and healthcare system more than £6 billion a year. Clearly, schemes have been attempted in the past, and some have worked and some have not. We looked around the world to see what we could learn from the rest of the world. In particular, we looked at the Singapore health challenge, and also the Amsterdam programme, to see what we could learn. One of the things that I noticed when I worked on projects in the past in one particular area was that, just because they worked in one area, it did not mean that they would necessarily work in another area. We have to understand the local factors that might make a project a success or not.

In addition, it is really important that we do tackle disparities, and I am very pleased that many noble Lords have brought up the issue of disparities. We now have the Office for Health Improvement and Disparities: the clue is in the title. “Disparities” means that we want to identify these disparities—all sorts of disparities: sometimes they are gender disparities; sometimes they are based on ethnic minorities; and sometimes within communities there are different disparities. It is always far more complex than we can predict in advance. One of the best ways of tackling things is to look at pilot schemes.

Let me see if I can now answer some of the specific questions. This is based on understanding what incentives people respond to. Many noble Lords will have read of schemes in the past that simply have not worked. We need to work out what works with certain communities and certain demographics. One of the bits of academic research that has been found to be quite helpful is that, quite often, people from lower-paid communities respond better to price incentives or reward systems, and we are going to put that to the test. We are not saying that this is definitely the case: we are saying that we are going to pilot this to see if what we think is going to happen will happen—and, if it does not happen, why does it not happen and what can we learn from that in the future?

The noble Baroness, Lady Merron, asks what assessment the department has made of the changes in the level of the public health budget. Public Health England has monitored and published data on trends, with a wide range of indicators of public health, set out in the Public Health Outcomes Framework. That function has now transferred to the Office for Health Improvement and Disparities, which shows the fact that we want to identify those disparities and see how we can tackle them.

The ring-fenced grant that we have provided to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. The grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived.

What is the breakdown, as we go over this? The publicly available information will contain the contract value, inclusive of £3 million to be spent on rewards for participants. The budget will be managed through standard contract procedures and there will be provisions in place to prevent overspend.

I shall go over the timescales. There was open procurement for the pilot, which closed on 16 August. The contract was awarded and unsuccessful bidders notified on 27 September. The pilot mobilisation period that we are looking at is 11 October to 31 December. The press release announcing the pilot provider was issued on 22 October. The pilot launches in January 2022 and closes in June 2022 with an evaluation report. That is critical. We want this to be evidence led; it is about time that we pushed for more evidence-led research. Before I came here, I had read reports from think tanks that had analysed government programmes, only to find that the evidence always backed it up. We want to make sure that this process is clearly evidence led and also to be aware of unintended consequences.

In terms of whether people can afford to eat a healthy diet, the Eatwell Guide represents government recommendations on a healthy, balanced diet to promote long-term health at the population level. Analysis by Scarborough et al in 2016—I shall not give a Harvard reference here—of the cost of achieving a diet in line with the Eatwell Guide concluded that in some cases it was 3p cheaper than the current diet.

In terms of audience and location, the pilot will target adults over the age of 18 in a chosen local authority. The approach will be tested to ensure that it combines wide appeal across the adult population with an ability to engage those who could get the most benefit from adopting healthier behaviours for physical activity and diet, such as those not meeting recommended guidelines. The pilot will take place in one local authority in England where there is a high proportion of our target groups. I hope that the information will become available publicly, or I will be able to update the House. We will be releasing further information in due course on the pilot location and on how residents can sign up to take part in the work. The scheme will be for England only but we will continue to work across the devolved nations to learn shared best practice. One of the things that we need to do is to make sure that we learn from what works well and what has not worked so well.

How will we safeguard data and privacy? I am sure that the noble Lord, Lord Scriven, will have recognised that I come to this post as a bit of civil libertarian, and perhaps civil liberties is one of the few things that we agree on. All data will be collected, stored, shared and used in alignment with all applicable law regarding the processing of personal private data and security standards, including the UK Data Protection Act and the UK General Data Protection Regulation. Full data collection and processing requirements will be shared with potential pilot users as part of the sign-up process. Consent to take part in the pilot is, I stress, voluntary. The Department of Health and Social Care is the data controller for the pilot, with HeadUp Systems as a limited data processor that collects data on the department’s behalf.

The noble Lord asked about the supplier. We contacted HeadUp Systems to deliver the pilot, and it has partnered with a number of organisations to deliver the requirements, including the Behavioural Insights Team. The advice of Sir Keith Mills who successfully launched and ran the Air Miles and Nectar programmes has also been sought. We are therefore trying to work with the best experts out there, including the Behavioural Insights Team, to bring knowledge and expertise on behavioural economics. I am sure that many noble Lords have read many interesting works on behavioural economics over the years. If the pilot does not work, we will work out why and how we can improve the scheme to make sure.

Given that obesity costs this country over £6 billion a year, surely it is worth a little investment, experimentation and discovery to see if we can make sure that we nudge our citizens, wherever they come from, whatever their background, towards healthier living.

[Lord Balfe (Con)]

My Lords, perhaps I may first apologise to the Opposition Front Bench for my confusing an Urgent Question with an Oral Statement. I thought that we had only 10 minutes for all of us.

My reaction is that this system will be quite easy to game. One cannot measure fruit and vegetables, and size of portions, by wearing a wristwatch; one can only use it to input data. That is the same for step counting, which, on a wrist counter, is well known as being not as accurate as elsewhere. I hope that the Minister and his officials will look carefully at the possibilities for gaming the system. If they are collecting the data remotely, they should be able to tell whether it is being gamed.

As a former president of the British Dietetic Association, I ask the department to look carefully particularly into the obese and overweight category. There is evidence that a BMI of around 26 does no harm to people, and I should like to see more medical evidence produced on that. I invite the Minister to ask the department to look at that.

Finally, will the department look at producing an app for all citizens, not with rewards attached but just an app of good practice that could be made available for free through the App Store so that we can all share in the wisdom of the department?

[Lord Kamall (Con)]

I thank my noble friend for those important questions, which are exactly those that I would have asked—and, in fact, did ask the briefing team when I was getting more details on this matter.

Of course, one of the most obvious things that we have to ask is: how do people game the system? Often, when one analyses a scheme, sometimes there are unintended consequences whereby people are able to game it. Someone asked me—I think and hope that it was in jest—“If I ate 75 cream cakes and blamed my metabolism, would I be able to get on to the scheme?” We have to make sure that our data is robust. The pilot will include robust anti-fraud measures in relation to users’ activity and access to incentives.

What is interesting about the scheme is that it is voluntary, but it will also make sure that the users input the data. There has been a lot of research around that, because it has seemed to be a potential weakness, if users were inputting the data, regarding whether they can game the system. We have been assured that measures have been put in place to avoid that sort of gaming but, once again, the evidence will tell. That is why the system is not national but is a pilot to test all these questions to the limit.

The noble Lord mentioned weight loss and obesity, which I shall come to. One of the things that we want to make clear is that the health incentives scheme is not a weight-loss programme; it is a programme for healthy living. It uses an innovative approach to rewards and incentives to help participants to adopt healthier behaviours for physical activity and diet. Of course, it will help those who are overweight. I have been on two diets in my life—no, really I have. What is interesting about this is that, when one looks at these issues, it is not just a question of consuming less but about burning off calories. That is why we want to encourage healthy living as opposed to purely tackling obesity. That is very important.

