Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Lord Kamall Excerpts

Wednesday 25th May 2022 Lords Chamber

Moved by

[Lord Kamall]

That the draft Order laid before the House on 28 April be approved. Considered in Grand Committee on 23 May.

Motion agreed.

Sugar Reduction Programme: Bread

Lord Kamall Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government why the recent sugar reduction programme, which challenged businesses to reduce the amount of sugar in food, did not include bread.

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

The sugar reduction programme focuses on those products which contribute the most to children’s intakes of sugar. Sweeter bread products such as buns, fruit loaves and bagels are within scope of the programme. Plain and savoury breads—for example, garlic bread—are included in the salt reduction programme, as these products make greater contributions to salt intakes than sugar intakes. Garlic breads are also included in the calorie reduction programme.

[Lord Brooke of Alverthorpe (Lab)]

I thank the Minister for that reply. Sugar is in so many products these days and is so damaging. As the Minister knows, we have a crisis with diabetes and with obesity. Does he not agree that we should endeavour to remove sugar wherever we can? There was no sugar in bread 60 years ago. Why is there sugar now? Why do the Government not look at this again and stop it?

[Lord Kamall (Con)]

I pay tribute to the noble Lord. Since my first day at the Dispatch Box, he has challenged me on both sugar reduction and alcohol abuse. There comes a stage where it is diminishing returns. I know that the noble Lord and I are very keen on puns and dad jokes. When bread is being made, sugar is needed—kneaded; excuse the pun—because it extends shelf life by reducing the oxidation which causes food to deteriorate, it reduces the rate at which bread becomes stale, it activates yeast for fermentation, it adds the colour during the baking process, and it adds to the texture. The sugar contributes only about 2% of free sugars intakes in children. Therefore, it is much more worth while and targeted to focus on products that are higher in sugar.

[Baroness Walmsley (LD)]

My Lords, will the Minister join me in congratulating Tesco and Sainsbury’s? They have announced that, even though the Government are backtracking on the proposed ban on volume promotion offers of foods high in sugar, salt and fat, they will do it voluntarily anyway, and on time, to support the anti-obesity campaign. Will he encourage other retailers to join them and to work with their suppliers to reformulate and reduce sugar?

[Lord Kamall (Con)]

We should welcome moves by those in the industry, including retailers; if they can meet deadlines earlier, that is all to be welcomed. Perhaps I might correct the noble Baroness on one inaccuracy. The Government have not backtracked; we have delayed location measures until October 2022.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

Delaying is different from backtracking.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

Next time I will bring a copy of the Oxford English Dictionary. Volume price will come in in October 2023 and advertising in 2024. We did that in full consultation with industry, and it is welcome when industry asks for deadlines and is able to meet them early.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, if the Minister is right that the Government are not backtracking but delaying, perhaps he could persuade the supermarkets that, instead of reducing the price of foods that are bad for you, they should reduce the price of good foods such as fruit and vegetables.

[Lord Kamall (Con)]

That is a very sensible suggestion. Across government, and with the Office for Health Improvement and Disparities, we are trying to work with both the food-supply industry and retailers to look at how we can pull customers towards healthier products and work with companies to reduce sugar, salt and other bad things in terms of food reformulation to make sure that we have a healthier population in the longer term.

[Baroness Boycott (CB)]

My Lords, in respect of the cost of living crisis and healthy food, why do the Government not make automatic enrolment in Healthy Start vouchers immediately happen? At the moment, only about 60% of people take up this good measure to spend on healthy food. This would certainly be a good counteraction to the delay in banning two for the price of one on sugary foods.

[Lord Kamall (Con)]

On the direct question that the noble Baroness asked, I will have to go back to find out more and will write to her. The Government are very keen on some campaigns that she will be aware of, such as the Better Health campaign, launched in July 2020. In January 2022 it took over from Change4Life. We now have the NHS Food Scanner app; with a quick scan of a barcode, families can see how much sugar, saturated fat and salt is in their everyday food and drink. There is also a campaign on on-demand video, as well as on YouTube, and we encourage people to download the app from the App Store or Google Play. More campaign resources are available, and I am sure that noble Lords would like to help promote them.

[Lord Suri (Con)]

My Lords, the staple food of many people’s day is bread. The sugar content in the average slice of processed bread varies but can be up to 3 grams. Sugar is formed naturally in the baking process, but it is often added into it. The benefits of adding sugar are favourable for the bread-making process but not for the people consuming it. Bread can be baked without adding sugar and, yes, that will indeed alter its texture, taste, freshness and the speed of its rise. If we look at the ancient history of bread, we see that making it uses grain and wheat flour; chapatis, naans and numerous Middle Eastern flatbreads usually do not have sugar added. These recipes are healthy and are still being consumed today. Health is wealth; take care of it.

[Lord Kamall (Con)]

Right. I begin by thanking my noble friend for that very comprehensive question. As I said earlier, some sugar is needed in the process, but he makes an important point about how we reduce the unneeded additional sugar that is added. I have already given the reasons why there is some sugar, and no doubt the chemical processes will be improved over time: as mankind’s innovation and ingenuity increase, we will see more substitutes for sugar. I was also interested in the point made by the noble Lord about chapatis; next time I go to a restaurant I will ask about their sugar content.

[Baroness Merron (Lab)]

My Lords, with the UK attending the 75th World Health Assembly in Geneva as we speak, it is concerning that the Government have delayed their planned measures to encourage a move away from foods that are high in fat, sugar and salt. To compensate for this, particularly for those who are experiencing higher levels of deprivation, can the Minister tell your Lordships’ House in what specific ways the Government intend to show the leadership that is so urgently needed?

[Lord Kamall (Con)]

I thank the noble Baroness for raising that point. Part of my role is in international health diplomacy, where other countries come to the UK wanting to learn from us. It is very interesting that a number of other countries are asking to learn from our sugar and salt reduction programmes, our alcohol and anti-tobacco programmes and our campaigns for healthy eating—not just telling people they should not do things but encouraging them to have a healthier lifestyle

[Baroness Hayman (CB)]

My Lords, the Minister has said that the Government accept the need for sugar in bread, which is controversial with many authorities and Members of this House, but they seem to be taking an extraordinarily long time to accept the fortification with folic acid of the flour used for bread. As the Minister has heard many times, this would have undoubted health benefits. Since the noble Lord, Lord Rooker, is not in his place, I felt the need to ask the question.

[Lord Kamall (Con)]

I would have hoped that the noble Baroness would have lined up the noble Lord, Lord Rooker, to be in his place. Only yesterday, I had a meeting with him, the noble Lord, Lord Patel, and a number of other noble Lords, together with departmental officials.

We have to do this within the general picture of the Bread and Flour Regulations. At one stage, the dispute was about the upper limit of folic acid. We have agreed that we will push forward as quickly as possible. We were waiting for the Northern Ireland elections. It has now been confirmed that the Northern Ireland Minister will remain in place until a new Executive is formed. He has promised to push his officials to give approval so that we can get on with the consultation and get this measure in place as soon as possible. I hope that the noble Lord, Lord Rooker, was happy with the progress we made yesterday. I am sure he will tell us in due course.

[Baroness Uddin (Non-Afl)]

My Lords, addiction to sugar begins very early. It is included in baby foods. Will the Minister ensure that manufacturers attend to this sector as a critical component of the Government’s strategy? Does he accept that many people who are digitally excluded may not have adequate access to these campaigns and information from the Government?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. Following our commitment in the Advancing Our Health: Prevention in the 2020s Green Paper, we launched a consultation on baby food. We are aware how important it is to reduce sugar intake. Those aged four to six should have no more than 19 grams of sugar—five cubes—per day. From the age of 11, this increases slightly to seven cubes. This shows the importance of addressing this issue at a very early age, and we are speaking to manufacturers about possible formulations.

NHS Dental Services

Lord Kamall Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Young of Cookham]

To ask Her Majesty’s Government what plans they have to improve access to NHS dental services.

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

The Government are working with NHS England and the British Dental Association to reform the current NHS dental system and to improve access for patients, tackling the challenges of the pandemic. We have also provided an extra £50 million for additional activity and patient appointments. We are working to return quickly to pre-pandemic levels of activity. For this quarter, a new activity threshold for NHS dentists has been set at 95% to increase patient access.

