NHS: Primary Care Surgeries

Lord Kamall Excerpts

Wednesday 24th November 2021 Lords Chamber

[Baroness Bakewell]

To ask Her Majesty’s Government what steps they are taking to prevent the takeover of National Health Service primary care surgeries in the United Kingdom by American health insurance companies.

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

The Government are clear that the NHS is not and never will be for sale to the private sector, whether overseas or domestic. Regardless of whether a service is run by an individual, a partnership or any other organisation, all providers of NHS core medical services are subject to the same requirements, regulations and standards. Patients will continue to receive high-quality care, free at the point of use.

[Baroness Bakewell (Lab)]

I thank the noble Lord for that Answer. I have two points to make. Once they know what is happening, NHS staff and the public increasingly oppose this move. A group action by Islington patients is going to court to challenge the change of control to an American profit-making company. First, will the Minister respond to such a groundswell and urge the Government to stop the encroaching control of the NHS by American health insurance companies? Secondly—

[Baroness Bakewell (Lab)]

Centene has a bad reputation across America. Since 2000, it has paid many millions of dollars in fines for 174 contract-related offences across the States, so will Her Majesty’s Government forbid the appointment of Centene-related staff and former staff to NHS CCG boards and their sub-committees?

[Lord Kamall (Con)]

I thank the noble Baroness for her speech. In answering, as this is for judicial review, I am sure she understands that I cannot comment on it. But I saw an interesting documentary over the weekend, so let me just read some words from it:

“Yes the NHS is a public service but how it spends its vast procurement budget, how it uses IT, how it fashions new processes and pathways for patients, plainly benefit from private sector experience.”


I admit I have plagiarised these words from Tony Blair, the last Labour Prime Minister to win an election.

[Baroness Pitkeathley (Lab)]

Is the Minister familiar with the research that shows that the longer the relationship between a patient and a GP, the less likely the patient is to need out-of-hours care or emergency hospital treatment, or to die, within 12 months? Are patients not right to be afraid that profit-making will interfere with those important relationships?

[Lord Kamall (Con)]

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

[Baroness Brinton (LD) [V]]

My Lords, one of the concerns is the transparency of agreements between clinical commissioning groups and these private companies. Are CCGs required to make absolutely transparent any arrangements they have made with these private companies?

[Lord Kamall (Con)]

The noble Baroness will understand that it is not for the Government to intervene in the decisions of CCGs. All who believe in devolution and decisions being made as close to the people as possible believe that we should not be interfering. These decisions are made by CCGs and it is not for the Government to interfere.

[Lord Bethell (Con)]

My Lords, I entirely welcome the Minister’s assertion that much of what is great about the NHS is the collaboration with international partners and the private sector. During the pandemic, many things that went well, including the vaccine, relied on that. With a special session of the World Health Assembly next week to discuss new global agreements on pandemic preparedness, what steps will the department be taking to foster international and business collaboration?

[Lord Kamall (Con)]

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a fellow of the Royal College of General Practitioners. Do the Government recognise that, with an increasing number of GPs working salaried and part-time, it is essential that they have security in their contracts? There is a tension when commercial providers need to provide profits to their shareholders, which can work in the opposite direction to the needs of the community, as the medical staff should be working as a co-operative to improve services locally.

[Lord Kamall (Con)]

I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

[Baroness Thornton (Lab)]

Notwithstanding the fact that the Minister says that the NHS is not up for sale, would he care to speculate what would motivate an American health insurance company to buy into a UK primary care GP market? Was this procurement carried out under the Covid relaxation that allowed contracts to be awarded without competition, or the usual procurement regime?

[Lord Kamall (Con)]

I wish I could read the minds of those who bid to run these services, but I am afraid I will have to admit that I cannot. The contracts are awarded at the local level by CCGs. It is their decision and it would be inappropriate for the Government to intervene.

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

My Lords, my local GP, who has been extraordinarily busy during this pandemic, tells me that he just wants to get on with treating people who are ill and preventing others from becoming ill. He is not interested in fighting off unwanted backdoor interference from Americans or any other predators. Will the Government give proper support to our NHS, without which some of us might not be around to pass on these views from the front line?

[Lord Kamall (Con)]

We all understand the importance of the role that GPs play in our NHS. I remind noble Lords that, when the NHS was created, once the state had seized the voluntary hospitals and hospitals from churches, it left GPs independent. It has been left up to them how to run their services. What is important is that we expect all GP services to offer the best-quality care, despite the business model they use.

[Lord Adonis (Lab)]

My Lords, I commend the Minister for congratulating Tony Blair, who, of course, led the best Government of modern times in this country. The Blair Government trebled health spending in real terms—three times the rate of growth under this Government. I encourage the Minister to learn further lessons from Tony Blair, in particular to significantly increase health spending and leave the National Health Service in a better condition than he found it, rather than, as is now happening, in a worse condition.

[Lord Kamall (Con)]

I pay tribute to the noble Lord on his contributions to the Blair-Brown documentary, which I am sure a number of noble Lords enjoyed watching and learning from. It is important that we learn the right lessons from whichever political party, so when Tony Blair, a former Labour Prime Minister, says that we should encourage the private sector to be more involved in partnership with the public sector, we will take that advice.

[Lord Rogan (UUP)]

My Lords, I have great respect for GPs, but with general practices paid for the number of patients registered with the practice, profit-driven services might carry the risk of some GPs choosing to register younger and fitter patients, who will need to be seen less often than older patients. Would the Minister really be comfortable if that situation played out?

[Lord Kamall (Con)]

I am sure that noble Lords agree that it is appropriate that GPs register as many patients as they are able to see, and that their patients, whatever their needs, can access our great system of healthcare in this country. I would indeed be concerned if there were barriers to accessing GP services.

[Lord Clark of Windermere (Lab)]

My Lords, the cost of locum doctors to the NHS is £6 billion a year, much of it in primary care surgeries. Does the Minister feel that this is good value? What are the Government doing to try to get back to having regular doctors?

[Lord Kamall (Con)]

The Government recognise that it is important that people can see GPs and, as much as possible, invest in making sure that there are more full-time equivalent GPs. We have done that and we will continue to do so.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Food (Promotion and Placement) (England) Regulations 2021

Lord Kamall Excerpts

Wednesday 24th November 2021 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 21 July be approved.

Relevant document: 12th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 23 November.

Motion agreed.

Food (Promotion and Placement) (England) Regulations 2021

Lord Kamall Excerpts

Tuesday 23rd November 2021 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Food (Promotion and Placement) (England) Regulations 2021.

Relevant document: 12th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, obesity is seen as one of the biggest health problems this country faces. The latest national child measurement programme data from 2020-21 showed that around 40% of children leaving primary school were overweight or obese, with one in four living with obesity. Regular overconsumption of food and drink high in calories or the consumption of sugar and fat can lead to weight gain and, over time, obesity, which in turn has a significant impact on health and well-being and increases the risk of certain related diseases.

The Covid-19 pandemic has highlighted the impact that obesity can have on people’s health. Evidence from a University of Liverpool study shows that those who are overweight or living with obesity and who contract Covid-19 are more likely to be admitted to hospital and suffer worse complications. This measure is part of the Government’s healthy weight strategy, which we hope will contribute towards achieving the ambition of halving childhood obesity by 2030.

The instrument we are discussing today concerns the introduction of restrictions on promotions of less healthy products by volume price and location for retailers in England with 50 or more employees. Location restrictions will apply to store entrances, the ends of aisles, checkouts and their online equivalents—for example, home pages and payment pages. Volume price restrictions will prohibit retailers from offering promotions such as buy one, get one free or three-for-two offers on less healthy products.

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I note that the retail food and drink sector has committed to delivering the proposals, but that sector needs to be a partner in tackling obesity. It is disappointing that there are so many questions about the drafting of the regulations, which do not appear to enable this. I hope that the Minister will reflect on that and do what he can to put it right.

[Lord Kamall (Con)]

I start by thanking noble Lords for their contributions to today’s debate. I shall try to turn to some of the questions from noble Lords and to answer as many as possible in the next three hours, if noble Lords will be patient with me. [Laughter.] Seriously, if I do not touch on a particular question, please write to me to follow up, particularly on some of the more technical questions.

I start with some of the questions from the noble Lord, Lord Brooke. He asked about the scope. Stores smaller than 185.8 square metres or 2,000 square feet—if you are wondering why such an unround number was chosen in metric—and specialist retailers that sell one type of food product category, such as chocolatiers or sweet shops, will be exempt from location restrictions but will need to adhere to the volume price restrictions. The policy will come into force in October 2022. The noble Lord referred to issues that I am always interested in, which are the evidence, as well as the impact, and how we look at the unintended consequences of any such moves. There will be a review within three—

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[Lord Kamall (Con)]

The policy will be reviewed within three to five years of it coming into force. I reassure the noble Lord that the intention is that the policy will come into force in October 2022. However, as the noble Lord and I have discussed in the past, I am always concerned about unintended consequences and evidence to see what has worked and what has not. In many ways, I am a fan of the discovery process. We do not have complete knowledge—in fact we have incomplete knowledge—and all we can do is trial and see what works and use the best evidence that we can to assess.

Part of this review of the regulatory framework provisions of the restrictions will consider whether penalties under the Regulatory and Enforcement Sanctions Act 2008 have been implemented effectively and achieve their ambitions. We will continue to keep the policy under review to ensure that it is both impactful and proportionate. I am sure noble Lords will agree that it is not sufficient just to pass a piece of legislation and hope it does its job. In fact, as I think many noble Lords would acknowledge, this in itself is not enough to tackle obesity. It has to be a multi-angled view with many different approaches. Some will work, some will not, but we have to learn from what works and make sure that we are not driving consumers into unintended consequences and leading them to worse health outcomes.

We hope that this strategy that we published in 2020 will be world leading. I think the noble Lord, Lord Brooke, mentioned Sir Keith Mills and his programme. This shows that it is not just this piece of legislation; it is a multichannel approach, if you like, including incentivising people to have healthier lifestyles —monitoring their steps and other exercise functions. Anyone who has looked at successful and unsuccessful diets will recognise the fact that it is not just about reducing what you take in; it is also about burning off those calories. We have to get the right balance. Each individual will have different BMIs and different physiologies and different strategies will work for different individuals.

In terms of the businesses that these regulations will impact, the location and volume restrictions apply only to medium and large businesses in England and around 24% of stores are in scope of the volume price restrictions. Given the size threshold for stores subject to location restrictions, these apply to approximately 16% of stores in England. Some 94% of estimated food retail revenue falls under the volume restrictions, while 84% falls under location restrictions. This means that these restrictions offer considerable potential, if done correctly, while ensuring that small businesses are not disproportionately impacted by the changes. I acknowledge that many noble Lords were concerned about the cost for both large and small businesses.

