Covid-19: Restrictions

Lord Kamall Excerpts

Monday 14th March 2022 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I beg to ask the Question standing in my name on the Order Paper, and I refer to my work with the Dispensing Doctors’ Association.

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

Throughout the pandemic, the Government’s approach has been informed by a wide range of scientific and medical advice and the latest data, as well as by economic, social and deliverability considerations. Ministers have always had regard to the scientific advice when taking decisions to implement or remove restrictions, but have balanced them against other considerations.

[Baroness McIntosh of Pickering (Con)]

Given that the level of infections is now running at 220,000 new infections per day, and given the fact that the Government are planning to remove free testing from 1 April and have already removed the legal obligation to self-isolate, having already removed the support payments for self-isolation, how do the Government intend to protect the most vulnerable in society and NHS staff, given the Government’s new policy provisions of Living with Covid-19?

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer them as best I can. We are now transitioning to a stage where we are able to live with Covid, and we have just announced our living with Covid strategy. At the same time, we are looking at the best way to help those who are particularly vulnerable medically or economically, who should still be entitled to free tests, for example, and issues such as affordability. We continue to monitor the new variants, the BA2 and the deltacron, and we will also continue to have the ONS surveys.

[Lord Reid of Cardowan (Lab)]

My Lords, given the fact referred to by the noble Baroness, Lady McIntosh, about the reversal of what was a very welcome decline in numbers, has any advice been given to the Government by the bodies to which the Minister referred about a further, fourth jab—another booster jab—for the elderly population? I suppose I should declare an interest.

[Lord Kamall (Con)]

I thank the noble Lord for declaring an interest. We are reviewing all scientific advice and looking at the spread and potential of new variants. Advice has been given on an additional booster, particularly for those over 75. I will not ask the noble Lord his age, but I commit to write to him.

[The Earl of Clancarty (CB)]

My Lords, one thing that some of the most vulnerable have been able to do is make a risk assessment about going out. If testing is not happening and local scientific data on cases not available, that risk assessment cannot be made—isolating the vulnerable even more. Will the Government reflect on that?

[Lord Kamall (Con)]

The Government have reflected on that and, in line with the public sector equality duty, have considered the impact of those decisions on the wider population but also on those who were previously classified as extremely vulnerable or clinically extremely vulnerable. For example, we are looking at whether it is appropriate to continue to give them free tests, and how they can get in touch with clinicians and others to ensure that they are more protected.

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, at the publicly streamed evidence session of the All-Party Coronavirus Group on 1 March, we asked some members of SAGE to outline SAGE modelling for the lifting of restrictions in the living with Covid plan. They replied to us that they had not been asked to model any such plans by Ministers. Given that cases, as the noble Baroness, Lady McIntosh, said, are now 221,000 a day, with active cases of more than 2 million and hospital admissions rising across England, exactly what modelling advice did the Prime Minister and Secretary of State for Health and Social Care take?

[Lord Kamall (Con)]

We constantly have meetings with the UKHSA and a number of different scientists join us for the calls when we have them, but we have always balanced things up. I shall give an example of a conversation I was having just before Christmas with some of the modellers. I asked them “What is your advice?”, and they said “Minister, before we give you the advice, you have to bear in mind that we are only considering the variant at the moment. It is for you to consider the wider medical balancing issues, and also the economic and social costs as well, and we recognise that you have to balance all those up.”

[Lord Cormack (Con)]

My Lords, further to the question asked by the noble Lord, Lord Reid, and declaring a similar interest, I ask my noble friend not just to write to the noble Lord, Lord Reid, but to make a general announcement, so that we know when these fourth jabs will be administered.

[Lord Kamall (Con)]

I can see that that may well be a reasonable request, so why do I not discuss what is relevant and perhaps write to all noble Lords?

[Lord Turnberg (Lab)]

Does the Minister agree that there is a link between the recent upsurge in cases and the decision to stop wearing masks on 1 March?

[Lord Kamall (Con)]

It is interesting that, when I was talking to some of the modellers and scientists about this, they said that whenever they look at models of changes in behaviour, they count in or consider that there will be some uptick because of people relaxing measures. Even though we are moving from a position where it was legal to where it is guidance, they reckon that number in, but they still felt that it was not significant enough not to go forward with the change in strategy.

[Lord Tugendhat (Con)]

My Lords, further to the question of my noble friend Lord Cormack, I have already received a summons for my fourth jab. My impression is that, in west London, the programme has been set up and will be working quite satisfactorily. I will be having my fourth jab tomorrow week.

[Lord Kamall (Con)]

Well, there we are: there is a result already—please never accuse me of working too slowly. In that case, it is quite clear that there is a programme, and I shall find out more details.

[Baroness Thornton (Lab)]

My Lords, three matters have emerged in the past few days: first, there is a new variant; secondly, as the noble Baroness, Lady McIntosh, said, Covid cases have risen by 55% in the past week; and, thirdly, the UK Health Security Agency intends to stop funding the fantastically successful and important ZOE COVID Study app. I appreciate that this Government have an aversion to counting in general, but this app has been vital in tracking and understanding Covid-19, so how will the Government maintain their capacity to monitor this virus, which has not gone away?

[Lord Kamall (Con)]

I thank the noble Baroness for reminding noble Lords that the virus has not gone away. That is one of the reasons why we laid out the Living with Covid-19 strategy. The UKHSA, the Office for National Statistics, and a number of academics, will continue to monitor it. Noble Lords who have read all the articles during the pandemic will be aware of how many scientists are also producing data. We continue to monitor all that data and balance it up when making decisions. We are also prepared to stand up rapidly should there be any variants of concern.

[Viscount Stansgate (Lab)]

My Lords, the Prime Minister has announced that at some stage there will be a major inquiry into Covid. Can the Minister assure the House that when it takes place, all scientific advice that has been received by the Government will be published? Can he also tell us whether he is aware of any scientific advice which has not yet been published?

[Lord Kamall (Con)]

If I was aware of any scientific advice that had not yet been published, I am not sure whether I would be unaware of it. I will try to find out. The Government have laid out the terms of the inquiry; only last week I sent the link to some people, which I am very happy to send to the noble Viscount, for the points that should be considered by the inquiry. During the pandemic, and even now, we continue to receive a wide range of scientific advice. The wonderful thing about scientists is that they continue to debate with and contest each other. Some say that we should never have had these measures, some that we lifted them too early, and some that you can never get the timing right, whatever you do.

[Lord Forsyth of Drumlean (Con)]

My Lords, as we enter an economic war, are the Government not absolutely right to balance the scientific advice with the economic consequences, and that by pursuing the policies which they have since before Christmas, they have put the economy in a strong position which guarantees that we can do as much as we can to help the most vulnerable people in our country?

[Lord Kamall (Con)]

I thank my noble friend for making that point. It is incredibly important, not only within the medical community, where we were asked, for example, to lift some restrictions so that we could start tackling the backlog. We were asked `by mental health experts to ensure that people were getting access to mental health care who had been unable to because of the pandemic. We have also balanced this against economic and social considerations—sometimes these things affect each other. Being unable to work and facing uncertainty can be one of the most destabilising things and can affect people’s mental health. My noble friend is right that we have had to balance a number of issues in the round.

Human Medicines (Amendments Relating to the Early Access to Medicines Scheme) Regulations 2022

Lord Kamall Excerpts

Monday 14th March 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Human Medicines (Amendments Relating to the Early Access to Medicines Scheme) Regulations 2022.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Lord Kamall Excerpts

Monday 14th March 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022.

Relevant document: 31st Report from the Secondary Legislation Scrutiny Committee

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

My Lords, over the course of this pandemic, we have had to put in place curbs on our liberties. Many of those curbs would at one time have seemed intolerable, but they were part of our national effort to slow the spread of the virus. We have now reached the position that we have been waiting for ever since this national effort began: a time when we can roll back some of the rules that have governed our lives over the past two years.

We are able to take this step because of the incredible progress that we have made; I thank noble Lords for alluding to that in the previous debate. When this virus first arrived, we knew very little about it. People were dying. There was no vaccine. We had to make tough decisions to protect our loved ones, our healthcare staff and the British people while we built up the defences to make us safe.

Since then, our vaccination programme has put more than 140 million doses in arms. That has included a booster programme where we were the first major European nation to boost half our population. It has resulted in more than 70% of adults in England receiving the booster, including 93% of those aged 70 and over. Vaccines have given us greater protection and slowed down the advance of the virus. They have allowed us cautiously to open up the country and attempt some return to normal life. The scientific protection that we have built up, together with our greater understanding of the virus, has shifted the odds.

We must be quite clear that our fight against the virus is not over, but we are now able to take a different approach, moving away from legal curbs towards an approach based on personal responsibility and public health guidance, where we trust people to make the right decision for themselves, for their loved ones and for those around them. I hope that noble Lords will bear with me while I talk through each measure in turn.

First, the legal requirements around self-isolation are being revoked. This includes the duty to self-isolate if you test positive, the duty to provide NHS Test and Trace with details of contacts, the duty to notify an employer that you are self-isolating and the legal duty on employers not knowingly to allow someone who is self-isolating to attend work.

Rather than relying on legal restrictions, we are encouraging people to act responsibly and to follow the guidance that has been set out. If you experience any of the main symptoms of Covid-19, you should take a test. These symptoms are a new continuous cough, a high temperature and a loss of or change in your normal sense of taste or smell. People who test positive should still stay at home and avoid contact with others for at least five full days. They may choose to follow this advice until they have received two negative test results on consecutive days.

Household contacts are also advised to work from home if they can and to avoid contact with individuals who are at greater risk from Covid-19. They should also limit close contact with other people outside their household and wear a well-fitting face covering in enclosed spaces. Following this advice for 10 days after the case’s symptoms started, or the day their test was taken if they did not have symptoms, can help to protect others. Specific guidance for staff, in particular those in vulnerable settings, such as adult social care, healthcare and prisons, is being kept under review and regularly updated.

The other regulations being revoked today are the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020. These gave local authorities powers to issue directions to close, prohibit and restrict premises, events or outdoor places. They also gave the Secretary of State powers to require a local authority to issue a direction for closure. These regulations were vital for a local response to the crisis, allowing us to act with speed in response to local outbreaks, but these powers have not been used since July last year and we are now seeing fewer outbreaks, meaning that they are no longer proportionate or necessary. With these regulations revoked, outbreaks will be managed by local authorities through local planning and pre-existing public health powers, as they would be with other infectious diseases.

Although we are able to take these steps, we must remember that this pandemic is not over. There are simple actions we can all take to limit the spread of Covid-19 to protect those around us: get vaccinated, ventilate shared spaces, wear a face covering in crowded or enclosed spaces, get tested if you have Covid-19 symptoms and stay at home if you are positive. It is important that those who test positive for Covid-19 follow the public health advice to stay at home and avoid contact with others for at least five days.

We are taking additional steps to protect the most vulnerable with targeted vaccines and treatments, including offering spring boosters as we announced and the protection offered by antivirals, of which we have a greater supply per head than any other country in Europe.

In our surveillance to build up our resilience to manage and respond to new variants, we will continue to rely on the world-leading ONS survey, allowing us to track the virus in granular detail. We will make sure that we still have the ability to ramp up testing should we need to and will help countries across the world to develop their own capability for surveillance. These defences will be our first port of call in the future, rather than relying on legal restrictions, while we maintain our vigilance.