[Lord Young of Cookham (Con)]

I am grateful to my noble friend, but with 86% of NHS dentists closed to new patients, do we still have a national dental service? The current dental contract was deemed unfit for purpose 14 years ago by the Health Select Committee in another place. Will my noble friend, as a matter of urgency, introduce a new dental contract which reverses the decline in NHS dentistry? As his fellow Minister has said,

“there is a shortage … not of dentists but of dentists taking on NHS work.”—[Official Report, Commons, 19/4/22; col. 7.]

Will my noble friend negotiate a contract with private dentists in the meantime to address the NHS backlog?

[Lord Kamall (Con)]

I half-thank my noble friend for giving me advance notice of one of his questions. I will try to answer that one. Many dentists who provide NHS treatment also already work in a private care capacity, and all dentists who provide NHS care must be registered on the performers list. The NHS uses the list to ensure high quality and safety standards in NHS dentistry.

On the UDA and negotiations, NHS England is in conversations with the BDA concerning both short-term changes and longer-term changes given the concerns that have existed since they were introduced in 2006.

[Lord Harris of Haringey (Lab)]

My Lords, I declare my interest as chair of the General Dental Council. The noble Lord, Lord Young of Cookham, has correctly highlighted the importance of the negotiations on the NHS contract for dentists, but there is another element to the problem. That is the long-term expectation in terms of how many of each of the various dental professions and the various dental specialties we need in this country. What is the flow in people leaving and what is the flow in recruiting dentists, including those from overseas? Do we have enough places and enough experience coming in? Does the Minister agree that we should do a proper study of what the long-term requirements are for dentistry and how they are to be met?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point about how we must look at this holistically and not just try to solve one problem or plug one gap while ignoring others. The important thing is what NHS England is doing in conversations about the new contracts. It is looking at how we incentivise dentists to offer services in those areas which are so-called dental deserts. It is also looking at how all the roles have changed over the years. We have certainly seen primary medical care taking on more secondary care. We have also seen pharmacies and others taking on more, so we are looking at different roles around dentists and whether they can take on more of that.

[Baroness Barker (LD)]

My Lords, the Government announced £50 million in extra support for dental practices earlier this year. How many of the practices which received some of that money are in rural areas, which are particularly hit and facing a crisis where about 20% of their dentists are due to retire?

[Lord Kamall (Con)]

The noble Baroness highlights one of the issues that must be addressed: those areas, particularly low-population areas, but also coastal and some rural areas which are so-called dental deserts. It should also be noted that a person is not necessarily permanently registered with a dental practice. You only have to register for as long as your treatment lasts, and if you cannot get treatment at one practice, you should be able to try other practices. You can try 111. I have heard various reports. Some people have told me that 111 is incredibly effective, while others have told me that there are still dental deserts in their local area.

[Baroness Bull (CB)]

My Lords, maternity exemption certificates provide free NHS dental treatment and check-ups for mothers during pregnancy and for a full year after birth. However, mothers who live in so-called dental deserts are denied this right, exacerbating health inequalities between different regions. Will the Government consider extending the duration of the maternity exemption certificate during this crisis of provision, so that more mothers can take advantage of their right to free dental care?

[Lord Kamall (Con)]

On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

[Baroness Merron (Lab)]

My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?

[Lord Kamall (Con)]

I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

[Lord Sikka (Lab)]

My Lords, in England, only a third of adults and half of children have access to an NHS dentist. There are reports of people extracting their own teeth because they cannot find a dentist. As a precursor to any reforms, can the Minister explain which government policies have created this dire state of affairs?

[Lord Kamall (Con)]

It depends which Government the noble Lord is referring to. I was listening to a podcast today in which there was an interview with the BDA, which said that some of these problems go back to 2006 and the UDA. We have to look at these concerns and what we have learned from the mistakes of the Government at that time, and make sure that we address them, particularly in areas that are dental deserts.

[Baroness Boycott (CB)]

My Lords, I want to follow up on the question about the delay to restrictions on “two for the price of one” sales and advertising. The prime reason that children under 10 go into hospital and have anaesthetics is to have all their teeth out, due to sugary drinks and too many sweets. Does the Minister not agree that this is a false idea, from the point of view of both obesity and dentistry? Could he clarify what he means by “delay”?

[Lord Kamall (Con)]

“Delay” means not the same date that was originally proposed. We clearly understand the children’s issues. During the pandemic, NHS dental practices were asked to meet as many priority needs as possible. One of the reasons that £50 million of additional funding was put in was to target them at those most in need of urgent dental treatment, including children.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not true that many of these deserts are in fact areas that need levelling up? I come from one of those areas originally and, when I was a child, a dentist visited the school to check all the children annually. Why do we not have a programme to ensure that schools in these deserts are visited by a dentist per annum?

[Lord Kamall (Con)]

It is important for any review to look at out-of-the-box thinking and to learn from the past. The suggestion made by the noble Lord may indeed be sensible and affordable, so I will take it back to the department. There are clearly concerns about the dental deserts, some of which may be resolved by negotiations with the British Dental Association, work practices, incentives and training. Can you train dentists and dental technicians close to those dental deserts, so that they stay there afterwards?

[Baroness Uddin (Non-Afl)]

My Lords, access to dental services for those with learning and other disabilities has been dire. What assessments and actions will the Government take to ensure that clear pathways are laid for them to access those services? They are not getting the kinds of services they rightly deserve.

[Lord Kamall (Con)]

The noble Baroness is absolutely right that everyone—not just people from deprived areas—should have as much access as they can to dental care. As I said, we are looking at the picture at the moment. During the pandemic, 700 urgent dental care centres were set up. As more dentists have come back on stream after the pandemic, the number has been reduced to 550. If someone is not getting care, they can ring 111 and be signposted to an NHS dentist.

Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Lord Kamall Excerpts

Monday 23rd May 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022.

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

My Lords, the Pharmacy (Preparation and Dispensing Errors—Hospitals and Other Pharmacy Services) Order 2022 was laid before Parliament on 28 April. This draft order extends to the United Kingdom. I note that the noble Lord, Lord Hunt, has submitted a Motion to Regret in relation to the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022. This will now be subject to a separate debate.

The draft order before your Lordships has been in development for a long time under the auspices of the Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board, whose members include representatives from across the pharmacy sector and professional and regulatory bodies. The draft order is welcomed by pharmacy professionals working in hospitals and relevant pharmacy services, and has the support of the four Chief Pharmaceutical Officers of the UK.

I apologise for the parliamentary time taken to progress this order. The Government had to make some difficult decisions to deprioritise non-urgent legislation following the general election in 2019, EU exit and the Covid-19 pandemic. We are now returning to more business-as-usual matters.

The purpose of the order is to extend the defences already available to pharmacy workers in community pharmacy premises made under the Pharmacy (Preparation and Dispensing Errors—Registered Pharmacies) Order 2018 to ensure that registered pharmacy professionals working in hospitals and other settings, such as prisons and care homes, have access to the same defences. This would provide them with access to the defences to the criminal offences set out in Sections 63 and 64 of the Medicines Act 1968, which concern the adulteration of medicinal products in Section 63 and the sale of any medicinal product which is not of the nature or quality demanded by the purchaser in Section 64. The order makes these defences available in defined circumstances and, importantly, incentivises the reporting of errors where pharmacy professionals make genuine dispensing errors, improving learning to prevent such errors occurring.

In summary, the order will support improved patient safety by encouraging a culture of candid and fulsome contributions from those involved when things go wrong. This is a culture we want to see right across the NHS. Within this culture, pharmacy professionals can increase their learning from dispensing errors and identify mitigating action to make recurrence less likely in the future. I therefore commend the draft order to the Committee.

[Baroness Walmsley (LD)]

My Lords, I have always thought that the purpose of highlighting errors in the health service should be to learn and to avoid repeats, rather than to lay blame. That is why I supported the HSSIB, which was made mandatory in the recent Health and Care Act 2022. For that reason, I also support this order, which can contribute to patient safety by extending the removal of the threat of criminal sanctions for inadvertent dispensing errors beyond current community pharmacies and into other places where medicines are legitimately dispensed. These will include hospitals, care homes, prisons and detention centres. Anything which deters people shining a light on errors is a bad thing and should be addressed; anything which enables learning from them is welcome. However, although the order is welcome, I ask the Minister whether there has been evidence that staff have been deterred from exposing or informing patients about a mistake that has been made.