The original timescale was to be April 2022, but having considered feedback from the industry, we have made the decision to extend the implementation to October 2022. I am well aware that some in the industry are asking for a further extension and, as noble Lords can recognise from the tone of the debate today, some are in favour and some are against and the Government are trying to get the right balance. The Government want to bring in these measures so we can start analysing whether they work. We are also very mindful of the fact that it falls on industry to implement them.

The other issue raised was about smaller stores and what are called symbol groups, which, as noble Lords may understand, are smaller retailers that come under a wider brand. If we excluded symbol groups in their entirety, that would take away some of the health benefits of the policy. Franchises and symbol groups make up about 60% of those in scope of the volume price promotions and 14% of the location restrictions. Approximately only 12% of symbol group stores are over 2,000 square feet, therefore the vast majority of these stores will be exempt from the location restrictions. I hope noble Lords understand the point about the cost falling particularly disproportionately on smaller stores.

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[Lord Kamall (Con)]

My noble friend makes a very reasonable demand that is difficult for me to refuse. Let me put it this way: I hope that I have not caused any shock waves, as it were.

There has been an impact assessment, which shows that the location restrictions over the 25-year appraisal period are expected to bring health benefits of more than £57 billion and provide NHS savings of more than £4 billion. The volume price restrictions are expected to accrue health benefits of more than £2 billion and provide NHS savings of £180 million. We recognise that there will be costs to businesses; once again, this is all part of that difficult balance and debate. A phrase I have often heard is, “Do not let perfection be the enemy of progress”. We want to try as hard as possible to get this right. From the consultation that has been going on, we are very aware that this will have an impact on a number of businesses but, at the same time, there is lots of pressure, as noble Lords will have heard today, just to get on with it.

[Baroness Neville-Rolfe (Con)]

I am sorry to interrupt again, but £57 billion is a much bigger figure than I have seen anywhere; £3 billion, perhaps separately, I could understand. It is really helpful to have the impact assessment but it is difficult to understand what the benefits and costs are, which we need to understand to give my noble friend the Minister the full support that he requires.

[Lord Kamall (Con)]

Once again, I thank my noble friend for making that request. I always make it clear that it is important that we publish as much evidence as possible and let it be challenged; that is part of a healthy debate. If things do not work as intended, we should see what works and what does not. I am always very sensitive when someone says, “the evidence suggests”. We need to have that challenge but also make sure that we know what works. At the end of the day, we all want to see less obesity across our country, so surely it is important that we make sure that the evidence is there. Where something does not work, we will just have to try other ways.

On compliance, it is for local authorities to decide how best to enforce the requirements. Where an enforcement officer suspects that HFSS food or drinks may be inappropriately promoted, they should request further information to verify. If the product is in scope and has been promoted contrary to the law, an enforcement officer will consider what action should be taken.

[Baroness Merron (Lab)]

I thank the Minister; it is generous of him to give way. I would be very interested in how he sees the greater responsibility on local authorities. Picking up my question again, does he feel that local authorities are resourced suitably? Can they expect some recognition of this new and extremely important role, because the regulations require their co-operation too?

[Lord Kamall (Con)]

I thank the noble Baroness for that question. The Government are committed to ensuring that enforcement is proportionate and fair, and we intend to support local authorities and the judicial system on additional costs incurred as a result of enforcing the policy. Up front, I cannot say what those costs will be, but we want to understand what they will be to help enforcement.

I was asked whether we had watered down the policies for some products. We have excluded some products that are not among the highest sugar or calorie contributors to children’s diets or are not heavily promoted, but we will continue to keep the policy under review.

The noble Baroness, Lady Brinton, asked about weight management and other ways of tackling weight issues, including exercise. In March 2021, we announced an extra £100 million for healthy weight programmes to support children, adults and families in achieving and maintaining a healthy weight.

On infant foods, we will shortly consult on proposals to improve the marketing and labelling of commercial food and drink products for infants and young children. I acknowledge many of the concerns expressed by the noble Baroness, Lady Brinton.

The noble Baroness, Lady Merron, asked why we are using secondary legislation. The different legislative approaches being pursued reflect the current legislative framework and implementation routes available to the Government. For the promotion restrictions, we used existing powers in the Food Safety Act 1990 to lay secondary legislation before Parliament in July 2021. The statutory instrument has been subject to the affirmative parliamentary procedure.

On how we look at issues of inequality, noble Lords made a very fair point. Perhaps I may be so bold as to suggest that one issue for people I talk to in many of the communities that we are supposed to be reaching out to is that, for far too long, the public health industry has been dominated by white middle-class people who feel they know better than immigrant and working-class communities. It is really important that we understand those communities. As someone who comes one of the communities that have been patronised, I recognise that we have to make sure that we work with them and do not just sit in a place like this and assume that we know better. It is important that we really understand them. What is really good about the Office for Health Improvement and Disparities is that “disparities” are on the label, on the tin, which means that we have to look at how we address them.

There were some questions about why smaller businesses are exempt. I hope that I have answered them.

On people not being able to afford to eat a healthy diet, anyone who has watched daytime TV will know that some of those programmes can show you how to cook a meal very quickly and much more cheaply than is the case with many of the convenience foods that you can buy. The problem is how we translate that from the TV and entertainment to people’s lives in reality. In many ways, it means understanding families, where the decisions are made and what they have access to in many of their communities. Anyone who has been to many of the immigrant communities, for example, will know that there are plenty of shops that sell and openly display fresh food, but how do we make sure that we translate that into healthy diets?

On their own, these regulations will not be enough. We also have to look at how we translate all this into understanding people’s lives right at the family and the community level. It is our goal to improve children’s health and to reduce obesity. The shopping environment plays a vital role in the way products are marketed to us—for example, the pumping out of the smell of fresh bread from bakeries. We know that marketing people are experts in understanding consumer behaviours, with factors such as the location of products at the end of aisles affecting what we buy. The Government are committed to getting the right balance between stopping bad practice and working constructively with industry. We also want to evaluate the evidence of the restrictions once the policy is implemented.

We believe that retailers can play a vital role in creating a healthier food environment that does not promote the overconsumption of less healthy products. The Government hope that these regulations will enable us to achieve a healthier food environment and make progress to halving childhood obesity by 2030, and allow us all to live longer lives in good health. I commend the regulations to the Committee.

Motion agreed.

Dementia: Art and Music-based Interventions

Lord Kamall Excerpts

Monday 22nd November 2021 Lords Chamber

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

Music can play an important part in supporting people who are living with dementia. Last year, NHS England and NHS Improvement facilitated three webinars resulting in the publication of guidance for social prescribing link workers to expand music prescriptions. We will be setting out a new dementia strategy in 2022. As part of that development, we are working in collaboration with stakeholders, including people affected by dementia, and will explore the role of arts and music-based interventions.

[Baroness Greengross (CB)]

My Lords, I thank the Minister for his reply. What further steps will the Government take to support brain health through social prescribing? How will any measures taken be incorporated into the Health and Care Bill currently being debated in the other place?

[Lord Kamall (Con)]

I pay tribute to the noble Baroness for all her work raising awareness of dementia, in this House and outside of it. The Government understand the importance of non-medical and lifestyle factors in supporting people’s health and well-being, including brain health. This is why we are continuing to roll out social prescribing across the NHS, in line with the NHS Long Term Plan commitment to have at least 900,000 people referred to social prescribing by 2023-24. The Department of Health and Social Care is working closely with NHS England and NHS Improvement to incorporate social prescribing into the guidance to integrated care systems. Some of this guidance has already been included in the document implementation guidance on partnerships with the voluntary, community and social enterprise sector that was published in September 2021.

[Baroness Wheeler (Lab)]

Around 25,000 people with dementia are from BAME communities and this is expected to double by 2026. The Alzheimer’s Society report, The Fog of Support, found that people from these communities, and those with English as an additional language, were more likely to use BAME-led groups. The report also found that there is generally a need for interventions to be much more culturally sensitive. What action are the Government taking to ensure that people with dementia can access culturally appropriate care, including art and music-based interventions, which reflect a wide range of cultures and languages?

[Lord Kamall (Con)]

The Office for Health Improvement and Disparities is looking at areas where there are clear disparities. As part of developing the dementia strategy, the Government are consulting with a wide range of stakeholders and ensuring that a diverse range of views from different communities is heard and that it is not targeted just at one particularly community.

[Baroness Bull (CB)]

My Lords, social prescribing is a key aspect of the NHS Long Term Plan. It has been described by the president of the Royal College of General Practitioners as an essential part of the toolkit for tomorrow’s doctors. Therefore, why is social prescribing absent from the core undergraduate curriculum in UK medical schools? Some schools offer optional modules, but there is no national consensus on what teaching should cover or how it is best delivered. Does the Minister agree that, unless social prescribing is integrated into the education of the future healthcare workforce, its benefits for patients and the NHS will never be realised?

[Lord Kamall (Con)]

The NICE quality standard on dementia, published in June 2019, includes guidelines for offering activities and social prescribing. They are also included in the NHS long-term plan. Obviously, different components are modelled that are social prescribe-enabled—not only music but other art-based activities. The education question will be for my noble friend in the Department for Education, but if the noble Baroness can write to me, I am sure that we can get the answer.

[Lord Bethell (Con)]

My Lords, music therapy is also increasingly helping Covid patients hit by inflammation and fibrosis that causes shortness of breath—a horrible condition. The Breathe programme from the ENO and Imperial College has classical-singing coaches providing psychological and physiological therapy to great effect. Can the Minister endorse this kind of social prescribing, and can he commit to meeting Dr Harry Brünjes and the Breathe team, which is seeking to take this programme nationally?

[Lord Kamall (Con)]

I thank my noble friend for that question. As an amateur musician—I stress “amateur”—I know that there is no better feeling than when you connect with your audience as a live musician. Music tugs at your heartstrings. Music touches your soul. But it can also unlock the mind. This shows the importance of music in social prescribing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I hope that patients get the benefit of what I am sure is the Minister’s excellent playing. He has been very positive in his responses, but he will know that the arts sector has been very stretched financially during the Covid years in particular. Will he open discussions with organisations such as the Alzheimer’s Society, with an offer of some funding to develop some of the schemes that we have heard about today?

[Lord Kamall (Con)]

I thank the noble Lord for his invitation to perform live—I am not sure that he will feel the same way after hearing my blues band. Last year, NHS England and NHS Improvement, in collaboration with the National Academy for Social Prescribing, the Alzheimer’s Society and Music for Dementia, facilitated a series of webinars. We are working in consultation with them. In February 2021, Music for Dementia also published social prescribing guides for link workers to help expand music prescriptions. The important thing here is that we are consulting with stakeholders.

