Fracture Liaison Services

Lord Kamall Excerpts

Wednesday 4th December 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lord Black for securing this debate. As noble Lords have acknowledged, he has championed this issue in this House and outside. In fact, I recall that during one of my earliest Oral Questions as a Minister, my noble friend explained to me the vital role that fracture liaison services play in identifying and treating osteoporosis; that osteoporosis is considered a silent disease, causing over half a million broken bones each year—one every minute; and that there are as many deaths from fractures as from lung cancer and diabetes.

As my noble friend Lord Black and indeed the noble Baroness, Lady Bull, said, fractures caused by osteoporosis affect half of all women and a fifth of men over 50. As the right reverend Prelate mentioned, those from lower-income households have a 25% higher risk of fractures, a higher mortality rate and slower recovery times from hip fractures. As the noble Baroness, Lady Donaghy, said, it can be unexpected. Each year, 1 million acute hospital bed days are occupied by hip fracture patients, and around £2 billion is spent on hip fracture care. I pay tribute at this point to my noble friend Lord Shinkwin, the noble Baroness, Lady Ritchie, and others for sharing their experience. That really brought it home and made it about more than figures.

As we move to a system of preventive healthcare, FLS have a huge role to play since they systematically identify people aged 50 or over who have had a fragility fracture in order to reduce the risk of further fractures. The Royal Osteoporosis Society, to which many noble Lords have paid tribute tonight, estimates that fracture liaison services reduce the risk of a patient refracturing the same bone by up to 40%.

Unfortunately, despite the attempts of previous Governments, only 51% of trusts in England currently provide fracture liaison services, covering only 57% of the population, as alluded to by the noble Baroness, Lady Quin. Earlier this year my right honourable friend Victoria Atkins, then the Secretary of State for Health and Social Care, pledged to expand fracture liaison services to every integrated care board in England and achieve 100% coverage by 2030, a target repeated in the Conservative Party manifesto. But as the noble Lord, Lord Rennard, and others have said, there is consensus—there is no political disagreement on this issue. Indeed, the Minister used to press me from this Dispatch Box when I was in her position.

In June this year, the then shadow and now current Secretary of State for Health and Social Care said that delivering a rollout plan for fracture liaison services would be an area for “immediate action” if Labour won the election. Noble Lords understand that these are still early days for the Government, but I am sure that my noble friend Lord Black and other noble Lords who have spoken in this debate wish to understand what the Secretary of State for Health and Social Care meant by “immediate action”. I have to concede that that sounds a lot better than “in due course”—a phrase I tried to avoid when I was a Minister, but not always successfully.

Unfortunately, no plan for the rollout of these life-changing diagnostic and preventive services has yet been released by the Government. Are they working on a rollout plan for fracture liaison services and, as the noble Baroness, Lady Donaghy, said, when do they intend to publish it—preferably avoiding the answer “in due course”? Can I tempt the Minister into sharing some clues or details on what might be in the plan? I know that many noble Lords of all parties and none support expanding this vital, preventive and effective service to as many people who need it as possible. Fracture liaison services are a world-beating preventive approach that we can all be proud of. If expanded, it would be good for those suffering from osteoporosis, good for the NHS and good for the Treasury.

NHS Plan: Consultation

Lord Kamall Excerpts

Monday 2nd December 2024 Lords Chamber

[Baroness Merron (Lab)]

I am very grateful to all those, including pharmacists, who have used all their networks and contacts to spread the word. That is why we have had over 60,000 responses and more than 1 million visits in what is the largest ever consultation in the history of the NHS. I call on all groups to continue their efforts to ensure that voices across all communities are heard loud and clear.

[Lord Kamall (Con)]

During the vaccine programmes for Covid, the NHS and the last Government put a lot of effort into looking at ways to reach people who are vaccine hesitant—often from some black and Asian communities and other excluded communities. What lessons have been learned by the Government and the NHS to ensure that the consultation on the 10-year plan reaches as many people as possible from these communities, so that their voices are heard?

[Baroness Merron (Lab)]

The lessons that have been learned are that there has to be a whole range of ways of consulting: in person around the country; online, where people can access the website; and through toolkits such as the “workshop in a box”. As I mentioned in an earlier answer, the consultation also needs to be tailored to the needs of those who need to speak up. We are asking the public, staff and organisations what is important, and we want, as the Prime Minister said, their fingerprints all over the 10-year plan.