It is vital that the duty of candour that applies to all health professionals is upheld. I welcome the news from the General Pharmaceutical Council that it plans to develop new learning resources to help pharmacists understand how to fulfil this duty and, crucially, why they should do so. Of course, the duty already appears in the Standards for Pharmacy Professionals. This is where actual offences come into the picture. It is right that pharmacists could still be prosecuted if they can be shown to have had deliberate disregard for patient safety, as such a person would not be acting in the course of his profession, so patient protection still applies.

Identifying such a situation would probably rely on whistleblowers, who need protection and confidence that they would not be penalised for revealing information. Will the Minister say who would be responsible for making this judgment? Would it be the General Pharmaceutical Council or a magistrate with professional advice?

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I welcome the Minister’s helpful introduction and his acknowledgment of the delay in bringing this statutory instrument before us. These Benches welcomed the initial preparation and dispensing errors instrument when it came before Parliament in 2017. That welcome was in line with that of a number of organisations, including the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. Today, we are very happy again to give that welcome to this statutory instrument, not least because it is entirely focused on patient safety and on improving safety for patients. It also brings parity across the pharmacy profession, something that has been much called for.

There were some 1 billion prescriptions dispensed last year. At this volume, it is, of course, impossible to avoid all errors, and it is certainly a credit to the pharmacy profession that they are statistically very few and far between. Most professional groups in the health service do not face criminal conviction and potential imprisonment for an inadvertent dispensing error, and therefore it would be quite wrong for pharmacists to be the only ones who do. It is therefore very welcome that this SI extends legal protections to pharmacists working in a range of locations, such as prisons, hospitals and care homes.

Those working in these settings are often under increased stress, and this has been exacerbated by the challenges of the pandemic. The Pharmaceutical Journal has found an approximate doubling of pharmacists reporting that they feel extremely stressed compared with recent years. In often very pressured circumstances, it is right that we, in the way we are discussing today, protect pharmacists—who are often people’s first point of contact with the healthcare system and too often victims of abuse—from unintended mistakes. Ensuring the right to legal defence against prosecution in cases relating to inadvertent error will undoubtedly remove some of the fear these clinicians feel when it comes to admitting errors. It will help to prevent and reduce patient harm through taking the wrong medication or dosage.

It will also assist in promoting a culture of transparency, as has been referred to already. That will help to inform future learning and improve protocols for the dispensing and preparation of medicines. I agree that this is very much a helpful step towards cultural change and towards a more positive and candid workforce, which, as we have already referred to, can only serve to make patients safer.

Of course, again, it is right that this SI extends only to inadvertent errors. Where they are wilfully negligent or intent on causing deliberate harm, those who are responsible will continue to face criminal prosecution. This is critically important and we certainly support that.

I move on to my outstanding questions on the SI. I am concerned that, of the 523,000 dispensing errors that occur each year, only 5% are reported. Does this not suggest that the 2017 legislation increasing protection for inadvertent errors has been largely unsuccessful in encouraging honesty? What more are the Government doing to increase that number? How will the Government further encourage individual pharmacists to feel safe to come forward if they have dispensed the wrong medication? I should like to understand further how the professionals affected by this legislation, especially those who are more isolated than those who have the benefit of a network of pharmacists easily accessible to them, are informed about these changes.

There is always so much more to do when it comes to patient safety, but this is a very welcome step forward. I look forward to the Minister bringing forward further improvements in due course.

[Lord Kamall (Con)]

I begin by thanking noble Lords for their questions. I shall try to answer as many as I can and, in the usual way, if I have missed any of them, I will go through Hansard and make sure I respond in more detail. The noble Baroness, Lady Walmsley, asked about deterrence. I have some statistics here. In 2021, a survey of community pharmacists found that 95% of pharmacists said that they report errors to improve practice and 80% to learn from mistakes. In response to her specific question about fear of prosecution as a reason not to report an error, it dropped from 40% in 2016 to 18% in 2021, largely attributed to the 2018 change in law. Therefore, we expect a similar drop in the fear of being prosecuted for the pharmacists covered by this order.

The noble Baroness also asked about the chief pharmacist. This is a statutory role that mirrors the statutory role of the superintendent pharmacist in registered retail pharmacies. This aims to strengthen the governance of pharmacy services by incentivising the creation of this role, if a hospital, prison or care home does not already have one, in order to benefit from these defences. However, to reflect the diverse arrangements in different health settings, organisations do not necessarily need a specific chief pharmacist role, but should ensure that the statutory functions of a chief pharmacist are included in the relevant individual’s job responsibilities if they want to benefit from the defences.

There was a specific question about where there is no chief pharmacist officer. I understand that, at the moment, existing pharmacists can have that duty extended to them, but I shall have to write to the noble Baroness with more detail. What is really important, as she acknowledged, is the duty of candour. We want to encourage an environment where people do not feel afraid to come forward in order to learn. Of course, there is always the right balance between those who have acted maliciously compared to those who have made a mistake. As the noble Baroness, Lady Merron, rightly said, when you are dispensing this number of prescriptions, statistically and probability-wise, there is probably bound to be some error.

To go back to the point about the chief pharmacist officer, given the flexibility, people do not need to adopt the statutory term of chief pharmacist as a job title; they can have the role of chief pharmacist assigned them. I just wanted to clarify that; if I have not been clear, I shall write to the noble Baroness.

I just want quickly to give a bit of a flavour of the errors to show how something might not necessarily be malicious but could be an error. A medicine intended for another patient could be dispensed to the wrong patient. The wrong medicine could be dispensed. An ingredient could have inadvertently been omitted or added when making up a medicine. A medicine could be dispensed at the wrong strength or in the wrong dosage form. These things happen, not intentionally but unintentionally, which is why we want to make sure that we learn from such mistakes.

Given that we have already introduced these offences for the majority of pharmacy professionals in the retail sector, it is right that we extend them to colleagues working in hospitals. By introducing this order, we are not only removing the fear factor for pharmacy professionals but helping to protect the patient under their care. We know from patients that it is important for them to know that, when an error is made, responsibility is taken and the service learns lessons. This legislation supports and incentivises that principle.

I am not clear whether I have answered every question, but I will check and write to the noble Baronesses as appropriate. I thank noble Lords for their interest and the positive debate today. I commend this draft order to the Committee.

Motion agreed.

North East Ambulance Service

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

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

My Lords, I shall repeat an Answer to an Urgent Question given in the other place:

“Mr Speaker, I was horrified to read the concerns raised about the North East Ambulance Service in reports over the weekend. My thoughts are, first and foremost, with the families affected by the tragic events they describe. I cannot imagine the distress they are going through. They have my unreserved sympathy and support.

In healthcare, a willingness to learn from mistakes can be the difference between life and death. It is because of this that, as a Government, we place such a high value on a culture of openness and a commitment to learning across our NHS. That is why allegations raised by the Sunday Times are so concerning. As was made abundantly clear by the Secretary of State’s predecessor almost a decade ago, NDAs have no place in the NHS, and reputation management is never more important than the safety of patients.

The Government are wholly supportive of the right of staff working in the NHS to raise their concerns. Speaking up is vital for ensuring patient safety and improving the quality of services, and should be a routine part of business in the NHS. That is why, over the past decade, substantial measures have been introduced to support the NHS in England to reduce patient harm and improve the response to harmed patients, including legal protections for whistleblowers, along with a statutory duty of candour and the establishment of the Health Services Safety Investigations Body and medical examiners across the NHS. It is also why, in response to a recommendation of the Sir Robert Francis Freedom to Speak Up review of 2015, the Government established an independent national guardian to help drive positive cultural change across the NHS so that speaking up becomes business as usual. However, when it comes to patient safety, we cannot afford to be complacent. Patient safety remains a top priority for the Government, and we continue to place enormous emphasis on making our NHS as safe as possible for patients.

I note that the concerns raised in this weekend’s reports have been subject to thorough review at trust level, including through an external investigation, and that the trust’s coronial reporting is subject to ongoing independent external audit and quarterly review by an executive director. I also note that, as the appropriate independent regulator, the Care Quality Commission has been closely involved. However, given the seriousness of the claims reported over the weekend, we will of course be investigating more thoroughly and will not hesitate to take any action necessary and appropriate to protect patients.