[Lord Clement-Jones (LD)]

My Lords, for more dementia patients to gain access to music therapy through social prescribing, there must be more training on the value of music for carers and healthcare practitioners and greater support for musicians to train as music therapists, and music education must be a much more mainstream part of primary and secondary school education. What assurance can the Minister give that the necessary government cross-departmental action is being taken to deliver on this?

[Lord Kamall (Con)]

The department itself is working closely with Music for Dementia and other organisations. Across government, we are looking at music, beyond just performance, to see how it can impact our lives and the role that it can have in levelling up and community cohesion, for example. Across government, I am sure that a number of departments are looking at this.

[Lord Vaizey of Didcot (Con)]

My Lords, the former Secretary of State, Matt Hancock, deserves an enormous amount of credit for setting up the National Academy for Social Prescribing. Before he came into the department, the Department of Health could not have been less interested in the power of the arts and music to have an impact on people’s health. The second anniversary of the academy has just passed. Can the Minister commit to issuing a report on its third anniversary—since I know that he will still be in the post—to suggest how to take it forward? Also, we still do not know what instrument he plays, but perhaps he could take it with him on his first visit to the academy, as soon as possible.

[Lord Kamall (Con)]

I am not sure which question to answer first. If noble Lords will excuse a second of self-promotion, I am an electric bass player and sing the blues as well.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

I thank noble Lords. Can I stop there? I also am aware that my noble friend is himself a music fan. I remember once bumping into him on the Jubilee line on his way to the O2 arena to see Led Zeppelin. Noble Lords across the House recognise the power of music and how it affects our lives.

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

My Lords, someone very close to me has Alzheimer’s disease. Music-based interventions such as the Alzheimer’s Society’s “Singing for the Brain” groups have been proven to have multiple health and well-being benefits. What support are the Government offering to charities such as the Alzheimer’s Society to ensure that they can keep delivering this kind of intervention? Will the Minister, with his musical ability, commit to attending a “Singing for the Brain” session?

[Lord Kamall (Con)]

I should warn all noble Lords that they have not heard me yet—their requests may be quite different after hearing my band play. In terms of the ability of music and, if you like, the instructions, we are working with a number of stakeholders as well as ensuring that, when it comes to training social workers and others, they understand the ability of music to make a difference to people’s lives.

[Lord Wigley (PC)]

My Lords, I declare an interest: my wife is a music teacher and my son runs a recording studio, at which I am sure the Minister would be very welcome. Does the Minister agree that one initiative which could help both dementia sufferers and young musicians and artists would be to sponsor of an internship scheme whereby such students could be working part-time in the care sector, thereby benefiting themselves and those in care?

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. We are looking, across the health sector, at how we can think outside the box and train students in other disciplines to help in healthcare. Clearly, music can potentially play a role. In terms of the music studio offer, can I just say “Wait until you’ve heard me”?

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked. We now move to the next question.

New Hospitals

Lord Kamall Excerpts

Thursday 18th November 2021 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what progress they have made towards their commitment of building 40 new hospitals.

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

The Government committed in October 2020 to build 40 new hospitals by 2030. We have confirmed an initial £3.7 billion to support these schemes for the first four years of the 10-year programme. This, together with eight previously announced schemes, will mean that we will have 48 new hospitals by the end of the decade. Six of the 48 new hospitals are currently in construction, including the first of the 40 new hospital schemes, and one scheme is now complete.

[Baroness Walmsley (LD)]

My Lords, as the Minister said, eight NHS capital schemes already under way when the promise was made were added to the Prime Minister’s pledge for 40 new hospitals by 2030, but now their cost overruns will have to be paid for out of the original pot of money. Can the Minister say how many of the originally promised 40 will now have to be postponed and how many are really new?

[Lord Kamall (Con)]

The Government have said that we will deliver 40 new hospitals by 2030 and in October 2020 we published the full list of the 40. This includes eight schemes that were announced by previous Governments but are to be delivered this decade and 32 new hospitals. We have also confirmed that we will identify further new hospital schemes, the process for which is ongoing, with a final decision to be made in spring 2022. This means that 48 hospitals in total are to be delivered over the decade.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have here the New Hospitals Programme Communications Playbook, which the noble Lord’s department has put out and which makes it clear that if you build a new wing of a hospital, that counts as a new hospital. What is worse is that NHS bodies are being instructed to lie and propagandise on behalf of the Government. Will he withdraw this disgraceful communication?

[Lord Kamall (Con)]

I hope that the noble Lord will recognise that whenever a new project is started and there is a decision to build a new hospital in a community, it surely makes sense to look at whether there is space on existing sites. Otherwise, if we start criticising new hospitals on existing sites, there may be a perverse disincentive for a hospital to say, “Well, let’s build elsewhere”. when there is a perfectly good site. It is important, whatever you call it, whatever the semantics, to recognise that we are building modern, digital, sustainable hospitals for the future.

[Lord Bethell (Con)]

My Lords, we very much welcome the investment in physical buildings, but the modernisation of the NHS also depends on digital infrastructure and training. Will the Minister please tell us what steps he is taking towards a programme of technological improvements that are needed to modernise the NHS?

[Lord Kamall (Con)]

I thank my noble friend for the question—I have picked up many of the things that he started when he was in post. One of the great things about being the Minister for Technology, Innovation and Life Sciences is having a real ability to drive through digitisation of the health service, making sure that we have a modern health service that is fit for the future, so that if you are a patient in one part of the country and something happens to you, all your information is available elsewhere for the clinicians at the time and you get the best possible care. That is something that we should be celebrating.

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

My Lords, one of the principles of managing taxpayers’ money is to take account of the revenue implications of a capital budget. In view of the projected increases in building costs, is the Minister confident that the new hospitals programme managers understand this? What is being done to recruit the necessary doctors, nurses, technicians and maintenance staff for these new and existing hospitals?

[Lord Kamall (Con)]

One thing that is exciting about the new hospitals is that we are going to transform the way in which we deliver new healthcare infrastructure. First, it will be sustainable, with net-zero carbon across the NHS. Digital transformation is key, making use of the latest technology, so no longer will we have microscope slides couriered between sites, but we can instantly see a digital image and assess it using AI. There will be standardised design and modern methods of construction and new hospitals will be integrated with local health and care systems. This is a project for a health system that is fit for the future.

[Lord Lancaster of Kimbolton (Con)]

Many of these new hospitals will be built in existing centres of population. My concern, though, is for areas of high projected population growth, such as the Oxford-Cambridge arc, where we always seem to be playing catch-up when it comes to medical facilities. Can my noble friend simply reassure me that the principles of “I before E”—infrastructure before expansion—will be applied when choosing where these hospitals will be?

[Lord Kamall (Con)]

I assure my noble friend that, in deciding where to build a hospital, among the things that the NHS and others look at are the needs in the community, existing infrastructure and making sure that we can build hospitals that are fit for the future, that are digital, that are transformative, but are led by clinicians as opposed to construction experts.

[Lord Mann (Non-Afl)]

The Minister said, just a moment ago, “whatever you call it”. When David Cameron was Prime Minister, he gave a pledge on district general hospitals and the definition of hospitals became important. Many of us said that, in order to be defined as a hospital, it had to incorporate 24-hour accident and emergency. What is the Minister’s definition of a hospital and is the pledge from David Cameron on district general hospitals current?

[Lord Kamall (Con)]

Each of the building projects will be a new hospital that will deliver brand-new, state-of-the-art facilities. One thing that we must be careful of is that if we say, “Well, you can’t call that a new hospital, even though it is a new facility, because it’s on an existing site”, we do not create perverse incentives, where the local NHS or the local ICS says, “We mustn’t build it there, because we will be accused of not having a new hospital”. Surely what we should be focusing on is outcomes, not inputs, and the fact that we are delivering modern, digital hospitals for the future.

[Baroness Thornton (Lab)]

My Lords, leaving aside the dubious and overinflated claims of 40 new hospitals, many of which are, in reality, upgrades—as welcome as they are—I and others in the House raised with the Minister’s predecessor but one in 2019 that there was an alarming repairs and infrastructure crisis, which was then in the region of £3 billion. Could the Minister explain to the House which part and how much of the new hospitals programme will address the immediate and urgent matter of crumbling wards, sewer leaks in wards and old and dodgy kit?

[Lord Kamall (Con)]

The noble Baroness will recognise that we need not only to build new hospitals but to upgrade existing infrastructure and this is all part of the capital programme. The decisions on individual hospitals and upgrades will be taken in local communities in consultation with clinicians and local ICSs.

[Lord Balfe (Con)]

My Lords, will the Minister avoid getting caught in a numbers game? We need an adequate number of beds in a good geographical spread to deal with the needs of the whole population. I hope that he will see this as part of an integrated expansion of the health service and that we will not get tied up with the numbers, as we did years ago—how many hospitals, how many this, how many that. We need an improved health service. This is a vital part of it, but it is only a part.

[Lord Kamall (Con)]

I completely agree with the sentiments expressed by my noble friend. Surely what we should focus on is output; surely what we need is the best healthcare system across the country. We need up-to-date healthcare with the best information from patients to make sure that we can diagnose and give them appropriate treatment, working with the very latest technology such as artificial intelligence to spot patterns, to make sure that we can also build in prevention when we look at tackling health issues in the future. I welcome my noble friend saying that we have to focus on output—modern digital infrastructure and modern digital hospitals fit for the future.

[Baroness Brinton (LD) [V]]

My Lords, my local hospital, Watford General, is on the list of 40 so-called new hospitals, although the plans have been in place and supported cross-party for close to two decades, and its infrastructure is failing. Despite a clear promise of funds by the Prime Minister during a visit to the hospital in October 2019, the trust is yet to be allocated funding from the Treasury and it remains a pathfinder. I want a clear outcome. When will funding be confirmed and granted?

[Lord Kamall (Con)]

On the point about the noble Baroness’s local hospital, I am afraid that I am not aware of where she is situated geographically, but I can tell her that six of the 48 hospitals are already under construction and one is now completed. I hope that the noble Baroness will write to me on the hospital that she referred to so that I can give her an answer.

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

My Lords, will the Minister stop waffling and put on record an answer to the question asked by the noble Lord, Lord Mann, saying precisely what he means by a “new hospital”? I tell him not to waffle back.

[Lord Kamall (Con)]

I thank the noble Lord for his advice just before I was about to answer. Whatever you call it—and we can debate semantics—the important thing is surely that we build new hospitals and upgrade existing infrastructure. Surely we should celebrate the fact that we are building 48 new state-of-the-art hospitals—

[Noble Lords]

You are not.

[Lord Kamall (Con)]

We should not celebrate building new hospitals? Well, there we are. We should celebrate the fact that we are building new hospitals to give patients the best possible care, aided by digital technology and making sure that they are sustainable.

