Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, this is an important group, so it is a shame that we are discussing it so late in the evening. It is important because it contains essential broad things that people need to stay well in their community. It is about the bread and butter of people’s health—their GPs, dentists, the physios and pharmacists, getting podiatry services and getting the proper social care that you need to be able to stay in your home. It is literally about helping people to stay local and stay well. In many ways, that is why I enjoyed the three years that I spent on a CCG so much, because I knew that it was local and that every month I was going to be visiting a GP surgery. I knew all those things, and I felt that that was an important contribution to healthcare in my area.

The amendment in the name of the noble Lord, Lord Crisp, is particularly important. If primary healthcare and these local services do not work, the rest of the NHS falls over.

[Lord Kamall (Con)]

My Lords, I am grateful to all noble Lords who have spoken on these amendments in this debate and in Committee, but I am also grateful for the discussions that we have had between the various stages and the conversations that noble Lords have continued to have with my officials—indeed, right up to the dinner break this evening. I shall speak to Amendments 34, 35 and 55 in my name, which I hope will go far in addressing many of the concerns raised in the debate.

We have heard the calls for greater clarity about what will be expected of ICBs in their forward planning. We also understand the importance of ICBs being transparent in discharging their functions to allow for public scrutiny and accountability. We have therefore brought forward these amendments to further clarify what ICBs must include in their forward plans and annual reports. These amendments provide that the forward plan must describe what services the ICB proposes to make arrangements for in the exercise of its functions. It must also explain how the ICB proposes to discharge each of its duties under new Sections 14Z34 to 14Z44. These duties include improving the quality of services, reducing inequalities, promoting the involvement of patients and carers in decisions about treatment and promoting the integration of health and social care services.

Amendment 55 requires an ICB’s annual report to explain how it has discharged each of its duties under new Sections 14Z34 to 14Z44. This would additionally include new Section 14Z47A, which is the new duty we discussed earlier requiring the ICB to keep under review the skills, knowledge and experience that it needs to discharge its functions and, when there are gaps, to consider what steps it can take to address or mitigate them. I hope that noble Lords will agree that these amendments represent a significant step forward in making sure ICBs are held accountable by ensuring that they are transparent in how they intend to discharge their numerous duties and functions.

I turn to the amendments proposed by noble Lords, and I shall address each of them as briefly as I can. On Amendment 19, I assure my noble friend Lord Farmer that the Bill already includes the power for ICBs to commission services or facilities for the prevention of illness under new Section 3A in Clause 16. The provisions in Clause 16 also require ICBs to act consistently with the Secretary of State’s duty for the promotion of a comprehensive health service, including in the prevention of illness. Further, new Section 14Z34 places a duty on ICBs to improve the quality of services including preventive services, and new Sections 14Z36 and 14Z38 place duties on ICBs to ensure that patients and carers are fully involved in these decisions, including about prevention.

I now turn briefly to Amendment 62, spoken to so ably by my noble friend Lord McColl and the noble Baroness, Lady Hollins. I also pay tribute to the noble Baroness, Lady Greengross, who in my brief time in this House thus far has really educated me about dementia and the fact that, as we are living longer physically, this will become more of an issue.

The department is currently developing a new national dementia strategy for England, which will be published later this year. This will include objectives focused on restoring the dementia diagnosis rates and improving the diagnostic experience for people living with dementia, as well as increasing the number and diversity of people participating in dementia research. I take on board the concern of the noble Baroness, Lady Walmsley, about getting the many volunteers for clinical trials at the right time.

There is already work under way to help restore dementia diagnosis rates back to the target of 66.7% following the pandemic, supported by an additional £17 million to address dementia waiting lists and increase the number of diagnoses. Increasing participation in all types of research is a top priority and is in fact part of my portfolio. The UK has invested in a range of digital platforms, including Join Dementia Research, and we are now working to increase the scale of and interoperability between systems, improve diverse recruitment and reduce the burden and costs of clinical research delivery.

On Amendments 22 and 24, I reassure noble Lords that the Bill already contains requirements on NHS commissioning bodies to tackle health inequalities. Commissioners are also required to promote the right of patients to make choices with respect to services or treatment. This includes allowing patients to choose to be treated outside their ICB area. To support this, we expect ICBs to actively co-operate with each other. Furthermore, we have amended the duty on ICBs to have regard to the need to reduce inequalities between patients, proposing by government amendment to extend this to “persons”, in respect of accessing services. This means we are capturing everyone, not just people accessing services. This duty would encompass the need to reduce inequalities with respect to geography as well.

