Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Lord Kamall Excerpts

Tuesday 14th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 9 November be approved.

Relevant document: 21st Report by the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

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

My Lords, I will make a Statement on measures to make sure that our health and care system is as safe as possible in the battle against Covid-19 by making vaccination a condition of deployment for more health and social care settings.

Across the UK, the overwhelming majority of British people have played their part by getting vaccinated against Covid-19. Over 81% of people over the age of 12 have had two doses, a figure that rises to around 91% when you look at NHS staff. The impact of this outstanding vaccination effort is clear. The UK Health Security Agency estimates that at least 127,000 deaths and 24 million infections have been prevented as a result of the Covid-19 vaccination programme. In addition, around 260,000 hospitalisations have been prevented in those aged 45 years and over.

But we still need to do more. Uptake rates vary between different health and care organisations and across the country, and, despite the incredible effort to boost uptake across the country, over 94,000 NHS staff are still unvaccinated. It is important that our health and care staff get jabbed to protect the vulnerable who are in their care and to protect the NHS workforce in the wake of new variants, such as omicron. We made vaccination against Covid-19 a condition of deployment in care homes from 11 November this year. Contrary to initial fears, we are not aware of any care home closures where vaccination as a condition of deployment has been the primary cause.

Today, we are putting before your Lordships the regulations to extend this requirement to health and other social care settings, including NHS hospitals and GP and dental practices, regardless of whether a provider is publicly or privately funded. Anyone working in health or social care activities regulated by the Care Quality Commission will need to be vaccinated against Covid-19 if they are deployed to roles that have direct contact with patients or service users, apart from a few limited exemptions—for example, for medical reasons.

I hear the concerns that have been expressed or raised about the impact of these measures on the workforce, especially during these winter months. For this reason, we are allowing a 12-week grace period to give people the chance to make the positive choice to get protected. We are committing to enforcement of the requirements by 1 April next year, subject to the will of Parliament.

We are also increasing the number and diversity of opportunities to receive the Covid-19 vaccine, using the booster campaign to make the most of walk-ins, pop-ups and other ways to make sure that people are getting the vaccine as easily as possible. The NHS has already written to all providers providing early guidance, setting out what vaccination as a condition of deployment means for the system, as well as advising on next steps to boost uptake and help to ensure smooth implementation. After consulting on the policy in September, we have seen a net increase of over 55,000 NHS staff vaccinated with a first dose.

These steps complement key interventions that we have made to support services, including bolstering capacity across urgent and emergency care and the wider NHS, including with a £250 million investment in general practice, £55 million for the ambulance service and £75 million for NHS 111, and publishing an adult social care winter plan, including £388 million to support infection prevention control and £162.5 million for workforce recruitment and retention. In addition, we have invested £478 million for support services, rehabilitation and reablement care following discharge from hospital, and we are ensuring that health and social care services are joined up.

Although the Government believe that these measures are a proportionate way of protecting those at greatest risk, we recognise that some noble Lords have asked whether we should or would extend these measures even further. So let me state clearly that although we have seen plans for universal mandatory vaccinations in some countries in Europe, we do not support them here. The Government have no intention of extending condition of deployment to other workforces or introducing mandatory vaccination more widely.

At this point, I would like to address head on some of the concerns your Lordships may have regarding concerns raised by the Regulatory Policy Committee and the Secondary Legislation Scrutiny Committee about these regulations. I sympathise with noble Lords who are concerned with some of the procedural aspects of the passage of this legislation, but in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable.

The Government have responded to the concerns raised by the Regulatory Policy Committee and the Secondary Legislation Scrutiny Committee as quickly as possible and have provided further information to your Lordships, including on the actions on workforce capacity—as I have set out—and the steps we are taking in collaboration with the NHS and adult social care sector to mitigate the risks to small business, which is of particular concern to the Regulatory Policy Committee. An updated Explanatory Memorandum has been provided to Parliament, and the department’s consideration of the RPC’s concerns has been published on the government website.

The updated Explanatory Memorandum provides further information on the scientific and clinical rationale for the policy, the exemptions that have been provided and those not provided, and the steps we have taken to further encourage uptake of vaccinations and to mitigate workforce issues. The Secretary of State also wrote to all Peers on 10 December to set this out.

In these difficult times, we have seen the very best of those who work in health and care. We have seen care, compassion and conscience. Noble Lords across the House continue to pay tribute to the heroic responses across the health and care sectors. Today’s Motion is about protecting not only health and care staff but the patients in their care. By protecting patients and staff, we protect the NHS from being overwhelmed. I commend this Statement to the House.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I just want to make a quick adjustment: we are of course debating the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021.

Amendment to the Motion

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[Baroness Thornton (Lab)]

My Lords, I declare an interest as a non-executive director of an NHS hospital. I thank the Minister for explaining this statutory instrument, although I have to confess that I had a moment of panic during his opening statement. I thank him also for explaining his understanding of how the Government arrived at this point. I note that the department has at last produced at least something called an impact assessment, as well as other documentation. This was the subject of my Motion to Regret, now withdrawn. That does not mean that I no longer regret the lackadaisical manner in which this Government approach their accountability to Parliament and the legislative process.

As most noble Lords, including the noble Lord, Lord Cormack, have said to the Minister in clear language, we still wish to know how the legislation will operate. We hope that the Minister will be more forthcoming about, for example, the “significant workforce capacity risk” which the Secondary Legislation Scrutiny Committee mentioned in its very critical report. We note that the committee was damning in its criticism, and I thank my noble friend Lord Cunningham for speaking about the fact that these things are not an option but a requirement.

I say to the noble Baroness, Lady Noakes, that we agree with her criticism of the Government’s handling of these issues. We absolutely agree about the procedure, the drafting and the lack of justification that supports the legislation. I have been commenting on this from this Dispatch Box since March last year. However, the noble Baroness did not say that this was necessarily the wrong way to go. I withdrew my regret Motion because, today, given the new clear threat of omicron, we need to focus on the way forward. I do not believe that that is a political reason for withdrawing the Motion. Had the noble Baroness tested the opinion of the House on her fatal Motion, we on these Benches would have supported the Government, just as we are doing right now in the Commons. The Labour Party has acted, and will always act, in the best interests of our NHS, our public health and our nation.

Of course, we want everyone working in the NHS to take up the vaccine. It is safe and effective, and the Government should be focused on driving up vaccination rates through persuasion, education and support for the vaccine-hesitant, as many noble Lords, particularly those on the Liberal Democrat Benches, have said. We know that omicron is now a clear threat. It is important that the elderly and the vulnerable, and those being cared for in healthcare settings, are protected. Vaccination also protects staff from severe disease, so we will not oppose the Government on this.

Compulsory vaccination for NHS staff is a difficult question—of course it is—as the right reverend Prelate the Bishop of St Albans and my noble friend Lord Hunt explained to the House. We would all much prefer that all front-line NHS staff voluntarily agree to have the vaccine. The latest SAGE advice, however, suggests that omicron may increase the risk of hospital-acquired infections. Vaccination will not eliminate all transmission, but it will reduce the risks and protect both patients and staff in the NHS from severe disease. It may also reduce staff absences caused by Covid.