The regulations we are debating today restore some freedoms to our nation, but we have to make sure we maintain our vigilance and continue to rely on a scientific evidence approach to keep us safe. I commend these regulations to the Committee.

[Baroness McIntosh of Pickering (Con)]

My Lords, I thank my noble friend, both for his Answer to my Question earlier, which I would like to pursue in more depth here, and for moving the regulations today. I also pay tribute to the work that he, the ministerial team and the department have done. They have worked exceptionally hard in challenging circumstances. I declare my interest as an adviser to the board of the Dispensing Doctors’ Association.

I understand, as my noble friend said in response to my Question earlier, that the department and the Government are reaching a balance in living with Covid. The context of these regulations must be set against that background. My concern is that we are still relying on the vaccination programme. I pause and say how welcome the vaccination and booster programme has been. I particularly welcome the fourth jab being rolled out to the most vulnerable. It seems slightly patchy: we heard earlier that some in London have a date for their vaccination, but hearsay and anecdotal evidence are that people are being told that they will have a vaccination but have no date yet.

My main concern is simply this. The Secretary of State has said publicly, and my noble friend has repeated it in the House and in Committee today, that the Government hope to respond and keep the development of the pandemic under review. I welcome that but my concern is very simple: that we are removing all the tools to enable the Government to do so.

--- Later in debate ---

[Baroness Thornton (Lab)]

The noble Baroness, Lady Brinton, has raised very many relevant questions, as did the noble Baroness, Lady McIntosh. Those questions come from the anxiety that people are feeling about what the future of living with Covid means, with what looks like not having all the instruments to identify it or the recommendations about what to do if you have it. There is also the support that people may or may not be able to get from their workplace; and the support that may or may not be available to local authorities, for example, which are going to pick up some responsibility for this.

Almost exactly two years ago, my noble and learned friend Lord Falconer and I faced the Minister and his Whip, two Liberal Democrat colleagues, a couple of people who were chairing the sessions and a skeleton staff as we put on to the statute book the restrictions we are lifting today. Everybody else had already gone into lockdown; we put the legislation on to the statute book about three days after the rest of the country had gone into lockdown. It was a bizarre experience and actually felt quite risky. I am sure the noble Lord, Lord Newby, will not mind me saying that he went home and told us the day after that he had got Covid. My noble and learned friend Lord Falconer and I were absolutely convinced that we were going to get it, because we had been sat very close together, but neither of us did at that point.

In a way, I am very pleased to see that we are rescinding these restrictions now, but the Minister needs to put some answers to what has already been put to him on the record. The first thing I want to ask about is the support for local government. If local government and public health authorities are to be picking up how to identify what to do about the pandemic if things get worse, I would like to know whether support is available to them to do that.

The second thing I want to raise is to do with monitoring and research. I excuse the Minister for not answering my question in the Chamber earlier, because it is quite hard to answer such questions in detail in the 30 seconds that might be available, but I will repeat the fact that the ZOE Covid study app is no longer going to receive its funding. The app was launched in March 2020, having been developed by King’s College London and the technology company ZOE to help discover new symptoms of Covid. It reported on the effects of vaccines and has provided up-to-date predictions about the spread of the pandemic. It has 4.7 million users, of which I declare myself as one, and 850,000 people contribute daily to its recording of more than 480 million health reports. The app was part of one of the largest studies of its kind in the world and has led to 40 peer-reviewed scientific papers, based on its findings.

Many noble Lords will have heard of Professor Spector. He has been doing weekly YouTube broadcasts that I have watched from time to time as part of my information gathering to do my job from these Benches more effectively. He has developed the study further to look at things such as heart disease, cancer and dementia. It is extremely disappointing and very short-sighted that the UK Health Security Agency is going to withdraw its funding for this programme. It has been an important tool in protecting the UK and could protect the UK from the next pandemic.

I want to hear from the Minister what he and the Government are going to do to replace the kind of surveillance that the ZOE app has provided to this country in a very cost-effective way. The Minister’s earlier answer to me in the Chamber said this and that, but he did not specify. We need to know why the Government have allowed this to happen and what they are going to do to replace this effective surveillance and reporting.

Thirdly, I would like the Minister’s view on the BA.2 variant. His honourable friend said that it is of no significance but that is not what the chief executive of the UKHSA said. She acknowledged it and said that we do not yet know whether it is significant. How do the Government propose to monitor this?

Finally, I want to talk about the problem of inequality that the Government’s withdrawal of free testing brings. I think it will mean us having two tiers of Covid in this country. Those of us who can afford to will continue to test because we believe that it is important to protect other people, particularly the vulnerable, when we go out and about. I do not want to come into the House of Lords without having a test in the morning because I would hate to bring an infection into the workplace, because of the young people and pregnant colleagues who are here. That would be irresponsible. But there will be those who cannot afford to buy tests; what do they do? Our part-time staff here, for example, might not be able to afford to test. The Minister needs to address the problem of the inequalities that the Government’s policy will bring about for those who may get Covid but cannot afford to test.

[Lord Kamall (Con)]

I thank all noble Lords for their questions today. I will try to answer as many as possible but, if I do not answer some, I hope that noble Lords will allow me to write to them in more detail.

I start with some of the questions from my noble friend Lady McIntosh. We have taken this step because of the success of the vaccination programme but the guidance states that, if you have Covid, you should stay at home and avoid contact with other people. On 21 February, we will continue to make tests available for a small number of at-risk groups. We are considering which groups will be eligible for tests after provision for the general public ends. We have also sent out 1.3 million PCR tests to clinically extremely vulnerable individuals. This will allow them to take an immediate PCR test, should they develop symptoms, and give priority to them to be prescribed antivirals.

UKHSA will continue to maintain what it calls critical surveillance capabilities. That includes the Covid-19 infection population-level survey, genomic sequencing and additional data. These will continue to be augmented by the SARS-CoV-2 immunity and reinfection evaluation, SIREN, along with the continuation of the VIVALDI studies. As for the assertion of the noble Baroness, Lady Brinton, that the VIVALDI studies are coming to an end, I do not have that information—I am, in fact, informed that they are continuing. So, the UK Health Security Agency still has a number of tools available, including surveillance. Positive cases should stay at home, as we said, and avoid contact with other people for at least five full days. They should continue to follow this advice until they have received two negative test results on consecutive days.

A number of noble Lords expressed concerns about the communication of this guidance. If they will allow me, I will go back to the department and ask more questions about the comms strategy to make sure that the public are clearly informed. As for the cost of LFTs, the Government are looking at how to make them freely available in particular settings, such as health settings, and for social care staff.

We are also looking very hard, as noble Lords have rightly said, at potential inequalities. These are issues that my right honourable friend the Secretary of State and I believe very strongly in—we have actually asked questions on this issue. How do we make sure that we do not end up with a two-tier system? How do we target this more effectively? Are there proxies, for example, to allow people to be given free tests? We are also looking at engaging with retailers to develop a strong private market for tests and make sure, I hope, that they are affordable. At the same time, we are in discussions with employers, et cetera. Some have said they will make testing available for their staff and we are looking at a number of different programmes. We are very aware of the inequalities issue and the Secretary of State and I have been asking questions about that.

On the number of cases, as indicated by the ONS infections survey and reported case rates, they have started rising after a period of sustained falls throughout February. Evidence indicates that the link between Covid-19 infections and progression to severe disease is substantially weaker than in earlier phases of the pandemic but, as I said, we are continuing to keep an eye on all the variants of concern with the tools that I explained.

People who are severely immunosuppressed are eligible, as many noble Lords will know, for a third dose of the Covid vaccine as part of their primary course and a booster fourth dose. I am also very aware that the noble Baroness, Lady Brinton, asked me about a potential fifth dose and I promise to write to her. The NHS is now offering new antibody and antiviral treatments to people with Covid-19 who are at the highest risk of becoming ill.

I was asked about local authorities. Local authorities will now be required to manage outbreaks through their local planning and pre-existing public health powers, such as those under the public health Act of 1984, as they would with any other infectious disease. The Department of Health and Social Care is also conducting work looking at the health powers framework for the future. We see that local authorities still have an important role in supporting businesses and public spaces to be Covid-safe—for example, by improving knowledge of infection prevention and control, ensuring that spaces are well ventilated and explaining the relevant best practice guidance.

A number of noble Lords wondered whether movement from mandating to guidance is sufficient. When I was travelling in today, for example, I noticed that some transport companies are still asking their passengers to wear masks in crowded places. Noble Lords made fair points about the communication of this guidance. As I said, I will find out from the comms team what we are proposing to do. The Government will retain the capability to stand up a national trace response if it is needed. Local health teams will also continue to use contact tracing and provide context-specific advice where they assess this to be necessary as part of their role in managing local outbreaks of Covid-19, as they do with other infectious diseases.

A number of noble Lords asked about the number of people who have yet to be vaccinated. Was that the previous debate? I am sorry; they kind of flow into one another at the moment. However, we are spending £22.5 million on a community vaccine champions scheme, following a £23 million investment in the initial scheme. We will continue to encourage people to get vaccinated.

--- Later in debate ---

[Baroness McIntosh of Pickering (Con)]

I am most grateful to my noble friend for repeating the responsibilities of the local authorities. Were they allocated special funds to do this or are they just relying on their existing public health budgets? In other words, are they not getting any new money for this role?

[Lord Kamall (Con)]

I am afraid I do not have a detailed answer, and I do not want to give an inaccurate one. I think I know the answer but I just want to double-check it. I will write to all noble Lords, as more than one Member raised that issue.

We see the importance of continuing to be vigilant, and of surveillance. We continue to monitor the virus and want to make sure that we have informed decisions and that everything is data-led. A number of noble Lords mentioned the ZOE app. Again, I will have to go back to the department to find out more information, if noble Lords will allow me.

In closing the debate, I thank noble Lords for their contributions. I apologise for the questions I have not answered; I will check Hansard and write to noble Lords. We should also thank the scientists, the health and social care workers, the volunteers, the life sciences industry, the postal, courier and transport workers and everyone who has helped us to get to this point. They have helped us to get through what has been a very difficult period in our lives.

We believe that the regulations before the Committee mark an essential step on our journey to living with Covid, away from legal restrictions and towards guidance and personal responsibility. Once again, I am grateful to noble Lords for raising their concerns, some of which I will have to go back to the department and check on, especially concerning the guidance and its communication. I have taken that point on board.

Throughout the pandemic we have sought to strike the right balance between the safety of the public and keeping the country open. We saw restrictions as a vital weapon in the armoury, but now we have the defences of the vaccination programme and the antivirals, along with a better scientific understanding of the virus, and can take a different approach. However, I repeat: we will keep monitoring the data, drawing on the latest scientific advice, and protecting the country through the defences we have built.

It is important that we follow public health advice should we display Covid-19 symptoms or receive a positive test result. We can all help each other in limiting the spread of the virus by getting vaccinated, ventilating shared spaces, wearing a face covering in crowded or enclosed spaces, getting tested if we have Covid-19 symptoms and staying at home if positive. Lifting these restrictions does not mean that we are ignoring the virus; it means managing the virus through the best possible guidance, as we do for other infectious diseases. I urge noble Lords to agree to these historic measures and commend the regulations to the Committee.

Motion agreed.

Care Homes: Evicted Residents

Lord Kamall Excerpts

Thursday 10th March 2022 Lords Chamber

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

It is unacceptable for a care home to punish a resident for raising concerns. This would be a breach of existing regulations, and the CQC will investigate any such cases. Although the Government do not collect figures on this, the CQC collects data on care home evictions and seeks assurances that visits are allowed by care homes on an ongoing basis. We are exploring ways to improve the complaints system and the quality of care.