I now turn to Amendment 30. I thank the noble Baroness, Lady Finlay. First, I should thank her for the daffodil I am wearing to celebrate St David’s Day. She assures me that it is not a listening device to eavesdrop on my conversations with officials. If she had eavesdropped, she probably would have been embarrassed by the amount of praise heaped on her. We acknowledge her desire to see strong provision of community rehabilitation and it is important that this is pushed up the agenda.

Under the existing Bill provisions, every ICB will be required to provide and improve rehabilitation services as part of its duty to provide a comprehensive health service. As an added layer of scrutiny, ICBs must publish an annual review detailing how they have discharged this function. Also, NHS England is currently working on a national intermediate care framework, digital and virtual pathways and models of care, improved data recording and reports, and interventions using a wide range of community assets and levers.

I now turn to Amendments 33 and 37 to 54. I thank the noble Lord, Lord Crisp, for his engagement on this issue—indeed, including right up to the dinner break this evening. We would like to put on record our gratitude to the noble Lord and the Royal College of General Practitioners for pushing us on this and reminding us that, as we move to ICBs, we should make sure that primary care is not the poor relation. In moving to ICBs from CCGs, where GPs and primary medical services have played a huge role, we have to ensure that these are not dominated by a few large trusts.

We understand and continue to recognise the importance of primary care. Indeed, primary care is taking on more of the functions of what would traditionally be considered secondary care, especially with some of the primary care services and community centres appearing in our local communities. Only this week, we have seen stories and press reports of pharmacists calling for more of the functions of GPs to be delegated to them. They have helpfully suggested that they could save the NHS money and also provide better primary care services by taking on some of those functions. There is clearly a demand out there and that has to be encouraged.

Before I turn to this, I note that we hold primary care in equal esteem to any other sector—acute, community or mental health. Right from the outset, we have said that primary care must not be lost and must be at the heart of the ICB. As the Integrated Care Systems: Design Framework said:

“Through a combination of their membership, and the ways in which members engage partners, the board and its committees should ensure they take into account the perspectives and expertise of all relevant partners”,


including primary care.

I know the noble Lord is especially concerned about why primary care is not explicitly referenced in new Clause 14Z50(1). I hope I can offer him some explanation. First, we are conscious that there are 43,000 primary care providers, and it is impractical to require each to be a partner in developing the ICB forward plan. Secondly, new Clause 14Z50 ties NHS providers to the plan, and a failure to play their part could trigger NHS England’s intervention. It will also guide the financial requirements imposed under Clause 24. In contrast, primary care providers, as private contractors, are bound to the plan in a different way, primarily through contracts. Thirdly, new Clauses 14Z50 and 14Z54, on the joint capital resource plan, are intimately connected and primary care capital is provided through other routes.

However, ensuring that the primary care voice is sufficiently involved in joint forward planning in integrated care boards is our common ambition. The law requires the involvement of a primary care representative drawn from primary medical services on ICBs, just as it does for acute providers. ICBs will have to consider how they can best access skills and knowledge across primary care.

In addition, there is a duty in new Clause 14Z52 to consult

“any other persons they consider it appropriate to consult”

about forward plans. We expect that, in publishing its plan, an ICB should set out how it has met this duty and consulted primary care and other partners. I am able to inform the House that NHS England has confirmed that its guidance will be explicit in its expectation that primary care will be a crucial partner in that process. We are happy to engage with the noble Lord further as that guidance develops to ensure that we stick to that commitment to make sure that primary care is at the heart of this.

More broadly, ICBs have the discretion to appoint additional members to the ICB or exercise functions through committees. Commissioning at a local level requires the expertise of primary care, and we expect it to play a significant role as many decisions will be taken at that level under the principle of subsidiarity. Further guidance will be published on the development of place- level arrangements, including the role of primary care.

I also note the Fuller review. NHS England chief executive Amanda Pritchard has announced that Dr Claire Fuller, senior responsible officer of the Surrey Heartlands Integrated Care System, will lead a review on how primary care networks can be supported in integrated systems. NHS England has announced that the review will set out how ICSs and primary care networks should go about improving out-of-hospital care. The findings of the review will then be applied to ICBs, subject to the passage of this Bill. We hope this work will help all ICBs to make progress on developing general practice in this area.