The Government are also committed to supporting the ambulance service to manage the pressures it is facing, ensuring that people receive the treatment that they need when they need it. We have made significant investments in the ambulance workforce: the number of NHS ambulance and support staff has increased by 38% since July 2010, and Health Education England has a mandated target to train 3,000 paramedic graduates nationally per annum from 2021 to 2024, further increasing the domestic paramedic workforce to meet future demands on the service. Furthermore, 999 call handler numbers were boosted to over 2,400 at the end of March 2022, about 500 more than September 2021, with potential for services to increase capacity further during 2022-23.

I fully appreciate the concerns of Members across this House and would be pleased to meet with those whose constituents have been affected.”

[Baroness Merron (Lab)]

My Lords, human tragedy permeates this scandal, which has seen up to 90 unnecessary deaths, gross negligence, cover-ups and public money buying the silence of staff. Quinn Beadle, who was just 17 when she tragically committed suicide, died because an ambulance worker failed to perform proper resuscitation. In the report that was then made to the coroner, North East Ambulance Service managers removed this detail. The Secretary of State said today that this and dozens more injustices will be investigated more fully. Will the Minister confirm that this will take the form of a formal inquiry, as it surely must? Will questions be asked of the Care Quality Commission, which, despite being tipped off two years ago, failed to flag or even spot this outrage?

[Lord Kamall (Con)]

I thank the noble Baroness for raising those concerns. I completely agree with the sentiments she expressed; this is completely uncalled for. As I said previously, my honourable friend Maria Caulfield pledged that there would be an investigation into this. As to whether it will be a formal inquiry, it is too early for me to give a direct answer, but I will go back to the department and as soon as I have more information I will write to the noble Baroness. I understand that these are historic incidents and that the CQC has said that its service is improving, but as more information is still coming out—even today when I had the briefing, not all the information was there—I will of course commit to write to the noble Baroness.

[Lord Shipley (LD)]

My Lords, in 2019, Matt Hancock MP, the then Secretary of State for Health and Social Care, vowed to end non-disclosure agreements in the NHS, yet earlier this year bosses at the North East Ambulance Service used non-disclosure agreements for the brave whistleblowers in return for settlement. What action will the Minister take with the North East Ambulance Service for flouting the very clear guidance and regulations relating to non-disclosure agreements?

[Lord Kamall (Con)]

As was said in the other place earlier today, the fact is that non-disclosure agreements have no place in the NHS, and the Government have been absolutely clear about that. I am afraid that I cannot give exact details, because it is obviously very recent, but I know that that is one of the issues that will be looked at. We are investigating, and all aspects will be looked at thoroughly.

[Baroness Masham of Ilton (CB)]

My Lords, will the Government do their best to stop cover-ups, which there have been over this matter, so that this does not happen in future?

[Lord Kamall (Con)]

Absolutely. It is really important that we have a duty of candour and that people can be open. We saw this during the passage of the Health and Care Act, with HSSIB. Although there might be an initial reaction to find the culprit, or whatever the issue is, it is really important that we learn from mistakes made. It is a difficult balance, but we have to make sure that we have an open environment and culture so that people feel safe to come forward and explain what happened, and to make sure that these services learn from what went wrong. We have been absolutely clear that there is a cultural issue that has to be addressed, but also that NDAs have no place in the NHS.

[Lord Clark of Windermere (Lab)]

My Lords, we really must learn the lessons, having witnessed this cover-up in one of the most deprived parts of the UK. I say to the Minister that he should not look at the case, for example, of the ambulance drivers in isolation. Will the Government announce now that they are prepared to have a proper workforce plan for the NHS?

[Lord Kamall (Con)]

I take the noble Lord’s point that you cannot look at things in isolation; we have to take a systemic view. Are these issues confined to the ambulance service or is it the wider NHS or the wider trust? These are all issues that have to be looked at. On the workforce plan, I assure the noble Lord that I have tried, but clearly there are issues. Health Education England has been mandated to come forward with workforce strategies, and there are workforce strategies at trust level as well.

[Lord Berkeley of Knighton (CB)]

My Lords, does the Minister agree that we have to be much more proactive in encouraging people to have the courage to be whistleblowers? It is the only way we are going to learn. Secondly, should we not outlaw NDAs of this sort, so that they cannot suppress information that is vital to the well-being of society? I agree with the previous speaker who said that we need to change the culture around this, not just small points.

[Lord Kamall (Con)]

Noble Lords are absolutely right to talk about the culture. Years ago, during my academic career, I looked at organisational change; one of the very difficult issues is that while you can change structures and processes, it is about how you address the culture. Quite often in organisational change, or any change, there is a cultural lag. Sometimes the lag is due to individual values and sometimes it is much more widespread than that, and there are questions about how the culture grew in the first place and how to address those roots. Sometimes it is about personnel change and sometimes it is about retraining. There are a number of issues when it comes to changing culture, which is quite often more difficult than structural change.

The Government have been clear, as has the NHS, that there are clear guidelines around the use of NDAs by the NHS, including that it should not prevent staff speaking up about concerns relating to the quality or safety of care. It will be important for us to discuss all the issues further with the trust, the CQC and others, to determine the appropriate steps to take from here, including on NDAs.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister makes a very interesting point about culture but does he not think that, whatever review is undertaken, it needs to look further? If this is proven to be so, what are the reasons why management would seek to take the action that it did, and to what extent is pressure on managers from higher up the system causing them to cover up because of punitive action? In other words, does he agree that the culture is set by Ministers at the top? If they deal with the health service in a punitive way, as they have often done over many years, they should not be surprised if the system responds by seeking to cover up what has been happening.

[Lord Kamall (Con)]

I recognise that the noble Lord was a Health Minister but I must say that, in my time as a Health Minister, I have never found it to be an adversarial relationship but always quite co-operative. In conversations that I have had with individuals I have met in the NHS, they have been quite clear that I have no power over them, as it were, but that we can discuss concerns—although, clearly, the Secretary of State does exercise certain powers. However, the culture goes deeper than this and the noble Lord is absolutely right to suggest that we have to understand the roots of that culture and the incentives and disincentives to certain behaviour. I am sure that this will all be looked at as we try to learn what went wrong in this case.

[The Lord Bishop of Durham]

My Lords, I should declare that NEAS serves the area that I live in; indeed, I shall be in Shildon on other business later this week. Will the Minister take the opportunity to applaud the work—on the ground and in the vehicles—of members of the ambulance service? They seek to do their best under incredible pressure, day in and day out. This is an opportunity to thank them, I think, even in the face of such tragedy.

[Lord Kamall (Con)]

I completely agree with the sentiment expressed. We should be grateful to all public service workers. They were put under immense strain during the early days of Covid and beyond, and still face some of those issues. There is no doubt that the extra pressure that people face in the workforce can have an impact on their behaviour. Going back to the point made about culture by the noble Lord, Lord Hunt, we have to look at incentives and disincentives, and why people behave in a certain way. We have to not only question that but ask what we can do better in the future. That is the point of learning. We want people to be as transparent as possible, and to feel free to come forward and explain where things have gone wrong.

[Baroness Foster of Oxton (Con)]

My Lords, this is not just about the ambulance service; it is about a culture that is endemic throughout the NHS. I have spent most of my life dealing with the aviation industry, which learned decades ago that if you cover things up, whether deliberately or not, you will never get to the source of the problem. This is why we have such high standards in that industry. Does my noble friend agree that, until and unless we take a fresh look at this and have a no-blame culture, which will then encourage people to come forward if they see things that are not working, we will not get past where we are today?

[Lord Kamall (Con)]

I begin by paying respect to my noble friend’s experience in the aviation sector. Noble Lords who took part in the debate on the Health and Care Bill will know that, when we spoke about HSSIB and safe space, that concept came from learning from the air transport industry and—I hope I get this right—the air transport accidents board, with respect to transparency. When that industry was able to have a frank, open culture and people felt free to step forward without fear of prosecution, it was found that people were frank and could learn from mistakes. This is what we are hoping to do with HSSIB, in the same way—to let people come forward, have a frank and open discussion about what went wrong, and make sure we learn from our mistakes. This is the important thing that we want to learn from the air transport industry; we hope that it will help us to improve the culture for health and care workers.

National Institute for Health and Care Excellence

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

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

A key priority for NICE this year is to increase the flexibility and capacity of its technology appraisal programmes through a more proportionate approach to assessments that will enable it to continue to consistently deliver timely guidance on new medicines. From April 2023, NICE aims to expand its capacity for technology appraisals by 20% to respond to increasing numbers of new medicines.