Covid-19: UK Arrivals

Lord Kamall Excerpts

Tuesday 16th November 2021 Lords Chamber

[Baroness Royall of Blaisdon]

To ask Her Majesty’s Government why international students and others who have been fully vaccinated and are not required to self-isolate on arrival in the United Kingdom subsequently have to self-isolate if a close contact contracts COVID-19; and what plans they have to change this policy.

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

Our current system for validating the vaccination status of close contacts relies on checking against records in the NHS national immunisation management system. We do not have access to equivalent records for those vaccinated overseas. We recognise the pressing need to resolve this issue as soon as possible and are urgently exploring a number of different options to extend the existing exemptions to contacts who have been vaccinated overseas. I hope to be in a position very shortly to brief the House on a proposed solution.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I will welcome that solution when it comes. The Minister talks of urgency but we have been waiting since the beginning of September for a resolution to a problem that I believe is rather small but which clearly disadvantages international students. To me, it feels slightly xenophobic and as though to date the Government have been intransigent. I know that Public Health England agrees that the policy is not logical in any sense or form, so why do international students have to self-isolate for 10 days when our own students from the UK do not? This disadvantages the international students and puts people off coming to this country. Also, how can international students who have had non-MHRA-approved vaccines be immunised in the UK in order to get a Covid pass, should that be necessary in the not too distant future, as it is in some other parts of the UK?

[Lord Kamall (Con)]

As someone whose family comes from outside the EU, who has taught in universities and who recognises the great asset that there is and the great advantages that there are in being open to the world, and global Britain, I share the noble Baroness’s frustration. Yes, we have left the EU, which is very much a project of white privilege, and moved to a more global outlook. It is really important that we now focus on the world generally. The issue is quite technical at the moment. One of the things needed for the test and trace system to work is that you need access to the underlying data and verification. We are looking at a number of different options for how to achieve that.

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Lord, Lord Flight, is not present so I call the noble Baroness, Lady Hayter of Kentish Town.

[Baroness Hayter of Kentish Town (Lab)]

As the Minister has said, our universities have long been a welcoming and inspiring academic hub for international students but stories such as the ones that we have heard—along with, I am afraid, the attack on freedom of speech at the LSE and the shameful treatment of Professor Stock, which we will come to shortly—added to Covid and online teaching, to say nothing of the Brexit fallout, which means that EU schools can no longer use group passports, all question our ability to attract youngsters from across the globe. What are the Government doing to re-establish our reputation in this sector?

[Lord Kamall (Con)]

The noble Baroness makes an important point about us being a global hub and welcoming the whole world. For centuries the UK has been open to a number of different nationalities from across the world. Indeed, my own family came to the UK in the Windrush generation. I have always been clear that we should be a global Britain, not just focused on one small part of the world.

I want to take the opportunity to answer the question that I forgot to answer about international students. Anyone in England is eligible for the vaccine if they fall within the current eligibility criteria, and international students are encouraged to register with a GP.

On free speech, it is critical that our universities remain places where you can have free expression without fear. The essence of free speech is being able to tolerate views that you may not agree with but it is important that they are expressed. Universities should remain hubs of free speech.

[Baroness Stuart of Edgbaston (CB)]

My Lords, I refer to my registered interests. Given that this is not really a public health problem in its scale, but it is a bar to the recruitment of international students and their integration once they are here, may I urge the Minister—even if he cannot find a quick solution to the NHS app—to put out some information on how Covid passes can be obtained and to make sure that all universities and students have access to that information as soon as possible?

[Lord Kamall (Con)]

Last night I took part in a debate that involved the issue of the Covid pass, particularly with the boosters. I was frustrated because I thought I had a date I could announce. That was pulled at the last moment, but we are very close to a solution. The technical point on test and trace is that, at the moment, it is unable to validate the vaccination status of people whose vaccines are not registered on the database. We are looking at whether that can be done on trust, or whether that would open a loophole for getting around the system. I have been assured when pushing the NHS on this that it is looking at an answer.

[Baroness Thornton (Lab)]

The Minister must accept that this a very confusing area for everybody. Perhaps he would like to clarify the Prime Minister’s comments yesterday on what impact tougher overseas travel rules and self-isolation for those without a jab might have. He mentioned those yesterday in the press conference. I think they are linked to the Question my noble friend asked. It is very important that the NHS app shows the booster as soon as possible, because it is going to cause a lot of trouble for Christmas travel.

[Lord Kamall (Con)]

I welcome questions from noble Lords, particularly on getting the booster on the app, because when I am talking to officials in the department and the NHS it shows how important it is that we do this as quickly as possible. One of the tasks is to be accountable and to push the NHS and others to make sure that we are doing this. Sadly, when I ask what the problem is on test and trace, I am told that it is unable to validate the vaccination status of people whose vaccines are not recorded on a national immunisation management system. I have asked about passenger locator forms and whether we could use a similar technology. At the moment that is done on trust, but you face a very high fine if you are misleading; maybe that could be a solution. I assure noble Lords that I really am pushing.

[Baroness Smith of Newnham (LD)]

My Lords, I refer to my registered interests. I have printed off the advice given by my university, Cambridge, to international students and what it means to be fully vaccinated. To come into the country, if they are fully vaccinated, they do not have to isolate when they arrive, as the noble Baroness, Lady Royall, pointed out. If the system can understand when they arrive in the country that they are fully vaccinated, why can the NHS app not understand that they are fully vaccinated when they get pinged by test and trace?

[Lord Kamall (Con)]

I share the frustration of the noble Baroness and others. This is not great for our international, global outlook, or for the fact that we want to attract the best students from around the world, not just Europe. We are a global country and we have to address this. I am pushing the NHS on this because it is really important. The problem is the national immunisation management system, to use the technical term, and the inability to validate the data of overseas visitors.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I can sense the Minister’s frustration in this, but we have been aware of it for some time; this should have been sorted out a long time ago, yet here we are now in November. Does the Minister accept that all departments must play their part in achieving the Government’s aim of increasing the number of international students? Will he assure us that his department will be both flexible and creative—with the emphasis on “creative”—in resolving this and other similar problems that may arise?

[Lord Kamall (Con)]

I assure the noble Baroness that when I was pressing this issue yesterday with officials in preparation for this Question, I stressed the importance of flexibility and creativity. We need to think outside the box on many issues. One issue we are looking at is: if passenger locator forms can do this, why can the NHS Test and Trace system not? I am told that is because it is based on self-certification. I am pushing the NHS to address and analyse the different options as soon as possible. It is really important we send a message to the rest of the world that we are open to the brightest and the best from across the world.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, in Queen’s University Belfast, the current position is determined by the Public Health Agency in Northern Ireland and is based on your vaccination status and age, rather than on whether you have home or overseas status. Would the Minister engage with the devolved Administrations, particularly the Northern Ireland Executive, who seem to have best practice in relation to this issue?

[Lord Kamall (Con)]

One of the advantages of having devolved Administrations and different practices is that we can learn from best practice, so I will take the noble Baroness’s advice.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, does the noble Lord believe the rules and regulations regarding the Covid-19 pandemic are clear, consistent and easy to understand?

[Lord Kamall (Con)]

I thank the noble Lord for that question. It depends on who you ask.

NHS England: Waiting Lists

Lord Kamall Excerpts

Tuesday 16th November 2021 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what steps they are taking to reduce NHS England waiting lists.

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

I thank the noble Baroness for raising this. It is a top priority for the Government and for the NHS. This year we are providing a record amount of funding to the NHS, with an extra £34 billion. This includes £2 billion this year plus £8 billion over the next three years to step up activity to tackle long waiting lists for elective care and to transform elective services. This funding could deliver around 9 million more checks, scans and procedures.

[Baroness Thornton (Lab)]

I thank the noble Lord for that Answer. I figured that that was what he would say. It is not about how much the Government intend to put in but how it is being spent. That is particularly important in the absence of any workforce strategy. If the billions were directed immediately at investing in social care and care workers, for example, both domiciliary and care homes, how many beds does the Minister believe could be freed up in the next eight weeks? What effect would that have on the throughput for elective surgery and accident and emergency departments?

[Lord Kamall (Con)]

When you look at the data on the waiting lists, what is interesting is that 75% of patients on the list do not require surgical treatment. Most actually require diagnostics. Some 80% of patients requiring surgical treatment could be treated without an overnight stay in hospital, and 20% of patients are waiting for either ophthalmology or orthopaedic services. That shows where you can target the spending to cut the waiting lists.

[Baroness Primarolo (Lab)]

My Lords, returning to my noble friend Lady Thornton’s point about social care workers, does the Minister agree that it is unacceptable that social care workers are leaving the sector to work in hospitality, supermarkets and other sectors because they are paid more and are given bonuses to attract them? Will the Government now agree—bearing in mind the contribution that more care workers can make to easing the pressures on the NHS this winter—to pay a bonus to care workers over the winter months to show we prize their skills and dedication, as recommended by the Association of Directors of Adult Social Services and NHS Providers, and to relieve pressures on the NHS?

--- Later in debate ---

[Baroness Primarolo (Lab)]

Will the Minister agree? Yes or no?

[Lord Kamall (Con)]

I hope that the noble Baroness will allow me as much time as her question took to answer. The Government have announced at least £500 million over three years to support the workforce and fund various initiatives. One thing that we are looking at in the Health and Care Bill is how we make sure that workers in the social care sector, whether in private or state-funded institutions, make sure that they earn enough. We have also launched a Made with Care programme, a publicity campaign to encourage people into the social care sector. It involves many existing social care workers, who talk about what a rewarding job it is and how they can make a difference in people’s lives.

[The Lord Bishop of Ely]

My Lords, can the Minister confirm the number of children waiting for treatment for speech and language and for physiotherapy and occupational therapy assessments after their initial assessment? Those treatments are vital for supporting educational development of children as we recover from the pandemic. Are those figures included in the published waiting list figures—and, if not, why not?

[Lord Kamall (Con)]

I thank the right reverend Prelate for that question. Unfortunately, I do not have the statistics with me, but I shall write to him.

[Lord Young of Norwood Green (Lab)]

My Lords, will the Minister tell the House whether he is encouraging the use of best practice, including new technology, between hospital trusts? There are still many examples where there is good practice out there, but it is not being spread.

On a point that we touched on last night, in relation to A&E, we have a serious problem. Paramedics are waiting for significant periods of time, which means that they are not getting out on the road to treat other patients. We really need to bring in some drastic measures to ensure that we create a new system. We cannot leave it for months and months because, if we do, the impact will mean that people’s lives will be lost. What measures does the Minister have in mind to deal with this problem?