I hope I have been able to assure noble Lords that we hold primary care in great esteem, and have given the noble Lord some reassurance that primary care will be involved in every level of the ICB, its functions and planning.

I now turn to Amendment 177 from my noble friend Lady Hodgson. I thank her for continuing to remind us of its importance and speaking movingly about her own experience. I remind noble Lords that all practices are already required to assign all their registered patients—including those aged 65 and over—a named, accountable GP. The GP must lead in ensuring that any GP services that they are contracted to provide, and that are necessary to meet the patient’s needs, are co-ordinated and delivered to that patient. Practices must take reasonable steps to accommodate the requests of patients to be assigned a particular GP and to see them for an appointment.

However, it is vital that practices retain clinical discretion to provide appointments, as is necessary and appropriate to meet the reasonable needs of patients—something that this amendment would remove. Through primary care networks and initiatives such as enhanced health in care homes and anticipatory care, we are supporting GP practices to improve continuity of care on the ground, including for older patients. We are committed to growing the general practice workforce and increasing access to appointments, in line with our manifesto commitments.

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Moved by

[Lord Kamall]

20: Clause 20, page 16, line 33, leave out “patients” and insert “persons”
Member’s explanatory statement
An integrated care board has a duty to have regard to the need to reduce inequalities in access to health services for patients. The amendment extends it to cover people before they are patients.

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Moved by

[Lord Kamall]

23: Clause 20, page 17, line 16, at end insert “facilitate or otherwise”
Member’s explanatory statement
This amendment provides that an integrated care board’s duty to promote research etc includes doing so by facilitating research.

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Moved by

[Lord Kamall]

25: Clause 20, page 18, line 27, leave out “The reference in subsection (1)” and insert “In subsection (1)—
(a) the reference”Member’s explanatory statement
This amendment is consequential on another amendment which provides that references in new section 14Z43 of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

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Moved by

[Lord Kamall]

28: Clause 20, page 18, line 38, at end insert—
“14Z43A Duties as to climate change etc(1) Each integrated care board must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with—(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.(2) In discharging the duty under this section, integrated care boards must have regard to guidance published by NHS England under section 13ND.”Member’s explanatory statement
This amendment would require integrated care boards, in exercising their functions, to have regard to certain matters relating to the environment, including climate change.

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Moved by

[Lord Kamall]

31: Clause 20, page 20, line 18, at end insert—
“14Z47A Duty to keep experience of members under review etcAn integrated care board must—(a) keep under review the skills, knowledge and experience that it considers necessary for members of the board to possess (when taken together) in order for the board effectively to carry out its functions, and(b) if it considers that the board as constituted lacks the necessary skills, knowledge and experience, take such steps as it considers necessary to address or mitigate that shortcoming.”Member’s explanatory statement
This amendment requires an integrated care board to keep under review the skills, knowledge and experience that it is necessary to have on the board and take steps to address or mitigate shortcomings.

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Moved by

[Lord Kamall]

34: Clause 20, page 21, line 12, at end insert—
“(za) describe the health services for which the integrated care board proposes to make arrangements in the exercise of its functions by virtue of this Act;”Member’s explanatory statement
This amendment requires the joint forward plan for an integrated care board and its partners to describe the health services that the board proposes to commission over the next five years.

Health and Care Bill

Lord Kamall Excerpts

Friday 25th February 2022 Lords Chamber

Moved by

[Lord Ashton of Hyde]

That the amendments for the Report stage be marshalled and considered in the following order:

Clause 1, Schedule 1, Clauses 2 to 14, Schedule 2, Clauses 15 to 17, Schedule 3, Clauses 18 to 27, Schedule 4, Clause 28, Schedule 5, Clauses 29 to 40, Schedule 6, Clauses 41 to 43, Schedule 7, Clauses 44 to 61, Schedule 8, Clauses 62 and 63, Schedule 9, Clauses 64 to 68, Schedule 10, Clause 69, Schedule 11, Clauses 70 to 74, Schedule 12, Clauses 75 to 98, Schedule 13, Clauses 99 to 112, Schedule 14, Clauses 113 to 123, Schedule 15, Clauses 124 to 149, Schedule 16, Clauses 150 to 159, Schedule 17, Clause 160, Schedule 18, Clauses 161 to 170, Title.