Of course, there is a precedent for certain NHS staff having to be vaccinated, for example against hepatitis, and given the evidence that being vaccinated reduces the risk of transmission, it is reasonable to ask whether those who are looking after our loved ones should themselves have taken every step possible to reduce the risk that they may pass the virus on to those whom they are caring for, many of whom may be elderly and vulnerable.

However, ahead of any rollout, the Government must ensure that this change does not make the staffing crisis in the NHS any worse and must work with the royal colleges, NHS Providers and the trade unions to agree a framework for how this change is rolled out. The trade unions and royal colleges have been critical of the proposals for compulsory vaccination, ahead of what will be, and is becoming, a very difficult and challenging winter for the NHS because of the implications this could have for staffing. So we welcome the fact that the Government have pushed the date back to April 2022, but we continue to be concerned about the implications that mandatory vaccination for NHS workers will have on staff shortages. We have asked the Government to set out a plan for this.

For the record, on the separate issue of mandatory vaccination for the public, the Prime Minister probably puzzled the whole nation—he certainly puzzled me—when he floated this idea. We are opposed to this—as is the Minister’s boss, I expect. We are opposed to the use of Covid status certification for access to essential services. Forcing the general population to have the vaccine would not only be wrong but impractical. The Government have not brought forward any measures to introduce this, and we would not support any future attempt to do so.

Finally, all of us want to enjoy Christmas safely this year. We all want to protect our NHS, which has been suffering from staff shortages and record waiting lists and has been performing miracles for the last 18 months. Our best defence against all variants of the virus, including omicron, is that we all get vaccinated.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords for taking part in this debate. I apologise to noble Lords for getting the terminology wrong at the beginning. I will make sure that that is corrected in future.

I thank my noble friend Lady Noakes for raising this important issue, and for challenging us and rightly holding the Government to account on many procedural issues. I accept that your Lordships perform an essential role in scrutinising the measures that we have put forward today. That is one of the things that makes me very proud to be a Member of this House. I recognise the strength of feeling of your Lordships for and against what we are proposing and about the procedures thus far. I know that these feelings are sincere and heartfelt.

I now turn to some of the point raised by noble Lords. My noble friends Lady Noakes and Lord Cormack and the noble Baroness, Lady Brinton, raised questions about the red-rated impact assessment from the Regulatory Policy Committee. I hear the concerns of this House, and I acknowledge that, due to the necessity to move as quickly as possible and minimise the risk to those who are vulnerable, we were unable to publish the full impact assessment alongside the regulations being laid. We set out a statement of impacts, and the full impact assessment has now been published on GOV.UK, but I accept the argument made by noble Lords that this is rather late. We have also now published additional consideration of the points raised by the RPC in relation to private businesses.

My noble friend Lady Noakes also asked what the Government have done in response to the criticisms of regulations from the Secondary Legislation Scrutiny Committee. I reassure noble Lords that we have published the updated Explanatory Memorandum to provide additional information on the specific concerns raised. I also accept the criticisms that this could have been more timely. This includes more information on the scientific and clinical rationale for the policy, the exemptions that have been provided for, those not included, and the steps that we have taken to further encourage uptake of vaccinations and to mitigate work- force risks.

The SLSC also raised concerns about the impact assessment on process. We have worked hard and as quickly as possible to finalise the impact assessment that we feel best captures the likely impact of this novel policy in the uncertain circumstances that we are still living through and the need sometimes to react quickly. As my noble friend Lady Noakes rightly said, this impact assessment was laid before the House in advance of this debate.

My noble friend Lady Noakes also raised the question of whether a cost of £270 million is value for money, considering the impact assessment. While it is not possible to model the non-monetised benefits that this policy would have due to the limited data available, the health benefits through reduced infections and deaths among health and care users—as well as the wider community—from the workforce being vaccinated are likely to be large and should be considered when focusing on costs.

A key benefit is the impact of reassurance to patients and care users that they are being looked after by staff who are vaccinated. This avoids the very dangerous situation of people feeling wary of going to the NHS and other health and care providers, which can have dangerous long-term implications regarding health outcomes for our society. This is non-monetised, yet it remains a highly significant factor.

My noble friend Lady Noakes also asked about the workforce impact of this legislative instrument. As of 5 December, 521,000 staff in all care homes, or nearly 96%, have been vaccinated with the first dose, and 511,000 staff, or 94%, are reported to have received a second dose based on responses from 99% of providers. Although NHS workforce figures are dynamic as people join and leave, since the Government consulted on the policy in September, the latest published figures show an overall net increase of NHS staff vaccinated with a first dose of over 55,000.

My noble friend Lady McIntosh also raised valid questions about the impact on the social care workforce. We are not aware of any care homes where VCOD is the primary reason for closure, but we continue to work with our regional assurance team, which works closely with regions across the country to understand the local and regional pressures, and offer support and advice as appropriate.

In social care, we have already put in place a range of measures to help local authorities and providers to address workforce capacity pressures; indeed, I have announced some of those in this House. As in healthcare, there will be a 12-week grace period for workers in the wider social care sector before requirements come into force, which will give all unvaccinated staff time to get their jab. We are focusing every effort on promoting and encouraging vaccine take-up across social care, and £300 million was announced for the workforce on Friday 10 December to support the care sector over winter.

My noble friend Lord Cormack, the noble Lords, Lord Cunningham and Lord Hunt, and several other noble Lords have eloquently raised points about the use of retrospective legislation and emphasised the importance of parliamentary processes. I sympathise with noble Lords who are concerned about some of the procedural aspects of the passage of this legislation.

As my noble friend Lord Cormack rightly said, in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable. Vaccination is our best defence against Covid. It reduces the likelihood of infection and therefore helps to break chains of transmission, as the noble Baroness, Lady Thornton, rightly acknowledged. It is safe and effective. The legislation will protect those receiving care in all health and social care settings as well as our valuable health and social care workforce themselves.

I agree with my noble friend on the point about reviewing the use of such legislation. I assure noble Lords that Regulation 5 sets out the requirement for the Secretary of State to carry out an annual review of these regulations, taking into account clinical advice and accessibility and availability of authorised vaccines, and to publish a report setting out the conclusions of this review.

On my noble friend Lord Cormack’s suggestion of an ongoing Joint Committee, I apologise if the response I suggested was inaccurate. I suggest that I discuss it with him so that I can learn from his experience of parliamentary procedures.

The noble Baroness, Lady Tyler, referenced the importance of encouraging the hesitant. I completely agree. We both come from the same part of London; indeed, she informed me that we went to the same school. We come from an incredibly diverse area, and we understand the different concerns and pressures in many of these communities; as noble Lords will recognise, I myself come from one of these communities. But as she will know, the NHS has focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking campaigns not only based on function, such as at midwifery staff, but directed at different communities, such as ethnic-minority groups and students, as well as using the booster campaign as an opportunity to re-engage staff. I repeat my gratitude to noble Lords across the House who have suggested to me ways that we can address many of these communities, including working with interfaith communities and networks which really understand these communities and have the trust of many individuals.

Medical Schools: Training Places

Lord Kamall Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Robathan]

To ask Her Majesty’s Government how many training places for new doctors there were in medical schools and other institutions in (1) 2000–01, and (2) 2021–22; and what plans they have, if any, to increase the number of places for 2022–23.