[Baroness Morgan of Drefelin (CB)]

I thank the Minister for his Answer and for writing to me on this. NICE does a really important job in our health system and I pay tribute to it for that. However, one thing that I have observed recently is that, in some of the more tricky technology appraisals, sometimes you have a first rejection, then another committee meeting, then possibly another reappraisal. This puts a huge amount of stress on patients, often at the end of life, when they are really worrying about whether they will have access to the treatments under review. Is there anything more that the Government can do to help ease the passage of these interim access agreements that patients can have?

[Lord Kamall (Con)]

I am sure that the noble Baroness appreciates that this was a new process, because of the Orbis trial. In some ways, NICE was not exactly prepared for that. NICE has learned from that lesson and 100% of its guidelines are issued within 90 days of licensing. It has learned the lesson but, sadly, there was a confluence of factors: one was Orbis and the other was that the committee meeting regarding recommendations ran over because there were a number of other cancer drugs that it was trying to look at. It has put this on the agenda for the next meeting.

[Baroness Walmsley (LD)]

One of the ambitions in the life sciences vision is to enable early diagnosis and treatment, including immunotherapies such as cancer vaccines. However, last year, 20 treatment evaluations were paused because of lack of capacity at NICE. If successful R&D cannot be translated into treatments because of lack of NICE evaluations, how will that impact on commercial incentives and the ambitions set out in the life sciences vision?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how this fits into the life sciences vision, and NICE is very aware of it. In fact, only last week, I saw a draft business case for NICE for future years, and it takes on board the very point the noble Baroness refers to. NICE is looking at making sure that is has more timely advice and that it can respond quickly; it has also increased capacity, not only for conditions like this but for more digital devices.

[Lord Hunt of Kings Heath (Lab)]

Can the noble Lord explain what he means by a more proportionate response? Does that mean that NICE is reducing the number of stages that are involved in this process? Is it going to increase the capacity it has? How is it going to actually deliver the improvements that the noble Lord has explained?

--- Later in debate ---

[Lord Kamall (Con)]

NICE has recently concluded a comprehensive review of its methods. It wants to introduce greater flexibility in the appraisal of medicines for more severe diseases but is also reviewing the criteria for highly specialised technologies, to make them clearer and more specific. We hope this will benefit medicines for patients with rare diseases and improve equitable access to new and innovative treatment. On the exact detail, I am afraid I am going to have to write to the noble Lord.

[Lord Lansley (Con)]

My Lords, would my noble friend agree with me that the publication by NICE last month, about its work on evaluating new treatments for severe drug-resistant infection, was really valuable, in that it looked at the benefits across the health system as a whole as the basis for an assessment of what an annual subscription for such drugs might be? Can my noble friend say how the Government are taking this work—which is a world first—and working with other countries to try to ensure that, collectively, that kind of subscription can incentivise the drugs industry to bring new treatments for antimicrobial resistance to the market?

[Lord Kamall (Con)]

I thank my noble friend for the question but also for highlighting the fact that NICE is trying to change the way it works to be more flexible and responsive. The new subscription-style payment model that the NHS is developing has been designed to try to address the lack of new antimicrobials being developed and the growing threat posed by antimicrobial resistance, or AMR. The recent guidance from NICE on the two new AMRs is a world first and an important step forward. What NHS England has now got to do is enter into negotiations with the manufacturer, with a view to making them available to NHS patients.

[Lord Turnberg (Lab)]

My Lords, NICE is a remarkably effective organisation, but is the Minister aware of the gross inefficiencies in the system which operates in order for health technology assessment approvals to occur? There is a huge number of committees through which this process has to go. Is there any way of reducing this nightmare?

[Lord Kamall (Con)]

I am aware of some of those issues, but I wonder whether the noble Lord could write to me with some more specific examples. In my meetings with various organisations, including the Health Technology Alliance and others, wherever they have raised these issues we have looked at them. The NHS, the department, NICE and others are trying to work with suppliers, manufacturers and providers to see how it can be more responsive. If we are going to realise the life sciences vision, we have to make sure that we make the best of the NHS as a global centre of excellence and show that we are at the forefront of research.

[Lord Naseby (Con)]

While we all understand the importance of NICE, can my noble friend reassure us that NICE is working within a fixed budget at this difficult financial time?

[Lord Kamall (Con)]

I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.

[Baroness Wheeler (Lab)]

My Lords, NICE is a critical participant in the Innovative Licensing and Access Pathway, launched over a year ago. It aims to make use of regulatory freedoms post Brexit to speed up access for NHS patients to new drugs, including cancer treatments. Can the Minister tell the House how many treatments have been or are being considered through ILAP and when we might expect to see the first ILAP treatment being made available on the NHS?

[Lord Kamall (Con)]

I know I have the answer here somewhere but I cannot find it, so I commit to write to the noble Baroness.

[Lord McColl of Dulwich (Con)]

My Lords, can the Minister kindly inform NICE and the Department of Health that they are misleading the nation and have done for years in telling them that all the calories we eat are used up in exercise? That is not true and has never been true. Only a fraction of the calories we eat are used up in exercise. Could the Minister do something about NICE and the Department of Health?

[Lord Kamall (Con)]

I will try my best. If I may, I shall use this opportunity to respond to the noble Baroness’s earlier question. We have seen horizon scanning in regulatory science, which means that ILAP is at the forefront of cutting-edge developments. It is open to commercial and non-commercial, and UK-based and global developers of medicines. As I said, I will write to the noble Baroness with more detail. On doing something about NICE and the NHS, I have constant meetings with the NHS, as do other Ministers. One of the challenges that came up during the passage of the Health and Care Bill—I know that noble Lords who have been Ministers previously made this point—was that Ministers here have to respond on issues but decisions are quite often taken at NHS level.

[Lord Patel (CB)]

My Lords, I am yet another doctor. In defence of NICE, it has, despite the financial constraint, delivered 50% more appraisals in 2020-21 and is likely to do an extra 20% this year. The important point I want to make is the point made by the noble Baroness, Lady Morgan of Drefelin: patients need to have access to effective treatment sooner. If the appraisals are causing delay, for whatever reason, that is the place where NICE needs help, to get patients early access. For instance, a breast cancer drug that treats patients with triple-negative breast cancers, with a higher mortality, is available in one part of the United Kingdom now, but it is not available in England.

[Lord Kamall (Con)]

The noble Lord makes a very important point. One of the things we are looking at, so that we will not only be a centre for life sciences but make sure that our NHS is at the forefront of healthcare worldwide, is to make sure that we look at the different stages of medicines when they are approved, if they have conditional marketing, and the different stages of approval to see whether we can get them to patients earlier. As the noble Lord says, we should share the good news about NICE. It issued guidance within 90 days for licensing of 100% of new active substances in 2021-22 and has the highest number of technology appraisals in any year since appraisals began. There is some good news, but NICE recognises that it has to do more and we are in conversation about that.

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Lord, Lord Howarth of Newport, who is contributing virtually, to ask the fourth Oral Question.

Long Covid

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

[The Earl of Clancarty]

To ask Her Majesty’s Government what steps they are taking to support sufferers of long Covid.

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

The Government are committed to supporting people with long Covid and are spending £224 million on long Covid care, establishing 90 specialised services for adults and 14 paediatric services for children and young people across England. Those assess people with long Covid and direct them into care pathways that provide appropriate support, treatment and rehabilitation. We are also spending £50 million on research better to understand long Covid and how to treat it.

[The Earl of Clancarty (CB)]

My Lords, the ONS reports that more than 1.1 million sufferers of long Covid in the UK are unable properly to undertake day-to-day activities as a result of their condition. Asthma + Lung UK has seen a doubling of those seeking help with long Covid in the last six months. Will the Government ensure that specialist clinics are provided across the whole country and that sufferers receive appropriate treatment without enduring long waiting times, as often appears to be the case at present?

[Lord Kamall (Con)]

I thank the noble Lord for his question. We have established 90 services and 14 paediatric services. We are at the forefront of research on this. A number of countries are asking about and looking at what are doing on so-called long Covid. I should be clear that long Covid is not an accepted medical term. There are three terms: acute Covid-19, which lasts up to four weeks; ongoing symptomatic Covid-19, which lasts between four and 12 weeks; and post-Covid-19 syndrome, which has lasted for more than 12 weeks. Each patient will have different forms and symptoms, and we are seeking to understand that through further research.