[Lord Kamall (Con)]

The noble Lord made a very perceptive intervention last night when asking us to think outside the box, and I gave an example of someone who I know suffers from asthma and forgot to take his blue inhaler with him to another city. His wife went to a number of places to try to get an inhaler from the pharmacy and from A&E, while telling him to stay in his hotel room. In the end, he was told that the only way to get an inhaler was to call the ambulance. We need to think outside the box and be more creative about when those situations occur—it is not necessarily political, but we need to be creative.

On technology, one of my jobs is Minister for Technology, Innovation and Life Sciences. I have been forceful, when talking to the NHS, that we have to digitise and share data. I accept that there are some concerns over sharing data, but the way to have an NHS that is fit for purpose is to make sure that we digitise and share data.

[Baroness McIntosh of Pickering (Con)]

I refer to my work with dispensing doctors. Will my noble friend join me in paying tribute to all the workforce of the NHS? Does he recognise that they are absolutely exhausted? The BMA has forecast that thousands of doctors will leave the profession in the next few years. Will the Government undertake to reinstate the commitment to have 6,000 more doctors by 2024?

[Lord Kamall (Con)]

In our conversations with the NHS, we are talking about the workforce plan. We are looking at ways to improve the way in which the NHS and social care plan for their workforce. We have committed to continuing to reflect very carefully on points made by noble Lords across the House. honourable Members in the House of Commons and many stakeholders. It is important that we value the workforce of doctors, nurses and other healthcare workers whom people often forget about. We should also value all those other workers who have provided services to us during lockdown, such as delivery drivers, postal workers, Amazon workers et cetera. They have all played a vital role, and we should not forget the role of civil society organisations.

[Lord Clark of Windermere (Lab)]

My Lords, we all recognise that the NHS and care staff are working under intense pressure. To attract additional members is vital. With that in mind, will the Government be more welcoming to individuals from overseas by easing further their entry conditions for those willing to come and work in the NHS and care sector, including a reasonable period of time for them to remain here?

[Lord Kamall (Con)]

Immigrants have always played a vital role in our country. If we cast our minds back to the post-war period, there were massive shortages in healthcare but also other public services. Indeed, my own father came over to work on the railways and buses. It shows the importance of immigration and immigrants to this country from across the world.

[Baroness Tyler of Enfield (LD)]

My Lords, does the Minister agree that the fundamental problem confronting the NHS is a lack of spare capacity and resilience? This means that the NHS is continuously running at unsustainably hot levels of bed occupancy. The UK has 2.7 hospital beds per 1,000 population compared to an EU average of 5.2, and significantly fewer doctors and nurses. What plans do the Government have to urgently increase capacity and deal with workforce shortages, which cannot all come from training new people from scratch, given the timescales involved?

[Lord Kamall (Con)]

If the noble Baroness looks at the statistics relating to the waiting lists, she will see that 75% of patients do not actually require surgical treatment: they require diagnostics. We have announced an investment in community diagnostic centres— sometimes in shopping centres or sports grounds—to make diagnostics more accessible to the public, rather than having to go to a healthcare setting. Moreover, 80% of patients requiring surgical treatments can be treated without an overnight stay in hospital, so they can do that as day patients. This is where we want to focus, along with making sure that we tackle all the waiting lists right across the board.

[Baroness Donaghy (Lab)]

Nine in 10 NHS chief executives, directors and chairs reported last week that the present system and organisation have become unsustainable. We can only guess at the pain and anxiety of those waiting to be treated. That is really what this is all about. My noble friend Lord Young talked about ambulances and the time wasted waiting outside hospitals. What plan do the Government have to boost the NHS workforce and ensure that there are sufficient numbers to help bring the waiting lists down?

[Lord Kamall (Con)]

The Government are in conversations with the NHS about the workforce plan and the winter plan. We are looking at ways to tackle the waiting list in more creative ways. As I said, 80% of patients requiring surgical treatments can be treated without an overnight stay in hospital. If we take medical care out to the community, especially at diagnostic centres, we can cut down a lot of the waiting list, but also in terms of the Health and Social Care Bill. One of the reasons is that the NHS has been asking the Government for changes to make sure that it meets the challenges of the future.

Dementia: Fuelling the Moonshot

Lord Kamall Excerpts

Tuesday 16th November 2021 Lords Chamber

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

My Lords, I am grateful to the noble Baroness, Lady Greengross, for securing this important debate. On a personal note, I thank her for the time she took earlier this week to discuss some of her priorities and experiences with me. I think we all know people—family or others—who have experienced dementia, so we have seen it first-hand. As we look at our ageing society, as we get old and the medical technology gets better at keeping us living physically longer, one of the issues that we will face more and more is dementia and Alzheimer’s.

I know that all noble Lords will pay tribute to the noble Baroness, Lady Greengross—indeed, they have done—as a co-chair of the All-Party Parliamentary Group on Dementia. I thank all noble Lords who have spoken so well today and conveyed such emotion and facts in such a short time. I am sure all noble Lords would like to express our thanks to the APPG on Dementia and to all those who contributed to the report for all the work that they put into the inquiry.

The recommendations in the report are incredibly timely since the Government are developing our new dementia strategy. The strategy will set out plans for dementia in England for future years, including our ambitions for dementia research. We will work closely with patients, researchers, funders and charities to incorporate things from the report into the development of the strategy.

I now turn to the central recommendation within the APPG report which is for the Government to deliver the dementia moonshot. As the report sets out, the Conservative Party’s manifesto committed to doubling funding for dementia research and delivering a moonshot. The moonshot will expand the UK’s internationally leading research effort to understand the mechanisms underlying the development and progression of dementia, deliver new therapies, enable people to live better with dementia, and look at ways to help prevent the condition.

We remain committed to supporting research into dementia and UK researchers are at the forefront of global efforts. The Government spent nearly £420 million on dementia research from 2015-16 to 2019-20. This was significantly ahead of our commitment to spend £300 million in this period, as set out in the Challenge on Dementia 2020.

We know that we need to go further to accelerate progress against this condition—progress towards the moon, if you like. However, increasing research spend takes time. One of the things I hear when talking to others about increasing research is that capacity building cannot be done at the press of a button. In addition, as I am sure noble Lords appreciate, in the current Parliament, the research system has been diverted to help combat the global pandemic, with all hands on deck and everyone focused on that.

In 2019-20, the most recent year for which spending figures are available, the Government spent over £75 million on dementia and neurodegeneration research. We have committed to maintaining at least this baseline level of spending, which equates to spending £375 million over the next five years.

The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing health challenges of our time. Clearly, dementia is way up that list. We are working across government to finalise the outcomes from the spending review and identify ways to significantly boost research on dementia to support the delivery of the moonshot. I am, and will be, speaking to colleagues across government about achieving this.

In the meantime, rather than just waiting, we have been taking positive actions so that we can prepare the ground. This includes the launch of a highlight notice on dementia within the National Institute for Health Research. This invites ambitious dementia research applications and signals to the community that dementia is a priority area for the NIHR. I am encouraged that dementia researchers are coming forward with proposals in response.

This Government are committed to supporting dementia research across the translational pathway, from basic science, to understanding the causes of disease, through to applied research on treatments, care and quality of life, as well as public health prevention. Through the UK Dementia Research Institute, scientists have made huge leaps in understanding the mechanisms underlying disease progression, and researchers have developed potential new diagnostics and treatments.

The Dementias Platform UK has established technology-based networks to better understand how dementia starts and to support experimental medicine studies. In partnership with the Alzheimer’s Society and Alzheimer’s Research UK, people with dementia and their carers continue to be recruited, via Join Dementia Research, to take part in a range of important research. Through our NIHR research, we are supporting high-quality studies on lifestyle prevention, service provision, care and care technology.

I will now cover the specific questions rightly raised by noble Lords. The Government are committed to delivering on dementia research as much as possible; I am sure noble Lords understand the hiatus due to the focus on Covid. As we continue to look at Covid—although not necessarily beyond it; it may be with us for some time and we may well be looking at annual boosters, for example, and managing Covid in the same way that we manage flu—it is important that we consider how we deliver the dementia moonshot. We are discussing across government a timetable for the delivery of this as well as the timetable for doubling the funding. Increasing research takes time and, as noble Lords will understand, a lot of stuff has been diverted to help combat the global pandemic. However, we will set out plans for dementia, including research, for future years.

We also recognise that Covid-19 has caused problems across the sector and many researchers, including dementia researchers, are considering leaving academic research—as noble Lords pointed out—due to the financial uncertainties created by the pandemic. I assure noble Lords that Ministers and government officials have been liaising closely with medical research charities to understand the impact of the pandemic, identify how we can work together and ensure that patients benefit from charity-funded research. Most recently, BEIS and the DHSC have announced a £20 million support package, which will support early-career researchers funded by charities, helping to protect the pipeline of talented researchers who play an important role in delivering patient-saving research.

The report contains a recommendation to maximise the success of the Join Dementia Research platform. I assure noble Lords that increasing participation in all types of research is incredibly important, as part of our life sciences vision and of global Britain. As set out in the UK vision for clinical research delivery, our ambition is to ensure that the UK has the most advanced and data-enabled clinical research environment in the world.

This plays to my portfolio and two of my priorities. One is digitisation and sharing data, and the second is ensuring, across government, that the UK is a hub for life sciences. That includes research, trials and medical studies. We will build on digital platforms like Join Dementia Research to improve our ability to recruit patients to studies and ensure that participating in research is as easy as possible.

The NHS is one of the most trusted organisations in the UK, and our priority is to ensure the highest standards of data transparency and accountability. Only today I was on a call with an individual who has been helping us make sure we have trusted research environments, so that people can be confident about their data being shared appropriately.

The APPG report recommends that we move Join Dementia Research to an opt-out model, but this would not meet the standards or patient expectations around how our data is used. However, we are building on complementary platforms such as NHS DigiTrials to support the best use of data to facilitate recruitment to clinical trials. Join Dementia Research will play a key role alongside this development to ensure that all potentially eligible participants are invited to participate in studies relevant to them.

Noble Lords mentioned the Life Sciences Vision that we published on 6 July 2021. It set out our commitment to improve translational capabilities in this research, so that new treatments reach patients faster. We are looking at ways to continue to make funding available for dementia research through UK Research and Innovation and the NIHR.

We support dementia research by funding a range of ground-breaking research. Besides the NIHR, the Medical Research Council supports dementia research across the discovery and translational pathway. Through the UK Dementia and Research Institute, significant advances are being made in understanding disease mechanisms. The Dementias Platform UK, a unique public-private partnership, has established a technology-based network. Also, the Medical Research Council funds longitudinal population cohorts, which provide opportunities for dementia researchers to exploit data-driven science—for example, through the UK Biobank, which provides by far the world’s largest programme for genotyping and brain-body imaging.