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

In the 2000-01 academic year in England, there were 4,300 government-funded medical school places. Initial data shows that, in 2021-22, 8,460 places have been taken up, including additional places for students who completed A-levels in 2021 and had an offer from a university in England to study medicine subject to their grades. The Government continue to monitor the number of medical school places that they fund to ensure that it is in line with NHS workforce requirements.

[Lord Robathan (Con)]

My Lords, the Answer is quite encouraging, but doctors and other medical staff are working flat out on our behalf, and we are told that there are not enough doctors. That is because we are not training enough. Some 21 years ago, Gordon Brown confected a row over a girl called Laura Spence, who was well qualified but was not able to get into Oxford to read medicine because there were not enough training places. We have had all three major parties in government in those 21 years, and there are still not enough training places. Rather than taking doctors from the poorest countries in the world, where they are needed, and bringing them here, does not my noble friend think that it is time to make sure that we train enough doctors in this country and that there are enough training places for them so we can actually service our own needs?

[Lord Kamall (Con)]

I thank my noble friend for the question, but there are record numbers of medical students in training. There are currently more than 35,000 doctors in undergraduate training and 60,000 doctors in foundation and speciality postgraduate medical training. On the international market, we follow strict ethical guidelines, in line with the World Health Organization guidelines.

[Lord Watts (Lab)]

My Lords, is it not the case that the extra doctors that we were promised by 2016 will not be enough to compensate for the number of doctors who will retire? Can the Minister say something about what he is doing about the number of doctors who are going to retire shortly, which will cause even more of a shortage?

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[Lord Kamall (Con)]

The noble Lord raises an important question, but the fact is that we are training more doctors, and we are recruiting internationally where it is ethical to do so. On retirements, we are looking at a scheme that lasts until 2024 to allow doctors to come back without it affecting their pension.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a fellow of the Royal College of Physicians. Do the Government accept the report from that body, Double or Quits, which has shown that we need 15,000 medical school places annually? Doubling the number of medical school places to that number would cost £1.85 billion, which is only one-third of what hospitals currently spend on agency and bank staff. Therefore, an increase is an investment to save.

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

[Lord Naseby (Con)]

My Lords, as well as increasing the numbers, is it not equally important that we ensure that every newly qualified doctor, on whom we spend well over £200,000, signs up for at least four years in the NHS, as do every male and female who joins our Armed Forces today?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. I will look into it and get back to him.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, will the Minister indicate what research has been carried out into the training opportunities for specialist doctors post-graduation who wish to pursue careers as consultant orthopaedic surgeons? At the moment, because of Covid investment resources, there are no training opportunities for them in Northern Ireland. Will the Minister raise this issue and indicate what efforts will be made to address it?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing the experience of Northern Ireland. It is really important that we ensure that we have more training places and that we address the types of training that we do. As the noble Baroness will be aware, it is no longer a simple question of nurses and doctors: we are training a number of physicians’ assistants and specialists, and we will continue to do so.

[The Lord Bishop of St Albans]

My Lords, this latest Covid omicron variant has made us realise that we are one human race, and we are now facing a scandal whereby we are relying on bringing in doctors from some of the poorest parts of the world to look after our needs. For centuries, this country was renowned for sending doctors and nurses abroad and founding hospitals in all parts of the world. What consideration have Her Majesty’s Government given to ensuring not only that we are producing enough of our own doctors but that we are expanding our tertiary education and bringing in more people to send them back to help some of these countries as part of our global Britain initiative?

[Lord Kamall (Con)]

When training doctors from abroad, we follow international guidelines and World Health Organization ethical guidelines. For example, when I recently had a meeting with the Kenyan ministry to talk about the UK-Kenya health partnership, the point was made to me that they were training far more people than they had places for in their own country. They thought that their talent was a valuable export, while at the same time, remittances went back to their country.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Does the Minister accept that long-term workforce planning requires an effective apparatus that is able to understand the changing population demographic, changes in the nature of the delivery of healthcare and how technology and innovation might impact that? Do Her Majesty’s Government have a view about establishing such an apparatus as part of the current Health and Care Bill before your Lordships’ House?

[Lord Kamall (Con)]

There has rightly been much discussion of workforce planning for the NHS and adult social care, and the Bill will build on this. Clause 35 will bring greater clarity and accountability in this area, requiring the Secretary of State and the NHS to produce a workforce plan.

[Baroness Merron (Lab)]

My Lords, with the intensification of the Covid booster programme, more doctors will, of course, be diverted from their usual roles, making it even harder for people to get an appointment at their local surgery, and record waiting lists will continue to increase. What revisions will the Minister make to existing plans for numbers of training places to meet the need for more trained staff, including doctors, nurses, lab technicians and auxiliaries? How will the Minister respond to the report from the Royal College of Surgeons that 13,000 planned operations have been cancelled in the last two months alone?

[Lord Kamall (Con)]

The focus and priority for the next three weeks is on omicron and making sure that people get their boosters as quickly as possible. It is not only doctors who are involved: nurses, pharmacists and, incredibly, a number of civil servants are now taking part in that programme. For the next three weeks, the focus is on getting more jabs into arms.

[Lord Sikka (Lab)]

My Lords, successive Governments have poached doctors from comparatively poor countries to meet the shortages here. As the Minister knows, it costs a vast amount of money to educate and train a doctor, so developing countries have been deprived of their talents. Will the Minister explain that, or give an undertaking that the Government will provide compensation to poorer countries for stealing their assets?

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[Lord Kamall (Con)]

The Government follow strict ethical guidelines on international recruitment, in line with WHO guidance, which says we should not be taking nurses and doctors from countries and depriving their health services. But where countries have a surplus—a number of developing countries around the world actually train more people than they have a use for in the local system—they see it as a valuable source of income.

[Lord Scriven (LD)]

My Lords, it is not just a question of the total number of doctors but the number in certain specialisms where there is already a dearth of professionals. What are the Government doing to ensure that, as more doctors come on, they are particularly geared to specialisms where there is already a dire dearth of doctors?

[Lord Kamall (Con)]

When it comes to workforce plans, particularly in local areas where there is understaffing, we are very much focused on specialisms that are understaffed.

[Lord Turnberg (Lab)]

My Lords, we are losing doctors more rapidly than we can train them, and it has been like that for a while. The average age at which a physician retires is now 58; it used to be 62. What are the Government doing to help doctors stay in post and to bring them back part-time after retirement to help the NHS?

[Lord Kamall (Con)]

As the noble Lord will be aware, there is a temporary measure to bring doctors back, without affecting their pensions, which lasts until 2024. We are looking into whether that should be continued, as well as increasing the number of training places.

Covid-19: PCR and Lateral Flow Test Providers

Lord Kamall Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government what due diligence they carry out on companies listed on GOV.UK, that offer travel PCR and lateral flow tests for COVID-19.

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

The private sector has stepped up extremely rapidly, and most of the tens of thousands of travellers have had an excellent and professional service. However, we do not tolerate any providers taking advantage of customers. All providers in the PCR international travel market are required to meet robust minimum standards, and we remove those we identify as having fallen short of them. Since we launched the travel service, we have removed over 100 providers.

[Lord Scriven (LD)]

My Lords, for many people that is just not their lived experience. The approved supply list for the two-day PCR test on GOV.UK is fundamentally flawed. Many thousands of people either do not receive the test results within the two-day timeline or at all. Despite many people reporting these companies to NHS Test and Trace, they remain on the list as of today, making tens of thousands of pounds while undermining the public health effort. What will the Minister do to ensure that this kind of procedure stops?