[Lord Wigley (PC)]

The Minister referred to £50 million being allocated to research. How much of that is for studies on affected children, estimated to number some 120,000, and what steps is he taking to ensure timely access to support for children with long Covid?

[Lord Kamall (Con)]

The noble Lord is absolutely right that we have to look particularly at the issue of paediatric care, as well as other long Covid sufferers. The research is varied in terms of the different medical definitions I just gave. Of the three categories, the latter two loosely tie in with what we understand long Covid to be. They are also in line with the WHO definitions. We have established specialised paediatric services, and the research will look across age groups to see what the most appropriate interventions will be.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, following on from the question of the noble Lord, Lord Wigley, some of the paediatric long Covid clinics are only treating children for fatigue, and not for respiratory, neurological or blood problems. Will the Minister meet with me and the Long Covid Kids support group to hear some of the problems they face?

[Lord Kamall (Con)]

I thank the noble Baroness for making us aware of that. I know that there has been extensive stakeholder engagement to understand what the particular issues are. I am happy to commit to a meeting with the noble Baroness.

[Lord Winston (Lab)]

My Lords, would the Minister be kind enough to let the House know through which body the funding for this research is being undertaken? Is it through UKRI or some other body? How is it split up between different funding bodies? What has been achieved so far with the research that has been done?

[Lord Kamall (Con)]

The NHS is working with the wider scientific community to better understand both Covid-19 and its long-term health impacts. The £50 million in research is to understand, first, the actual condition—and, as I said earlier, it is not necessarily a medical condition—and how we map and treat it. In addition, we have had 22 research studies to examine the cause of long Covid, to diagnose the condition and to optimise the design of healthcare systems. A lot of this has been done by the National Institute for Health and Care Research, which continues to welcome applications for further research.

[Lord Suri (Con)]

My Lords, long Covid must be taken seriously, as it is a sickness that has different degrees of symptoms for everyone recovering from coronavirus. Although most people recover quickly, there are those who have symptoms which last weeks or months after the infection has gone. There is also a burden on the people who must look after, and take care of, those suffering from long Covid, as it impacts people across all age groups. I request that Her Majesty’s Government take the necessary steps for research into long Covid so that people do not continue to suffer for such lengthy periods following the infection stage.

[Lord Kamall (Con)]

My noble friend is absolutely right that we must take this seriously. This is why, first, we have tried to map it to the three medical conditions I mentioned earlier: acute Covid-19, ongoing symptomatic Covid-19 and post-Covid-19 syndrome. We are also looking at the WHO definition, which defines post-Covid-19 condition as the condition that

“occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms … that last for at least two months”

and which

“cannot be explained by an alternative diagnosis.”

In my meetings with other Health Ministers from across the world, they want to learn from us what we are doing on long Covid and how we can co-operate better.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has stressed the fact that the diagnosis of long Covid is quite tricky and variable, according to the period of time over which people have suffered from it. Can he tell the House what support the NHS is able to provide for GPs to understand how to look at people who are presenting with an unspecified collection of symptoms which might be long Covid? Can he also say what is being done to help employers to understand this?

[Lord Kamall (Con)]

The noble Baroness makes an important point because there have been some reports that patients feel that GPs have not taken their concerns seriously. In response, NHS England has worked with the Royal College of General Practitioners to provide advice for GPs on the identification and management of long Covid. They have also worked with Health Education England to produce e-learning modules on Covid-19 recovery and rehabilitation. Rather than take up too much time, I commit to writing to the noble Baroness on her second question.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Harris of Richmond.

[Baroness Harris of Richmond (LD) [V]]

My Lords, my 15 year-old grandson has long Covid and has not been able to go to school since November. His school has been fantastic at trying to assist him, but there is only so much that it can do. What are the Government doing to help schools to support these pupils?

[Lord Kamall (Con)]

The noble Baroness emphasises just how wide, varying and diverse the symptoms of long Covid are. We know that children and young people can develop long Covid, just as adults can. NHS England has therefore not only established specialised paediatric services to provide care for children and young people, but is looking at providing specialist advice and support to general paediatric services as we learn more, as well as co-operating with international partners to learn from their experience.

[Lord Patel (CB)]

My Lords, the Minister quite rightly referred to the correct definition for people who suffer from long Covid as having a post-Covid-19 syndrome. That implies that people may suffer from multi-organ conditions and, in that respect, training is important. Does the Minister agree that NICE should be asked to publish guidelines for all professionals to recognise this condition?

[Lord Kamall (Con)]

The NICE guidelines start with the definitions as I have laid out previously, and the NICE definitions are aligned with the World Health Organization. On the noble Lord’s specific question, I will have to write to him.

[Baroness Merron (Lab)]

My Lords, the Equality and Human Rights Commission made an announcement on Twitter that it recommended that long Covid should not be treated as a disability. That would mean that those suffering from the condition would have to take their employer to a tribunal if they felt that they were being discriminated against. Can the Minister tell your Lordships’ House what his view is on how reasonable or not this is? What steps are being taken to promote understanding by employers of this debilitating condition and to encourage and guide them to be open to making changes in the workplace to support sufferers in continuing to work?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are learning more about the different types of long Covid, how to treat them and what interventions they need. People will not always need to go to a primary or secondary care centre for their treatment; in fact, there is an app to help people who can be supported at home. In terms of general advice about disability or to employers, we are working across government as we learn more about this in order to give appropriate advice to employers.

International Healthcare Outcomes

Lord Kamall Excerpts

Thursday 19th May 2022 Lords Chamber

[Baroness Merron (Lab)]

I shall start again. I beg to leave to ask the Question standing in my name on the Order Paper.

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

I assure the noble Baroness that I am only too happy to answer the Question standing in her name.

The Government value the use of robust international comparisons to help improve and reform health services, and work closely with the OECD in compiling such statistics. The Civitas report is based on data already known to the Department of Health and Social Care, which highlights both where the NHS is world-beating as well as where it needs to improve.

[Baroness Merron (Lab)]

My Lords, the recent Civitas report on international health outcomes does not make pretty reading, showing the UK to be the worst for stroke and heart attack survival. With the NHS and patients facing record waiting times and soaring turnover and vacancy rates in the workforce, and no corresponding social care proposals in the Queen’s Speech to alleviate pressure, will the Government finally commit to a proper workforce plan with projections of future need and a proper plan to meet those requirements?

[Lord Kamall (Con)]

I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.

I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.

[Baroness Andrews (Lab)]

My Lords, my noble friend asked a very specific question about workforce. We are 100,000 short of NHS staff. The last NHS workforce plan was 19 years ago in 2003 under a Labour Government. When will we have the next one?

[Lord Kamall (Con)]

As the noble Baroness will be aware, during the debates on the Health and Social Care Bill, we made quite clear the different approaches to the workforce strategy. Indeed, Health Education England has been asked to compile a strategy. The NHS has the people recovery task force, which involves health and well-being and is not only for retention. Also, in our recruitment, we are on track to meet our manifesto commitment of 50,000 nurses. We had over 30,000 more nurses by February 2022. We are looking at different areas, not only from the department but from the ground, bottom up.

[Lord Patel (CB)]

My Lords, does the Minister think that the government target of diagnosing 75% of all cancers at stage 1 and 2 by 2028 needs revising?

[Lord Kamall (Con)]

When one looks at these reports, one sees that one area where the UK clearly needs to improve is on cancer. One of the great issues of this is diagnosis. As many noble Lords will know, when we look at the waiting lists and the backlog, we see that 80% of those people are waiting for diagnosis. It is essential that we tackle that. For children, the one-year survival rate has risen in recent years. We will continue to focus more on diagnosis, including community diagnosis centres.

[Lord McColl of Dulwich (Con)]

My Lords, in discussing the various factors involved, does the Minister agree that one of the main ones is that 71% of the British people are overweight or obese? Obesity impairs the immune system and leaves patients vulnerable to all kinds of illnesses which put an enormous burden on the NHS. Does he agree that the answer is for people to buy fewer calories and put fewer calories into their mouths?