[Lord Hunt of Kings Heath (Lab)]

My Lords, may I urge the Minister to do even more than he suggested today? We know that some care homes are still being very highly restrictive on visits. The Alzheimer’s Society, the Relatives and Residents Association and other organisations report that many relatives are frightened to go through the homes complaints system for fear of reprisals such as visit bans, or even evictions in the most extreme cases. The CQC will not investigate specific complaints. Will he change that policy and give support to relatives who wish to make legitimate complaints?

[Lord Kamall (Con)]

I thank the noble Lord for raising this issue. I am sure he will recognise, from when we have worked together on a problem, that the first question I ask officials is: what is the problem and what are we doing about it? When I asked this question, I found that my colleague Gillian Keegan, Minister for Care and Mental Health, has met relatives and residents’ associations to hear directly about their experiences and focus on how we could strengthen the CQC role. In addition, in the Living with Covid-19 strategy, we are reviewing a range of measures in place for homes, including visitor restrictions. The updated position will be set out in guidance by 1 April. We are encouraging representatives, patients and patients’ groups to come forward and feed into that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my role as chair of the National Mental Capacity Forum. There are many people with impaired capacity in care homes, whose mental state is deteriorating through lack of stimulation, inability to be taken outside and lack of general overall mental activities. Does the CQC have any idea of the number of people with impaired capacity still subject to restricted visiting by their relatives?

[Lord Kamall (Con)]

The noble Baroness has identified a potential issue that we have to address, which is drilling down into detail. One of the things that the CQC does is to look at aggregate numbers of complaints and concerns. Of course, there is a Local Government Ombudsman who looks at this issue as well. We are looking at ways where that works and where it does not work, and at how we could improve the system. This is all part of the ongoing review to build up a better, integrated health and care system.

[Baroness Wheeler (Lab)]

My Lords, on the issue of carers hesitant to make complaints to care providers, the confusion and muddle over the current complaints system and the roles of the care home, the CQC and the ombudsman compound the problem. Does this not underline the urgent need for the review of the current arrangements to ensure that people making complaints about their loved ones feel reassured and protected through the process and comforted that appropriate action will be taken?

[Lord Kamall (Con)]

Having looked at the different procedures, I am sure that the noble Baroness is absolutely right. One thing that we want to do is to ensure that the guidance is quite clear. The CQC collects certain data and the ombudsman can investigate certain cases, but the CQC cannot investigate individual cases. It clearly is confusing and one thing that we want to do to improve the system is to make sure that we have a better complaints system and, overall, a better quality of care for patients all round.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, will make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, the provision of high-quality, personalised care in residential care settings is likely to reduce the chance of complaints being raised in the first place. The Skills for Care workforce review showed that only 44% of care staff have any training on dementia. Will the Government commit to all social care staff receiving tier 2 training in the dementia training standards framework?

[Lord Kamall (Con)]

The noble Baroness raises a very important point. When we look at the current landscape in the social care sector, it is clear that people do not really understand the overall sector. One thing that we are looking at in regard to the voluntary register is encouraging care staff to come forward to register. Registration includes their standard of education and the qualifications they have received. We will look at how we can improve and have a more consistent qualification system, so that being a care worker is a more rewarding vocation in the future.

[Baroness Pitkeathley (Lab)]

My Lords, is the Minister aware that restrictive practices about visiting in care homes extend not just to relatives and friends visiting but to the outside people who come in to provide stimulation to residents? These include people who bring in animals, for example, and people who do physiotherapy or all sorts of word games and so on. Those people are also restricted now by some homes, though not all. That results in further deterioration in the mental and emotional health of residents, as referred to by the noble Baroness, Lady Finlay.

[Lord Kamall (Con)]

One thing that has clearly upset a lot of people is that they are unable to visit. This means not just relatives but, as the noble Baroness rightly said, people who enter care homes to offer healthcare, stimulation and other services to residents. These issues were brought up, I understand, in a meeting with my colleague, the Minister for Care and Mental Health, when she met residents’ associations. It is very important that we recognise all the problems and that we tackle this in a holistic way to make sure that, as we improve the quality of our social care system, and make it more joined-up and integrated with the health system, we are aware of all these problems so that the patient experience is far better all the way through.

[Baroness Neville-Rolfe (Con)]

My Lords, I agree with my noble friend the Minister and noble Lords opposite that it is very important that people can visit their family and their friends in care homes. My husband has had a copy of Wisden from last year for a friend who has been in a care home, and he has not been able to deliver it.

I want to make a wider point about the importance of focusing on social care, despite other preoccupations of the Government. How many care homes do we have now in this country? Is provision going up, or do we have a serious problem?

[Lord Kamall (Con)]

I am afraid I do not have the detailed answers to my noble friend’s questions, but I will write to her. On the overall sentiment behind that question, it is clear that people now recognise—as we have an ageing population and people are living longer—that we should not see social care as a sort of bolt-on or a Cinderella service. It should be properly integrated, which is why we published the paper on health and social care integration and why we want to make sure that people and patients, all the way through their lives, have access to good-quality care, whether in the current health system or in the care system, at whatever stage of their lives they need it.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

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

My Lords, I thank all noble Lords who have spoken and particularly thank the noble Baroness, Lady Pitkeathley, for her continuing championing of carers.

Discharging people as soon as they are clinically ready is increasingly recognised as the most effective way to support better outcomes. The evidence shows that the “discharge to assess” approach reduces time spent in a hospital bed and supports people to remain independent at home wherever possible. Although the hospital discharge clause does not mandate discharge to assess, the Government are supportive of local areas that choose to implement this best practice model. We believe that carrying out long-term needs assessments at a point of optimum recovery leads to a more accurate evaluation of people’s abilities and needs and more appropriate care packages. Many people discharged from hospital require longer than two weeks to recover. Requiring social care needs assessments to be completed within two weeks of discharge would not necessarily be in the patient’s best interests.

I understand that noble Lords are concerned about safe discharge from hospital and safeguards for patients and carers. However, relevant NHS bodies are expected to ensure that patients’ health needs are met safely in hospital and in the community. Local authorities also have duties to assess patients’ and carers’ needs and, where relevant, ensure that appropriate support is put in place for them. In addition, the CQC monitors, inspects and regulates services to make sure that they meet the fundamental standards of quality and safety, which are set out in legislation.

The Government do not believe that these amendments are in the best interests of either carers or patients. They would create new burdens on NHS bodies and local authorities, and Amendment 144 would create new penalties for local authorities for failing to carry out assessments within a specified timeframe. In doing so, the amendments would undermine the entire purpose of Clause 80 and hinder the ambition, shared across the health system and by Members of this House, to ensure that people are discharged in a safe and timely manner. The creation of significant bureaucracy between local authorities and the NHS risks damaging relationships and would go against the spirit of integrated working that this Bill seeks to support. We agree, however, that accountability and transparency are key to ensuring that local systems deliver high-quality and safe discharge services, which is why we welcome the fact that NHS England now publishes hospital discharge data.

Additionally, a duty on NHS bodies and local authorities to co-operate with one another is already set out in Section 82 of the NHS Act 2006. To specify how this duty will apply to hospital discharge, we are co-producing guidance with organisations including Carers UK, the Carers Trust and Barnardo’s. This will set a clear expectation that, where appropriate, unpaid carers should be consulted during the discharge process. As noble Lords have acknowledged, this guidance will be statutory; NHS bodies and local authorities will therefore be required to have regard to it or risk claims for judicial review potentially being brought against them. We agree that, where we can do more to “think carer” across the NHS, we should. With this in mind, we can commit that we will consult with the public, staff and carers on including a stronger reference to the role and regard of unpaid carers in the NHS constitution, for which a review will be launched this year.

I am also mindful of the specific concerns that have been expressed in relation to young carers. As well as using the guidance to include a much broader definition of carers than that set out in Schedule 3 to the Care Act, I can inform the House that the new Explanatory Notes for the Bill provide clarity that young carers and parent carers are included within the everyday definition.

In response to a number of noble Lords’ questions, I repeat what I said earlier: our new guidance includes a broader definition of carers than Schedule 3 to the Care Act, which applied only to adult carers of patients requiring a long-term needs assessment before discharge. Adult carers’ rights to an assessment of their own needs, under Section 10 of the Care Act, and young carers’ rights, including those as part of the Children Act, remain unchanged under the proposed hospital discharge arrangements.

We believe that statutory guidance is more appropriate here. At the moment, current guidance is not statutory; this will be statutory. Where a young carer is identified, or staff have concerns, the local authority should be notified. Local authorities must then carry out a needs assessment if it appears that the young carer needs support. We are not imposing new duties on local authorities; the existing legislative duties placed on local authorities to assess and meet patients’ and carers’ eligible needs remain unchanged.

I recognise the good intentions behind Amendments 113 and 144, but we believe they would have the effect of undermining the ability of local areas to adopt best practice for hospital discharge. I am not confident when I say this, but I hope that, having heard what I have said, noble Lords may feel able not to press their amendments when reached.

[Baroness Pitkeathley (Lab)]

My Lords, I thank all noble Lords who have spoken and the Minister for his responses, particularly about consultation and about broader definitions and identification of carers. I was a little puzzled when he mentioned transparency, since the latest updated version of the impact assessment says:

“The level of support required as well as the associated impact on work hours and salary would vary significantly case-by-case and the impact on unpaid carers is difficult to assess. We are therefore unable to quantify the impact on unpaid carers at this stage.”


I am very concerned that, if we cannot quantify the impact on carers, we cannot really do anything to support them.

The problem with guidance, good practice guidance or statutory guidance, is that we have been here before. I have seen other bits of guidance—the identification of carers by GPs, breaks for carers—I have seen those bits of guidance fall away when another priority takes over. Therefore, I am very concerned that we need to have the rights of carers enshrined in primary legislation, and I wish to test the opinion of the House.

--- Later in debate ---

Moved by

[Lord Kamall]

126: Schedule 16, page 242, line 11, after “(h)” insert—
“(a) omit the “and” at the end of sub-paragraph (iv);”Member’s explanatory statement
This amendment is consequential on paragraph 5 of Schedule 16 to the Bill, which adds a new sub-paragraph (vi) to section 19A(6)(h) of the Criminal Procedure (Scotland) Act 1995.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, these Benches support Amendments 141, 143 and 144A. I congratulate all who have spoken and laid out the very important issues that we are talking about in this group. I will add one more point, which is that the fairly small savings that the Government might make under these measures, unless they are amended, would be paid for by the most vulnerable people. That is unworthy of a Government who say that their ambition is to level up across the country.

[Lord Kamall (Con)]

I thank all noble Lords who have spoken in this debate and I am sorry I was unable to engage as much on this issue as I was on others. I will speak first to government Amendments 128 to 140 and 187. We believe that these amendments are crucial to make the adult social care charging reforms work as intended. If they do not stand as part of the Bill, it will lead to unfairness between those whose needs are met by a local authority and those who self-fund their care. The intention of these amendments is to correct this.

Without these amendments, some costs which individuals have incurred will not meter towards the cap when they should do so. Currently, individuals eligible for funded support who have not had a timely needs assessment may incur costs in getting their needs met in the interim. This applies whatever system of charging we come up with. The costs incurred during periods of delay currently do not count towards the cap, and my amendments fix this. We came across this issue when we were looking back at previous Bills and unintended consequences.