[Lord Kamall (Con)]

It is important to distinguish between PCR tests if you are contacted by NHS Test and Trace and PCR tests for travel purposes. If you are contacted by test and trace, you are sent a PCR test for free. But when it comes to travel, the view is that the traveller should bear that cost rather than the taxpayer. After I saw this Question, I went on to one of these websites and tested it out for myself. As the noble Lord says, the price quoted is often not the first price. I have had a conversation with those that provide it, and they are looking at a number of different solutions.

[Baroness Rawlings (Con)]

My Lords, why can vaccines only be obtained through the National Health Service, while Covid tests valid for travelling can only be obtained privately?

[Lord Kamall (Con)]

I am not sure I completely agree with the premise of my noble friend’s question, but I will double-check. The decision had to be made that if people are contacted by test and trace, it is only right that they are sent a PCR test. But if they are travelling, should the taxpayer bear the burden of the cost of their PCR test, or should they? A number of travel companies are now recommending PCR tests for their passengers.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, it is not just Matt Hancock and Randox, or Rupert Soames at Serco: a large number of these companies that have multimillion—even multibillion—pound contracts for testing have links with Tory members, MPs and Peers. Is this just a coincidence? Is it serendipity? Or is it something more sinister?

[Lord Kamall (Con)]

I suggest that if the noble Lord would like to take a PCR test before he travels, he goes through a number of price comparison websites and chooses the one he feels is more suitable for him.

[Lord Cormack (Con)]

My Lords, there are rumours circulating—more than rumours, I think—that we are running out of testing kits. Is that true? Can my noble friend give us some reassurance on that front?

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[Lord Kamall (Con)]

I thank my noble friend for bringing that to my attention. I was in a meeting with my right honourable friend the Secretary of State for Health and Social Care as well as other Ministers today. We were told categorically that we have ordered many more tests to enable people to test more often.

[Baroness Thornton (Lab)]

My Lords, there are hundreds of private test companies to choose from when you are heading abroad, and that is part of the problem. Which? carried out some mystery shopping in the autumn and revealed a list of companies that give the most reliable and best-value tests—I share that information with the House—and also the ones to avoid as being rip-offs and unreliable. Is the Minister aware of this consumer research? What notice will the Government be taking of the ones that Which? recommends not to use? Have they yet been removed from the Government’s list?

[Lord Kamall (Con)]

I thank the noble Baroness for making noble Lords aware of that particular comparison website—let me put it that way. We try carefully not to recommend particular private providers or comparison websites, but this market is developing, and there are lots of comparison websites out there looking at this market. As we start to have more testing and do more diagnoses at home, this market will develop.

[Lord Bilimoria (CB)]

My Lords, I was one of the first people in the country to call for lateral flow tests, going back to August last year, and I am delighted that the Government now provide these free to businesses and the public. Can the Minister assure us that these tests will continue to be made available free as we continue to fight this pandemic? Secondly, as president of the CBI, let me say that the aviation sector is suffering hugely. Is there a need for pre-departure PCR tests when we could use lateral flow tests?

[Lord Kamall (Con)]

Let me assure the noble Lord that there will be sufficient tests; and if you are contacted by test and trace, you will either be asked to take a lateral flow test or be sent a PCR test. But when it comes to international travel, we feel it is only right that the traveller or the company bears the cost. At the moment, travel companies are offering and recommending specific PCR tests.

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

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

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[Lord Kamall (Con)]

I thank the noble Baroness for suggesting another price comparison website. There is an accreditation scheme, and every time companies are reported to the Government, we look at how to remove them. There is a four-stage process for UKAS accreditation, and sometimes when companies are reported, another one pops up.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister say what the average cost to the NHS of both a PCR and a lateral flow test is, so that that can inform people in relation to the cost in the private sector?

[Lord Kamall (Con)]

I do not have the exact numbers, so I will write to the noble Baroness. On loss-leading services, anything under £15 was removed because it was deemed that that was dishonest or underpriced.

[Lord Naseby (Con)]

Following on from that question, I remind my noble friend that, as far as I am aware, all the PCR tests are endorsed by Her Majesty’s Government, but the price varies from £60 to over £120. In that condition, if they are endorsed, will my noble friend talk to the companies concerned and decide on a recommended price level?

[Lord Kamall (Con)]

When I was discussing this with the people responsible for accreditation, they said that often a number of companies are reported to them and they look into them. Quite often companies will then be removed, but they can come back. The issue is that companies sometimes get provisional approval at the first stage while they are going through the full approval process. That will be reviewed in time.

[Lord Harris of Haringey (Lab)]

My Lords, in answering the noble Lord, Lord Scriven, the Minister referred to the fact that 100 companies had been removed from the list, presumably by his department or NHS Test and Trace. He presumably monitors all of this, so could he tell us exactly how many complaints there have been and how many of such complaints are necessary before a company is removed?

[Lord Kamall (Con)]

I am sorry to disappoint the noble Lord; I do not personally monitor this, but I will get the figures and write to him.

[Lord Watts (Lab)]

My Lords, can the Minister explain the wide difference in price from these companies? It seems to the general public that some are ripping clients off, but the Government do not seem to want to do anything about it.

[Lord Kamall (Con)]

One of the issues the Government have is that the GOV.UK website is pretty rudimentary. As this market develops over time, more and more people will look to private comparison websites—noble Lords have mentioned a few of them. It is also important to distinguish between the different types of PCR test. Some companies charge far more but offer a much quicker turnaround than those whose service might take a few days.

[Viscount Waverley (CB)]

My Lords, one might imagine that laboratories would give a reasonably consistent price. This is really all about consistency and fair pricing. That is the issue that needs to be taken into account, and I commend my Cross-Bench colleague for the point she made about the NHS. Given that the written word is often in the eye of the beholder, would it be helpful to have more flow chart-type messaging on the GOV.UK website? The perception is that what is on there is extremely complicated to understand.

[Lord Kamall (Con)]

The noble Viscount makes an important observation. When I looked at the website myself, I saw how confusing it was. When I discussed this with the people responsible, they said that they had changed it over time; for example, it now has minimum prices—one of the suggestions I made was that perhaps it should also have maximum prices. There is also the question of how you categorise, because there are different tests; some can be turned around in 24 hours, while others take a few days.

Covid-19 Update

Lord Kamall Excerpts

Wednesday 8th December 2021 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Health and Social Care. The Statement is as follows:

“With permission, Mr Speaker, I would like to update the House on the Covid-19 pandemic. We are working night and day to understand more about the omicron variant. There is a lot still to learn, but some important data has emerged very recently and I would like to update the House on the latest developments.

There are three reasons why the omicron variant is a threat. The first is that it is far more transmissible than the delta variant. The delta variant was much more transmissible than the alpha variant, and we are confident that omicron is significantly more transmissible than delta. We can see this most starkly when looking at how many days it takes for the number of infections to double for each variant. For delta, this was around every seven days, but for omicron, based on the latest data from here and around the world, our latest analysis is that it is between 2.5 and three days. This has made the virus an even more formidable foe.