[Lord Kamall (Con)]

The Government are doing a lot on the anti-obesity strategy in conjunction with the Office for Health Improvement and Disparities. We have brought together a number of issues. We have existing actions to halve childhood obesity by 2030 with new interventions. We have invested large amounts in weight management services. However, it is not only about reducing the calories taken in but about burning off those calories and getting the right balance between activity and consumption.

[Lord Reid of Cardowan (Lab)]

My Lords, just over 20 years ago, the waiting list for operations in the National Health Service was around 1 million people. That figure was considered so horrific that there was a massive effort in finance, recruitment and restructuring which over four years reduced the waiting list to 400,000—still too high but significantly better. The waiting list is now 6.1 million people. It cannot be blamed on Covid, because even before Covid it was over 4 million. What are the Government going to do to take those people out of fear and out of pain?

On a lighter note, given the Minister’s previous concern about my spring booster jab, within three days of my birthday, I received an invite and had it two days ago, and it all went very well.

[Lord Kamall (Con)]

I appreciate the fact that the noble Lord has had his spring booster. I would love to take some credit for it, but that must go to our wonderful health and care staff and how they deal with these issues.

The noble Lord is absolutely right: the waiting list, however big, is too big. However, when we analyse the waiting list on the backlog, we see that 80% of people on it are waiting for diagnosis, not surgery. Of those waiting for surgery, 80% can be seen within a day and do not need to stay overnight. We understand the granularity of the waiting list and are taking targeted action to ensure that it is focused on needs.

[Lord Hamilton of Epsom (Con)]

Does my noble friend the Minister accept that, last year, the United Kingdom spent, as a percentage of GDP, a higher amount than any other country in the EU? Does he, therefore, also accept that all these internationally poor comparisons cannot be attributed to a lack of money?

[Lord Kamall (Con)]

My noble friend makes an important point. When you look at the Civitas report, there are a number of statistics where the UK does quite well, but they were not always highlighted. This comes back to the point that this is not only about money; it is about how you spend that money and ensure that you focus on outcomes. One thing we are looking at is better use of the money, for example by using new technology to identify the waiting list and prioritise based on need, as opposed to waiting time.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Civitas report shows that UK deaths from haemorrhagic strokes have increased by over a third over the last nine years, compared to an average fall of 5% elsewhere, with a stark increase in deaths from 2017 onward. This coincides with the Government’s introduction of category 1 and category 2 calls for ambulance services, and the downgrade of suspected strokes to category 2. South Western Ambulance Service figures have shown that the current ambulance wait for category 2 is now one hour and 20 minutes. Will the Government now move strokes into category 1 as a matter of urgency?

[Lord Kamall (Con)]

When we looked at the statistics, which clearly included data from the OECD, some were repeated from the Civitas report, which ranked the UK as quite good in some places and as needing more work in others. In 2019, the UK was ranked as having the fifth highest mortality rate out of 21 countries. Given that, in a long-term plan published in January 2019, the Government outlined commitments to improving stroke services, including better stroke rehabilitation services. Because we have a better understanding of strokes, we also have new ways of tackling the issue.

[Lord Turnberg (Lab)]

My Lords, I think everyone agrees that primary care is in disarray. I met a young general practitioner, aged 51, who was about to retire because she could not stand the pressures being placed on her. It is not simply a matter of manpower or workforce planning; it is a matter of doing something urgent now. What are the Government’s plans?

[Lord Kamall (Con)]

I had a meeting only a few days ago with the person responsible for primary care—a doctor herself. One of the issues we discussed is how we make more effective use of different levels of primary care. What is interesting here is that primary care has, over time, taken on some of the services that used to be provided by secondary care. At the same time, some of those primary care services are now being contracted out or delegated out to, say, pharmacists or physiotherapists, et cetera. We are looking at a solution-focused way of tackling these issues, rather than focusing on who provides the care.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as part of a solution-focused diagnosis, NICE has recently made a recommendation to reduce the waiting list for breast cancer diagnosis by suggesting the use of magnetic diagnosis. What acceptance will the department give to this proposal from NICE?

[Lord Kamall (Con)]

I regularly read recommendations from NICE, as do the relevant policy officials. Yesterday, for example, I was asked to the review the NICE business plan for the next few years, so the department will review the NICE recommendations. However, if the noble Baroness will allow me, I will have to write to her on the exact details.

St George’s Hospital: Patient Deaths

Lord Kamall Excerpts

Wednesday 18th May 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and in so doing declare an interest as a member of the GMC.

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

NHS England and Improvement will review the coroner’s prevention of future death reports and respond within the agreed timescales. The coroner’s investigations are ongoing. The Government are committed to improving the standard of investigations into serious patient safety incidents in the NHS to create a culture of learning from mistakes and to improve patient safety.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. This is a serious issue. An independent review into cardiac surgery at St George’s Hospital found evidence of shortcomings and a number of avoidable deaths. This finding has been totally contradicted by the senior coroner for inner west London, who found the methodology used in the review completely flawed and said of a particular case that the coroner was dealing with that the doctor’s approach had been without reproach. Given the review that will now be undertaken, does the Minister accept that, if the coroner is right, the whole method used by the NHS for these reviews will come under question?

[Lord Kamall (Con)]

I understand the premise behind the assertion and the Question but, as I explained to the noble Lord yesterday, a number of issues are ongoing—the coroner’s inquest, an employment tribunal and a number of other reviews—which, sadly, I am not allowed to comment on. However, I can say at the moment that we are committed to improving the standard of patient safety investigations. We have set up the independent patient safety investigation service and HSSIB to look at this, as the noble Lord will know from the Bill, and we have a number of independent investigations guidance for standard operating procedures by NHS England and Improvement for teams to use.

[Baroness Finlay of Llandaff (CB)]

In the light of the criticisms levelled by the coroner over the structured judgment review in particular, will the Government undertake to require the royal colleges and the new bodies set up to look at the procedure used? Although it looked at case notes, it included neither full oversight of previous medical history nor direct observation of clinical procedures, surgical technique—including anaesthesia—and post-operative nursing, all of which have an impact on outcomes. We all know that clinical opinion varies; the point at which a procedure is judged as high risk versus futile varies from centre to centre and can vary within them from one surgeon to another.

[Lord Kamall (Con)]

The noble Baroness clearly draws on her own experience of this. First, we have to wait for all the coroners’ inquests to finish; I think 36 have been completed at the moment. There will then be reviews, to which there is a statutory guideline on when they have to be responded to. However, it is also important to recognise the differences between the coroners’ inquests and the work of the independent mortality review, which was not undertaken to determine the cause of death in individual cases or attribute blame to individual clinicians—it was looking at a number of procedures.

[Lord Suri (Con)]

My Lords, it is nice of the noble Lord, Lord Hunt, to put this Question to the House. It is a very serious matter that patient deaths at St George’s Hospital were unnecessary. Having digested the comments, we must take the appropriate steps so that such negligence is not repeated. Hospitals are meant to save the lives of patients, not end them. Human life is very important.

[Lord Kamall (Con)]

My noble friend makes very important points which I am sure many noble Lords will agree with. It is about understanding what went wrong in places and learning from that. NHS England and Improvement is committed to improving the standard of patient safety investigations. It set up a new patient safety investigations team; as many noble Lords will know, HSSIB and a number of other panels and investigations are also looking to learn. In addition, NHS England and Improvement will have to respond to the coroners’ reports.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the coroner noted that the NHSI investigation had not used expert investigators and in some cases used only desktop research, looking at case papers, failing to interview key staff witnesses and take a longer view. Given that HSIB uses independent specialist teams and provides a safe space for staff and whistleblowers to talk, is there not a case for asking HSIB now to do its own investigation into this?

[Lord Kamall (Con)]

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

[Lord Kakkar (CB)]

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

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord raises a very important point about the complexity of having a number of investigating bodies. When I was being briefed yesterday, I was surprised by the number of ongoing investigations. We acknowledge that there needs to be a consistent approach to establishing and running investigations and inquiries. We are currently looking to develop an effective and user-friendly guide to handling inquiries and involving DHSC policy procurement IT colleagues in the development of a framework. We are working also with the Cabinet Office to ensure consistency across government, so that whatever we do in health is consistent with other investigations.