Motion agreed.

Government Contracts: Randox Laboratories

Lord Kamall Excerpts

Monday 21st February 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, at the heart of this Question is almost £500 million of public money, awarded in two public health contracts to Randox Laboratories without competition. My honourable friend asked this Question in the Commons and raised the dissonance in what has been said by the Government over the months since the issue was first raised. I have two questions for the Minister. Does he agree with the former Minister of State for Efficiency and Transformation, the noble Lord, Lord Agnew, that the Government were paying dramatically over the odds for Randox products? If so, can he explain why the Government then entered into a second, more lucrative, contract with the firm? Secondly, the chief operating officer for the Civil Service requested the restoration of competitive tendering by March 2021. Can the Minister set out how many further contracts have been issued after that date without tender and explain why the emergency procurement rules are still in place almost a year later, given that we are coming, as the Prime Minister just told the Commons “out of Covid”?

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

I start by thanking the noble Baroness for those questions. On her first point, we should remember the stage that the Government were at at the beginning of the crisis. People were dying every day and there were panics; they were not sure what was out there. Clearly, they were going out looking for suppliers for testing and other equipment. There were a number of approaches and different meetings, but one thing that has been quite clear is that all contracts were awarded according to the Public Contracts Regulations 2015. I have been reassured about this by officials. Authorities are permitted to procure goods, services and works via direct award, using Regulation 32 of the Public Contracts Regulations 2015, in exceptional circumstances, such as extreme urgency, without competing or advertising the requirement. I contend that the beginning of the Covid crisis was such an emergency, and that is one reason it was awarded without competition. There are clear procedures, we are committed to openness and transparency and details of the contracts are available online.

The decision on whether to procure a product from a supplier ultimately sits with departmental officials once the offer has cleared assurance steps. These include clinical acceptability and financial due diligence. I often get emails from people who have sat next to me somewhere who say, “I have this fantastic product”, but I have to reply to them and say, “I’m very sorry—I will copy officials into this but I can take no further part”.

I shall try to answer on the emergency procurement procedures, but I want to make sure I have the right note. Clearly, there are unforeseeable circumstances such as, for example, the rapid onset of omicron at the end of 2021. That also required UKHSA to act with extreme urgency. We used Regulation 32 in some cases at the end of last year to supply LFTs over the Christmas and new year period due to increased demand. The use of Regulation 32 was necessary because our DPS 2 procurement had reached its limit of extension and there was no time to run additional procurement. I am sure the noble Baroness and others will remember the end of last year, when people just could not get hold of testing equipment and we were trying to buy as much as we could on the world market.

[Baroness Barker (LD)]

My Lords, since the start of 2020, Randox has secured almost £620 million of government contracts and the firm has been shown repeatedly to produce goods which are faulty or do not work. It got those contracts using personal contacts. Will the Minister undertake that there will be an independent investigation of those contracts and recovery of any public money spent on faulty goods?

[Lord Kamall (Con)]

At the time of the award of the original contract in March 2020, almost no UK supply was available and Randox was able to provide an end-to-end testing service. The department then engaged with a number of suppliers in its effort rapidly to build from scratch the largest testing industry in UK history. That has played an important role in stopping the spread of Covid-19 and saving lives. The service that Randox provided was a very important part of that.

A number of Randox home testing kits were recalled in the summer of 2020 after tests found that swabs were not sterilised. A Public Health England investigation did not find any instances of swabs causing ill health. Randox agreed to provide new Covid-19 self-test kits. The contract was necessary to meet the increase in testing needed. An independent assessment in June 2020 had placed Randox ahead of other laboratories, and Randox was meeting its delivery targets by September 2020. Without Randox, we would not have been able to meet the volume of testing needed over the winter period.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I declare an interest in that Randox Laboratories is a major employer in a constituency that I represented for 10 years in the other House. It cannot be challenged that Randox Laboratories has been globally recognised in the diagnostics industry over many years. Therefore, can the Minister place on record the Government’s appreciation for firms such as Randox that rose to the health emergency and exercised their best efforts to achieve our unprecedented national effort?