I have also tabled an amendment to clarify the circumstances in which an independent personal budget must be provided by a local authority and what information those documents must include. We want these to be forward-looking documents, personal to the care user. To support this and to simplify the metering process, we are also removing the link between these documents and what meters.

Finally, as set out in the recent impact assessment, our charging reform implementation plan includes a small number of trailblazer local authorities that will implement charging reform earlier than others. I have tabled Amendment 187 to allow these trailblazer local authorities to begin implementing the reforms before others. For these reasons, I ask that noble Lords support my amendments.

On the other amendments, a number of noble Lords have asked questions and I will try to answer them. We believe that the £86,000 level set for the cap balances people’s personal responsibility for planning for their later years with a need to put in place a system to ensure that nobody faces unpredictable costs. Removing Clause 155 or simply omitting Clause 155(2) would have the effect of removing the ability to meter towards the cap by individual contribution only. Instead, progress towards the cap would be based on both individual and local authority contributions to care costs. This policy is unfair. However, it is also considered unaffordable.

Removing these clauses would increase the cost of the overall reforms by about £900 million per year, if you keep all other parameters the same—although. of course, other noble Lords have asked for other amendments, so those parameters would not necessarily be the same. This would require raising the cap, reducing means-tested support or expecting people to make contributions towards their daily living costs that are unaffordable from most people’s income. None of these is preferable to the approach that the Government are proposing to take.

We argue that the Government’s reform package is affordable and deliverable. We have indeed seen many reports over the years, and I understand that the noble Lord, Lord Warner, was on the Dilnot commission, but we have to ask ourselves why these were not implemented. Although we may see many merits in a number of a different systems, and we all have our own biases or views on what the system should—

[Lord Warner (CB)]

May I give the Minister the answer to why they were not implemented? Successive Conservative Chancellors declined to implement them.

[Lord Kamall (Con)]

The noble Lord may say that, but I have been advised that they were considered unaffordable.

On Amendment 142, I thank the noble Lord, Lord Lipsey, for his engagement with me on his very interesting idea. I agree with him; I regret the fact that the private sector has not come forward sufficiently to offer products. I agree that that could have solved a number of problems, but I should clarify that the taper rate is not linked to income, as suggested. It is what people are considered to be able to afford to pay towards the costs of their care, based on their capital.

The amendment would make the means-testing regime significantly more generous than in the Government’s proposal, and I can see why that is attractive. However, once again, to answer the questions from many noble Lords, that would be considered to make charging reform unaffordable. We would be unable to afford to invest in wider improvements in the social care system that we are all keen to see. The Government’s plans balance providing protection and predictability when it comes to care costs with how much additional burden should be placed on the taxpayer. We believe that our reform is responsible, deliverable and affordable. I repeat that although it may not be optimal, our proposal is better than the existing system, where there is no cap.

Amendment 143 suggests a zero cap, which would equate to free personal care for those identified as having eligible care needs before the age of 40. We considered this issue carefully and, as acknowledged by the noble Baroness, Lady Campbell of Surbiton, we looked at this system and engaged with her, but, as she rightly said, the issue was the cliff edge. One may disagree about the cliff edge, and there are other cliff edges, but we felt that one of this magnitude was unfair. We also believe that younger adults will benefit from the announced charging reforms. From April 2022, the social care allowances will be uprated in line with inflation to allow everyone to keep more of their income.

The noble Baroness, Lady Campbell, asked about data on the under-65s. We need to improve the data that we hold on under-65s who are drawing on care and support so that we better understand their needs and how reforms impact them. The Minister for Care and the Minister for Disabled People this week met a large number of organisations representing working-age disabled adults to discuss this and other issues. This group will continue to meet as our reform programme progresses. I hope that that offers some reassurance to the noble Baroness.

Amendment 144A would require the full rollout of the government reforms to be commenced before 1 April 2023. One of the reasons we looked at October is that we recognise that implementing reforms of this magnitude —noble Lords will have heard me say previously that we have grasped the nettle—requires a significant lead-in time to enable local authorities to prepare. We have invested £3.6 billion in preparation for these reforms, and we cannot do it overnight. In addition, we want to have the flexibility to work with some of those trailblazer authorities to make sure that we really get the best of the discovery process to ensure that it works and that we can spot any unintended consequences.

We do not believe that there is sufficient time for local authorities to prepare for full national rollout by April 2023. It is vital that we take the time to work with the sector and local authorities on the process of implementation if we are going to get this right. To enable a successful rollout, we want to see how the trailblazers will work before we go for the full national rollout by 2023. Trialling and engagement with the sector would have to happen anyway, whether Clause 155 stood or not. As I have said, if Clause 155 does not stand, we would not be able to afford to implement charging reform.

--- Later in debate ---

Moved by

[Lord Kamall]

128: Clause 155, page 124, leave out lines 19 to 29 and insert—
“(a) in relation to eligible needs met by a local authority, to any amount the local authority charged the adult under section 14(1)(a) or 48(5) for meeting those needs;(b) in relation to eligible needs met by a person other than a local authority, to what the cost of meeting those eligible needs would have been to the local authority that was the responsible local authority when the needs were met.”Member’s explanatory statement
This amendment de-couples the costs that accrue towards the care cap from the costs specified in the budgets and simplifies the drafting for determining those costs that accrue.

--- Later in debate ---

[Baroness Greengross (CB)]

I will be very brief because this is a slightly different subject. I shall speak to Amendment 181, which places a duty on the Secretary of State to ensure that each hospital has sufficient accommodation for patients who are rehabilitating and no longer require a hospital bed but still have needs. Further, as part of this duty, the Secretary of State must ensure that any spare land owned by the NHS is considered for this use.

In Scandinavia, patient accommodation of this nature has been part of the state health system since the late 1980s. Having patients stay in these facilities, which are designed to cater for people still needing some medical care, has delivered considerable savings to the public health system. The savings from these facilities is significant. In the previous group, much of our discussion—as always—was about the cost of our health and care system to the taxpayer, and to those who need care. This amendment, as well as delivering better rehabilitation and care for someone recovering from being in hospital, also delivers a significant saving. As I pointed out in Committee, NHS trusts are currently spending money putting up patients in hotels, with rooms costing as much as £275 a night. One London hospital has spent over £1 million on hotel rooms in the last three years. The cost of someone staying in a hospital bed for longer than they need is even greater than that. This is something that I would very much like to take up further with the Government.

Over the last few years, I have been working with a chartered architect who has identified various sites where this could happen throughout England. One is not terribly far from here. This is a real opportunity and I hope the Government will take it to include this as part of the Bill.

[Lord Kamall (Con)]

My Lords, I start by thanking noble Lords who have spoken in this debate. In the end, this turned out to be an eclectic mix of amendments. Given that, I hope I can get the right balance between giving noble Lords comprehensive enough responses, while bearing in mind the more basic need of a dinner break for some noble Lords who have been in this debate today. I will be as brief and as comprehensive as I can be.

I turn first to Amendment 144B. We should be clear that the CQC is not intended to be an investigative body for an individual seeking redress. Other statutory bodies already exist to investigate individual cases and complaints, including the NHS complaints system. If complainants remain unsatisfied, they can raise their complaint with the independent Parliamentary and Health Service Ombudsman. Where the risk is serious or life-threatening, the CQC can act on a single concern and take regulatory action. Similarly, complaints about adult social care services should be made first to providers. They can also be made to the local authority, if the local authority is commissioning the care. Thereafter, complaints can be made to the Local Government and Social Care Ombudsman. Providers must investigate all complaints thoroughly and take necessary action where failures have been identified. The CQC monitors health and social care providers’ complaints processes and can compel providers to provide a summary of complaints received and their responses. Failure to do so within 28 days is considered a breach of the regulation and could lead to prosecution of the provider.

On Amendment 147A, I hope to assure the noble Lord that work is already in place for a framework for assuring the quality of people working in social care. Registered managers are already assessed by the CQC, to confirm their fitness to be registered. Nurses are regulated by the Nursing and Midwifery Council and social workers by Social Work England. Any person delivering personal care must have a DBS check. If, in the future, it was decided that adult social care workers in England should be subject to statutory regulation, the power to do so already exists in Section 60 of the Health Act 1999.

I turn now to the amendments in my name. I start by thanking the noble Baroness, Lady Merron, for raising this issue with the House, and thank all those noble Lords, including the noble Baroness, Lady Finlay, who have raised concerns about the need for regulation of this ever-evolving industry. As I hope noble Lords will now acknowledge, the Government are committed to improving the safety of non-surgical cosmetic procedures by establishing a licensing system. This will support the introduction of consistent standards that individuals carrying out such cosmetic procedures will have to meet, as well as hygiene and safety standards for premises. The definitions in the amendment are intended to cover the broad range of cosmetic procedures which, if improperly performed, have the potential to cause serious injury and harm. The subsequent regulations will set out in detail the treatments to be covered by the licensing system, and the detailed conditions and training requirements individuals would have to meet. The purpose of this amendment is not to ban procedures or stifle innovation, but rather to ensure that consumers who choose to undergo a cosmetic procedure can be confident that the treatment they receive is safe and of a high standard. The Government will work with stakeholders, including noble Lords, to put in place a licensing regime that works for both consumers and providers, protecting those who choose to receive cosmetic procedures without placing unnecessary restrictions on legitimate businesses.

The noble Baroness, Lady Finlay, asked me a number of questions, so I will try to answer them. I begin with radiofrequency. Given the broad range of skin-tightening procedures, proposed new subsection (2)(e) provides scope to encompass a variety of treatments which involve a wide range of application techniques, including radiofrequency and ultrasound devices. The aim of the licensing scheme is to protect the public from the risk of harm. To achieve this, the regulations will specify the standards of training required. The proposed new clause will also allow regulations to make provisions about the duration, renewal, variation, suspension or revocation of licences.

The range of non-surgical cosmetic procedures available to consumers is vast. Therefore, drawing up the regulations will require detailed consultation with a range of stakeholders. This will include a number of partners, such as the cosmetics industry and local authorities. We will try to do this as quickly as possible, while ensuring that the list is as comprehensive as possible. We will try to get that balance. For these reasons, I hope I can ask noble Lords to support these amendments and I ask the noble Baroness to consider not moving her amendment.

Elderly Social Care (Insurance) Bill [HL]

Lord Kamall Excerpts

3rd reading
Friday 4th March 2022 Lords Chamber

[Baroness Merron (Lab)]

The Lord Speaker is most kind: I will be quicker in future.

I thank the noble Lord, Lord Lilley, who is not able to be in his place today, for his considerable consideration and work during this Bill’s passage. I am grateful to him for having given your Lordships’ House the opportunity to discuss such important issues, which are particularly timely considering the passage of the Health and Care Bill. As noble Lords will be aware, while discussion on the Bill was welcome, it has unfortunately not found favour across the House. I certainly look forward to the Bill being an encouragement to the Minister to come forward with ways to support the sector properly. I look forward to a real and sustainable plan for fixing the issue that faces us. So, I extend my thanks to all Members of your Lordships’ House for their contributions during the passage of the Bill, and to the noble Lord, Lord Lilley, and I look forward to hearing from the Minister.