[Lord Sentamu (CB)]

My Lords, the murder of Stephen Lawrence really caused a lot of trouble. The Met had a review and another review—and another review. The last person to do an apparently thorough review, Sir William Macpherson, turned up at the inquiry and said, “Your evidence is so awful we cannot listen to it any more.” Kent Constabulary carried out a review, but it did not uncover all the stuff that the Stephen Lawrence inquiry found. It was therefore suggested that there must be an independent police inquiry body so that the police are not marking their own homework. I wonder whether the same thing is happening here and whether this new independent review will uncover all that is required.

[Lord Kamall (Con)]

The noble and right reverend Lord raises a number of important points about consistency and the number of investigations. Their remits are often different, which can confuse the picture, and sometimes some of the investigating bodies are seen to extend beyond their remit, causing further confusion. In this case it is important to recognise the difference between the coroner’s inquest and the work of the independent mortality review. Coroners’ inquests are different, and an independent mortality review was not undertaken to determine the cause of death in individual cases or to attribute blame. It was all about processes, procedures and culture.

[Baroness Merron (Lab)]

My Lords, it is hard to imagine the trauma and pain that bereaved families have suffered, and the terrible impact on surgeons, the staff team and patients. It is concerning to read reports that junior doctors have been prevented from returning to work at the unit to keep them out of a toxic culture of inappropriate behaviour. Can the Minister tell your Lordships’ House what is being done to stamp out toxicity, not just in these tragic circumstances but in NHS workplaces more generally, and what assessment has been made of the problem?

[Lord Kamall (Con)]

Let me begin by agreeing with the noble Baroness on how important it is to recognise the impact that this has had on the bereaved families, and the uncertainty they have experienced. They thought it was going in one direction; clearly that was addressed by the coroner and now the coroner may apologise. When I was looking at this in more detail, I was sadly told not to discuss the culture because of ongoing investigations, but I commit to write to the noble Baroness, to make sure that I am not breaking any legal principles and that I give her a proper response rather than an inappropriate one now.

NHS Mental Health Patients in Private Hospitals

Lord Kamall Excerpts

Thursday 28th April 2022 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have, if any, to address the reported £2 billion per year the NHS is paying to private hospitals to take on its mental health patients as a result of bed shortages.

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

Non-NHS providers have always played a role in delivering NHS services for patients since the founding of the NHS. The CQC regulates both NHS and independent providers to deliver care to the highest quality. The Government and the NHS have an ambitious transformation programme to increase investment in community mental health services and to introduce new models of care so that more people are cared for in their communities, reducing reliance on inappropriate in-patient admissions.

[Baroness Thornton (Lab)]

I thank the Minister. I beg the indulgence of the House to record that this is my last outing as opposition health spokesperson—although I shall be taking up other Front-Bench duties so your Lordships have not escaped completely. I wish to record a huge thank you to colleagues across the House with whom I have worked over many years; my especial thanks to the small but perfectly-formed Labour health team, my noble friends Lady Wheeler and Lady Merron and indeed the Back-Benchers; and my thanks to the many Ministers whose well-being I may not always have enhanced over the years.

On this Question, the issue is not whether it is a good use of NHS funding to spend £2 billion a year on privately provided mental health beds. It is about whether, given the parity of esteem for mental health recently reinforced in the brand new Health and Care Act, the Government have a plan to invest in reversing the decline of mental health beds and increasing the number of NHS mental health beds available at community level, as the Minister mentioned, where they are needed, and over what period.

[Lord Kamall (Con)]

I begin, if noble Lords will allow me, by paying tribute to the noble Baroness for her doughty and robust opposition, but also for the advice when I was a new Minister suddenly thrown in at the deep end. It was very comforting to have one of the Opposition help me and give advice—I make no comments about the quality of the advice but I was incredibly grateful. I also pay tribute, to requote her words, to the perfectly formed shadow team. I thank them very much for all their holding us to account.

On the issue, when I was looking at the future of mental health, one thing we have to look at its granularity. There are different types of mental health; someone suffering from eating disorders, for example, will have a very different need from someone who is schizophrenic. It is really important that we do not just assume that everyone needs to be in a bed. Where appropriate, we should move people out to the community but make sure that they are supported there, not just kicked out the door and left to fend for themselves. We are looking at a massive programme of investment and at how we can have more targeted interventions for those suffering from different mental health issues.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as the recent chair of a major HEE review, recommending ways to improve and deliver the mental health nursing workforce, which was released on 20 April. Can the Minister really drill down on the extent to which the new ILATs will be accountable for both local provision of mental health in-patient beds—services are not enough and some people need admission and care in hospital—and the consideration of workforce needs, not only locally but for the services they purchase in the independent and not-for-profit sector?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how we ensure that those who require services in their community receive them, while ensuring that we have the appropriate workforce. She will know that throughout debate on the Health and Care Bill, we have discussed the fact that Health Education England, as well as NHS England, is developing workforce strategies—as are local trusts at their level, which know their needs and requirements at the same time. In terms of the specific question, I shall have to write to the noble Baroness.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, I too congratulate the noble Baroness, Lady Thornton, on her outstanding contribution in her health Front-Bench role. From these Benches, it is always a pleasure to work with her and we look forward to continuing with her in her new role. Yesterday, the CQC served the Norfolk and Suffolk mental health trust with an improvement notice, reporting that staffing levels remain unsafe, waiting lists were long and, on average, 49 people per month died within six months of contact with that trust. There are staff shortages across NHS mental health services, so can the Minister say what the Government will do to ensure that there are enough qualified mental health professionals in the NHS?

[Lord Kamall (Con)]

I thank the noble Baroness for the question and for repeating the fact that you can find problems in the independent sector and in NHS providers. What is really important is that we are looking at the HEE workforce plan as well as the NHS workforce plan, while working with trusts at the local level and other providers of care to ensure that we have the most appropriate staff levels to meet local conditions.

[Lord Young of Cookham (Con)]

My Lords, if the £2 billion which the NHS is paying to the private sector is enabling vulnerable mental health patients to get high-quality care, is this not to be welcomed as it takes pressure off the NHS?

[Lord Kamall (Con)]

I should remind noble Lords that the noble Baroness said that she was not against private provision out of principle. Private provision can be very helpful and has always worked with the NHS, ever since it was founded. If we think about responders—for example, the impact of lockdown on many people—we have seen an increase in mental health needs. What do you do to increase the provision of mental health services? Do you wait for a new NHS hospital to be built? No—if there is a private provider out there, or an independent provider that can provide those services, you engage them. That is why the NHS and the independent sector, working together, is a really important partnership.

[Lord Turnberg (Lab)]

My Lords, is the noble Lord aware of the Migration Advisory Committee’s report, which pointed out what we all know: poor pay is driving social care workers, including mental health workers, out of the service and into the private sector? For example, they are losing more through inflation than they can keep up with and their pay certainly runs behind private sector pay. I understand that a social care worker can earn more in an Amazon distribution centre than they can in the social care sector. Can the Minister bring to the notice of the Treasury the damage that this policy is doing?

[Lord Kamall (Con)]

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

[Lord Kakkar (CB)]

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

--- Later in debate ---

[Lord Kamall (Con)]

Can I begin by—if my information is correct—wishing the noble Lord a happy birthday? If it is not his birthday, I have made a fool of myself. I am sure all the House joins me.

Wherever there is a tragedy, we have to learn the lessons. We spoke about this during the Bill, for example with HSSIB and making sure we have a safe space to understand what went wrong and ensure it does not happen again. We have to make sure that, as we move towards different models of care for people suffering from mental health conditions, it is appropriate to their condition. Not all mental health conditions are the same. Some will need in-patient provision and others will need care in the community, but we should make sure they are actually supported in the community.

[Baroness Parminter (LD)]

My Lords, I declare an interest in that I have a daughter currently in a private eating disorder facility out-of-area, which the NHS is paying for—for which I am extremely grateful. Given the increasing numbers of people suffering from eating disorders, both children and young people and adults, what hope can the Minister give families like mine that in future their young people and family members will not be sent far away, when we want to see them? They might be in hospital for four, six or nine months at a time. What hope can the Minister give people that—yes, there are brilliant community services for eating disorders and we need more of them—we will open up more beds in local areas to help families and sufferers of these appalling diseases?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her very personal story. It is important that we understand it is more than stats and figures, which are provided to me by the department. In the community, we understand it is important to make sure that provision is as close to the patient and family as possible. We have to remember that care is not just for the patient; it impacts friends, family and others. We are looking at ways to ensure that care is delivered close to families and those suffering from these conditions.