The other day, I met a young lady who was very slim. She said, “Why do you keep going on about obesity and type-2 diabetes? I am slim and I have type-2 diabetes”. So sometimes we have to make sure that we are clear about these connections.

[Lord Scriven (LD)]

The Minister has been going for about two minutes now.

[Lord Kamall (Con)]

Oh I see. I bow to the superior expertise in this House of the noble Lord, Lord Scriven, and I will sit down.

[Baroness Boycott (CB)]

My Lords, I want to ask the Minister a question based on an answer he gave earlier. He said specifically that the Government’s “eatwell plate” was as affordable as any other meal. I would like to challenge that, in my role as a member of the Food Foundation. It points out that, if you are on a low income, eating the “eatwell plate” is going to take about 60% of your disposable income. The reality of the cost of healthy food is this: if you have a pound to spend, you could get three peppers, which add up to 65 calories; six apples, which add up to about 200 calories; or a packet of sweet biscuits, which would give you 1,000 calories. If you are a mother or father struggling on a low income, and you need to feed your kids, you are going to go for the high-calorie option; this is how the food system is worked. If the Minister has data that proves that the “eatwell plate” is affordable, on whatever income you happen to have in this country, I would be very grateful for that knowledge. If he does not have it now, please could he write to me?

[Lord Kamall (Con)]

I thank the noble Baroness for that important question. When I am being briefed, I test my officials and make sure that I am able to answer as many questions as possible. I am told the “eatwell plate” costs about 3p less per adult per day than the current diet in the UK, but I will write to the noble Baroness with more detail. If the noble Baroness is not happy, she can challenge that.

[Baroness Chapman of Darlington (Lab)]

My Lords, I really think the Minister can afford to be less prickly about all this. No one is disparaging the idea of a pilot; there have been many hundreds of pilots in this space, to my knowledge, and probably many more that I do not know about. The easy thing is piloting it; the hard thing is rolling this stuff out and having an impact. It is just that we are rather underwhelmed with the scale of this pilot, given the scale of the challenge we face. But in the interest of being positive about all this stuff, a Parkrun practice pilot has been taking place in GP surgeries up and down the country—only about 20% of them are actually taking part. Early assessment looks incredibly positive. It does not actually cost anything to implement. I encourage the Minister to try to accelerate the rollout of this initiative and, if he does not already, to take part in his own local Parkrun.

[Lord Kamall (Con)]

I thank the noble Baroness. I would like to know on what basis she thinks I should take part—I hope I am not looking unhealthy. I also apologise to noble Lords if I have come across as prickly; maybe I just got too excited about this scheme. As someone who been quite critical in the past of schemes that do not work and who has looked at evidence behind such schemes, I am excited that this is a real pilot, as opposed to a one-size-fits-all national system. We can see what works and then roll it out. I also thank the noble Baroness for making me aware of the scheme in GP surgeries. Maybe the noble Baroness could do me a favour and send me some details, so I can look into it in more detail and see how we could roll it out.

[Lord Fox (LD)]

My Lords, in giving his answer, the Minister failed to answer one of the questions from my noble friend Lord Scriven on school sport. So perhaps we can give the Minister a second go at responding. When will the Government throw their full weight behind reviving, revitalising and extending school sport?

[Lord Kamall (Con)]

I have responded to questions, including the noble Lord’s question about sport in schools, which is of course incredibly important—we all benefited from that. One of the things I have to be clear about is which department it falls under. As I understand it, some of this does fall under the Department for Education, so if the noble Lord does not mind, I will write to him.

[Lord McNicol of West Kilbride (Lab)]

I want to follow on from the question on sport. Since 2010, the Government have given authorisation for the sale of over 220 school sports fields. Does the Minister see any correlation between the sale of these school sports fields and the rise in health inequalities? I understand the Minister might not be able to answer this and may need to go back, so if we could get a response from the Department for Education, that would be great.

[Lord Kamall (Con)]

I thank the noble Lord for that question. It is an interesting data point to look at to see whether it is correlation, coincidence or there is a link. As the noble Lord acknowledges, I do not have the answer at my fingertips, particularly because some of this will fall under the Department for Education. If the noble Lord will allow me, I will go back and investigate this and write to him.

Social Care

Lord Kamall Excerpts

Thursday 28th October 2021 Grand Committee

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

My Lords, I congratulate the noble Lord, Lord Lipsey, on securing this important debate and I thank him for his well-argued case for the importance of the private sector in helping people pay for care. As he rightly acknowledged, it puts a Conservative politician in an interesting place when a Labour Peer is explaining the benefits of the private sector. I acknowledge his long-standing interest in this area; he brings a wealth of experience to the topic, not least as a member of the Royal Commission on Long Term Care for the Elderly, which in 1999 began the important discussion of how people should pay for their care. We should also be clear, however, that successive Governments, even before then, have kicked the can down the road. Reports have been issued and have gathered dust on bookshelves. I worked for an economic think tank which surveyed a range of views across the political and ideological spectrum—good ideas that have just been ignored for many years.

In that spirit, whatever one thinks of the announcement made by the Prime Minister on 7 September, it marks an important step on the journey to reforming adult social care. We are no longer talking theoretically or about blank pieces of paper. We are talking about a proposal that can be critiqued and, we hope, improved. I hope that in time, with noble Lords’ experience across the House, we will be able to come up with a package that addresses many of the criticisms made today.

The Government’s view at the moment is that the £86,000 cap in England will end the worry that individuals may face unlimited care costs. In addition, anyone with assets worth between £20,000 and £100,000 will be eligible for some means-tested support, helping people without substantial assets. The Government’s view is that the reforms will bring people peace of mind from knowing that their assets will not be wiped out if they end up needing care.

Let me turn to a couple of the points made by the noble Lords, Lord Desai and Lord Lipsey. A few years ago, I read a very interesting article in the Financial Times about financial planning. The journalist asked why we plan for people to build ever larger amounts of wealth towards the end of their lives, then leave it to someone without benefiting themselves; surely we should encourage people to build large amounts of wealth that they then spend towards the end of their lives, including on their own care. That raises some substantial questions, which, I agree, the Government will need to address.

The cap marks an important step in enabling people actively to plan for the cost of their care, and agree that this is where the private sector can play a critical role. Of course, the new cap will protect people from facing unlimited costs and give greater clarity and certainty about what costs they may face. However, I take on board the point made by the noble Baroness, Lady Brinton, about making sure that we have proper publicity and public information. People will need to plan. As many noble Lords have said, to date, too few people think about the cost of care until a point of crisis when they or a family member are affected.

We believe that the financial services industry can play a critical role in helping people to meet their needs and in supporting people to pre-fund their care cost if they wish to do so. As many noble Lords acknowledged, the financial services industry already offers a range of products that can be used to help people to meet their care costs; they may not necessarily be marketed as help for care costs, but they help to build up a sum that can be used for such costs. There will continue to be a landscape of products to meet people’s needs and, we hope, to enable them to fund the cost of their care up to the cap. It is not a one-size-fits-all measure, as the noble Baroness, Lady Brinton, outlined.