[Lord Kamall (Con)]

I thank the noble Lord for reminding us of the importance of all the companies that supplied equipment or scaled up at pace or were able to meet the initial requirements. It was a time of panic; thousands were dying, and we did not have equipment. This was a time before the vaccine. The department and its officials tried to speak to as many people as possible around the world to find out what was available, what could be done and what the timescales were. Clearly, as the noble Lord said, Randox played an important role in meeting the testing requirements initially.

[Lord Winston (Lab)]

My Lords, the Minister suggests that the Government were panicking. Does he agree that panic in a laboratory or when one is dealing with tests of this kind is not satisfactory? Is not one of the problems that it is clear that Randox’s methods were not satisfactory and would not stand up to absolutely accurate testing? Is it not the case that the Government still cannot tell us what percentage of its PCR tests were inaccurate or in some ways contaminated?

[Lord Kamall (Con)]

I used the word panic because I think everyone was panicking. People just did not understand what was going on. They did not understand the pace of coronavirus; they did not even understand the disease itself and the transmission of it. I was reading over the weekend a couple of books on the history of the virus so far, where it broke out and what people thought it was originally, and some of the reassessments of historical epidemiology. Clearly, we needed testing performance. Randox was the only company at that time, in March 2020, that was able to provide that capacity at the scale needed. As I said earlier, where we identified problems, we made Randox aware of them and it supplied new kit.

[Lord Robertson of Port Ellen (Lab)]

My Lords, the Government held a full-scale exercise in 2016 based on pandemic flu, Operation Cygnus. Anybody who reads the report of that exercise today can see that there was a looming problem with PPE. Between 2016 and 2020, the Government did nothing about that identified problem, so that, when 2020 came, we domestically produced only 1% of the PPE that was required in the NHS. Why was so little done to be ready for something that had been predicted in advance?

[Lord Kamall (Con)]

The noble Lord makes a point about predicting it in advance, but it is very easy to say that with hindsight. Let us look at a number of different countries and the WHO: some people argue that the WHO and Public Health England had only one job, and they were not prepared for it. Clearly, people were caught unawares; we were not the only country to be caught unawares.

[Lord Robertson of Port Ellen (Lab)]

We did the exercises.

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[Lord Kamall (Con)]

There were countries all around the world which were not prepared. That is why everyone scrambled on to the international market; it is why prices were paid at the time that, with hindsight, would not be paid nowadays. It is important to remember where we were at that stage, what we were trying to get hold of, the world market and our understanding of the virus, and at a time when there was no vaccine.

Covid-19: Lateral Flow Tests

Lord Kamall Excerpts

Thursday 10th February 2022 Lords Chamber

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government how many COVID-19 lateral flow tests are awaiting approval under the Medical Devices (Coronavirus Test Device Approvals (Amendment) Regulations 2021; how many have been approved; and how many that already hold Medicines and Healthcare products Regulatory Agency approval will fall if not re-approved by the extended deadline of 28 February.

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

As of 3 February 2022, 87 lateral flow devices were in the CTDA approval process, and none have been approved—

[A noble Lord]

Speak up.

[Lord Kamall (Con)]

I am sorry, this is a 2.45 am hang- over. Lateral flow devices from 20 CTDA applications are currently included on the temporary protocol. If we interpret the phrase “Medicines and Healthcare products Regulatory Agency approval” as CE marking, we are currently considering proposals to ensure the continued supply and usage of tests beyond 28 February and will announce plans once a decision has been confirmed.

[Baroness Finlay of Llandaff (CB)]

I am grateful for the Minister’s response despite the late hour of last night’s debate. I am concerned that the information I have is that there are still 200 tests waiting, 46 have been assessed and validated at Porton Down, and the process is not well-aligned with the MHRA processes. What is being done to bring those processes back in line? What is being done to bring forward applications from devices that provide a differential diagnosis between Covid and influenza? These are already being used in Europe, but I understand that none are available in the UK because they have been held up in the validation process.

[Lord Kamall (Con)]

I should perhaps start with some background on this and why we have reached the situation we are in. Her Majesty’s Government began the large-scale procurement of Covid-19 test kits at the height of the pandemic. To ensure supplies for the universal testing offer, Porton Down assesses tests offered to Government. It found that three-quarters of those offered failed to meet their stated performance in their instructions for use. For most testing technology, the manufacturer needed only to do self-assessment to meet the CE marking rules, but clearly, when they were tested, they were not meeting those standards. We considered that the current standard was insufficient and did not keep bad tests off the market. That is why we had a public consultation in April that showed strong support for a more rigorous regime. In terms of avoiding a cliff edge, as it were, if they have not been validated, we are looking at solutions.