The rate of growth in S-gene dropout cases in England, using S-gene dropout as a reliable proxy, is similar to that observed in South Africa. Although there are only 568 confirmed omicron cases in the UK, we know that the actual number of infections will be significantly higher. The UK Health Security Agency estimates that the number of infections is approximately 20 times higher than the number of confirmed cases, so the number of infections is closer to 10,000. UKHSA estimates that, at the current observed doubling rate of between 2.5 and three days, by the end of this month infections could exceed a million.

The second is severity. We do not yet have comprehensive data on the severity of this virus, but rising rates of hospitalisation in South Africa show that it certainly has the potential to cause harm. South Africa is a country where the average age is 13 years lower than in the UK, where they have a high level of antibodies from natural infection, and where it is currently the middle of summer. Even if the severity is lower than or the same as delta, high transmissibility means that the omicron variant can still have a severe impact, with the threat of more hospitalisations and unsustainable pressure on the NHS. This would mean an impact not just on Covid treatment but on non-Covid care that we all rely on, such as emergency care if somebody was involved, sadly, in a serious accident. When we set out plan B, we said we would act if the NHS was likely to come under unsustainable pressure and was at risk in providing the care and treatment that people need. The omicron variant has given us cause for concern.

Thirdly, we have been looking closely at what the omicron variant means for our vaccination programme. New laboratory data which has emerged in the last 24 hours suggests that there is lower immunity against omicron from vaccination compared with the delta variant, so that two doses of a vaccine are less effective at reducing transmission in the community. Early research published today by Pfizer suggests, however, that a third dose of the Pfizer vaccine neutralised the omicron variant to levels that are similar to the impact of two doses against the original strain of the virus. So it is more important than ever that we get the boosters available for all those eligible, and keep strengthening the defences that we have built. Today we have opened booster bookings to 7 million more people in England, so people aged 40 and over, and those in high-risk groups, will be able to get their booster jab from three months after their second dose.

Another defence is new treatments, which have a huge part to play in protecting the most vulnerable from Covid-19, especially for those who are immunosuppressed, for whom vaccines may be less effective. Today we have announced plans for thousands of people across the UK to be among the first in the world to access life-saving antivirals through a new national study. People who are at highest risk from the virus—for example, those who are immunocompromised or cancer patients—will also be able to access treatments outside this study from next Thursday if they have a positive PCR test.

We have built some powerful defences. We have put more boosters in arms than any country in Europe, we have built a huge nationwide infrastructure for testing, and we are leading the world in the deployment of new treatments. Thanks to these defences and our decision to open up in the summer rather than the winter, we are much better protected than we were this time last year, and we need this protection now more than ever. Although omicron will become more and more prevalent over the next few days and weeks, we will see the delta and omicron variants circulating together. Facing these twin threats without these pharmaceutical defences would have been hard enough, but even with them in place, we still face a perilous winter and so, unfortunately, we need to take steps against the threat of this new variant.

When we were moving down our road to recovery, we looked at four tests to see whether we should proceed to the next stage: that the vaccine deployment programme continues successfully; that the evidence shows that vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated; that infection rates do not risk a surge in hospitalisations, which would put unsustainable pressure on the NHS; and that our assessment of the risks is not fundamentally changed by new variants of concern. Unfortunately, the situation is markedly different now to how it was in the summer, when we were able to open up, so we must take proportionate steps to meet this emerging threat. These are not measures that any of us want to take, but these measures give us the best chance of saving lives and protecting our freedom over the next few weeks. It is precisely because we do not want lockdown that we are putting these proportionate steps in place now. As we have seen before, if we act early, firmly and decisively, and come down hard on this new omicron variant now, we can avert tougher action later on.

I know that the news of further measures will be disappointing for many people and that every measure comes with a cost. I can assure the House that in making these decisions we have taken a wide-ranging view, looking at the impact not just on the NHS in terms of Covid and non-Covid care but on the nation’s education, economy, life chances and mental health.

I would like to update the House on the measures we will take to enact plan B. First, we will reintroduce guidance on working from home; it will be updated to say that only people who cannot work from home should continue to go into their workplace. We know that this has an important part to play in slowing transmission, both at workplaces and on public transport. Secondly, we will introduce mandatory certification, based on vaccines or tests, in nightclubs and large events. This will reduce the number of unvaccinated, infectious people in venues, which could limit overall transmission. Thirdly, on face coverings, we will extend the legal requirement for shops and public transport to all indoor public settings, including attractions and recreation, although hospitality will be exempt and we will exempt specific activities where it is not possible or practical to wear a face covering, such as singing and exercise. We will lay those regulations tomorrow, to come into force the following day.

Fourthly, as omicron spreads in the community, we will introduce daily tests for contacts instead of isolation so that we keep people safe while minimising the disruption to daily life.

Fifthly, on communications, we will be urging caution in all our communications on Covid-19 and keep urging people to get their booster doses and follow the little steps that they can to get the virus under control. These regulations will be reviewed on 5 January, when we will also update the House, and they will sunset on 26 January.

Finally, we will also be taking further measures to protect and support social care and we will update the House on a package of measures later this week. It is better to stay a step ahead of the virus rather than reacting to what it brings, taking control of our response now rather than waiting for what comes next. Waiting a few weeks would make it easier to explain the need for these measures, but by then it might well be too late. So we need to act now and take these balanced and proportionate steps. We take these steps with a heavy heart, but we do so confident that we are doing everything in our power to keep our nation safe this winter. We have come so far over the course of this year, thanks to the defences we have built against this deadly virus. Now, as we face this new threat, we must draw on the same spirit that got us here, strengthen our defences and think about what we can do to get this virus under control. I commend this Statement to the House.”

My Lords, that concludes the Statement.

--- Later in debate ---

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for repeating the Statement. The chaos to even get it heard in the Commons and the very late notice on whether we were having this or Monday’s Statement sum up the chaos that the Government find themselves in.

As the noble Baroness, Lady Thornton, outlined, the Government have once again lost the trust of the public. My first question is: how on earth will Ministers persuade people to follow these new, very important restrictions, with the chaos going on at the moment?

We understand that restrictions are disappointing but, from these Benches, we have always said we want people to remain safe. As for these proposals, we have said before and say again that we think the Government are once again late to move to plan B.

I note that the arrangements will remain until 5 January and that there is a sunset clause of 26 January. Please can we debate the regulations before they expire—preferably next week, before we rise for Christmas?

Today, there are 131 new cases of omicron, a rise of a third in one day, taking the UK to nearly 600 cases. This confirms that the doubling rate is between two and three days. Scientists are talking about an R rate of between 2 and 4 and it is also following the same rapid transmission trajectory seen in many other countries. Unfortunately, in the last 48 hours, we have seen that South Africa is now showing increasing hospital and critical care bed admissions, showing that, even if there is less likelihood of serious disease, there is still some serious disease.

Ministers are right to be concerned about superspreader events, which are being reported all over Europe. Assuming that doubling continues at this rate and with a million cases possibly by the end of the year, that is very worrying, as is the news of the lower immunity against omicron from the vaccine compared to delta.

Just this afternoon, Antonio Conte, head coach of Tottenham Hotspur, reported that eight of his first team members and five members of staff have tested positive ahead of a big European game. He said:

“The situation makes me very upset … It’s contagious and there is a big infection.”


He is right.

The Statement does not mention that there is a higher percentage of young children both contracting omicron and going into hospital in South Africa. What arrangements are being made to ensure that parents recognise that and understand the different symptoms that young children have?