Some people may prefer, for instance, to invest in a long-term savings product such as a lifetime ISA, or increase their pensions contributions to make use of their pension freedoms. Others may wish to use some of the products that noble Lords have mentioned, such as immediate needs annuities. Some people may wish to draw on their housing wealth, in consultation with their family, to pay for their care and, as such, make use of equity release products offered by either banks or local authorities through a low-interest deferred payment agreement.

No one single product or approach to planning for care will meet everyone’s needs. Therefore, as the noble Lord, Lord Lipsey, rightly pointed out, quality financial advice will be critical so that people can make informed decisions about paying for their care costs up to the cap. There is already a legal obligation on local authorities to help people to understand how they can access independent financial advice, but we recognise that more is needed. We are working with stakeholders to consider what people need and how the Government can support them.

Noble Lords may think it rather far-sighted of me that, 20 years ago, I started looking at financial products and how I could save for my future. Interestingly, when I interviewed financial advisers, one thing I was advised was that they were not necessarily financial advisers, and that they may well have been financial salespeople trying to sell products. As we ensure that better financial advice is available, we are going to have to be clear about making a distinction between independent advice and the incentive-based sale of products. In many cases, this is where mis-selling has occurred—that is, where the incentives have incentivised the so-called financial advisers to sell an inappropriate product, rather than the most appropriate product, to the person requiring help. With increased demand, and given that this sends a signal that people will have to start thinking about their social care, the Government hope that the market will evolve. I cannot say that for certain because no one can predict how markets will evolve; that is the wonderful thing about spontaneous order, with existing products adjusting and new products developing.

However, as the noble Lord, Lord Lipsey, and other noble Lords acknowledged, this will not happen overnight. We will listen to and work with partners and industry over the coming months to consider the development of financial products to help people to plan for their care costs, in line with the introduction of the cap on care costs in October 2023. The Government have also held initial discussions with the ABI. What is interesting about those conversations is that we were clear that this will not be spontaneous, and that these measures will emerge with time as people start to understand the parameters and the amounts that they need to raise for their future. We hope to continue these conversations with a broader range of sector representatives in the months to come.

I give this pledge to noble Lords across the Committee: I want to learn from the expertise in this Committee. Some very valuable points have been made in this debate. I will hope to take them back when discussing with the Government the future course of the Bill. We will be listening and there is great and deep expertise. As I indicated before today's debate, I would like to have a long conversation with the noble Lord, Lord Lipsey, and others because there are some valuable points being made.

It is important to see the reforms as a package. The noble Lord, Lord Lipsey, said—and this is something we should all be aware of—that this should not be something for the wealthy; it should be for everyone. There is not just the cap, but also a much-extended means test. It is about how we can support people with their care costs right from the beginning and be aware.

The problem with being purely private, as I think the noble Baronesses, Lady Wheeler and Lady Brinton, said, is that there might be some who cannot afford to take out some of these products—those with less or the just about managing. In that case, unless one is a complete anarcho-capitalist, one would see a role for the state to help those who are unable to make those informed decisions.

Regarding equity release schemes, the deferred payment schemes are effectively a local authority-administered equity release scheme and available in certain circumstances. The Build Back Better document says that we want to make these more accessible, better value and not necessarily for profit.

A number of noble Lords asked questions about raising awareness. We have committed to providing information. We want to make sure that those looking to prepare for their own future, or maybe helping their parents prepare for the future, make informed decisions. It is critical that we make sure that they are getting independent advice. I welcome noble Lords’ advice on how we ensure that we make that distinction between advice, objective advice and pure sales. We also want to work on how to improve access to this advice, for example through the citizens advice bureaux.

My noble friend Lord Balfe talked about people paying for their own care. For this Government, it is about balance. We recognise—as I said previously and many other noble Lords have said—that people do not start thinking about this until it is sometimes quite late. We agree that people should pay towards their care, but we want to make sure that they can somehow plan and overcome this issue of unpredictable costs at the same time. How do we get the balance right between personal responsibility and state support for those unable to provide for themselves?

My noble friend also talked about equity release schemes and existing equity release schemes. He made some very interesting points, as did the noble Lord, Lord Desai, on these. We should take them on board.

The noble Baroness, Lady Brinton, talked about the possibility of the insurance market. We agree that the most important point is that the cap in itself will not mean that an insurance market will magically spring up. It will take time for the industry to understand and work through the consequences—particularly the very clever minds in the insurance industry—and then to see what demand there is from the public.

We need to make sure there is a better understanding of who pays for what, as the noble Baroness, Lady Brinton, said. An extensive campaign should be launched. We very much hope once again to draw on the experience of noble Lords across the House in reaching the public. We are finding this with some other health issues. How do we reach those difficult-to-reach markets?

We will publish details of policy parameters later. I will end with a couple of points. My noble friend Lord Balfe talked about Denmark. It is important that we learn from the best and worst international experiences. If my noble friend can send me details of other international schemes, we will look into those.

The noble Lord, Lord Desai, said that women tend to look after men. My wife would probably say that that is not just in old age—I think they start rather young. As my wife says to me, she has two sons but three boys.

I apologise if I have not covered all points made by noble Lords today. If I have not, I hope noble Lords will write to me and follow up. I will try to get the answers if I can. I thank the noble Lord, Lord Lipsey, for securing such an important debate today and thank all noble Lords who have taken part.

People with Learning Difficulties and Autism: Detention in Secure Settings

Lord Kamall Excerpts

Thursday 28th October 2021 Grand Committee

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

My Lords, I thank the noble Baroness for securing this important and heart-wrenching debate, and for leading the work on the independent reviews of people with a learning disability and autistic people in long-term segregation. I also thank the oversight panel that works with the noble Baroness on this vital issue for its report and recommendations, which the Government wholeheartedly welcomed and responded to in July this year.

Some of the stories we heard were heartbreaking. I am extremely concerned to hear about the number of people who remain in long-term segregation and, in too many instances, the unacceptably poor care to which they are subject. As the noble Baroness rightly says, no one should be detained where they do not need to be and where they can live a full life in the community but, sadly, we know that this is still happening and, frankly, it is not good enough. The Government are committed to taking action, both for those already detained who can and must be discharged, and to prevent people who do not need to be admitted from being so in future. We must move away from responding to crises to ensuring that the right care and supporting legal framework are in place from the very beginning of someone’s life.

We are determined to reduce the number of people with a learning disability and autistic people in mental health hospitals, which is why we are investing more than £90 million of additional funding in 2021-22 in community services and support for discharges. The Government are also undertaking wider action, which I will set out as I address the important points raised in this debate. I aim to address as many of noble Lords’ points as possible today.

The noble Baroness, Lady Hollins, started the debate by talking about housing. There is clear evidence that the right housing arrangements can deliver improved outcomes and meet people’s preference to remain in their own home. We agree, as the noble Baroness said, that the right housing for people with learning disabilities and autism is not always available, or available as quickly as we would like. In England, we are providing funding to build specialised housing through the Care and Support Specialised Housing Fund—CASSH—for older people and adults with learning and physical disabilities or mental ill health. We have provided £71 million for the fund in 2021-22.