We recognise that Covid-19 has caused problems across the sector and for many medical charities, which we recognise are a vital part of this. I reassure noble Lords—even if I have said it before—that we are liaising with medical research charities to understand the challenges they face, and to help them through it.

Government responsibility for delivering dementia research is shared between my department, the Department of Health and Social Care, with research delivered by the NIHR, and BEIS, with research delivered by UK Research and Innovation. In 2019-20, the NIHR spent £29 million on dementia research, and UKRI spent £46.7 million. The charities Alzheimer’s Society and Alzheimer’s Research UK are also funders of dementia research. We are working in partnership with those two charities, and with the UK Dementia Research Institute, which is a significant part of the ecosystem.

A number of noble Lords raised the issue of early diagnosis. We support a range of issues in this important area. For example, at the UK Dementia Research Institute, scientists are trialling technologies such as cameras and sensors to detect dementia earlier. Dementias Platform UK is undertaking research on wearable devices which can monitor the progression of Alzheimer’s disease, and the NIHR recently launched the £9 million programme that we talked about.

During our one-to-one conversation, and in the debate tonight, the noble Baroness, Lady Greengross, mentioned arts-based interventions. I know that I will be facing an OPQ on this. As I have mentioned before, as an amateur musician—let me stress “amateur”—I say that we all know the role that music plays and the way it touches our hearts as well as our minds. There is no better buzz or thrill than being a live musician, playing in front of a live audience and seeing them respond. When I say “respond”, I mean hopefully in a positive way. In fact, you see how people feed off each other, and that energy helps you connect with people. It touches hearts and minds, affects your mood and quite often helps unlock people. It is a way of people expressing themselves in a way that they would not do ordinarily.

We understand that arts-based interventions such as music therapy can play an important role, along with social prescribing, which is currently being rolled out across the NHS for local agencies. We will set out some of these plans in future years. Let me give a couple of examples of projects we are working on. The MARQUE project, jointly funded with the ESRC, is looking at care home staff and non-drug treatments for agitation in people with dementia; the WHELD programme is helping the well-being of people with dementia living in care homes; and there is the IDEAL project.

I am sorry that I have overrun in my enthusiasm for arts-based subjects. There are other issues that I wanted to touch on, including capacity building. But let me end by saying this: we need to continue to build on our success to accelerate progress in dementia research, but we cannot do this alone, especially when there are so many experts among noble Lords and across government, but outside government as well. By working across government, co-operating with charities and the research community, and recruiting people with dementia, we hope to bring forward ambitious plans in our new dementia strategy.

House adjourned at 8.02 pm.

Covid-19

Lord Kamall Excerpts

Monday 15th November 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 earlier in another place. The Statement is as follows:

“Mr Speaker, I will start by saying a few words about the incident that took place at Liverpool Women’s Hospital yesterday. This is an ongoing investigation into what has now been declared a terrorist incident by police so it would not be appropriate for me to comment in any detail, but I express my thanks to all the NHS staff and emergency services who responded to the incident. They showed the utmost professionalism in the most difficult of circumstances and my thoughts—and, I know, the thoughts of the whole House—are with them and anyone who has been affected.

With permission, I shall make a statement on the Covid-19 pandemic and the life-saving work of our vaccination programme. A year ago today, we were in the midst of our second national lockdown, a time when we endured major restrictions on our life and liberty and when we observed a period of remembrance where we could not come together and pay our respects in person in the way that we would all have wanted to. Our country has come very far since then. We have put over 109 million vaccine doses in people’s arms through our world-leading vaccine programme, which means that we can approach this winter with the best possible chance of living with the virus. The data clearly demonstrates that vaccines work. This month’s figures from the ONS show that, between January and September, the risk of death involving Covid-19 was 32 times greater in unvaccinated people than in those who are fully vaccinated.

However, although we have built up that huge protection, this is not a time for complacency. Earlier this month the WHO’s Europe director said that Europe was

“back at the epicentre of the pandemic”.

Just this weekend, the Netherlands and Austria have put in place partial lockdowns after surges in cases.

We also still face the risk of new variants just as we have seen with the emergence of AY.4.2, the so-called delta-plus variant. The latest data shows that it now accounts for around 15% of cases in the UK. Although delta-plus may be more infectious than the original delta variant, our investigations indicate that our vaccines remain effective against it. Still, we know that there will be more variants in future, and we do not want to go backwards after all the progress we have made. So we must stay focused on the threat in front of us and seize every opportunity to bolster our vital defences as the winter moves in.

That includes our vaccination programme, which is our primary form of defence. Last week, I announced to the House that health and social care providers in England must make sure that all workers other than those who are medically exempt, are fully vaccinated against Covid-19 so that vulnerable patients have the greatest possible protection against infection. Today, I shall update the House on more measures that we are taking to keep ourselves on the front foot.

First, we are expanding our booster programme, which is essential so that we can keep upgrading our protection in this country. Our vaccination programme has given us a strong protective wall, but we need to use every opportunity to shore up our defences. Evidence published this month shows how protection against symptomatic disease, hospitalisation and death from Covid-19 gradually wanes as time passes, and this is more likely if you are older or clinically at risk. Even a small drop in immunity can mean a big impact on the NHS; if protection drops from 95% to 90% against hospitalisation in those who are double-vaccinated, that would mean a doubling of hospital admissions in that group of people, so topping up our immunity through booster doses is essential to our security for the long term.

Today, the UKHSA has published the first data on booster vaccine effectiveness in the UK. It shows that people who take up the offer of a booster vaccine increase their protection against symptomatic Covid-19 infection to over 90%, and protection against more severe disease is expected to be even higher. So we are intensifying the booster programme ahead of the winter. Over 12 million people have now had their top-up jab, and over 2 million were given it last week. We have also made changes to the national booking service so that people can prebook their top-up doses a month before they become eligible. Last Monday, we saw almost 800,000 bookings in a single day in England, which is a new record.

Secondly, we are taking another step forward. The JCVI has recommended offering all adults aged 40 to 49 a booster dose six months after their second dose, using either the Pfizer or Moderna vaccines. I have accepted that advice, and 40 to 49 year-olds will be able to get their top-up jab from next Monday if they are eligible. The JCVI has also said that, in due course, it will be considering whether boosters are needed for all 18 to 39 year-olds, along with whether additional booster doses are required for the most vulnerable over the long term. I look forward to receiving that advice in due course.

Just as we extend protection through booster doses, we are also ramping up our efforts to protect younger people. Our programme for 12 to 15 year-olds is progressing at pace. Yesterday, we hit the milestone of 1 million 12 to 15 year-olds being vaccinated in England. We are also offering a vaccine to 16 and 17 year-olds. I would like to update the House on some further steps that we are taking.

In August, we decided, in line with JCVI advice, that all 16 and 17 year-olds could be offered a first dose of a Pfizer vaccine. That was apart from a small number of those in at-risk groups who were offered two doses. Now, the JCVI has advised that all 16 and 17 year-olds should also be offered a second dose, and that it is even more confident about the safety and benefit of doses in 16 and 17 year-olds. As Dr June Raine, the chief executive of the MHRA, said this morning: “As the data have accrued, we’ve become more and more reassured that the safety picture in young people and teenagers is just the same as what we’ve seen in the older population.”

The JCVI advises that, unless the patient is in an at-risk group, the second dose should take place 12 weeks after the initial dose, rather than eight weeks. I have accepted that advice. The NHS will be putting it into action. Once again, these jabs will start going into arms from next Monday. This will extend the protection of a vaccine to even more people and strengthen our national defences even further.

Our vaccination programme has paved our path out of this pandemic and given us hope of a winter that is brighter than the last. Today, we are going even further, extending our booster programme and offering great protection to younger people, so that we can fortify the defences that we have built together and help our nation to stay one step ahead of the virus. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for repeating the Statement. At this afternoon’s No. 10 press conference, Professor Chris Whitty made it very clear that doctors and scientists are increasingly concerned about the average of 37,500 cases over the last week and the high number of Covid cases in hospitals. Professor Whitty said that it would be a tough winter and added that, in addition to the nearly 9,000 Covid patients in hospital, all other areas of the NHS are under growing and intense pressure. He recommended that, in addition to getting their vaccinations, everyone should use face masks and ventilation to help reduce the number of cases.

This morning, Oliver Dowden, who was just referred to, said “It is in our hands” whether further restrictions in plan B are put in place this winter, but clearly the Government’s current communications on just encouraging using face masks and ventilation indoors and on transport are simply not cutting through. It certainly was not on my Tube journey in today, where distressingly few people were wearing a mask. Even if the Government do not want to implement the whole of their plan B, why will they not at least mandate face masks and improving ventilation on public transport and indoors when so many people across the spectrum are crying out for this to happen?

Leaving it to individual choice and personal responsibility is far too weak and inconsistent a message. It is crystal clear that the Prime Minister does not want to implement plan B, but is the reality not that he is far more likely to have to do so—or, indeed, move straight to plan C, a total lockdown—if mask-wearing is not made mandatory immediately? Does the Minister agree with me, and the point just made by the noble Baroness, Lady Thornton, that all parliamentarians and most particularly Ministers have a duty to set a clear example of mask wearing inside and on public transport?

Professor Whitty highlighted the stark figure that 98% of pregnant women admitted to hospital had not been vaccinated, and that same ratio applied to those in intensive care. What specific steps are the Government and the NHS taking to talk directly to pregnant women to encourage them to have their vaccinations?

It was worrying this afternoon when the Prime Minister said that he “hoped” that booster and third jabs could be logged on the online system “soon”. We have been asking questions about this system for weeks now. Can the Minister look into Pinnacle, one of the systems that logs people’s Covid status, to find out why practitioners are not yet able to record a third jab for the clinically extremely vulnerable, as well as a separate listing for booster jabs for everyone else over 40? As the Prime Minister said this afternoon, evidence of booster jabs will be required for travel this Christmas, but because third vaccinations and booster doses are still not appearing separately on the NHS Covid app, there is a great deal of anxiety and frustration among people who will need not only to have had the jabs but to be able to provide the evidence. Can the Minister say—I underline the point made by the noble Baroness, Lady Thornton—when all third doses and boosters will be on the online system?

Finally, although I welcome the announcement that it is safe for 16 and 17 year-olds to receive a second dose, can the Minister explain where 16 and 17 year-olds will be able to get that second dose? Too often, young people wishing to have their initial jab were put off because they had to travel to a centre some way away, often by bus, train or car, often involving parents providing the transport. Will the Minister undertake to look into ensuring that there are centres in town centres and other easily accessible places so that young people can more easily access their second dose?