From these Benches we have been urging the Government to move ahead with plan B since cases started rising steadily in September. Today, all cases—of whichever variant—still number over 51,000, with a further 161 deaths. It is vital that we make sure that those numbers do not go up.

Face masks are vital, especially with increased transmission. But do I understand the Minister to say that singing, which we already know is high risk for transmission, will be exempt? On what medical grounds is that sound? I understand that hospitality has exemptions too. Is this taking us back to when you could take your mask off if you were sitting at a table and eating, but had to wear one when you were moving around a pub, bar or restaurant?

Ventilation is vital. Can the Minister say how many schools have received the air filters they were promised a year ago?

I notice that we are moving now to lateral flow tests rather than isolation. Can the Minister say what the current percentage of false negatives is for lateral flow tests and how that is going to be managed?

It makes sense to follow both Scotland and Wales in asking people to work from home if they can. How is that likely to affect the working arrangements on the Parliamentary Estate, including your Lordships’ House? In particular, and as a minimum, should the House consider returning to remote voting to avoid noble Lords mixing together in large numbers? We know we have a large number of votes over the next few weeks.

There are also a large number of notable omissions from this Statement. The first is the difficult issue of social care and support for those in homes, or housebound, as well as the staff who look after them. I see that the Statement says that there will be information to follow.

The second is the lack of mention of the Covid app. Given that many people are saying that their third dose or booster dose information is still not being recorded properly, can the Minister say if these difficulties have been resolved? The consequences of having to have Covid certification will affect people from Friday.

Thirdly, there is not one word about the clinically extremely vulnerable: that is 3.7 million people, of whom 800,000 are severely clinically extremely vulnerable. Most of the larger group should have had their booster jabs by now, and should be reasonably protected, but can the Minister say yet if that is true of omicron, especially as no one will have had three doses of Pfizer?

I thank the Minister for arranging our meeting next week to discuss the problems that the severely clinically extremely vulnerable are facing. Doctors are already telling this group that they will have a less good and shorter-lived response—if any—to vaccines. Is there any data on vaccinations for this group and omicron?

Other problems remain, as the Minister will have seen from the responses to my tweet this morning. Many people are still finding that their GPs do not know they should have a third dose, because there is no register and their hospital consultants have not had time to write to every patient’s GP. The NHS app still is not recognising third doses. GPs are not sure if it should be eight weeks or 12 weeks between the third dose and the booster.

While the news about the antivirals and retrovirals is good, most CEV people do not want to catch Covid. So above all, following this Statement, where is the specific guidance to both groups who are alarmed by the high number of delta cases, the growing number of omicron cases, and the marked reluctance of people generally to follow mask guidance. This is not a “nice to have”. This is 5% of the population who risk severe disease or dying from Covid. Please can the Minister agree to advise this group in the same way that there will be advice for the social care sector?

[Lord Kamall (Con)]

I will try to answer as many of the noble Baronesses’ questions as I can. Regarding the more scientific data and evidence, I hope that Peers have received an invitation—if not, I will make sure that it is sent out—to a call with Dr Jenny Harries and me on Friday, during which we will be providing further details and data. It will be an all-Peers call, so noble Lords can discuss a lot of the scientific facts and evidence.

We are advising that you should work from home if you can. If you cannot, you should take lateral flow tests regularly when attending the workplace. We are requiring the wearing of face coverings in a wider range of settings. If noble Lords will forgive me, I will go into some detail here and, if appropriate, I will place these details in the Library.

Last week, we took the initial step of making face coverings mandatory again in England in shops, including contact services such as hairdressers, on public transport and on transport hubs. We are now going further, requiring the wearing of face coverings in a wider range of locations. Police and community support officers can take measures if members of the public do not comply with the law. Exemptions apply for children under the age of 11 and those unable to wear a mask covering due to health, age, equality or disability reasons.

From Friday, the settings requiring face coverings will be attractions and recreation venues—concert halls, exhibition halls et cetera—cinemas, theatres, museums and galleries. I have a longer list and I am happy to share that as appropriate with noble Lords. Other settings include bingo halls and casinos, snooker and pool halls, skating rinks, circuses, other business ventures such as public areas in hotels and hostels, play and soft play areas, sports stadia, other indoor public venues, places of worship, crematoria, chapels, community centres, public libraries and polling stations.

Places that already require face coverings, just to remind noble Lords, are shops and supermarkets, shopping centres, auction houses, post offices, banks and building societies et cetera, estate agents and letting agents, premises providing personal care, veterinary services, retail galleries, retail travel agents, takeaways without space for consumption, pharmacies, public transport and others.

So, face coverings have been reintroduced. We know that they are effective at reducing transmission indoors. I thank the noble Baroness for the support for these measures. We appreciate it on this side of the House.

It will not be a legal requirement to wear a face covering in hospitality settings, restaurants, cafés, canteens, bars, shisha bars and premises other than registered pharmacies providing medical or dental services, including services relating to mental health, and photography studios. The reasoning behind that, I am sure, will be covered in the call on Friday. I do not have all the details and the scientific evidence to hand, given the late notice of this, but I hope that Dr Jenny Harries can share much of that detail with noble Lords.

On the booster rollout, we have already seen nearly 21 million people take up their booster dose, with 1.9 million people coming forward last week. The NHS vaccine programme is to be extended today. People over 40, along with those in high-risk groups, can take their dose.

I was interested to hear from the noble Baroness, Lady Brinton, that people were still reporting that the booster was not on their app. I was not aware of that. In fact, a number of noble Lords had told me that it was on the app. I apologise for not recognising this—this is the first I had heard of it.

[Baroness Smith of Basildon (Lab)]

The app has crashed.

[Lord Kamall (Con)]

I am told the app has crashed. Thank you. I am being heckled about technology now. I will endeavour to look into that and clearly, the relevant people at NHS Digital can do so too. I will try to report back, probably by the Friday meeting.

The NHS will offer anyone who is eligible their booster jab by the end of January and will contact each group to be vaccinated. In addition, as I am sure a number of noble Lords will appreciate, there have been other settings in their area; for example, a number of pharmacies have erected marquees outside their premises and have rolled out to local communities. There have been partnerships with sports stadiums and places of worship, and I have read of a number of inspiring partnerships that have been formed in order to vaccinate as many people as possible.

We have been working with a number of local community groups, experts and others to try to get to those hard-to-reach communities and those who are more suspicious and less trustful of authority. We are looking at ways to do that. I am also grateful to the many noble Lords who have given me their advice on how we should reach more groups. I continue to welcome that advice, but we stress, as noble Lords across the House recognise, that we really need to roll out the vaccines as much as possible.

On ventilation, oxygen monitors were provided for all state-funded education settings from September so staff can quickly identify where ventilation needs to be improved. Letting fresh air into indoor spaces can help remove air that contains virus particles and is important in preventing the spread of Covid-19. Backed by a £25 million government investment, the new monitors will enable staff to act quickly when ventilation is poor and provide reassurance that existing ventilation measures are working.