Also in England, we fund the disabled facilities grants to support eligible people, including people with learning disabilities and sensory impairments, in adapting their homes to make them safe and suitable for their individual needs, subject to a means test, eligibility criteria and their needs assessment; £573 million has been provided for this in 2021-22. Housing is one of the six priority work streams of the Building the Right Support delivery board, and will form part of its upcoming action plan.

The noble Baroness, Lady Hollins, and the noble Lord, Lord Addington, mentioned training and expert staff. We accept that the right workforce is critical in enabling the highest standards of care and support for people with learning disabilities and autistic people. Skilled staff, leadership and creativity can be key in supporting someone towards discharge. For those in long-term segregation, the launch of a senior intervenors pilot is vital. Senior intervenors are being recruited, and we hope that they will help to remove barriers and bring creativity to planning and moving people towards discharge. The role will bring with it the necessary expertise and experience to assist in overcoming some of the barriers to progress.

More generally, we have provided £1.4 million of funding for the development and trialling of Oliver McGowan mandatory training to improve awareness and understanding of learning disability and autism for health and social care staff. Hundreds of staff have already been trained through the trials. The Government recently announced at least £500 million over three years to fund social care professionalisation initiatives to improve workforce well-being and other issues, especially for those who work with patients with autism and learning disabilities.

As we set out in Right to be Heard:

“Our vision is that in future all professionals will, before starting their career or through continuing professional development, undertake training which covers a ‘common core curriculum’ for learning disability and autism so that we can be confident that there is consistency across education and training curricula.”


The Government are currently working with Health Education England, the Medical Schools Council, regulators and medical schools to establish the best approach to developing a core curriculum. In addition, to improve patient services supporting autistic people, we are investing £1.5 million to develop training for staff in adult in-patient mental health centres. I know that the noble Lord said that there are much wider issues around mental health, but it also includes supporting autistic people, in line with tier 3 of the core capabilities framework.

As part of the Oliver McGowan mandatory training in learning disability and autism programme, we are working with a number of people, backed by that £1.4 million investment. Subject to evaluation, this should be available to all of the 2.8 million health and social care staff on autism and learning disability. As I said, the workforce is one of our six priorities. Also, as part of the new national autism strategy, we are taking a number of steps to improve the understanding of autism among educational professionals, as well as the training that we have already announced.

There are a number of incredibly important reports and recommendations, especially those by the Joint Committee on Human Rights, the Health and Social Care Committee and the CQC oversight panel. The Building the Right Support delivery board has been established to drive further and faster progress on the exact issues that a number of noble Lords raised today. We are considering how to bring these recommendations together as part of the Building the Right Support action plan; this will require a cross-government, cross-system effort, as many noble Lords have said.

We also want to ensure better reporting on the number of people being detained. The Government are fully committed to reducing restrictive practices and poor care for people with learning disability and autistic people. Reporting on our progress on the use of these restrictive practices is an important part of that, which is why the Mental Health Units (Use of Force) Act statutory guidance, on which we recently consulted, set the reporting requirements for restrictive practices under the Act. That guidance makes reference to the mandatory requirement to report this information, in line with current NHS England and NHS Improvement requirements. We will publish the final guidance, reflecting feedback from the public consultation, later this year.

The noble Baroness will be aware of existing reporting data which is also already published. NHS Digital publishes its annual Mental Health Bulletin, a monthly public dashboard about the use of restrictive interventions and assuring transformation data about the number of people with a learning disability and autism in in-patient settings.

The noble Baroness, Lady Hollins, and perhaps one or two other noble Lords, also raised the issue of changing the rules so that care workers can enter the skilled worker immigration scheme. We should all acknowledge the valuable role that immigrants play in our economy. Within the social care workforce, nurses, occupational therapists and social workers are eligible for the health and care visa. The new health and care visa will make it cheaper, quicker and easier for eligible social care professionals from around the world to come to work in the UK. We hope to attract the best talent from around the world.

The noble Lord, Lord Addington, asked whether we have training for staff to de-escalate and minimise restrictive practice. NHS England and NHS Improvement have commissioned the rollout of the HOPE(S) model, a national training model to be delivered through NHS-led provider collaboratives to reduce the use of restrictive practices and long-term segregation and to develop positive cultures. The HOPE(S) model will follow a human rights-based approach, be person-centred and be informed by experiences of trauma. A number of noble Lords raised the issue of trauma and we think it is important that we address it. I would welcome feedback from noble Lords across the Committee who take an interest in this issue to make sure that we are on the right path.

I want to dwell on the senior intervener role, which is being trialled in response to the recommendation of the noble Baroness, Lady Hollins, for the introduction of an additional senior person to support local services to plan discharge, guide where there is challenge and agree actions to facilitate a reduction in restrictions. It is important that we do this planning and that we are planning for discharge as the ultimate goal. The project builds on the positive evaluation of the pilot of children and young people’s senior interveners. The ultimate goal of senior interveners is to establish and oversee this robust programme, making sure that we are all working towards discharge from long-term segregation and hospital.

I was asked by a number of noble Lords, especially the noble Baroness, Lady Hollins, about independent case reviews. We have accepted the recommendation made by the noble Baroness, Lady Hollins, and the oversight panel to resume independent case reviews for those in long-term segregation. We are working with NHS England and the CQC to ensure that IC(E)TRs will be restored as soon as possible. It is important that the reviews that take place are high quality and that we have the right panel of experts in place. We are trying to work on this as fast as possible in the context of the Covid-19 pandemic.

A number of noble Lords asked about Winterbourne View and targets. We have a clear target in the NHS long-term plan of a 50% reduction by 2023-24 and are taking action across several fronts to achieve this. There have been more than 10,000 discharges since March 2015 and a 28% net reduction in in-patient numbers. We accept that this does not meet the target of a 35% reduction previously set out in March 2020, but we hope to continue and to make real progress.

The noble Lord, Lord Touhig, talked about mental health issues and Mental Health Act reform. Reform of the Mental Health Act is important and a White Paper was published in January 2021. We have consulted publicly on the proposals, and we published a response in July 2021.

I will try to answer the other questions. The noble Baroness, Lady Bull, and the noble Lord, Lord Touhig, talked about limiting the scope of detaining people with learning disabilities or autistic people. The proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and make every local area understand and monitor the risk of crisis at individual level.

I would like to say more about commissioners, if I may, but, if I have not answered noble Lords’ questions in the time allotted, I hope that they will write to me, so that I can give them all a more thorough response.

I end by thanking the noble Baroness, Lady Hollins, for this important debate. I think all noble Lords agree that all parts of the system must play their part and take action, so that no one is detained when they do not need to be. Hospitals must always have a therapeutic purpose and detain people only for as long as is absolutely necessary. We hope that the actions we have set out today for both the long and short term—I will write to noble Lords about our significant reforms—demonstrate the range of activity already under way or planned. We hope that this will help to ensure that we prevent people with a learning disability and autistic people being detained when they could live a full life in their community with their friends and family, as every one of us deserves.

Once again, I thank the noble Baroness, Lady Hollins, for securing this debate. I look forward to working with her in future.

Social Care

Lord Kamall Excerpts

Wednesday 27th October 2021 Lords Chamber

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

On 7 September, we announced £5.4 billion of new funding for adult social care over the 2022 to 2025 period. We have also announced that this includes more than £3.6 billion to reform the adult social care charging system and to help local authorities better sustain their markets by moving towards paying providers a fair rate for care. It also includes more than £1.7 billion for much-needed wider system reform. Further details will be announced in a White Paper later this year.