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

My Lords, I begin by thanking the noble Baroness, and the Lord Speaker for allowing us time for this debate. I congratulate my noble friend Lord Lilley on securing the time for Third Reading of the Bill, which proposes a state-backed insurance company for social care. I am sure noble Lords across the House will wish my noble friend a speedy recovery. I thank him for his thoughtful proposal to address the long-standing issue of unpredictable social care costs. As many noble Lords will recognise, there have been many reports over the last few decades and they have just sat there gathering dust on shelves: to date, we still do not have a proper system. The Government wholeheartedly agree with much of the analysis underpinning the Bill and I shall mention but a few of the ideas that stood out for us.

First, we are well aware of the challenges around the private market delivering insurance for social care costs, so we recognise the benefits of delivering insurance through a public not-for-profit company owned and guaranteed by government. I also particularly admired how the proposal addresses affordability by allowing people to pay for the insurance premium through equity on their home. Lastly—this is probably the Bill’s strongest selling point—it would be cost-neutral to the Exchequer. I recognise the opportunity this presents for the savings to be invested in financial support for those not able to access the insurance offer—for example, people who do not own a home.

I reassure my noble friend that his proposal has been carefully considered in the lead up to the announcement of our reform package from October 2023, but I point out that one of the key benefits of the cap and extended means test is that it is a universal offer—universal for everyone, irrespective of age or home ownership. We believe that a universal cap means people can plan ahead for their care from the outset. Knowing that the cap is there will benefit everyone, not just those who own a home. The home ownership landscape is changing over time, and within that context the Government have developed a package of reforms which is future-proof and gives support and certainty to the current generation, as well as future generations.

In addition to the cap, from October 2023, anyone with assets of less than £20,000 will not have to make any contribution for their care from their savings or the value of their home, ensuring that those with the least are protected. Anyone with assets below £100,000 will be eligible for some means-tested support, helping people without substantial assets and ensuring that many more people benefit from funded support earlier in their care journey. We believe that our reforms significantly improve the current system. In developing the reforms, we had to make tough choices, balancing the generosity of the reforms with how much extra we ask taxpayers to contribute and pay for them. My noble friend may disagree with our current formulation of the cap, but we believe the plan is credible, deliverable and affordable. Therefore, while the Government are not convinced that the Bill is the right course of action, we agree with his intelligent analysis that underpins it and, as the noble Baroness, Lady Merron, said, we will debate this further.

I again thank my noble friend Lord Lilley for putting forward this proposed Bill, and for his engagement in discussing our reforms after this debate.

[Lord Hamilton of Epsom (Con)]

My Lords, I know that my noble friend Lord Lilley will be very grateful for the compliments from both Front Benches and he will be glad that he stimulated so much thought in the minds of the Government, judging by the remarks of my noble friend the Minister. He will probably be watching this from his sick bed but if not, I am sure he will read it tomorrow in the Official Report.

Organ Tourism and Cadavers on Display Bill [HL]

Lord Kamall Excerpts

3rd reading
Friday 4th March 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, first, I congratulate my noble friend Lord Hunt on this very welcome Bill. It is a pleasure to see the issue debated so well and regularly in this House. As my noble friend knows, he has the full support of these Benches in his endeavours. UK citizens must not be permitted to support the international organ tourism industry, where those organs are sourced illegally. I hope to see an end to the display of human cadavers in cases where the displayers have not obtained the consent of the deceased to do so. On so many levels, the issues with which this Bill deals are totally unacceptable, and I am glad that this Bill gives your Lordships’ House the opportunity, as we also had last night, to consider how to take action. This is a moral imperative, and my noble friend can count on continued support from these Benches.

As we approach the end of this Third Reading, I thank the Minister and your Lordships’ House for the time spent on and engagement with this issue. I wish the Bill every success.

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

My Lords, I thank the noble Lord, Lord Hunt, for bringing this Bill to the House and for enabling further debate on the best approach to tackling transplant tourism and how to ensure that consent is always provided for the public display of bodies of the deceased.

While all noble Lords will agree with the sentiment behind this Bill and have been horrified by the way in which the Uighurs are treated by the Chinese Government, we feel that that the new provisions it would introduce could create unnecessary burdens while doing little more than the existing legislation to address their concerns about human rights abuses. Looking at the data, the Government have not seen evidence of any large-scale travel of British citizens to other regions seeking a transplant for payment or without consent. Indeed, despite our having a growing and ageing population with increasing healthcare needs, the figures from NHS Blood and Transplant demonstrate a steady and consistent decline in patients receiving follow-up treatment on organs received overseas: from 72 patients in 2006 to just seven in 2019.

In addition, existing provisions in the Modern Slavery Act and the Human Tissue Act already make transplant tourism an offence in many circumstances. Because of this, we believe that the most effective action we can now take is to work towards removing any incentive for UK residents to seek to purchase an organ by continuing our efforts in improving the rates and outcomes of legitimate organ donations, while maintaining the highest standards of care for those in need of an organ.

I turn now to the issue of the public display of bodies, on which there has been some debate, especially in terms of people who have given consent before their death for their bodies to be displayed. We believe that existing rules make it clear that any establishment which seeks to display bodies must provide proof of consent. If it cannot, it will not receive a public display licence from the Human Tissue Authority, and any exhibition of bodies without a licence, when one is required, will be breaking the law. I am informed that the Human Tissue Authority does receive requests from people in Britain who seek permission for their bodies to be displayed after their death.

That said, I thank all noble Lords for their contributions, which allowed for an important and wide-ranging debate on this topic. It also served as an opportunity to highlight the broader human rights concerns which I know all noble Lords share. I particularly acknowledge the persistence of the noble Lords, Lord Hunt and Lord Alton, in bringing these issues forward for debate. I congratulate the noble Lord, Lord Hunt, on being successful in the ballot with this Bill.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to my noble friend Lady Merron for her kind remarks, and to the Minister, who has given up quite a lot of time to allow us to discuss this. As he knows, I do not agree with the Government’s conclusion. He is very busy at the moment with Report stage of the Health and Social Care Bill, and he has much to contemplate over the weekend. I just hope that he may undertake a conversion when it comes to my Amendment 162, and that next week, he will be sympathetic.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

The powers of reconfiguration being sought by the Secretary of State in Clause 40 would enable this Government to change the decisions of those put in place locally, who are well qualified to make those decisions in a non-partisan and needs-based way, and thus allow the Government to wield unwarranted political power and take it from the competent people they have put in place to take those decisions. I do not trust this Government, who are currently trying to use the Elections Bill to ensure that they continue in power, to resist using these Secretary of State powers in this Bill for political purposes. It is incumbent on all parties to stop them, and to stop any future Government doing this, by removing Clause 40.

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

I thank noble Lords for bringing this debate to the House today. I am sure that the Secretary of State will be grateful for the desire to save him from himself and his powers. Let me read out the following quote:

“If we went out to Parliament Square now and straw-polled people walking by, asking them who they thought was responsible for the NHS in England at a national level, I think we would wait a very long time before anyone gave any answer other than the Government and, by extension, the Secretary of State”.—[Official Report, Commons, Health and Care Bill Committee, 21/9/21; col. 393.]


These are not my words, but those of the Opposition spokesman during Committee in the other place.

One of the core pillars of the Bill is to ensure appropriate accountability for the NHS. This is of the utmost importance as we invest further in local service decision-making and delivery. It is critical that, in line with the aims of the Bill to empower local systems, the Secretary of State has the appropriate levers to meet the public expectation for ministerial accountability.

There has been some confusion about what the powers in the Bill will do, and if noble Lords will allow me, I will spend a moment on this to add clarity. Clause 39 will simply allow the Secretary of State to direct NHS England—and only NHS England—on matters where it already has functions. This is not a power over local bodies. Clause 40 and Schedule 6 will allow the Secretary of State to call in and decide on reconfiguration decisions. They do not remove any of the existing safeguards, including the requirement to consult or the role of the Independent Reconfigurations Panel in providing advice to the Secretary of State.

I understand the arguments put forward in Amendment 83, and I will take procurement first. We agree that it is inappropriate for the Secretary of State to be involved in individual procurement decisions. That is not the motive behind this power, and it is not the way it would be used. The regulation-making power inserted by Clause 70 prevents the Secretary of State being able to use this direction-making power to direct NHS England—

[Baroness Thornton (Lab)]

The Minister said that this was not the motive behind the power, but motive is not the point here. I am sure that the Secretary of State has the best of motives, as does the Minister, but the point is the effect of what the Bill says.

[Lord Kamall (Con)]

I thank the noble Baroness for clarifying that. Of course, we completely understand the concerns that have been raised. The Secretary of State must use regulation-making powers where they exist, rather than using the power of direction to achieve what could be achieved under regulations.

Turning to the allocation of resources to the ICBs, the Government have no ambition to use this power to interfere with individual allocations of money to the system. It will not be used to interfere with the independent Advisory Committee on Resource Allocation. NHS England will continue to make funding allocations to ICBs to support them to deliver functions via the target formula, in order to reduce inequalities between patients. We have attached safeguards to this power to make sure it is not misused. Any exercise of this power must be done transparently: it must be made in writing, be published and be made in the public interest. This will enable Parliament to challenge Ministers and hold them to account.

Turning to Amendment 84, Clause 40 and Schedule 6 will allow the Secretary of State to better support effective change and respond to stakeholder concerns, including views from the public, health oversight and scrutiny committees and parliamentarians, in a more timely way. The clause and schedule will ensure that key decisions made about how services are delivered are subject to democratic oversight.

It is a misapprehension that the Secretary of State currently has no role in the decision-making process for reconfigurations. He does and without these provisions that role will continue. However, currently, referrals usually come at a very late stage in the process, which represents neither good value for the taxpayer nor good outcomes for patients.

I understand the concerns from noble Lords, including former Ministers, about how these powers might be used. But I have been asked to make clear that we expect the vast majority of reconfiguration decisions to continue to be managed by the local system—

[Lord Hunt of Kings Heath (Lab)]

I am sorry to interrupt, but does the Minister not take my point that it is not that Ministers will have to use those powers; it is that they have powers that will change behaviour immediately in the health service? That is the issue.

[Baroness Walmsley (LD)]

Before the Minister answers that question, I wonder if he would be kind enough to answer two from me. He just gave a list of what the powers will not be used for, but could he tell us what sort of thing the powers will be used for and under what circumstances? Can he also say why previous Secretaries of State—some of whom are not very far from where I am standing now—did not feel the need for those powers and still felt themselves accountable for the health service?

[Lord Kamall (Con)]

I thank noble Lords for those interventions. If they will allow me, I will come to answer them in my remarks.

We understand the concerns about how these powers will be used. It is in the interests of nobody, least of all the Secretary of State, to be making every decision in the system, and stakeholders will be encouraged to continue to resolve matters locally where possible. Duties for those responsible for reconfigurations to involve patients and consult the local authority will continue. Nevertheless, the Secretary of State is ultimately accountable for all changes to the health service. Therefore, it is entirely consistent with democratic principles that he or she should have the ability to intervene where it is deemed to be in the interests of the public.

We recognise that, in exercising these powers in this clause and schedule, it will be vital that the Secretary of State receives expert and clinical advice. That is why the Independent Reconfiguration Panel will continue to provide independent advice to the Secretary of State, allowing them to benefit from its many years of experience. This will mean that the Secretary of State will have independent advice that will include the views of both overview and scrutiny committees and patients, and the clinical case for change—

[Baroness Cumberlege (Con)]

I thank my noble friend. On this clinical advice, he is aware of the enormous changes that were made to stroke services in London. In the reconfiguration that took place, many lives were saved. But when it came to east Kent, the reconfiguration request, which was to do with stroke services, sat on the Secretary of State’s desk for two years. I just wonder how many people died for that delay.