The noble Baroness, Lady Brinton, also asked about the immunosuppressed. Shielding was introduced at the start of the pandemic urgently to protect the most vulnerable. While the advice serves the important purpose of safeguarding the most vulnerable people from the risk of infection, this has always been balanced against the significant impact that such restrictive guidance has on individuals’ lives and their mental and physical well-being. Following the advice, we ended that shielding and are now doing everything in our power to make sure that the severely immunosuppressed are able to get their third dose and that those at higher risk who test positive for the virus will be able to access the novel monoclonal antibody Ronapreve or the antiviral molnupiravir from 16 December.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I thank the Minister for repeating this very important Statement. Many people are concerned about taking the booster because they do not know what the result will be of mixing vaccines such as Pfizer and AstraZeneca. Nobody seems able to give advice. It is very worrying. GP surgeries just do not want to know. What can the Minister do about this? Some of these people are elderly, but there are also young people. How can one advise them? They want to speak to a human being, not just a repeated voice which does not answer their questions. Some of these people are pregnant. The ones I talk to are in a rural area; I do my best to tell them how important it is to have a vaccine, but they just want an official voice. I hope the Minister can give some advice.

[Lord Kamall (Con)]

I thank the noble Baroness for that question. As far as I am aware, the places administering the booster should be able to give that advice. For example, when I walked in for my booster, they asked which vaccines I had previously had and said that the half-dose I had was sufficient. When I asked about my children, they told me which vaccine was more appropriate for that age group, depending on which vaccine they had. If that advice is not available at the place of vaccination, please let me know. I was not aware of that and I promise that I can look into it.

While I am here, I realise that I did not answer the question from the noble Baroness, Lady Thornton, about the R number. It is currently at 0.9 to 1.1; the latest growth rate range for England is minus 1% to plus 1% per day. As the omicron data comes in, that may well increase, but we have looked at all these measures and are being as precautious as we can in balancing everything up.

In response to the earlier question about the pass—I apologise for the long answer—I have just been told that the NHS has tweeted:

“We are aware of an issue affecting access to the NHS COVID Pass on the NHS App and website. We are investigating this as a priority and will update as soon as we can”.


Clearly, the NHS has been listening to this debate and discussion, and I thank the noble Baroness for raising that. I am sure that noble Lords will agree that that tweet shows the effectiveness of having this debate, so that we can share as much information with the public as possible. I repeat this request: if any noble Lords are aware of any particular problems with the rollout, information et cetera, please let me know and I will investigate as quickly as I can.

[Lord Naseby (Con)]

Last evening, I mentioned to my noble friend the predicament of the 300,000 people who are housebound and cannot go and get a vaccination. I appealed to the Minister, saying that every GP practice knows who these housebound people are and where they live. Will my noble friend now commit himself and the NHS to making sure that every GP practice is asked to go out and give vaccinations to the 300,000 mainly elderly people who are awaiting vaccination?

[Lord Kamall (Con)]

I thank my noble friend for that question. As far as I am aware it has always been the advice that, if people are housebound, they should be able to receive their vaccination in their home. If my noble friend knows of any incidents where that has not happened, please let me know and I will chase them up.

[Lord Hussain (LD)]

We have heard about the advice on face coverings, but could the Minister tell us about social distancing in public places, particularly places of worship?

[Lord Kamall (Con)]

In many public places, advice has been posted about continuing to socially distance, but the main thing is now to wear a face mask and ventilate indoor spaces. But, if social distancing is again seen to be a factor, we will update as soon as we can.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I did not agree with cancelling Christmas last year: I thought that it was disproportionate and far too risk-averse, based on the evidence then. It was cruel, with millions of front-line workers who had worked their guts out during the lockdowns having their parties cancelled and their family celebrations snatched away. Does the Minister understand what has changed now that the public know they were taken for mugs last Christmas? How can seething citizens, including me, give any credibility to data or a risk-averse plan B being based on evidence, rather than a tactic of political crisis management, which is what it feels like?

[Lord Kamall (Con)]

I understand the frustration of the noble Baroness and a number of civil libertarians, but we have always been clear that we have to have a balance between keeping the British people safe by being cautious and making sure that we follow the data. We have always looked at a number of different factors, including hospitalisations, the proportion of admissions due to infection, the rate of growth in cases, vaccine efficacy and many others—but, quite clearly, when we see this doubling rate of the omicron variant and do not yet have enough data, we are being cautious. By doing this now, we could prevent a worse situation later.

[Baroness Blake of Leeds (Lab)]

My Lords, when you go on to your app, you do indeed get a message that says, “There are currently issues with accessing the Covid pass on the NHS app and the website”. Given that the advice is that this mandatory certification will be required from Friday, this is an issue not only for the individuals trying to access the certification but for the venues. Can the Minister assure us that, if the problem continues, there will be clear advice to venues as well? Otherwise, there will be untold chaos when this comes in on Friday.

--- Later in debate ---

[Lord Kamall (Con)]

The noble Baroness makes an important point. Let us hope that the NHS will fix it. As the NHS says, it is aware of the issue and will try to fix it and update as soon as possible. But, clearly, if that is not possible, we will have to update the guidance, and I will take that back to the department.

[Baroness McIntosh of Pickering (Con)]

My Lords, I think that my noble friend said that the peak of the omicron infection rate is expected in January. Will he confirm that the lateral flow testing will last through January to March if that is the case? Will he join me in congratulating the Dispensing Doctors’ Association, with which I declare my interest as an adviser, on rolling out specifically the programme to which my noble friend Lord Naseby referred of vaccinating the housebound? Can he look into the fact that the Covid pass that is issued reflects only two vaccines and not the booster vaccination?

[Lord Kamall (Con)]

I pay tribute to my noble friend for making us aware of the dispensing doctors, and for making people like me, who are much more urban-centred, aware of some of the issues in rural areas. On the Covid pass, up to now, in most countries it has not been a requirement to have the booster shown in order to travel. Clearly, all countries will now be updating their travel requirements and restrictions. I am afraid I have a terrible short-term memory. What was the first question?

[Baroness McIntosh of Pickering (Con)]

Lateral flow tests.

[Lord Kamall (Con)]

Yes. Given the advice on testing, especially if you are pinged and have to test, clearly we will make sure that there are sufficient tests available.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the noble Lord say a word about enforcement? In my observation of the use of face masks on London transport, for example, compliance has increased significantly in the past week, so there is a disposition on the part of many people travelling to comply. But there are still a significant minority—and that minority is important—who do not comply and do not appear to carry or exhibit any evidence of exemption. Will people whose job it is to ensure that people on public transport or elsewhere are wearing masks get the help and guidance they need to understand where the limits of their powers might be?

[Lord Kamall (Con)]

Enforcement has been a constant concern throughout, and workers have been concerned about having to enforce. The police and certain transport operators may issue fixed penalty notices to those who refuse to wear a face covering when required to do so and are not exempt or do not have a reasonable excuse. This will be used only as a last resort. The fines will start at £200, which will be halved if paid within 14 days. For repeat offenders, the second offence will be £400, the third £800, the fourth £1,600, the fifth £3,200, and the sixth and subsequent offences £6,400. The price mechanism will be used as a deterrent, but I am sure that the authorities will exercise discretion, so they may give an informal warning first, as has happened. They can also take measures if members of the public do not comply with this law without a valid exemption. They can deny access to public transport services, and direct someone to wear a face covering or leave a service if they are not wearing one without a legitimate reason.