[Lord Kamall (Con)]

I thank the noble Baronesses for those sets of questions; I will answer them as best I can. I will work backwards, starting with where people can get their vaccines: the same places where the rest of the population can get their vaccines. Only last week, I booked my booster and was reassured to find that, rather than having to go even to my local doctor—which I was quite happy to do—there were two or three pharmacies, or chemist shops, near me that were giving the booster. One of my sons has booked his vaccine and that will be at the same pharmacy. So, clearly, we are rolling out the vaccines to more accessible places than initially; I do know someone considered clinically vulnerable who had to go quite far before, but we are now bringing the vaccines as close to people as possible.

I will try to answer some of the other questions. We are focused on building a wall of defence across the country. More than 261,500 hospitalisations have been prevented in those aged 45 and older, up to September 2021. Estimates suggest that 127,000 deaths and 24 million infections have been prevented as a result of the Covid-19 vaccination programme. This is why we are keen to stress that vaccination remains the best defence against this virus.

We are also working hard to make sure that as many people as possible have their jab as soon as they can. While we are very encouraged by the booster uptake and the record numbers, only today I have been in meetings where we have been talking about how to reach those hard-to-reach communities. I know that we have spoken about this before in this House. I have, very kindly, been offered advice from noble Lords across the House and I have been working with some noble Lords in relation to their experience as community organisers or working with certain communities where the demographics have shown a lower uptake. We are rolling out the programme, and there will be a publicity programme rolling out as well. As we get more data, the JCVI and others are even more reassured by the safety of the vaccines and want to stress that as much as possible.

As I said, we are rolling out the booster programme. Nearly 10.6 million people have now received their third dose, and we are looking to vaccinate children as quickly as possible. We are working closely with schools, colleges et cetera to make sure that we get as close to people as possible.

I had hoped to be able to give a date for the booster appearing on the app. A number of noble Lords raised this with me both formally and informally, and I got straight on to NHSX to try to get an answer. I had hoped to be able to announce a date today, but I am still not able to do that. I am told, however, that good news will be available soon, and I hope it will be announced as quickly as possible. I think there are a few more checks to go through; those who have been in government before will understand how this works.

On the issue of NHS capacity, as of 12 November the number of beds occupied by Covid-19 patients had decreased by about 4% across England in the last week. Regionally, there was a drop of 4% in the east of England; a 2% increase in London; a 5% drop in the Midlands; an 8% drop in the north-east and Yorkshire; a 5% drop in the north-west; no real change in the south-east; and a drop of 8% in the south-west. Hospital admissions have decreased by 10% across England last in the week. There was a drop of 16% in the east of England; an increase of 1% in London; a drop of 11% in the Midlands; a drop of 15% in the north-east and Yorkshire; a drop of 11% in the north-west; a reduction of 8% in the south-east; and a drop of 10% in the south-west. Rates of admission to hospital with Covid-19 therefore appear to be decreasing. Hospital admissions in England were at 821 people per day as of 10 November. There were 6,777 patients in hospital in England as of 12 November, including 838 patients in mechanical ventilation beds.

In line with the approach that we have taken, we are constantly relying on data from the JCVI and its judgment, and this is constantly being reviewed in terms of rollout to different age groups. We are very fortunate to have secured a steady supply and delivery of Covid-19 vaccines. Many will also be aware of the other method by which the dose can be taken.

On making sure that we are focusing on elective care recovery, we have given £2 billion to help tackle the backlog that built up during the pandemic and have committed £8 billion over the next eight years. We hope that that funding will deliver the equivalent of 9 million more checks, scans and procedures to tackle the backlog, and we hope to have 30% more elective activity by 2024-25.

Turning to care homes, one of the campaigns being launched is the “made with care” campaign, which is advertising the fulfilling careers that can be had as social carers. It is very much focused on people who want to make a difference to other people’s lives. There is £550 million, including £162.5 million on the “made with care” campaign, and noble Lords will see that campaign rolling out.

Fortunately, 90% of staff in in older-adult care homes have received both doses, and 94% of such staff have had at least one dose. The data we are getting shows that, where care home owners are able to sit down with the workers who may have some doubts, there is an increase in uptake. Also, on a temporary basis until 24 December, people who have a medical reason why they are unable to have a Covid-19 vaccine can self-certify that they are exempt on medical grounds until that can be proven one way or another.

I am trying to make sure that I am answering all of your Lordships’ questions. If there are some that I have missed, let me assure noble Lords that I have not done so deliberately, and I will write to them to fill that information gap.

[Viscount Stansgate (Lab)]

My Lords, I hope the House will forgive me if I emphasise an issue that has already been raised by both Front-Bench speakers: when this booster jab, which I am very glad the Minister has had, as have I, is going to be recorded. As I hope the House knows, it will prevent people, many people in this House, travelling to various countries—I mention France and Israel as only two of them—unless we can prove that we have had it. Although I am very pleased to know from the Minister that he has had the booster jab, and of course I believe him, I would like to know in what way he can prove it to me by showing it to me on his phone.

[Lord Kamall (Con)]

I apologise if I have misled the House: I have booked my booster jab but I have not had it yet. I was able to book it in advance but I cannot have it until—perhaps I should not make this public, but they have given it to me one day before the six months is up. This will be all over the front pages tomorrow, it will be a huge scandal and noble Lords will be calling for my head. I understand that.

On the serious point, I share the frustration of all noble Lords who have brought this issue up. I was hoping to be able to announce a date today, but it was scratched at the last minute. I think there was some technical reason, but we hope to have good news soon. I know that will be as frustrating to many noble Lords as it is to me. Believe me, I would rather have good news than to be seen to be avoiding answering the question.

[Baroness Finlay of Llandaff (CB)]

I shall follow up on the question asked by the noble Baroness, Lady Tyler, in relation to pregnant women in particular. There were maternal deaths early on. It would be most helpful if we could have the data on the number of such women, the pattern of vaccination and the pattern of maternal deaths from Covid and severe infection. Women are still worried and hesitant because there was a failure to vaccinate early on, because the data on safety was not there. Having data on the drop in the number of deaths will help to persuade women of childbearing age to pursue being vaccinated, whether they are already pregnant or not.

[Lord Kamall (Con)]

The noble Baroness raises a very important point and I apologise for not spotting it and answering it earlier. Many noble Lords will be aware of the very sad story of a young lady who died because she felt that the vaccine was not safe; her mother is encouraging other pregnant women to have the vaccine. For that reason, we want clearly to communicate that the vaccine is safe and will not affect fertility, so getting the vaccine is the best way to protect yourself. Pregnant women are more likely to get seriously ill from Covid-19, and we know that vaccines are safe for them and make a huge difference. In fact, no pregnant woman who has had two jabs has needed hospitalisation with Covid-19. We need to make that clearer, and I will take this back to the department and the Government to make sure that we communicate more clearly. We all share the same will to share that message more widely.

[Lord Pannick (CB)]

On the NHS app, it is not simply the inconvenience to those travelling but the waste of time of NHS practitioners who are being asked to provide letters to people who are travelling. It is vital that the Minister uses his best endeavours to make sure this problem is resolved very speedily. My understanding is that those of us who travel with children under the age of 16 who have had one jab have no means through the NHS app of proving that they have had the vaccine. Is that right? If so, can the Minister do something about it?

[Lord Kamall (Con)]

The noble Lord’s first point repeats what other noble Lords have said, but for a good reason. I hope that our mentioning this more than once this evening stresses to the NHS and NHSX that it must be sorted out as soon as possible. As I said, I had hoped to have a date to announce this evening, and I am as frustrated as everyone else. We all want to travel and, importantly, there are countries that require proof of the booster.

In terms of children travelling, a solution has been developed to allow fully vaccinated children aged 12 and over to demonstrate their vaccination status. Up to now, some countries have required no proof from children aged 12 and over, but I am being told that a solution is being developed. I will try to push for that date as well, but I definitely want to get a date for when the booster will appear on the NHS app. All I can do is apologise that we have not done this yet.

[Lord Cormack (Con)]

My Lords, as we are clearly going to have to live with this vaccine for several years to come, could we have quite soon a programme for annual jabs worked out? It is clear that that is going to be necessary, and we ought to advance-plan. On the subject of masks: where one is in close proximity with others, they really should be obligatory. I came up on the train this morning, and at least half the people in the carriage were not wearing them. I am on my own on these Benches tonight, but I always wear one when others are around me, and I think that it is very important indeed that we take this elementary step so that it is compulsory on public transport, in shops and other places where people are in close proximity.

[Lord Kamall (Con)]

On future vaccinations, my noble friend raises an important point, and many will have seen in the media and elsewhere all the discussion about living with this vaccine. At the moment, we have boosters at six months; as the technology and the understanding get better, it seems likely that we will move to annual vaccinations, as we do flu jabs. I cannot say that for definite, but the trend is going that way, given the development of the virus, the variants and the waning immunity over time. The effectiveness of each vaccine at the moment is six months, but one can see the longer term. However, please do not take that as a given—if that is incorrect, I will update the House.

On public transport: I went to a funeral today, and as I was travelling back on the underground, it said, quite clearly, that you must wear a mask, so that is being encouraged. It is part of plan B if we have to move to plan B, but all that data is being analysed and constantly updated with different factors. There is no one trigger for moving to plan B. In previous appearances at the Dispatch Box, I have read out the list of all the factors that are considered. At the moment, the main message is: the vaccine works. We want to encourage people to get the vaccine and especially try to reach those communities that have not even had their first or second vaccine yet.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a trustee of the GMC and the Royal College of Ophthalmologists. Can I ask the Minister about the impact on the NHS generally and the pressure it is under? He will be aware that the Academy of Medical Royal Colleges issued a statement a few weeks ago on its concern about the abuse of NHS staff. What are the Government doing to ensure that NHS staff are able to go about their work without the horrific abuse that many have had to endure?

Secondly, I refer the Minister to the report of the Royal College of Physicians, a census that shows that 48% of advertised consultant posts across the UK were unfilled last year? Does this not show that Covid has exposed the frailties in the NHS? Unless the Government grip this workforce issue quickly, the pressures on the service are going to get worse and worse. What are the Government doing?

[Lord Kamall (Con)]

The noble Lord raises a really important point on staff, doctors, nurses and other healthcare workers in our health system. The Government have a zero-tolerance approach to abuse and harassment; we are investing in better security at GP surgeries and are committed to working with the NHS to make sure our primary care workers feel properly supported. We are also constantly having conversations with trusts and the NHS generally about making sure that staff feel safe to work and how we can make sure that that happens. Anyone who has visited a hospital recently will have seen the signs about zero tolerance.

We are constantly talking to NHS England about workforce pressures. We are looking at specific campaigns—for example, we have announced social care recruitment—and other campaigns to attract more workers to the NHS.