When I put forward an amendment in Committee, I said that a decision must be made within three months by the Secretary of State if it is before his view, on his desk. Delay costs lives. It is absolutely critical that decisions are made fast in these reconfigurations, because we will lose lives.

[Lord Kamall (Con)]

Indeed, sometimes it is absolutely critical that decisions are made quickly. Where there are concerns about the speed of those decisions, the Secretary of State may ultimately decide to intervene, subject to advice from the Independent Reconfiguration Panel, overview and scrutiny committees, and patients, and based on the clinical case, should he or she decide to exercise powers under this clause.

I understand the concerns raised in this House and have heard the arguments presented today and in Committee. However, I think it would help if I reminded noble Lords that the Secretary of State’s powers included in the Bill are to ensure accountability. The public rightly want to hold the Government to account for the health service, and these powers allow that to happen effectively. The other place acknowledged that approach and supported it—

[Baroness Walmsley (LD)]

I cannot believe that the Minister meant to imply that all the structures being set up in this Bill are not accountable, because there are a whole lot of accountability measures in this Bill which will hold to account the people making these decisions without the Secretary of State. One might think from what he just said that the powers are very narrow.

But I draw his attention to page 206 of the Bill. In proposed new Section 68A(4)(3)(a), it just says that the Secretary of State can decide whether a proposal goes through or not, but in proposed new Section 68A(4)(3)(b) it says that the Secretary of State can intervene in the “particular results” that have to be achieved. In proposed new Section 68A(4)(3)(c) he can decide the procedure and other steps that should be taken in relation to the proposal. In proposed new Section 68A(4)(3)(d) there is the

“power to retake any decision previously taken by the NHS commissioning body”.

These seem to be very broad powers; they are not just small intervention powers by the Secretary of State.

[Lord Kamall (Con)]

The noble Baroness raises some important points, but I remind her that, alongside those, she should consider safeguards and limitations that are being put in place to address these concerns and the importance of ensuring due accountability for health service delivery. I understand the strong feeling among noble Lords and have tried to go as far as I can in addressing those concerns. I once again, perhaps in vain, ask noble Lords to think about the assurances that have been given and not to move their amendments when they are reached.

[Lord Lansley (Con)]

My Lords, I am grateful to my noble friend. In particular I am grateful for his specific assurances on the powers of procurement and the question of resource allocation. We can be pretty confident that the Secretary of State would not interfere with the Advisory Committee on Resource Allocation or the NHS England response to it. If the Secretary of State were to start messing with the formula, we would get into a very difficult place.

I am still of the view that there was a very good reason we gave NHS England greater freedoms. I think it would not have been possible for NHS England to have published its Five Year Forward View in 2014 or even more so the Long Term Plan in 2019, in circumstances where it had occupied the same relationship with the Secretary of State as it did in the past.

This is taking NHS England from its current degree of independence to something that it was not in the past, but is a little more ambiguous. It will be difficult, for precisely the reasons the noble Lord, Lord Hunt of Kings Heath, explained, for the NHS to feel that, when the successor to the long-term plan is published by the successor to the noble Lord, Lord Stevens of Birmingham, it is the NHS’s own plan. That has been very important; Ministers have said it a thousand times. Why do we not let that happen? The measures in Clause 39 take a real risk of infringing on the idea that it is the NHS’s own plan.

It does not mean that the Secretary of State is not accountable, but that they are accountable in ways that they can legitimately control: the resource allocation and an expectation of the priorities and outcomes. That is where the Secretary of State should be putting the weight of the Government, not in trying to decide how outcomes in the NHS are best achieved. I do not agree in principle with what is proposed in Clause 39, but I am not going to press that point.

I will, however, if the noble Baroness, Lady Thornton, pushes it, support her on Clause 40. I say to my noble friend: look at Schedule 6. The structure of it does not even mention the Independent Reconfiguration Panel. As soon as there is a proposal for a reconfiguration from any of the NHS bodies, it quite clearly places in the hands of the Secretary of State the responsibility to decide whether to go ahead with it or not. That will be exactly the moment when the Secretary of State is drawn in and is not able to be extricated from it.

My noble friend has simply to look at the example of the reconfiguration of congenital paediatric cardiac services to realise that no sensible Minister would have been drawn into that debate at an early stage with any confidence of being able to make a decision that would have been accepted by any of the parties to that debate.

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Moved by

[Lord Kamall]

85: Clause 45, page 50, line 6, leave out “The reference in subsection (1)” and insert “In subsection (1)—
(a) the reference”Member’s explanatory statement
This amendment is consequential on another amendment which provides that references in new section 26A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

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Moved by

[Lord Kamall]

88: Clause 54, page 53, line 16, at end insert “in respect of a single financial year”
Member’s explanatory statement
This amendment means that any order imposing a limit on the capital expenditure of an NHS foundation trust may only relate to a single financial year (rather than spanning more than one financial year).

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Moved by

[Lord Kamall]

92: Clause 59, page 55, line 37, leave out “The reference in subsection (1)” and insert “In subsection (1)—
(a) the reference” Member’s explanatory statement
This amendment is consequential on another amendment which provides that references in new section 63A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

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Moved by

[Lord Kamall]

97: Clause 67, page 61, line 42, at end insert—
“(2AA) For the purposes of subsection (2)(da) (as read with subsection (2A))—(a) a reference to the effects of decisions in relation to the health and well-being of the people of England includes a reference to the effects of the decisions in relation to inequalities between the people of England with respect to their health and well-being; (b) a reference to effects of decisions in relation to the quality of services provided to individuals includes a reference to the effects of the decisions in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statement
This amendment provides that references in new subsection (2)(da) of section 96 of the Health and Social Care Act 2012 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

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Moved by

[Lord Kamall]

109: After Clause 77, insert the following new Clause—
“Meaning of “health” in NHS Act 2006
In section 275(1) of the National Health Service Act 2006 (interpretation), at the appropriate place insert—““health” includes mental health;”.”Member’s explanatory statement
This new Clause clarifies that in the NHS Act 2006 “health” includes mental health (unless the context otherwise requires). Although the natural meaning of health is capable of including “mental health” the existing provisions of the Act are inconsistent about whether they mention mental health expressly which could cause confusion.

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Moved by

[Lord Kamall]

110: Clause 79, page 69, line 42, at end insert “and the “and” before it”
Member’s explanatory statement
This amendment is consequential on Clause 79(3) of the Bill, which omits paragraph (c) of section 100(4) of the Care Act 2014.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

Moved by

[Lord Kamall]

36: Clause 20, page 21, line 25, at end insert—
“(ba) set out any steps that the integrated care board proposes to take to address the particular needs of children and young persons under the age of 25;”Member’s explanatory statement
This amendment requires the joint forward plan for an integrated care board and its partners to set out any steps that the integrated care board proposes to take to address the particular needs of children or young persons under the age of 25.

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

My Lords, I thank the House for its continued focus on addressing the needs of babies, children and young people and thank noble Lords for bringing forward amendments on this issue again today. I am also really grateful to noble Lords who have engaged with the me and my officials, and I hope that this has resulted in amendments that your Lordships’ House feels that it can support.

I start with Amendment 36, in my name. This amendment will require an integrated care board to set out any steps that it proposes to take to address the particular needs of children and young people under the age of 25 in the forward plan. In addition, the Government have committed to produce a package of bespoke guidance, which explains how the ICB and the ICP should meet the needs of babies, children, young people and families. This guidance will contain provisions for the integrated care partnership’s integrated care strategy to consider child health and well-being outcomes and the integration of children’s services, as well as providing that the integrated care partnership should consult local children’s leadership and children, young people and families themselves, on the strategy.

NHS England has also agreed that it will issue statutory guidance, expecting that one of the ICB executive leads will act as a children’s lead, with responsibility for championing the needs of babies, children and young people. I hope that noble Lords are supportive of this government amendment and its underpinning commitment to support, improve and enhance services for babies, children and young people.

I turn to Amendments 157, 185 and 186. Safeguarding children is a priority for the Government, and we share the horror and concern provoked by the awful murders of Arthur Labinjo-Hughes and Star Hobson. The Government are committed to addressing barriers to safe, timely and appropriate sharing of information to safeguard children, and we have heard clearly the strength of feeling across the House on the value of a consistent identifier for children. In particular, I pay tribute to the noble Baroness, Lady Tyler of Enfield, and other noble Lords, for pushing us on this issue.

To this end, we are committing in this legislation to publish a report, within one year of the section coming into force, that will describe the Government’s policy on information sharing in relation to children’s health and social care and the safeguarding of children and will include an explanation of the Government’s policy on a consistent identifier for children. It will also include the Government’s approach and actions to implement the policy set out in the report. The Government agree with noble Lords that action is needed. The report will reflect a cross-government position on what actions will be taken to improve safe and appropriate information sharing.

This amendment, of necessity, is limited by reference to health and social care, reflecting the scope of the Bill. However, the report to which this amendment refers will be laid by the Secretary of State for Education, who intends that it will cover improved information sharing between all safeguarding partners, including the NHS, local authorities and the police, as well as education settings. The Department for Education has already started its work, which will look at the feasibility of a common child identifier. I hope these amendments will reassure noble Lords that the Government are committed to safeguarding children and improving services for babies, children and young people. I beg to move.

[Baroness Hollins (CB)]

My Lords, I am grateful to the Royal College of Speech and Language Therapists, the National Children’s Bureau, the Disabled Children’s Partnership and the Royal College of Paediatrics and Child Health for their support with this amendment and for their constructive engagement with the Department of Health and Social Care. I also thank the noble Baroness, Lady Tyler, for adding her name to this amendment.

I welcome the amendments that the Minister has laid relating to the needs of babies, children and young people but, despite the good progress made, this amendment seeks to go further by requiring NHS England to conduct a performance assessment of each ICB in meeting the needs of babies, children and young people in each financial year. This includes its duties concerning the improvement in quality of services and reducing inequalities and the extent of its public involvement and consultation.

There are significant challenges in meeting the health and care needs of children and young people, including their mental health needs, which are different and arguably more complex than for adults. This is particularly the case for disabled children and young people and those with special educational needs. A recent survey by the Disabled Children’s Partnership and the parent campaign group, Let Us Learn Too, found that 40% of families with disabled children have seen their savings wiped out by fighting and paying for support.

I shall give one brief example from the West Midlands. Joanne, whose autistic son also has pathological demand avoidance and communication difficulties, explained that the local authority refused to do an occupational therapy assessment, so she paid for one privately. Eventually, she took the local authority to tribunal at considerable expense in legal fees. Despite winning, it is one year on and still no support is being provided by the local authority.

One in three families with disabled children said they needed publicly unprovided essential therapies for their disabled child, but could not afford them. Some 60% of families with disabled children have sought NHS mental health support for a family member due to the stress of fighting for basic services. The Disabled Children’s Partnership cites individuals feeling a sense of societal resentment toward disabled people, says that carers are persistently undervalued and underrepresented in policy and details the enormous physical, emotional and financial burden they endure in caring for their disabled family member without adequate support from the health and care sectors. Joanne said, furthermore, that the local authority blamed her for her son’s disability and put a child protection plan in place rather than supporting her, although thankfully it was removed shortly afterwards.