[Lord Wood of Anfield (Lab)]

My Lords, the Health Foundation has calculated that, over the next three years, the funding required just to meet current social care demand is bigger than the extra money going into social care from the levy. So this levy will not even start to address issues such as the need for better pay and conditions for social care staff, local government’s lack of resources, and the need for community care, personalisation, et cetera. Could the Minister explain how he expects the country to believe the Government’s plan that, after three years of operation, the NHS portion of the levy, which is currently the majority, will be cut and transferred to social care? Can he confirm that the plan is really to cut NHS funding in 2025 in the face of ever rising demands on its services?

[Lord Kamall (Con)]

The Government have always been clear that the share of the levy going towards the NHS to tackle the backlog was temporary and that, in the longer term, we would move to funding social care. As I am sure the noble Lord is aware, for decades, Governments have kicked the can down the road and have not tackled this difficult issue. The Government have been quite firm in committing money and have been learning, in our constant discussion with stakeholders, how best to reform the social care sector.

[The Lord Bishop of Bristol]

Can the Minister give an assessment of whether the health and social care levy will enable more people with moderate care needs to become eligible for social care funding?

[Lord Kamall (Con)]

I thank the right reverend Prelate for that question. I am not able to answer it directly now, but I will send an answer.

[Lord Young of Cookham (Con)]

My Lords, further to the question from the right reverend Prelate, I understand the concern that the proceeds from the ring-fenced levy may not be enough to relieve all the pressure on social care. So will the Minister encourage the NHS trusts, which are receiving the bulk of the extra funds, to use Section 75 of the National Health Service Act 2006 to commission social care, thereby taking some of the pressure off local authorities?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion, and I will take it back. What we have to remember about the way social care is funded is that, in reality, it is mostly private providers that provide social care, and these are funded by private and state-funded patients. Quite often, we find it is private patients who cross-subsidise state-funded patients. I will take the question from my noble friend back and send an answer.

[Lord Morse (CB)]

My Lords, the NHS hospital system is the carer of last resort. When the community’s needs are not being met as they ought to be by social care or primary healthcare, they go into hospital. This puts excessive demand on hospital resources, which should be devoted to dealing with the elective backlog and waiting lists. Does the Minister recognise that this distortion, with its damaging effects on the NHS, can be corrected only when the NHS is partnered by a well-funded and reformed social care system?

[Lord Kamall (Con)]

It is quite clear that, if we want to make sure that the social care system is fit for purpose, we have to make sure that, in the model, enough money is going in to reform the system. Part of the funding does go to helping local authorities push for reform, but, at the same time, it is true that some of the additional productivity as a result of digitisation will help make the NHS more efficient.

[Baroness Pitkeathley (Lab)]

My Lords, is it not an unfortunate fact that not a single penny from the levy will actually go to the front line of social care to relieve those overworked and underpaid staff making 15-minute visits, which is the real urgency? Even when the money does come to social care, some way down the line, will not much of it be taken up with bureaucracy, in making assessments and testing eligibility for the cap that the Government have put into the system? Surely that is something that we have to look at. How much of the money is actually going to go to the front line, not just now but in three or four years’ time.

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we have to see reforms in the social care sector. The spending of £5.4 billion includes £1.7 billion for wider system reforms, including at least £500 million to support the adult social care workforce in professionalisation and well-being. We are also working closely with providers of care, local government charities, the unions, professional bodies, and users of care and their representatives, and will respond to their views in the forthcoming adult social care system reform White Paper, later this year.

[Baroness Brinton (LD) [V]]

My Lords, so far the Minister has responded only on the issue of adult social care. Freedom of information requests from every local authority in England by the Disabled Children’s Partnership reveal that 40% of authorities cut the respite care for parent carers during the pandemic. This comes as eight in 10 parent carers are experiencing some form of anxiety—a rate much higher than among the general population. Can the Minister outline specifically how the health and social care levy will help restore short breaks and respite care for families with disabled children?

[Lord Kamall (Con)]

The noble Baroness makes an important point that we should address. In looking at the wider picture, we recognise that unpaid carers play a vital role in our care system and make a considerable contribution to society, alongside the paid social care workforce. The Care Act encourages local authorities to support unpaid carers and provide preventive care to stop people’s early care needs escalating. The announcement of the £5.4 billion funding marks the next step in our transformational plans for the sector.

[Baroness Eaton (Con)]

My Lords, if the care system is to improve, a critical element is that of a suitably skilled workforce. Can my noble friend tell the House what plans there are to deliver a new deal for the care workforce?

[Lord Kamall (Con)]

I thank my noble friend for that important point. We have listened to the sector and prioritised the adult social care workforce. The investment of at least £500 million over three years will deliver new qualifications, progression pathways, and well-being and mental health support. This workforce package is unprecedented investment, which will support the development and well-being of the care workforce. It will enable a fivefold increase in public spending on the skills and training of our care workers and registered managers, as well as on their well-being.

[Baroness Wheeler (Lab)]

My Lords, the Secretary of State, Sajid Javid, has admitted that the Government cannot commit to clearing the NHS treatment backlog generated by Covid within three years. This is despite the fact that £12 billion a year raised from the levy will mostly go to fund this work and that he is also announcing another £6 billion in capital funding for the same purpose. Does this recognition of the scale of the NHS challenge mean that social care will have to wait even longer than three years for any levy funding? Can the Minister confirm, as he failed to do last week, that the £162.5 million announced for the social care workforce and recruitment fund was new money and not part of previous repackaging, as we have seen with the Chancellor’s pre-spending review announcements so far?

[Lord Kamall]

The funding commits us from 2022 to 2025—it is three years’ funding. The point that the noble Baroness makes is that, of course, we are hoping that we can clear as much of the elective backlog as possible. After that, the money will be moved and will focus on social care reforms. On her specific question, I will write to the noble Baroness.

[Baroness Watkins of Tavistock (CB)]

My Lords, my question builds on that of the noble Lord, Lord Young of Cookham. Can the Minister explain how social care is to cope now, when there is a crisis, without a larger allocation of the levy in addition to funds announced, and, in particular, how delayed transfers of care from acute hospitals may be reduced? Should there be central guidance to the NHS to commission social care services to assist in safe rapid discharge?

[Lord Kamall (Con)]

In looking at how we reform the adult social care workforce, we have consulted a wide range of stakeholders, not only on what we do from 2022 to 2025 but on what we do in the short term. Further details will be announced soon.

[Baroness Tyler of Enfield (LD)]

My Lords, £1 in every £12 spent by local authorities on social care goes towards funding mental health social care, supporting people of all ages who live with severe mental illness, and their carers. Can the Minister say what proportion of the planned levy will be used to fund mental health social care, which provides such a lifeline to all those affected?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Baroness makes a valuable point about the need to look at mental health and social care. The issue is that, sometimes, for some of the patients who are being helped, it is not only mental health that we are looking at; there is a multiplicity of issues. I will try to get a specific answer and will write to the noble Baroness.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Covid-19: Vaccinations Administered Abroad

Lord Kamall Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Paddick]

To ask Her Majesty’s Government when COVID-19 vaccinations administered abroad will be recorded on the NHS app.