[Baroness Bennett of Manor Castle (GP)]

My Lords, on the Minister’s comment about masks on public transport, my understanding is that that is only in London and is not the case in the rest of England. I draw to your Lordships’ attention my experience in Edinburgh Waverley station yesterday evening. Scotland of course does have a mask mandate, and it was very clearly announced at extremely regular intervals. Additionally, it came with a message that said, “That means that you are not allowed to eat anything in the station”, which I have never heard in England.

The Statement says that

“we must stay focused on the threat that is in front of us and seize every opportunity to bolster our vital defences”.

As most of the Front-Bench questions pointed out, this Statement entirely focuses on vaccines. We have been very aware of the issue of aerosol transmission for a very long time now. The last figures that I have been able to find—from a week ago—show that fewer than the promised 300,000 carbon dioxide monitors for schools have actually been delivered. They were promised by the end of the autumn term. Of course, all those CO monitors do is identify the problem—the lack of air circulation. They do not actually deal with it. Will that target be met, and will schools get their carbon dioxide monitors? More than that, are the Government providing adequate support for schools and indeed other organisations that identify a problem with ventilation?

I notice that the UK Health Security Agency is funding a trial of air purifiers of different sorts in 30 Bradford primary schools. This is two years after the pandemic started, and we have known for a long time about aerosol transmission and the problem of unventilated rooms. Not all school rooms or rooms in general—including in your Lordships’ House—can be ventilated. Are the Government really paying the attention that they should be to dealing with aerosol transmission, ventilation and air purification?

[Lord Kamall (Con)]

A lot of investment has gone into making sure that there is ventilation in schools. I will talk to my counterpart in the Department for Education to see what more can be done, but I know that the department is very aware of this issue and is looking more into it.

On the noble Baroness’s first question, we want to be clear and not confuse the message: vaccinations work and are our best line of defence. We do not want people to get a false hope that there are other ways to protect themselves. Not all people who do not take the vaccine are anti-vaxxers: some of them think that just wearing a mask may well protect them.

We want to focus on this message: get vaccinated; if you have been, get your booster; and if you have had your first vaccine, get your second one. There is nothing to fear from getting vaccinated. We are not only sending that message out but actively looking at different campaigns to reach those difficult-to-reach individuals in many communities.

[Lord Young of Norwood Green (Lab)]

My Lords, on the importance of vaccination, what are the Government doing to combat the anti-vax message? My second point is on the terrible situation in hospitals, where paramedics are forced to stay and wait with patients. There must be something that we can do to alleviate that situation until there is a long-term solution. Have we identified best practice? The Government ought to be thinking outside the box about what we can do to stop paramedics being trapped in hospital, denying them the ability to deal with other urgent cases.

[Lord Kamall (Con)]

I am sorry, but my memory has gone. What was the noble Lord’s first question?

[Lord Young of Norwood Green (Lab)]

It was on anti-vaxxers.

[Lord Kamall (Con)]

The issue of anti-vaxxers is very difficult in a society where we believe in freedom of speech. Clearly, if they are impeding people from attending school, going to certain places or getting vaccinated, that is obstruction. However, if they are saying that they do not believe that the vaccines are safe or whatever, it is really difficult and we have to get that balance right. We are clear that we want people to be vaccinated but, at the same time, we believe in freedom of speech. Quite often, if you really believe in freedom of speech, you have to allow people to say things that you disagree with, I am afraid. However, where they are actively blocking people from getting vaccinated, I think we have work to do.

As for thinking outside the box, we are looking at a number of different areas. For example, the other day I heard a case of someone who had forgotten his asthma inhaler. His partner told him, “Stay here, I’ll get you another one from the all-night chemist”. The all-night pharmacist said, “I can’t administer that”. She then went to A&E with her partner’s details. A&E said, “No, he has to come in here”. In the end, when she went back to the hotel, the hotel said, “We’ll have to call the ambulance”. All that could have been avoided had there been a way for the person who had forgotten his inhaler simply to get another one, rather than having to call in paramedics. Therefore, there are a number of different ways that we can think outside the box to make sure that we do not put undue pressure on the NHS at this time.

Clinical Negligence Claims

Lord Kamall Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Storey]

To ask Her Majesty’s Government what assessment they have made of the increase in the value of clinical negligence claims, which are expected to cost £8.3 billion from incidents in 2019-20.

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

The costs of clinical negligence are rising at an unsustainable rate, eating into resources for patient care. Annual cash payments have quadrupled in the last 15 years to £2.2 billion in 2020-21. That is equivalent to 1.5% of the NHS budget and these costs are forecast to continue rising. This is despite our substantial safety programmes. The Department of Health and Social Care is working intensively across government to address these issues.

[Lord Storey (LD)]

I thank the Minister for his reply. I have raised this issue every year and have heard a similar response from the Minister sitting there every year. When a child is born severely disabled, the parents have to fight to get compensation or money to be able to look after that child. That can often take years. Does the Minister agree with the former Secretary of State for Health, Jeremy Hunt, that we should look at the Swedish model in which, if a child is born severely handicapped, the money is made available straightaway and the parents do not have to wait for the courts to provide support?

[Lord Kamall (Con)]

The Government have looked at a number of different schemes from abroad. It is always very important to learn from good and bad practice, but what happens in a number of those cases is that the costs of compensation end up increasing. So We are looking at various solutions.

[Baroness Davidson of Lundin Links (Con)]

My Lords, the new indemnity scheme for historical clinical negligence that was brought into effect last year, the Existing Liabilities Scheme for General Practice, initially applied only to general practice members of the Medical & Dental Defence Union of Scotland, with general practice members of the Medical Protection Society due to come under its purview a full year later, in April just past. So I ask the Minister to update the House of any formal or informal assessments of the workings of this scheme in Scotland, the level of uptake and lessons learned, before it was further rolled out.

[Lord Kamall (Con)]

Before I respond, I wish to give a belated welcome to my noble friend Lady Davidson. I have worked with her often in the past, and she displays a wisdom beyond her years and a sense of humour that excels that of many on our Benches. To answer my noble friend, the Existing Liabilities Scheme for General Practice covers the historical liabilities of GPs, where the department has agreed commercial transactions with the previous indemnity providers. The scheme applies only to general practice in England and is part of the state indemnity reforms introduced in England in 2019. These 2019 reforms mean that GPs in England now benefit from more stable and affordable indemnity to cover future negligence claims. I understand that similar arrangements were introduced in Wales at the time. I am afraid that the policy on state indemnity is a devolved matter, but officials in the department are in regular contact with their counter- parts in the devolved Administrations.

[Baroness Stuart of Edgbaston (CB)]

My Lords, some 10 years ago the NHS Litigation Authority concluded in its maternity claims report that

“the most effective way to reduce the financial and human cost of maternity claims is to continue to improve the management of risks associated with maternity care, focusing on preventing incidents involving the management of women in labour”.

Yet, in the intervening 10 years, the number of claims has gone up from 391 in 2009 to 765 in 2019-20. Is it not about time that we put patient safety first in these considerations rather than looking at what happens to lawyers, and take some lessons from the airline industry where, if something goes wrong, we start by looking at no-fault and do not allocate blame but look at improving the system?

[Lord Kamall (Con)]

The noble Baroness raises an important point. However, in looking at the system overall, there is no evidence to suggest that the rise in overall costs is due to a decrease in NHS safety. Nevertheless, safety and learning from incidents are essential in their own terms. Our ambition is for the NHS to be the safest in the world and for maternity safety to be a priority, and there are various schemes in place.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the Minister tell me why the Government do not move to repeal Section 2(4) of the Law Reform (Personal Injuries) Act 1948, which essentially disregards treatment that the claimant may receive under the NHS? Can he also do something about the record of NHS Resolution in paying damages in 80% of litigated cases, with its lawyers being paid on a win-or-lose basis and therefore incentivised to carry on with unsustainable defences?

[Lord Kamall (Con)]

The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.

In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.

[Baroness Walmsley (LD)]

My Lords, the element of compensation in clinical negligence cases which relates to the cost of further health treatment is based on the cost of care in the private sector. Why is this so when NHS treatment is as good or better? Should not private health costs be provided only where the patient cannot get treatment on the NHS?

[Lord Kamall (Con)]

Quite often patients choose to go on the NHS and when they are unable to do so because of various factors they will go private. I wonder whether we should be giving preference. We want to treat all patients equally.

[Baroness Eaton (Con)]

My Lords, given that the key to reducing the overall cost of clinical negligence is to have less of it, the real issue is the need to increase joined-up patient safety learning across the NHS. Does my noble friend the Minister accept that the cost of current legislation—that is, damages and claimant legal costs—is reducing in any event, as detailed in the NHS Resolution annual reports of 2020 and 2021, and that the overall payment for claims in 2019-20 was therefore £2.2 billion?

[Lord Kamall (Con)]

My noble friend raises an important point. The Government remain committed to continuous safety improvement, particularly on developing learning cultures in our health system and tackling the issues of denial and delay. While we strive towards this goal, we have seen that the cost of clinical negligence claims has quadrupled in the last 15 years, and there is no guarantee that reducing harm would necessarily result in fewer claims. In many cases, the overall costs are being driven by increases in the average cost per claim. Indeed, claims have recently levelled out, falling from £2.26 billion to £2.17 billion but this is largely due, in least in part, to the coronavirus pandemic.

[Baroness Wheeler (Lab)]

My Lords, the annual cost of clinical negligence has risen from £1 million in 1975 to £2.2 billion last year, as we have just heard. The Medical Defence Union’s evidence to the Health and Social Care committee’s inquiry into NHS litigation reform predicted that any money raised by the new health and social care levy would be entirely swallowed up by the amounts being paid out each year in NHS clinical negligence claims. What assessment have the Government made of this claim, how does it impact their plans to reduce the huge NHS waiting lists for treatments, and what money will be left for social care?

[Lord Kamall (Con)]

The noble Baroness raises an important point that spending more on compensation means less money for the care of patients. That is why we are committed to looking at various ways of reducing this and are working with the Ministry of Justice. Issues include the role the royal colleges play and the training they give to their medical staff, while needing to instil a culture of more openness when things go wrong. When things go right, we are ready to praise but when things go wrong, they have to stop hiding, delaying and denying, and be open.

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Lord, Lord Walney. He is not present. I call—

--- Later in debate ---

[Lord Walney (CB)]

Thank you. I accept entirely what the Minister says about learning from experience but was this not supposed to have been baked into the NHS after numerous reports in recent years? Does he accept that we need to look again at the way in which the NHS trusts are often slow in learning from their mistakes, rather than allowing this culture to continue?

[Lord Kamall (Con)]

I completely agree with the sentiments behind the question. It is important that at all stages we bake in a culture of openness in the NHS so it can no longer hide behind the fact that we are full of praise for it when it does things well. However, when things go wrong, I am afraid that it shuts up shop and hides behind various techniques. It is important that we are as open as possible in trying to make sure we tackle some of the problems and learn in the future.