Drug-related Deaths in England and Wales

Lord Kamall Excerpts

Tuesday 26th November 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness will have heard me say before that we had to take some tough decisions at the Budget to fix the foundations in the public finances, and that enabled a settlement for the Department of Health and Social Care of some £22.6 billion. As she knows, the employer national insurance rise will be implemented in April 2025, and in due course the department will set out further details of the allocation of the funding I referred to for next year.

[Lord Kamall (Con)]

My Lords, I know this Government take drug-related deaths seriously, as did the previous Conservative Government when we awarded 12 projects a share of a £5 million fund to reduce rates of fatal drug overdoses, adopting a similar approach to that of the Vaccine Taskforce to tackle health challenges. Has there been any evaluation of how successful those projects were? What plans are there to continue or expand them?

[Baroness Merron (Lab)]

Our continuing work in this area is part of the Office for Life Sciences programme. This Government continue to fund research into wearable technology, virtual reality and artificial intelligence, all in a bid to support people with drug addictions. Since coming into office, we have awarded £12 million to projects across the UK that are showing innovation in respect of technology, because we want to support people with addictions.

Mental Health Bill [HL]

Lord Kamall Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, this has been a fascinating debate. Having read the various reports sent by many organisations, including the excellent briefing from the House of Lords Library, I felt pretty well briefed but, having listened to today’s contributions —including the moving contributions from my noble friend Lady Browning and the noble Baronesses, Lady Parminter, Lady Keeley and Lady Ramsey—I realised that there is so much more for us to learn.

These Benches welcome the Bill. In particular, I pay tribute to my noble friend Lady May, who, as Prime Minister, commissioned the Wessely review to consider a number of issues: why, as we heard from many noble Lords, were detention rates increasing and, in particular, what could be done to reduce inappropriate detention? I understand very well the point made by the noble Baroness, Lady Parminter, about when detention may be appropriate or inappropriate. The review also considered how to improve the way that different agencies respond to people in crisis to ensure that they are treated with dignity and respect. It looked at the disproportionate number of people from certain ethnic backgrounds, specifically Afro-Caribbean men, being detained under the Act and what should be done about it.

I am also grateful to noble Lords who served as members of the pre-legislative Joint Committee on the 2022 draft mental health Bill, which was based on the recommendations of Sir Simon Wessely’s review. Some of them have spoken in this debate: in particular, my noble friend Lady Buscombe, who chaired the Joint Committee; my noble friend Lady Berridge; the noble Baroness, Lady Hollins, who has a long history in this area from personal and professional experience; the noble Baroness, Lady Barker, who has many times said, “I told you so”; and the noble Lord, Lord Bradley, who was a champion for mental health during the passage of the Health and Care Bill. Quite often I was urged to resist some of his amendments but, with hindsight, I am glad that he prevailed to ensure that we continue to discuss the parity between mental and physical health. As many noble Lords have said, the challenge is how we turn those words into action throughout the system. I also thank the noble Baroness, Lady Neuberger, who sat on the Wessely review and who, when we looked at and discussed this when I was the Minister, gave me quite a bit of time—partly, I think, because she chairs the trust of the hospital where I was born.

They all had very incisive insights so, in approaching this debate with my noble friend Lord Howe, we considered the report from the Joint Committee and this generated many of our questions. We wish to probe the Government on the recommendations from the report, especially those with which the Bill seems to disagree. We will not, at this stage, tell the Government where we agree or disagree; it is more to understand the Government’s reasoning for not including specific recommendations from the Joint Committee.

We also ask the question: if and when the Bill is passed, what next? How and when will the Government implement the main changes in the Bill, as was alluded to by the noble Baroness, Lady Murphy, and the noble Lord, Lord Scriven? Last week during Oral Questions, one of the ministerial colleagues of the noble Baroness, Lady Merron, made what sounded like a government commitment. But when questioned by one of my noble friends, that Minister admitted that it was not a commitment but an aspiration.

Similarly, the briefing notes accompanying this year’s King’s Speech stated that the Bill would take

“a number of years to implement”

and that the Government would introduce these reforms

“in phases as resources allow”.

At this stage, therefore, we would like to understand which changes the Government plan to introduce immediately and which reforms they are aspiring to, rather than actively planning. This is to make sure that we avoid some of the problems that the noble Lord, Lord Alderdice, alluded to in his contribution.