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

My Lords, a pilot was launched in England on 30 September for residents vaccinated abroad who request that their vaccines are uploaded to the national database. Vaccines equivalent to those that are UK-approved—those regulated by the FDA, EMA or Swissmedic—can generate an NHS Covid pass, currently AstraZeneca, Pfizer, Moderna or Janssen in the US, EU, EEA and Switzerland. So far, 53 individuals have had their records updated, covering 22 countries. Vaccination centres have been quick to adapt and users so far are happy with the resolution.

[Lord Paddick (LD)]

My Lords, the Government say how important it is for eligible people to have their Covid booster jab, but those vaccinated overseas are not being called forward for their boosters because their initial vaccinations are not recorded on NHS systems. When will the Government fulfil the promise made by the then Vaccines Minister in the other place in July that this problem would be fixed by August, and how can those vaccinated overseas get their booster jabs?

[Lord Kamall (Con)]

What we have done is look at a wide range of vaccines that are being administered worldwide and look into how we understand the vaccines that have not yet been approved by the MHRA. We are requesting trial data, for example. Only a couple of days ago, I was in a meeting with a Chilean Minister who was asking me about Sinovac, which was very important. It was very helpful that they were sharing data with the MHRA so that it could make a decision as quickly as possible.

[Baroness Quin (Lab)]

My Lords, on a recent visit to France, I found that it was very easy to transfer my English record of vaccinations to the French anti-Covid app, which I then used when going into restaurants and public buildings. This system worked well for residents and tourists alike. Yet, according to the Government’s own website, the English Covid app cannot generally even import the records from Scotland, never mind other countries. What discussions are the Government having across the UK and internationally to ensure that the pilot that he mentioned is rolled out properly and that we have a fully effective system in the future?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Baroness raises a very important issue about the devolved Administrations. As the noble Baroness will know, health is a devolved matter; we are keeping the devolved Administrations informed of progress on the overseas vaccination solution and they are looking to set up similar processes within their own jurisdictions. A Northern Ireland service has just launched. Bidirectional data flows have also been set up by NHS Digital for those who have been vaccinated cross-border between England, Scotland, Wales and the Isle of Man. Bidirectional data flows between England and Northern Ireland will be live soon.

[Baroness Brinton (LD) [V]]

My Lords, in July, the Minister’s predecessor, the noble Lord, Lord Bethell, told your Lordships’ House that the problem with registering Covid vaccines—whether it was UK residents jabbed abroad or those who had taken part in clinical trials—would be resolved by August, in time for the holidays. A further problem is that the app still cannot tell the difference between a third dose and a booster dose. That is important because third-dose people need a further booster dose. To hear that only 53 people have now got their records on an app is appalling. What are the Government going to do about this mess?

[Lord Kamall (Con)]

One of the reasons for the delay has been the wide range of vaccinations that have been administered worldwide. MHRA is working to make sure that it is confident about recognising them in a Covid pass. There is also a range of issues relating to anti-fraud measures that have to be put in place to maintain the integrity of a Covid pass service. The multi-organisation approach that has been adopted has ensured a high-quality service. NHS England has engaged vaccination centres, provided training and enhanced the vaccine data resolution service capability. NHS Digital has updated the API to allow overseas vaccinations to flow from the vaccine database—the so-called national immunisation management system—to the Covid pass. Also, NHSX has built the certification rules to enable overseas vaccinations in the Covid pass.

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Lord, Lord Flight, is not present, so I call the noble Baroness, Lady Walmsley.

[Baroness Walmsley (LD)]

My Lords, another group of people who are not having their jabs recognised are the public-spirited people who took part in the Novavax clinical trial. Novavax has said that it cannot guarantee that having a Pfizer booster is safe for those in their trial, because it has not trialled it. Yet, the Government are now saying that they can have the booster—or they can start all over again and have one of the other jabs. Why?

[Lord Kamall (Con)]

One of the difficult issues we face is pushing international partners to agree that the participants of well-regulated vaccine clinical trials should be treated as fully vaccinated. Only a couple of weeks ago I was on a call with G7 health and transport Ministers, trying to push them to ensure that they recognise those very brave people who came forward for vaccine trials. So far, sadly, we have not had much success. We continue to push them, but, in the meantime, we have found the solution of giving people another vaccine in order for them to be recognised. However, we would prefer international recognition.

[Baroness Thornton (Lab)]

I think the Minister needs to simplify this for the House—it is a very simple issue. If it is possible to register in France that you have been double vaccinated through its systems, why is it not possible to do that in the UK? While the JCVI may be working to fix the issue for UK residents who have been double jabbed abroad, British entry regulations have left foreign visitors in limbo. So, although two doses of Covid vaccine administered by a UK-approved regulator is enough to enter Britain without having to self-isolate, it does not seem to be enough to avoid being pinged by what has now been exposed as our expensive and not very effective test and trace system. Does the Minister agree that this does not make sense, and can he confirm that the JCVI review will also aim to resolve this?

[Lord Kamall (Con)]

As I said, we are looking to resolve as many of these issues as possible. There is no logical reason for this not to happen—it is just that we have to push international acceptance but also make sure that we have gone through the processes, especially for those vaccines not recognised by the MHRA.

[Baroness Hoey (Non-Afl)]

My Lords, further to the point made by the noble Baroness, Lady Quin, about Scotland, does the Minister realise that there has been a huge amount of buck passing between the Northern Ireland authorities and the English authorities about people who are temporarily working in England who have a vaccination and then try desperately to get the Covid pass when they go back? It is really not acceptable. Will he give an assurance now that anyone from any part of the United Kingdom who has been double vaccinated will be able to get a Covid pass, no matter where they got that original vaccination?

[Lord Kamall (Con)]

The Covid pass can be accessed via the NHS app, but, where that is not possible, patients are able to go to the NHS website or to call 119 to get a letter version.

[Lord Lancaster of Kimbolton (Con)]

I remind the House of my interest as a member of the Army Reserve. Many serving personnel and their families have been vaccinated overseas, either by defence medical services or local practitioners, and they too have had a challenge getting their vaccines on to the NHS app. Equally, in reverse, many serving reservists here in the United Kingdom have been unable to get their vaccinations on to JPA—the MoD administration system —meaning that there is a potential delay in their deployment. Since this is not an international problem but a national one between two government departments, can my noble friend simply use his good influences to sort it out?

[Lord Kamall (Con)]

I thank my noble friend for making me aware of that issue; I was not aware of it. On the availability of the Covid pass, I repeat that the NHS Covid pass is available online and via NHS.UK, provided that individuals already have an NHS login. Users can then access it from anywhere in the world and download a Covid pass PDF. Individuals need to be in the UK to download the NHS app, but, once it is downloaded, it can be accessed worldwide. In terms of the conversations between the Department of Health and Social Care and the Ministry of Defence, I will make sure that I do that, and I will write to my noble friend.

[Lord Jones of Cheltenham (LD) [V]]

Following on from the question from the noble Baroness, Lady Thornton, if you are double jabbed in England and test and trace tells you that you have been in contact with someone who has tested positive, you can get a test and, if it is negative, carry on regardless. If you have been double jabbed abroad, you cannot—you have to self-isolate for 10 days. So these people are restricting their social contact with others in case they have to self-isolate. Why can the two categories not be treated equally?