[Lord Fox (LD)]

My Lords, the Government are effectively outsourcing a lot of the policing of this to the businesses of this country—small, medium and large. Those businesses will not be able to do that unless they have a full understanding of what is expected of them, full public backing from the Government that they have to do this and details of how they will be helped. I understand that it is not the Minister’s portfolio, but I ask that he takes this to both BEIS and the Treasury and that we get quick answers for British businesses, which have to police vaccine passports and the use of masks all over this country for this policy to have any reason at all.

[Lord Kamall (Con)]

I thank the noble Lord; we had a conversation earlier about the importance of business and of informing businesses as quickly as possible, and the important role that they play. It is clear that the police and transport operators have fixed penalty notices. We know how sometimes it can be difficult for individuals, particularly in retail, to enforce the law—that they are worried about being seen as police officers. But we hope to make it clear that it is an offence not to wear a mask in places where you are required to do so, and we are issuing further guidance on that. I will take the matter back, as the noble Lord says, and get a cross-governmental response.

[Lord Patel (CB)]

My Lords, I cannot resist this: my app did not crash because it is Scottish. Can the Minister clarify the government advice to work from home if he can? Is the advice that you should or that you could? Secondly, what advice do the Government have for people who have recovered from Covid on the risk of them spreading the virus, and for how long?

[Lord Kamall (Con)]

I am pleased to hear that someone’s Covid app has not crashed. I am not sure if it is due to Scotland or if that is a coincidence; some of the people in the devolved Administrations may want to raise that with me. The guidance is that you should work from home if you can, but clearly there are some issues. I know that there were mental health and other issues before, but that is the guidance. On the medical question, I hope that the noble Lord will join the all-Peers meeting with Dr Jenny Harries on Friday, when he will be able to put that question to her. If not, he should write to me and I will put that question to her.

[Baroness Neville-Rolfe (Con)]

I thank my noble friend the Minister for making a timely Statement, for the boost to the booster programme and for progress on Covid drug treatments. All are very important to our families and friends, and to the country. Against that reassuring background, I think that some of this evening’s comments were a bit over the top and, I have to say, my NHS log-in leapt into life as the Minister was speaking, so it looks as though it is back on track. I have two questions for him. The first is for an update on cancer cases, especially the outstanding number of cancer operations and hospital treatments, and the impact of plan B on their throughput. My second concern is the economic impact of these new measures until the sunset date of 26 January. We have working from home, vaccine passports and enforcement of masks, which will hit travel, entertainment, business, hospitality and so on. What is this wider economic hit? The Government will not publish impact assessments, as they should, despite my efforts to persuade them, but can the Minister expand on the economic aspects and the impact on growth, employment and productivity? The country is indebted as a result of Covid—and the hit has been 10% over the last year—and businesses have been hit by this. We have to look at the economic side as well as the disease control side, which he dealt with so well.

[Lord Kamall (Con)]

I thank my noble friend for making those two important points. As we know from what happened previously, as a consequence of lockdown, many people were unable to have operations or even diagnoses. In fact, much of the waiting list—80%—is for diagnosis. It is too early to tell what the impact will be, but I will find out and write to her. It is quite clear that there will be a negative economic impact. I do not think one has to be the former head of research for an economic think tank to say that, but it depends on how long this lasts and what economic activity continues in the meantime. I will look at that.

[Lord Kakkar (CB)]

My Lords, the Minister rightly made the point that two variants will shortly be circulating in high volume—the delta and omicron variants. Is he content that there is sufficient genomic sequencing capacity to distinguish between the two and, therefore, understand the epidemiology and the natural history of the two competing virus strains, at a basic level?

[Lord Kamall (Con)]

I attended a meeting this afternoon with leading epidemiologists, showing the data and separating the omicron variant, the delta variant and the original coronavirus. They have the data, and one of the reasons we have made this announcement is because we are able to distinguish between them. We are constantly reviewing the data for the original coronavirus and the variants but, if the noble Lord has any more scientific or medical questions, he should let me know or attend the briefing with Jenny Harries on Friday.

[Lord Scriven (LD)]

My Lords, the Statement says that the Government are looking to introduce daily tests for contacts instead of self-isolation. I have a couple of questions. My noble friend Lady Brinton asked what the false negative rate is for lateral flow tests at the moment. Secondly, what will be the legal obligation for a person to take this test and then to upload the result so that people know that contacts are taking the lateral flow test?

[Lord Kamall (Con)]

I am not quite sure about the latest data, because clearly more people have been taking them, but accuracy was in the very high 90s. However, I will commit to write to the noble Lord. On his second question, I will make sure that we get that information out as quickly as possible.

NHS: Elective and Cancer Care Backlog

Lord Kamall Excerpts

Tuesday 7th December 2021 Lords Chamber

[Lord Rooker]

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

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

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

[Lord Rooker (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Clark of Windermere (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Stuart of Edgbaston (CB)]

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

[Lord Kamall (Con)]

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

[Lord Brownlow of Shurlock Row (Con)]

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

[Lord Kamall (Con)]

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

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

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

[Baroness Wheeler (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Kakkar (CB)]

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

[Lord Kamall (Con)]

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

[Lord Hamilton of Epsom (Con)]

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

[Lord Kamall (Con)]

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

[Lord Stirrup (CB)]

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

[Lord Kamall (Con)]

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

[Lord Watts (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Finlay of Llandaff (CB)]

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

[Lord Kamall (Con)]

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

Health and Care Bill

Lord Kamall Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Bill be now read a second time.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

--- Later in debate ---

[Lord Kamall (Con)]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lord Kamall Excerpts

Monday 6th December 2021 Lords Chamber

Moved by

[Lord Kamall]

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

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

Motion agreed.

Health and Social Care

Lord Kamall Excerpts

Monday 6th December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

[Baroness Finlay of Llandaff (CB)]

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

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

[Lord Kamall (Con)]

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

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

[Baroness Bennett of Manor Castle (GP)]

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

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

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

[Lord Kamall (Con)]

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

[Baroness Walmsley (LD)]

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

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

[Lord Kamall (Con)]

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

[Baroness Pinnock (LD)]

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

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

[Lord Kamall (Con)]

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

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

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

[Baroness Bennett of Manor Castle (GP)]

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

[Lord Kamall (Con)]

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

Cigarette Stick Health Warnings Bill [HL]

Lord Kamall Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Lord Naseby (Con)]

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

[Lord Kamall (Con)]

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

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

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

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

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

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

Adult Social Care

Lord Kamall Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

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

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


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

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

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

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

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

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

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

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

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

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

[Lord Kamall (Con)]

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

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

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

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

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

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

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

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

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

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

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

[Lord Kamall (Con)]

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

[Baroness Pitkeathley (Lab)]

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

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

[Lord Kamall (Con)]

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

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

[Baroness Fox of Buckley (Non-Afl)]

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

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

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[Lord Kamall (Con)]

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

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

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

[Baroness Watkins of Tavistock (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Walmsley (LD)]

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

[Lord Kamall (Con)]

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

[Lord Dubs (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Tyler of Enfield (LD)]

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

[Lord Kamall (Con)]

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

[Lord Lilley (Con)]

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

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[Lord Kamall (Con)]

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

[Lord Desai (Non-Afl)]

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

[Lord Kamall (Con)]

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

[Lord Hamilton of Epsom (Con)]

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

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[Lord Kamall (Con)]

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