Integrated care boards have a crucial role in commissioning primary and community healthcare services directly for babies, children and young people. They will play a key role in the joint commissioning of services for disabled children and those with special educational needs, as well as contributing to education, health and care plans and in the commissioning of joined-up services in the first 1,000 days of life, in which the Government are, importantly, investing. Crucially, ICBs will be jointly responsible for the leadership of local child safeguarding partnerships, together with the police and local authorities.

Yet support for children and young people varies geographically. Local systems find themselves pulled in different directions by different government initiatives and separate pots of funding, which creates a profound risk of destabilising what are relatively new local safeguarding partnerships. The Wood report, published in May 2021, reviewed the new multi-agency safeguarding arrangements put in place by the Children and Social Work Act 2017. It revealed just how stretched the resources are in protecting children, as well as the need for a more effective culture of joined-up working and a more consistent and detailed understanding of the role of the three statutory safeguarding partners—the local authority, the CCG and the chief officer of police. The Wood report also emphasised the importance of accountability regarding the quality of these services and the need for inspectorates and regulators to develop a model to analyse performance against what is deemed to be best practice, something that this amendment goes a long way to trying to achieve.

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[Lord Kamall (Con)]

I thank all noble Lords who have raised important points in this debate; I also thank them for accepting some of the amendments that we have tabled in response to their engagement. That engagement was very constructive, and I hope that as they look to hold the Government to account we will continue to have engagement on these issues.

First, I shall deal with a couple of specific questions. The noble Baroness, Lady Tyler, again asked about the identifier. As I have made clear, the report will include an explanation of the Government’s policy on a consistent identifier for children. It will also include our approach and actions to implement the recommendations in the report.

We all agree that the principle of a consistent identifier is right, but there are complex issues in applying that consistent identifier in safeguarding children. This is why we want to investigate all the issues thoroughly in a report that will be laid before Parliament a year after commencement. There is one issue in which I am personally interested—I am sure noble Lords will remember that I geeked out on this one. I think there are some technical solutions, but I can also see some technical unintended consequences. I myself will look very closely at the report, especially at the technical solutions.

Like other noble Lords, I welcome my noble friend Lord Shinkwin; it is good to see him back. I thank him for engaging with me—almost from his hospital bed, I think, which demonstrates his commitment to these issues. He talked about speech and language therapy, and the Government recognise the importance of communications needs, and the important part that they play in children’s development. We will work with stakeholders on the development of guidance, and ensure that we engage with the Royal College of Speech and Language Therapists.

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Moved by

[Lord Kamall]

55: Clause 20, page 24, leave out lines 39 to 43 and insert “sections 14Z34 to 14Z44 and 14Z47A (general duties of integrated care boards),”
Member’s explanatory statement
This amendment requires the annual report for an integrated care board to explain, in particular, how it has discharged its duties under sections 14Z34 to 14Z44 and 14Z47A (rather than just some of those sections).

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[Baroness Merron (Lab)]

My Lords, I rise to share all the concerns expressed about the open-endedness of what is in the Bill and the concerns about the lack of protection for patient data. Clearly, there has been much debate and discussion, and I think it is right that we hear from the Minister.

[Lord Kamall (Con)]

My goodness—I thank noble Lords for their brevity. I am afraid that I shall not be as brief as I would want to be. I would like to confine myself to single-word answers, but I do not think that would give the reassurance that noble Lords are looking for.

I begin by thanking all noble Lords who have engaged with me on this, especially the noble Baroness, Lady Brinton, and the noble Lords, Lord Clement-Jones and Lord Hunt. As they know from our discussions, this issue is very close to my heart and something I feel very strongly about, so I welcome their pressing the Government on this and their continuous engagement—in fact, right up to this morning. I do not think that this is the end of that engagement but I hope to give some reassurances. I completely understand the interest in the integrated care boards’ power to disclose information that is personal data. I hope I will be able to clarify some of the intentions.

New Section 14Z61, inserted by Clause 20, recreates the section that applies to CCGs, which sets out the circumstances in which CCGs are permitted to disclose information obtained in the exercise of their functions. The clause in question already restricts ICBs’ powers to disclose information, by limiting these to the specific circumstances set out in the clause.

In addition, the existing data protection legislation, including UK GDPR, provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data protection principles for the sharing of personal data. Health data is special category data—that is data that requires additional protections due to its sensitivity. For this type of data to be processed lawfully, a further condition must be met as set out in UK GDPR and the Data Protection Act.

In addition, the common law duty of confidentiality applies to the use of confidential patient information. This permits disclosure of such information only where the individual to whom the information relates has consented, where disclosure is of overall benefit to a patient or is in the public interest—for example, disclosure is to protect individuals or society from risks of harm or where there is a statutory basis for disclosing the information or a legal duty, such as a court order, to do so.

Every health and care organisation has a Caldicott Guardian—a senior person responsible for protecting the confidentiality of people’s health and care information and making sure that it is used properly. Caldicott Guardians decide how much information it is appropriate to share—they may decide that even legally permitted information may not be shared—and they advise on disclosures that may be in the public interest. They act in accordance with the eight principles, which are the framework to ensure that people’s confidential information is kept confidential and used appropriately. The UK Caldicott Guardian Council works closely with the independent statutory National Data Guardian, whose role is to advise and challenge the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly.

Nothing in the clause overrides the range of requirements in law that provide key protections and safeguards for the use of an individual’s personal data. I can also confirm that NHS England’s power to issue guidance for ICBs will apply to their functions relating to data sharing, and that may be a helpful route in making it clear to ICBs what their duties and responsibilities are, in respect of any confidential data they may hold, in a way that illustrates how legislation applies.

The effect of the amendment is to prevent the effective operation of the clause as drafted. This would prevent the ICB from effectively discharging its functions where it may be necessary to disclose personal patient data, including investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system where different rules apply to different organisations.

On Amendment 116, once again I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this issue before this House. Our aim is to put data and analytics at the heart of NHS delivery and remove incoherence in the organisational leadership, for the benefit of patients and their outcomes. It is a solid recommendation for improving how health and social care data is used more effectively, closing that gap between delivery and the use of data to inform and improve services.

I understand that noble Lords fear that the movement of the statutory data functions from one world-class arm’s-length body, NHS Digital, to another, NHS England, which indeed runs the NHS itself, would result in a decline in the exercise of those functions. We feel that this fear is perhaps overexaggerated but I would be very happy to continue discussions on this.

However, that movement would be accompanied by the transfer of several thousand expert staff and all their supporting expertise and technology, along with the existing statutory safeguards, which would be preserved. NHS Digital and NHS England have a history of very close working on data, most recently of course in how the management of data has underpinned efforts to defeat Covid-19, through the protection of shielded patients and the management of data on vaccinations. The Government and Parliament held NHS Digital to account for the delivery of its functions, and they will continue to hold NHS England to account for the delivery of any functions which transfer.

As to the concern about a conflict of interest, the data collections which NHS Digital undertakes are the result of directions from either the Secretary of State or NHS England, and obviously the direction-making power of the former will continue to be relevant should the proposed merger take place. Directions include details of how data must be shared or disseminated. NHS Digital is required to publish details of all such directions and maintain a register of the information it collects. There is also a rigorous process for external data access requests and audits of how data is used.

The intention here is that such safeguards would continue when the functions transfer to NHS England and would make it very difficult for the organisation to suppress or otherwise refuse to make available any data which it is required to collect and disseminate in fulfilment of its statutory role. I hope, perhaps overoptimistically, that I have reassured the noble Lord, Lord Warner—clearly not—in terms of suppressing information.

There is a rigorous process for external data access requests. NHS England’s Transformation Directorate will be assuming responsibility for NHS Digital’s functions, and for accomplishing the alignment of delivery and data proposed in the Wade-Gery review. There will continue to be external, independent scrutiny—for example, by the Information Commissioner and the National Data Guardian—of the use by the NHS, and NHS England in particular, of health and care data.

I hope that I have given noble Lords some reassurance that these important issues have been considered by the department, and that they will feel able not to move their amendments when reached. Of course, given my strong interest in this subject, I am prepared and happy to have further conversations to make sure that we close any remaining gaps and for me push the department and NHS England as appropriate.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

I now invite the noble Baroness, Lady Brinton, who is taking part remotely, to reply to the debate.

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[Baroness Merron (Lab)]

This powerful debate has focused on two simple truths. First, without the full team of people in place at the right time, it will not be possible to provide the health, social care and public health services we need. The second simple truth is that this will not just happen on its own. I am therefore glad to have put my name to Amendment 80, joining the noble Baronesses, Lady Cumberlege and Lady Brinton, and the noble Lord, Lord Stevens, in so doing. I thank the noble Baroness, Lady Cumberlege, for her impactful introduction of the amendment. I share the view of the noble Baroness, Lady Walmsley, that this is the amendment to focus on, the one that will take us in the direction we need to go.

It is hardly surprising that the need for workforce planning has come up time and again during the passage of the Bill, and it is not going away. Workforce planning is at the core of all the plans, yet it remains unresolved and continues to cause considerable disquiet, including in the Health and Social Care Select Committee. We know this is an urgent requirement to tackle, and I hope that, even at this late stage, good sense will prevail and the Minister will be able to give the assurances that your Lordships’ House seeks.

The lack of sufficient staff, trained and able to deliver care, is the biggest issue facing the NHS and social care. Whatever claims are made about how many staff there are, they are meaningless unless posed against what is actually required. Since the Bill was published there has been universal opposition to the limited and inadequate provision in Clause 35. As my noble friend Lord Hunt noted, the Treasury’s robust resistance to publishing anything that sets out properly the gap between the number of staff required and of those in post is a badly kept secret. I regard that as short-sighted for all the reasons that have come up in the debate thus far.

It is reported that a record number of 400 members of staff are quitting the NHS every week. The United Kingdom has 50,000 fewer doctors than we need, and there are currently 100,000 vacancies. Workforce planning needs to be in place to give us the chance to assess and tackle the workforce crisis. Today we have the opportunity to put that right. As we have heard, the amendment is supported by a major coalition of some 100 health and care organisations. As my noble friend Lord Bradley said, it also takes strength from giving the opportunity to consult a comprehensive range of organisations and groups that know the reality of what is needed to run our care services. We should add our support to that.

I am grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Patel, for adding their support to my Amendment 81. It tackles the same problem, but from the bottom up. Without the foundation of a workforce plan, no ICB can plan anything properly, as they are required to do by other parts of the Bill. There is also the wider point that the national strategies or definitions of systems planning have no reality unless they transfer down to those who actually have to deliver the outcomes. We know that there are widespread and well-evidenced arguments in support of workforce planning. I urge the Minister to accept the wisdom and the reality of these amendments and to take the opportunity to fix a challenge that surely is not going away.

[Lord Kamall (Con)]

My Lords, I am grateful to noble Lords for bringing the discussion of workforce planning before the House today. Perhaps before I go further, all noble Lords will want to join me in wishing the noble Lord, Lord Patel, a speedy recovery. He definitely would have spoken in this debate if he had been able to join us. I should also say that I was particularly impressed by the double act of the noble Lords, Lord Hunt and Lord Stevens. Perhaps they will be known in future as the Morecambe and Wise of the House of Lords.

We all agree that the workforce is at the heart of our NHS and social care. It is right to ensure that we have the workforce that we need for the future to keep delivering world-class, safe and effective healthcare. Some noble Lords may not like to hear this, but I remind them that we have a record number of nurses. We continue to look at different ways of recruitment, and in response to Oral Questions I have referred to the way that we are looking at different pathways into nursing for British people. It is also a fact that we have always recruited people from overseas. Indeed, our public services were saved, post-war, by people from the Commonwealth coming to work in public services. I remind noble Lords that now we have left the EU we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans. We will focus on ensuring that we have equality across the world.