[Lord Kamall (Con)]

The noble Lord makes a very fair point. This is what we are trying to achieve, but we have to work through the trials and the data to make sure that we can do it as soon as possible.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Health Care and Adult Social Care

Lord Kamall Excerpts

Wednesday 27th October 2021 Lords Chamber

[A noble Lord]

Round three!

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

I am on a hat trick. The department welcomes the report by the CQC and recognises the challenges that providers and local authorities are currently experiencing in recruiting and retaining staff, especially social care staff. While local government has a key role to play in tackling staff shortages, the department has been monitoring the situation closely. We have already put in place a range of measures, including funding to help local authorities and care providers address workforce capacity pressures.

[Baroness Wheeler (Lab)]

My Lords, the CQC’s concern about the desperate social care staff shortages this winter and warning about a tsunami of unmet need unless urgent action is taken is very worrying. It is clear that the health and social care levy will not provide any real means of dealing with chronic staff shortages for at least two years. The recent £162.5 million for the workforce retention and recruitment fund gives less than £100 per social care worker, according to this week’s analysis from the Homecare Association of care providers. The CQC has echoed the Commons Health and Social Care Committee’s call in May for an urgent total overhaul of workforce planning in light of workforce burnout after dealing with Covid; a people plan for social care; and an annual independent report with workforce projections. Can the Minister tell the House what progress is being made on this and when we can expect a fully costed and funded workforce plan for this key sector?

[Lord Kamall (Con)]

I thank the noble Baroness for her reference to the £162.5 million of funding for social care through the workforce retention and recruitment fund to help boost staff numbers and support existing care workers through the winter. This is on top of the third infection control and testing fund, introduced in October 2021, which is providing a further £388.3 million of adult social care Covid-19 support until March 2022. This means that, during the pandemic, we have made available more than £2.5 billion in funding specifically for adult social care. We are also taking action to support adult social care providers through a national recruitment campaign.

[Lord Bethell (Con)]

My Lords, this important report is challenging reading for all those who worked on the front line of the pandemic. Its most challenging section is undoubtedly the part on the recovery of services; in particular, as the noble Baroness, Lady Wheeler, said, the importance of

“investment in workforce development and formal changes in service specifications.”

Can the Minister give us some more precise details on how that budget will be spent?

[Lord Kamall (Con)]

I thank my noble friend for his question and for the advice he has given me to date. Even though I have size 11 feet, I am finding it rather difficult to fill his large shoes. On the funding announced, local authorities have a key role in supporting recruitment and retention in their local areas. We are working with them to make sure that they support local providers by identifying workforce shortages, developing workforce plans and encouraging joined-up services. We also continue to work closely with providers, councils and our partners to assess the situation and consider what further action may be necessary.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, the CQC’s annual report highlights the challenges faced by people with learning difficulties, their families and their informal carers. Does the Minister acknowledge this problem? The CQC accepts that its inspection procedures require more emphasis on the knowledge and experience of family and informal carers, following Professor Murphy’s report on the failures and abuse in Whorlton Hall. How can we hope that the CQC and other agencies in health and social care will give priority to the role of family and informal carers when the Government’s main policy statements and papers still virtually ignore their existence?

[Lord Kamall (Con)]

The Government recognise the valuable role that paid and unpaid carers play in social care. We are looking at how we can make sure that we recruit and retain staff. We understand the challenges that many care homes, quite often those in the private sector, face when trying to recruit and retain staff, given the competitive pressures around the jobs market. The Government certainly take seriously the role of unpaid and paid carers.

[Baroness Brinton (LD) [V]]

My Lords, in addition to the winter’s and next year’s workforce plan, the CQC reports that providers of residential care showed the vacancy rate rising month on month from 6% in April to 10.2% in September. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that already are at, or close to, capacity. In recent weeks, two homes in York have announced that they are closing. I appreciate the discussion about planning for the workforce but this is a current crisis. What is the Minister going to do as councils are overwhelmed trying to find beds for patients when there are none?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for the specific examples that she gave. The department is constantly monitoring the workforce capacity pressures. We are continuing to gather a range of qualitative and quantitative intelligence in order to have a strong and live picture of how the risk is developing and emerging. In more detail, this includes drawing on evidence gathered by a regional assurance team and regular engagement with key stakeholders, including the Association of Directors of Adult Social Services in England, local authorities and care provider representatives. We are also monitoring data from the capacity tracker, Skills for Care’s monthly workforce reporting and wider market data. To ensure that we are aware of any emerging workforce capacity pressures, we are strongly encouraging providers to continue sharing available capacity and completing the capacity tracker.

[Baroness Donaghy (Lab)]

My Lords, I conveyed my commiserations to the Minister last week. As he said, he is on a hat trick today, but he is no Salah just yet. The noble Lord is obviously not a Liverpool fan. As the report says, over the past year the pandemic has further exposed and exacerbated health inequalities. Case rates and mortality rates were higher in deprived areas—2.4 times higher than in the least deprived areas for mortality. The report stated that

“strategies to identify and tackle health inequalities were not yet well established.”

What is the Government’s strategy for this, given that deprived areas, such as those in London, are often next to the wealthiest?

[Lord Kamall (Con)]

The noble Baroness raises an important point but before I answer that specifically, I reassure her that I am a Liverpool fan, as well as an Enfield Town fan. It so happens that my middle name is Salah. I think that I can wear that name on the back of my shirt with pride. I assure noble Lords that I did not line that question up. One reason why the Office for Health Improvement and Disparities was set up in the first place was to look at disparities across a wide range of issues, not only in social care but in relation to gender inequalities, ethnic minority inequalities and some of the other inequalities and disparities between various areas. As the noble Baroness rightly says, sometimes one can find some of the poorest communities right next to the some of the wealthiest. We are hoping to address those issues through the work of the Office for Health Improvement and Disparities, by first identifying where disparities are and then addressing them.

[Lord Scriven (LD)]

My Lords, with more than 105,000 vacancies in social care, we have a bit of a crisis. Which job would the Minister advise a low-paid worker to take when offered one of these three full-time jobs, all advertised today: a delivery driver at £11 an hour, a supermarket shelf stacker at £10 an hour or a senior care assistant at £9.25 an hour?

[Lord Kamall (Con)]

I do not see myself as someone who is able to offer jobs advice or careers advice. But the points made by the noble Lord help to explain in many ways some of the pressures that care home providers are facing when recruiting in a competitive market. The Government have looked at funding and how we can work with care providers, particularly as many are in the private sector, as I said earlier. They are not directly controlled by the Government and we can therefore work with local authorities and care providers on how to make sure that they pay a competitive salary to attract care workers to work in the social care system, as opposed to some of the more competitive sectors that the noble Lord mentioned.

[Lord Hunt of Kings Heath (Lab)]

My Lords, one of the areas where there is most pressure has been that of unpaid carers. Not only are they having to take on a much greater load but for a long period they could not even visit their loved ones in care homes. In all the programmes that the Government are taking on, can the Minister say explicitly what is going to be done to support carers in their invaluable role?