[Lord Scriven (LD)]

My Lords, reports indicate that the Government are seeking to implement testing only in health care settings and for the most vulnerable people, along with stopping the requirement to self-isolate if a person has Covid-19, in the next two weeks. What evidence from SAGE and NERVTAG do the Government have to show that at present, this is in the best public health interest of the country?

[Lord Kamall (Con)]

I am not aware of any announcements or measures that accord with the noble Lord’s question.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, for some time I have been testing every day and use testing kits that I acquire online and pay for from the same manufacturers that the Government use to distribute free tests. Why are those tests not registerable through the Government website, so that you can get an email confirmation of a negative test? The QR codes are not recognised if you buy tests yourself.

[Lord Kamall (Con)]

I must say to my noble friend that I was not aware of that, and therefore I will have to go back to the department. If he could write to me about that, I will be happy to respond.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the Minister say how many British companies are caught in this and waiting for approval? Can he also say how many billions of pounds we have spent importing these tests from China?

[Lord Kamall (Con)]

I will try my best to answer the questions, but if I do not, I hope the noble Lord will accept a written response. Some 25% of approved devices are from UK manufacturers, but it is important, as a fair and neutral regulator of market access that all applicants are treated equally. The Government are working to review applications for devices submitted by the process. At the same time, while we want to make sure that the British tests are of the highest standard, we are determined to harness the power of the UK’s leading diagnostic industry. We will continue to be enormously engaged with UK manufacturers and trade bodies to support a thriving domestic diagnostic industry.

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

My Lords, I wish the Minister a speedy recovery. He has been working late hours and deserves our total sympathy. I wonder, however, whether he could give us some indication of how much was wasted in preferential procurement of this kind of equipment. How much has all the equipment that is now out of date and has to be destroyed cost? I do not blame him for any of it, because he has relatively recently become a Minister, but will we have some kind of inquiry into preferential procurement and the wastage of all this equipment?

[Lord Kamall (Con)]

It is interesting that an earlier question asked if we are looking at British-based manufacturers. We want to be very careful that there is no preference, it is all based on merit and we have tests that meet all standards. To answer the question about the wider procurement process, there was a Question last week when I gave some detailed answers about the write-down of some of the value. We bought some of that equipment at the height of the market when people were desperately trying to buy equipment all over the world. Ships were being redirected en route when people thought they were receiving goods. That is why we paid the market price at the time.

[Baroness Wheatcroft (CB)]

My Lords, there is still the occasionally ping heard. Can the Minister bring us up to date with how many people are still employed on Test and Trace and what the total cost has been so far?

[Lord Kamall (Con)]

That is a valid question and if the noble Baroness could write to me, I will respond.

[Baroness Merron (Lab)]

My Lords, in addition to the need to improve the approval process for lateral flow tests, when can we expect to see a real plan for living well with Covid? Will this include proper provision for better sick pay, improved testing and those who are clinically vulnerable.

[Lord Kamall (Con)]

Clearly, the noble Baroness raises a number of important considerations for when we come up with a living with Covid strategy. At the moment, we are consulting on it to make sure that we have an appropriate strategy that covers many of the issues she referred to.

[Lord Cormack (Con)]

My Lords, am I right in thinking that my noble friend said that 25% of the testing kits are made in this country? Does it follow from that that the other 75% are made in China, or is there a wider field of manufacture?

[Lord Kamall (Con)]

As far as I am aware, they are from other countries; I do not know the exact figure for China. The suppliers that have been chosen have passed our protocol and meet the requirements of the procurement framework. It is really important that we have a rigorous standard, given that we found that many of the tests did not meet the instructions for use, as they claimed. We want a testing regime that is not only one of the best in the world but also very well trusted, especially if we are looking at using home testing for future diagnostics to identify more diseases and viruses, rather than waiting for people to go into hospital.

[Baroness Featherstone (LD)]

My Lords, given the Prime Minister’s announcement that in a couple of weeks, people will no longer have to isolate, what can the Minister say to those who have been shielding for all this time and who are now terrified that if they go out of their door, they will meet someone who is positive, so they will have to stay at home? Are their lives not as valuable as those of the rest of us?