I will not repeat what I have said about other issues, but if you are to have workforce growth, which we all want, it must be accompanied by effective, long-term workforce planning. That is why the department has commissioned Health Education England to work with partners to develop a robust, long-term strategic framework for the health and regulated social care workforce for the next 15 years. This includes regulated professionals working in adult social care, such as nurses and occupational therapists, for the first time.

[Lord Warner (CB)]

I am sorry to interrupt the Minister but when I listened to that last statement about Health Education England, I wondered whether he had seen the article in the Economist of 5 February, which shows that the guaranteed forward funding of Health Education England extended to less than a month ahead.

[Lord Kamall (Con)]

I am grateful to the noble Lord because that was a point I was hoping to come to when I lost my line. The budget will be agreed by the start of the new financial year and, as in all previous years, following the outcome of the 2021 spending review, spending plans for individual budgets in 2022-23 to 2024-25 inclusive will be subjected to a detailed financial planning exercise, and it will be finalised in time. We have also commissioned NHS England to develop that long-term workforce strategy and the key conclusions from this work will be set out.

Clause 35 will increase the transparency and accountability of the workforce planning process. Noble Lords referred to Her Majesty’s Treasury. The department is working closely with the Treasury to deliver a bigger and better NHS and social care workforce. The spending review 2021 provides a further £23 billion for the NHS for April 2022 to March 2025 and gives a three-year settlement. It will keep building a bigger and better-trained workforce.

Noble Lords also referred to agency staff. The flexible staffing policy aims to provide sufficient temporary staff to the NHS to meet fluctuations in demand. In 2015 the Secretary of State announced the introduction of several measures to reduce the agency spend, including price caps, procurement frameworks and expenditure ceilings. These have contributed to the NHS reducing spending on agency staff by one-third, but we recognise that there is more work to be done. We also recognise that the health and social care workforces are often spoken about separately, and the department is working to integrate the two workforces, as outlined in the integration White Paper. Noble Lords will recall that, in addition, we have started a voluntary register for care staff, which we hope to move to being mandatory in due course, following a consultation to better understand the landscape of the workforce, and to look at different qualifications and make it a better career.

We know that work on long-term workforce planning at a national level will need to be replicated at a local level. Subject to the passage of the Bill, ICBs should be the vehicle to support that. To guide that work, in August 2021 NHS England published draft guidance for ICBs explaining their central role, ensuring that the health and care system has the necessary workforce to meet the needs of the populations it serves. A copy of this guidance has been laid in the House Library. In addition, the amendments on ICBs’ forward plans and annual reports will require ICBs to report on how they exercise their duty to promote education and training for the current and future workforce.

Amendment 82 refers to safe staffing. The Government are committed to ensuring that we deliver safe patient care and that there are safe staffing levels across the NHS. Safe staffing should remain the responsibility of local clinical and other leaders, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality healthcare is influenced by a far greater range of issues than how many of each staff group are on a shift, even though that is clearly important, and it is why the Government are committed to continuing to grow the workforce.

I now turn to the amendment addressing GP distribution. We fully support the intention, particularly as part of our agenda to level up and recover from the pandemic. However, the pandemic’s impact on the workforce is not yet fully understood and the system is moving to meet the impact in new ways. As a result, a review of GP distribution is likely to be premature but, as noble Lords will recall, we have opened new medical schools in areas where there has been a lack of workforce, in the knowledge that many people stay in the areas where they were trained. That is part of our plan to make sure that there is more equitable distribution. We will also use the targeted enhanced recruitment scheme to incentivise trained doctors to work in hard-to-recruit areas.

Eating Disorders

Lord Kamall Excerpts

Tuesday 1st March 2022 Lords Chamber

[Baroness Parminter]

To ask Her Majesty’s Government, further to the report of the Parliamentary and Health Service Ombudsman Ignoring the alarms: How NHS eating disorder services are failing patients, published on 6 December 2017, what steps they are taking to ensure that eating disorders are taught appropriately in medical schools.

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

My Lords, following the Parliamentary and Health Service Ombudsman’s report regarding the tragic death of Averil Hart, the Department of Health and Social Care has been engaging with partners through a delivery group led by NHS England and NHS Improvement to continue to address the recommendations. This includes work with Health Education England to improve training for GPs and with the General Medical Council to ensure that eating disorders are included among outcome measures for newly qualified clinicians.

[Baroness Parminter (LD)]

I thank the Minister for his reply. GPs receive on average less than two hours’ training for eating disorders. Inadequate training was identified by the PHSO report in 2017, as he says, and by numerous coroners’ reports since then, including the latest Prevention of Future Deaths report in Manchester in December following the tragic death of Nichola Lomax. What specifically is the Minister doing to hold the GMC, the Academy of Medical Royal Colleges, Health Education England, NHS England and NHS Improvement to account for their responsibility to ensure that trainee doctors graduate with the skills and the knowledge to be able to identify, safely manage and refer patients with eating disorders?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about how we identify the issues and tackle them. It is two-pronged: one way is about the amount of investment into mental health services, including tackling disorders, and the other is training. NHS England and NHS Improvement have been working with Health Education England and other partners to look at training courses that will increase the capacity of the existing workforce to provide evidence-based treatment to more people. We are also working with the GMC and the Academy of Medical Royal Colleges as well as Beat representatives. In addition, Health Education England is looking to increase the exposure of doctors to eating disorders. The GMC’s Outcomes for Graduates states that

“Newly qualified doctors must explain and illustrate”


their understanding of

“the principles for the identification, safe management and referral of patients with mental health conditions”,

including eating disorders.

[Baroness Wheatcroft (CB)]

My Lords, the eating disorders charity Beat conducted a survey last autumn and found that 69% of those with eating disorders had found that their GPs did not know what to do with them. That result was, if anything, worse than the same survey conducted five years earlier. It is good the Government are acknowledging that medical students need to learn more about how to deal with eating disorders, but could the Minister give us a guarantee that those GPs already in practice who know nothing about eating disorders at the moment—and choose not to—can be helped to understand the issue better?

[Lord Kamall (Con)]

This is an opportunity to pay tribute to the work of Beat and to remind noble Lords that it is Eating Disorders Awareness Week, and we should be aware of these issues. One of those issues is understanding the different types of eating disorders. Eating disorders is a catch-all phrase and we have to understand that there is: anorexia nervosa, which is more common among people aged eight and over; bulimia nervosa, which tends to affect people at 12 or 13; binge eating disorders, which affect people in adolescence and also their later years—their 30s and 40s; and other atypical eating disorders. It is really important that we understand this and, when we look at training for the general workforce and specialist mental health workforce, that they are more aware of the issues of eating disorders.

[Lord Watts (Lab)]

My Lords, if a GP identifies that, for example, a child has an eating disorder, many times they want to refer them to see a psychiatrist. There is an acute shortage of child psychiatrists. What are the Government going to do to speed the process up? It is no use just identifying the problem if you cannot resolve it.

[Lord Kamall (Con)]

The noble Lord is absolutely right; it is not just about understanding the issue but resolving it. Before the pandemic, we were meeting the targets of ensuring that people with disorders were seeing a specialist. Sadly, as a result of the pandemic, we have fallen behind. One of the reasons we are investing extra money in community health for adults and children now is to ensure that we catch up and make sure that people who are suffering with eating disorders are seen by clinicians who understand the issues and the differences between types of eating disorders, so that they are not misdiagnosed or given inappropriate information.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister will know that, although we routinely associate eating disorders with adolescents in particular, they may have roots in adolescence but sometimes emerge very powerfully in later years. They are consequently a lot more difficult to diagnose and manage. The noble Baroness, Lady Parminter, used the word “manage” in talking about how these illnesses should be treated. It is a matter of concern that GPs in particular and hospital services are extremely overstretched. The long-term management of remitting and recurring eating disorders is very hard to sustain. Can the Minister tell us what the Government are doing about that?

--- Later in debate ---

[Lord Kamall (Con)]

As a result of the work that has been undertaken in response to the report, and in conjunction with Beat and many other stakeholders, we are looking at the issues. First, we are making sure that people are trained to understand the issues as part of their education. Secondly, we are looking at what we can do retrospectively for those who have already qualified. We are working with various bodies—the royal colleges and others—to see how we can make sure there is more awareness and training available, including e-learning resources.

[Baroness Janke (LD)]

My Lords, there is a need for urgency on this issue. We do not get the impression that the Government are treating this very urgently, but anorexia has the highest mortality rate of any mental illness. If it is not treated early, it becomes worse, much harder to treat and puts lives at risk. In view of the unprecedented growth in sufferers, what will the Government do to accelerate access to treatment for those in urgent need and prevent more needless deaths?

[Lord Kamall (Con)]

I think the noble Baroness is being unfair in suggesting that the Government are not taking this issue seriously. In the conversations that I have had in the lead-up to this Question, it has been quite clear that they are taking it very seriously. They recognise its granularity and the differences in types of eating disorder. As the noble Baroness rightly said, people quite often associate eating disorders with adolescents or young females and young men, but binge eating disorders in particular can occur among adults who are 30 or 40 years old. The Government are looking, first, at education. Secondly, they have made a number of investments in adult and children’s services relating to mental health, including eating disorders.

[Baroness Merron (Lab)]

My Lords, there has been a 72% increase this year in the number of children and teenagers referred for urgent support for eating disorders, but a new, dangerous issue has emerged, that of specialist mental health services with no capacity having to bounce back even those who are at risk of suicide, self-harm and starvation to GPs, who, as we have heard, often have no specific training to deal with this. Can the Minister apprise your Lordships’ House of what assessment has been made of the incidence of this so-called bounce-back? Will he commit to tackling it by various means, including a recovery plan for mental health services that has a focus on children and young people and ensures that there is a trained workforce to deliver this support?

[Lord Kamall (Con)]

The noble Baroness’s suggestions are reasonable, and I think that many noble Lords would agree that it is important that we tackle this on a number of levels. For example, under the NHS long-term plan, extra funding has been going to children and young people’s community eating disorder services every year, with £53 million per year invested in 2021-22. That will increase the capacity of 70 new or improved community eating disorder teams covering the whole of the country. In response to Covid and to help meet the waiting time standard, we have invested an extra £79 million in 2021-22 to significantly expand children’s mental health services. In addition, as part of the additional £500 million that we announced in 2021-22, some of this is also being done via the mental health recovery action plan. NHS England and NHS Improvement have announced a further £40 million in 2021-22 to address the impact of Covid on children’s and young people’s mental health. These are some of the different ways in which we are addressing this very serious issue that a number of noble Lords have quite rightly raised.

[Lord Harris of Haringey (Lab)]

My Lords, adolescence has been referred to repeatedly, but does the Minister recognise that there is a gulf between adolescent mental health services and those for adults? A young person reaches the age of 18, ceases to be dealt with through child and adolescent mental health services and is very lucky to get any sort of appointment thereafter. What are the Government going to do about that gulf?

[Lord Kamall (Con)]

There are number of areas—not only eating disorders but elsewhere—where people are often concerned about that transition from children’s services to adult services. We are looking at that holistically to make sure that healthcare is patient centred. It is one of the reasons why we want to make sure that the Health and Care Bill is completely integrated. It will be healthcare whereby the patient is looked after right from their birth all the way through their life, including that transition from children’s services to adult services.