[Lord Kamall (Con)]

I think that all noble Lords will agree with the point made by the noble Lord about the importance of unpaid carers and also paid carers. In relation to unpaid carers, we hope that as the social care reforms, in particular, come through, patients will be able to take advantage of social care. That will remove some of the burden from unpaid carers and free up their time. We are, however, looking closely at the implications and consequences of some of the proposed reforms.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, that concludes Oral Questions for today.

NHS England Funding: Announcement to Media

Lord Kamall Excerpts

Tuesday 26th October 2021 Lords Chamber

[Baroness Thornton (Lab)]

The Minister must by now be aware of the chronic staff shortages in the NHS. He will also be aware of the desperate state of some of our buildings in the NHS, and indeed the inadequate facilities for some of our mental health wards. This announcement mentions diagnostic staff, of which already one in 10 are missing. There is a 55% shortage of consultant oncologists, a shortage of radiologists, a shortage of specialist cancer nurses and, so far, no comprehensive NHS staff plan. Could the Minister tell the House who will run the proposed diagnostic centres? Will it be the NHS? Where will the staff for the diagnostic centres, surgical theatres and to operate the new equipment come from?

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

I thank the noble Baroness for her question. Since 2010, we have increased the clinical radiology workforce by 48%, from 3,239 to 4,797 full-time equivalent posts. Numbers of diagnostics radiographers are up by 33% since 2010 and therapeutic radiographers are up by 44%. We are offering those who want to join the radiographic workforce at least £5,000 as a non-repayable grant for each year of their training to be a radiographer. Since 2016, we have seen a 26% increase in those studying diagnostic radiography and a 10% increase in those studying therapeutic radiography.

[Baroness Brinton (LD) [V]]

My Lords, the £5.9 billion in the Chancellor’s early announcement is to pay for physical infrastructure and equipment, not for current services. The NHS Confederation says that next year’s NHS funding allocations are nowhere near enough either. Last week, the Royal Cornwall Hospital declared a critical incident in its A&E department when it had 100 patients in the 40-bed department and 25 ambulances queuing. Its ambulance service is also under intense pressure, reporting that 50 ambulances have queued at times—again, that is much larger than the actual department. This is echoed across the country. How will Ministers help A&E departments and ambulance services in crisis right now?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Baroness refers to what she sees as the workforce shortage. The Government are fully committed to supporting our health and care professionals and to making sure that we have the right number of people with the right skills to deliver excellent patient care and support the increased elective activity committed to under Build Back Better: Our Plan for Health and Social Care. The Chancellor will confirm to the House our three-year settlement for wider health budgets at the spending review on Wednesday, which will support the NHS to undertake long-term planning for the workforce and elective recovery. I will write to the noble Baroness on specific staff numbers for A&E.

[Lord Laming (CB)]

I wonder whether the Minister would agree that the NHS cannot succeed without adequate social care. In the last seven days we have had two reports that show just how vulnerable the social care system is. Can the Minister sign up to a new agreement to protect the NHS by supporting social care? That was absent in this statement.

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. We see social care as incredibly important, which is why we will soon have before the House a health and social care Bill to make sure that we look at both health and social care, from birth all the way through one’s life.

[Baroness Manzoor (Con)]

My Lords, I welcome the sum of £5.9 million, which comes on top of the additional commitments that were previously made by the Government. However, it remains the case that, with demographic changes, an ageing population and many more chronic diseases and illnesses, we will see a rise in cost. Can my noble friend say whether there is an active plan to look at a forward-thinking strategy as to how we will deal with this funding in the long term?

[Lord Kamall (Con)]

I thank my noble friend for that question. Last week we had a discussion on healthy ageing and making sure that the population of the UK is able to live healthy lives for longer. That is very much part of the overall thinking on health reform and we hope to have more details in due course.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister says that Ministers are dealing with workforce shortages. But surely he knows that, throughout the health service, there is a critical crisis. No one is in charge; it does not seem to be the responsibility of Ministers, Health Education England or NHS England. Who will sort this out and who will be held to account?

[Lord Kamall (Con)]

The noble Lord makes a valid point on workforce shortages. The Chancellor will confirm wider health budgets at the spending review, which is in only a few more days. We have already increased training places this year and will feed through into the available workforce. Ensuring that we have the workforce necessary to support this expansion will be driven by a combination of things, such as enforced workforce productivity, including from the spending review digital diagnostic investments, which are expected to deliver a 10% to 15% workforce productivity uplift. We are also looking at existing Health Education England funding, which will provide a pipeline for growth in training numbers.

[Lord Cormack (Con)]

I congratulate my noble friend on an auspicious beginning to his ministerial career. But I also draw his attention to the wording of this Urgent Question, which mentioned an “announcement to the media”. I give strong support to Speaker Sir Lindsay Hoyle in the other place for rebuking the Government for time and again bypassing Parliament. The Government are answerable to Parliament—that is fundamental to our constitution. It is an absolute disgrace that, time after time, Ministers blab to the press before making Statements in either House.

[Lord Kamall (Con)]

My noble friend makes a valuable point. It is important that we are accountable to Parliament, and we will continue to be so. I hope that the fact I am here today shows a willingness to be accountable to Parliament.

[Lord Scriven (LD)]

The Minister has just said in a previous answer that, to deal with the social care crisis, a Bill will be coming forward. The crisis is now. Care homes are not able to take people and are turning them away because of the lack of staff. You will not clear hospitals while social care cannot hope. What will the Government do now to deal with the social care crisis in this country?

[Lord Kamall (Con)]

The money that has been announced is for April 2022 onwards, for three years. In dealing with the specific issue now, believe me, we are having conversations within the department and elsewhere about how we address some of the issues that people are raising with us.

[Lord Patel (CB)]

Going back to the Question on the Order Paper, can the Minister state whether it is the Government’s intention to involve the private sector in delivering some of these diagnostics? If so, will they be paying the private sector tariff or the NHS tariff?

[Lord Kamall (Con)]

I thank the noble Lord for that question. It is important that we recognise that this is a public/private partnership and that we make sure that we can rely on expertise and investment from the private sector. On the specific question, I will write to the noble Lord.

[Lord Balfe (Con)]

My Lords, I point out that the NHS has an insatiable capacity to spend money. I put it to the Minister that political control must be re-exerted over the NHS. Nye Bevan did not found the NHS by asking civil servants to do it. I encourage the Minister to bring a Bill to this House PDQ to get political control back into the NHS and into running it.

[Lord Kamall (Con)]

I thank my noble friend for the very important point he has raised. A friend of mine with completely different politics from me—probably closer to that of noble Lords on the Benches opposite—once said to me, “The thing about working in the NHS is that we always want more money and we are always looking at how to balance that when we get more money”. I think it is important for the public, but also for workers, staff and patients, that we remember value for money and ensure that we spend as productively as possible.

[Baroness Barker (LD)]

My Lords, every NHS provider and professional group is telling the Government that the key shortage in the NHS is staff—and staff who are not exhausted. Can the Minister share with the House the evidence that led the Government to conclude that what the NHS needs above all else for the next three years is kit?

[Lord Kamall (Con)]

The noble Baroness makes a valuable point. We appreciate the hard work that the NHS workforce—doctors, nurses and other healthcare professionals—has put in. This announcement lays out how we will be spending on more kit but also how productivity will help take some of the pressures off the NHS workforce.