I move now to the main areas that have been raised in today’s debate on which we would like to learn more about the Government’s intentions. The noble Lord, Lord Touhig, reminded the House that autism is not a mental health condition. My noble friend Lady Browning highlighted the lack of understanding of people with autism. The Joint Committee recognised the risk that people with autism or a learning disability could be given additional and unnecessary medical mental health diagnoses in an attempt to justify detention, when they can no longer be detained under Part II of the Mental Health Act. What firm plans do the Government have, in this Bill or otherwise, to try to manage and mitigate this risk?

The Joint Committee recommended a full statutory review of the use of community treatment orders within three years but, as my noble friend Lord Howe pointed out, there is no commitment to such a review in the Bill. Can the Minister explain the Government’s reasoning for not committing to a review within three years?

On children, both the independent review and the Joint Committee made recommendations—some of which are not in the Bill—about the treatment of children, such as the inappropriate placement of under-18s into adult wards or into facilities that may be miles away from their home. Can the Minister clarify the Government’s position on these two specific issues?

On advanced care documents, which the noble Baroness, Lady Barker, has championed for many years, the Joint Committee recommended that these be made a statutory right for all patients detained under the Mental Health Act. As my noble friend Lady Buscombe has said, this could be done in the form of an app if we make sure to push through the digitalisation of the NHS and the whole care system. The Bill as it stands does not follow up on this recommendation, preferring to place a duty—one noble Lord alluded to it being “vague”—on NHS England and ICBs to inform patients about advance care documents. Many noble Lords, including the noble Lord, Lord Stevens, have raised this issue, so I think the House would find it helpful if the Minister could explain the Government’s reasoning behind not introducing these documents as a statutory right in the Bill.

We welcome the Bill removing police stations and prisons as places of safety for patients not in the criminal justice system. However, as my noble friend Lord Howe said, one unintended consequence raised by several bodies was that this could lead to a rise in the number of people admitted to A&E departments, sometimes escorted by police and having to wait in crowded spaces with a lack of specialised facilities until they can be assessed by clinicians. When do the Government envisage that NHS trusts will be able to deal with the potential increase in the number of mental health patients admitted to hospitals as places of safety?

The president of the Royal College of Psychiatrists, who contributed to the independent review, raised concerns about the proposed changes to the treatment of those with learning disabilities or autism, as there may be times when community services cannot manage the level of risk that such patients present, and when it might take some time to decide whether this is related to co-occurring mental illness. In such cases, patients may be brought into A&E, but what happens if their behaviour is perceived as affecting the safety of others in the A&E department? This could lead to the police being called, and suddenly they are in the criminal justice system. I wonder how the Minister sees the Bill dealing with such a situation.

I now turn to the issue of early intervention, which the British Association of Social Workers raised during pre-legislative scrutiny and which the noble Baroness, Lady Watkins, raised today. The BASW stressed the importance of early intervention to prevent the admission of mental health patients into hospitals in the first place, which they described as being at

“the interface of mental health and mental capacity legislation”.

A number of noble Lords have talked about whether we could have gone back to first principles and started with fusion legislation. We note that Sir Simon Wessely suggested that this was not practical or would take too much time; I do not wish to misquote him. My noble friend Lady Berridge also mentioned the interface with the Children Act. This all asks how we can do this in a holistic way, but by taking a step back are we just waiting even longer for something to be done to fix the problems with the existing legislation? We have obviously decided on this route but I ask the Minister what thought is being given to future fusion legislation or rethinking the interface between the various Acts affected here?

The pre-legislative scrutiny committee also recommended

“the creation of a Mental Health Commissioner … to oversee the direction of travel … and implementation, monitoring outcomes and supporting cultural change … be an advocate for patients, their families and carers and speak up about the stigma still attached to severe mental illness”.

Yet the Government have decided not to accept this recommendation. I note that a number of noble Lords across the House have spoken on this missing part of the legislation. Can the Minister explain why the creation of a mental health commissioner has not found its way into the Bill?

One of the main reasons for commissioning the independent review was to examine why so many people of Afro-Caribbean heritage are detained under the Mental Health Act. Indeed, Sir Simon Wessely wrote in his report that one of his earliest academic papers, in 1989, was on the subject of the overrepresentation of those of black, African and Caribbean heritage among those diagnosed with schizophrenia. Are the Government, the NHS and the department any closer to understanding the key factors behind this overrepresentation? What do they believe can be done to reduce this disparity, or does it need further research?

The Minister might find this odd coming from me, given that when I was Minister I quite often tried to shield the Government from this—now that the roles are reversed, there might be a certain irony—but I will ask about a workforce plan. In all honesty, when we were in government we were pressured by the Treasury not to accept this, and it quite often pushed back when we tried to make the case for this, so I understand that it is a real challenge for the Government. We completely understand, and it would be unfair of me now to take advantage of the fact that I am in opposition. Our Government belatedly published a workforce plan. What is the thinking on publishing a workforce plan, given that many noble Lords across the House have asked about this, particularly once the Bill becomes an Act? How long would it take to actually implement this? We need to understand more about the resources—otherwise, it could make things worse.

I realise that I and other noble Lords have asked many questions, and I certainly do not envy the Minister. We look forward to her responses, either now or in writing, and we welcome her engagement with noble Lords across the House.

NHS: Dentistry Provision

Lord Kamall Excerpts

Monday 25th November 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, the Minister said that it was not only about rocking up to the General Dental Council, as the noble Lord, Lord Harris, said, but about having conversations. Can the Minister confirm what specific conversations the Government have had with the NHS, with the General Dental Council and with other dental bodies to encourage the opening of schools of dentistry in so-called dental deserts, especially in areas such as Norfolk, which my noble friend Lord Fuller described as the Sahara of dental deserts?

[Baroness Merron (Lab)]

As the noble Lord will know, we are very keen to see that the areas that are most underserved—as I know from my own experience in Lincolnshire—are targeted. One of the reasons is the problem of recruiting and retaining dentists, as there is not a dental school to call upon. That point is well understood. We are keen to target the areas that need the most, as well as providing additional urgent dental appointments. Early conversations have also taken place with the Minister for Care, Stephen Kinnock, about reforming the dental contract, which is absolutely key, and that work will continue at pace.

NHS: Treatment of Children from Other Countries

Lord Kamall Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to make reference to the UK rare diseases framework. The intention of that is to improve the lives of those with rare diseases—for example, by helping to get a faster diagnosis, increasing awareness of rare diseases, better co-ordination and care, and improving access to care, treatment and drugs for those in this country. I will add his suggestion to the list of matters to raise with the department.

[Lord Kamall (Con)]

My Lords, we can all be proud that the UK is home to some of the world’s best medical experts on rare conditions. As the noble Lord, Lord Hogan-Howe, said, there are patients in other countries—often poorer countries—who seek the help of a UK expert. The Minister knows that in the UK the NHS charges, understandably, and that is welcome, but there are other challenges if that expert goes abroad. She spoke about some international agreements in an earlier answer, so can she say a bit more about how NHS England works with other systems in other countries, especially with reference to some of those agreements?

[Baroness Merron (Lab)]

The agreements that the UK has in place which contain referral arrangements whereby the funding is discussed and agreed as part of the process of the referral are with the member states of the EU, Switzerland, the EFTA-EEA bloc of countries, the British Crown dependencies and some overseas territories. As the noble Lord rightly acknowledges, it is only fair that those using the NHS are those contributing to it, and we therefore have to ensure that we stick to those agreements. If trusts seek to undertake work outside of that area, that will be a matter for individual trusts, which will have to make decisions about their funding and their requirements to serve the NHS.

Carers and Poverty: Carers UK Report

Lord Kamall Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Merron (Lab)]

I and my ministerial colleagues are extremely aware of the anxiety the overpayments have created, and they are being independently reviewed to establish exactly why they happened. While I cannot commit to the amnesty the noble Baroness asks for, I can assure her and your Lordships’ House that we and the DWP are working to be as sympathetic to people as possible. I urge anyone in receipt of carer’s allowance to inform DWP of a change in their circumstances, so that overpayments can be avoided in future.

[Lord Kamall (Con)]

My Lords, we on these Benches also add to the tribute to the noble Lord, Lord Prescott, who has passed away.

My noble friend Lady Verma referred to the stress unpaid carers are under. We know that unpaid carers who look after family members may themselves have mental health issues, or may be looking after people with such issues. What support do the Government currently provide for the mental health of unpaid carers and those they care for, and what extra measures do they plan to introduce?

[Baroness Merron (Lab)]

One of the key things in all this is the identification of carers. As has been discussed in your Lordships’ House on a number of occasions, a lot of people do not identify as carers. Therefore, we are encouraging GPs and, in the case of young carers, schools, to identify carers, so that they can get the support they deserve. The noble Lord, Lord Darzi, identified that making sure that unpaid carers receive recognition and support is key, and it will be in the 10-year plan as we go forward.

Type 2 Diabetes: Continuous Glucose Monitors

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

Cancer: Older People

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

National Carers Strategy

Lord Kamall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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