[Lord Kamall (Con)]

I am sure the noble Baroness will appreciate that you always have to get the right balance. There will be those who do not want to stay at home and who want to return as quickly as possible, and you also have to consider the wider economy. We cannot shut down the whole economy for a small section of people. What we have to do is make sure that they are looked after. I have recently seen a submission about what we are going to do in future with people who are now termed clinically vulnerable and extremely vulnerable, and we will be publishing that in detail. In fact, just recently I approved a letter to the noble Baroness, Lady Brinton.

[Lord Watts (Lab)]

My Lords, will the Government learn the lesson of Covid and look at supply chains and the need to stockpile equipment in the future?

[Lord Kamall (Con)]

I could bore for Britain on supply chains. It was one of the academic subjects that I looked at, globally. As we become more economically efficient and supply chains become more efficient, they become more brittle. We saw how the shops were affected by lockdown and by China, and much of the manufacturing, as part of that supply chain, started in China. Companies across the world have looked at different options. Some have looked at sourcing elsewhere; some have looked at stockpiling; some have looked at reshoring; but all those options add considerable costs to the supply chain. Some have even looked at intermediary solutions, including warehousing in cheaper countries and then bringing the goods in closer. I am very happy to go on at length to the noble Lord at any time, but not now.

Medical Abortion Pills

Lord Kamall Excerpts

Thursday 10th February 2022 Lords Chamber

[Baroness Sugg]

To ask Her Majesty’s Government what plans they have to extend the availability of the home use of pills for early medical abortion.

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

We are carefully considering all evidence submitted to the Government’s public consultation on whether to make permanent the temporary measure allowing for home use of pills for early medical abortion. We will publish our response as soon as possible and before the end of March to give providers sufficient time to plan for whatever the outcome is.

[Baroness Sugg (Con)]

I thank my noble friend the Minister for that Answer. The consultation on this finished 12 months ago and the current regulations expire next month. Abortion providers have made it clear that without telemedicine services, we will face enormous demand pressures resulting in longer waiting times, later abortions and even women having to resort to unsafe abortions. It would be very helpful to understand the delay to a permanent decision and why it cannot be reached when the evidence is so clear.

[Lord Kamall (Con)]

One of the reasons, as my noble friend would acknowledge, is that we had lockdown and then we were let out, and then we had more restrictions. We did not want to announce something and then have to go back on it. All I would say is that it was always intended to be a temporary measure. We have looked at the responses to the consultation in order to reach a decision, and we will be issuing our considerations later.

[Baroness Blackstone (Ind Lab)]

My Lords, I wish to declare my interest as chair of the trustees of the Royal College of Obstetricians and Gynaecologists. Following up on the question from the noble Baroness, Lady Sugg, I find it very strange that the Government are taking so long to make this decision. The temporary service that was provided for early medical abortions comes to an end at the end of next month. The evidence is clear. According to a survey of 50,000 women published in a leading medical journal, telemedical abortion is

“effective, safe, acceptable and improves access to care.”

In these circumstances, what is holding up the Government’s decision? It seems obvious that it would be welcomed by doctors involved in the treatment of such women, and by the women who need this care.

[Lord Kamall (Con)]

As I am sure noble Lords will acknowledge, this is a very sensitive area. Initially, it was meant to be a temporary-only service. If we do decide to respect its temporariness, an extension will probably be made to ensure that the clinics and other medical services have time to adapt before returning to the position before the pandemic.

[Baroness O'Loan (CB)]

My Lords, is the Minister aware of a recent study, based on FOI requests to NHS trusts, which revealed that in 2020 more than 10,000 women who took at least one abortion pill at home, provided by the NHS, needed hospital treatment for side-effects? That is equivalent to more than one in 17 women, or 20 women a day, needing hospital treatment. Does the Minister agree that such reports indicate a serious and disturbing lack of understanding by its advocates of the dangers of the telemedical abortion policy?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for giving the other side of the debate; it shows what a difficult subject this is. Sometimes people dig up the wider debate, but I think we have to be very careful and focus on the issue. This was a service offered to women, and the initial consultation was in person, but we made temporary provision, rightly, during the pandemic to ensure that women were treated with dignity, while appreciating that it had to be done at distance. We have looked at whether this should continue to be temporary or become permanent, and we are still weighing up this difficult decision. I think the debate today shows that there are a number of views, and it is not as simple as either side proposes.

[Baroness Barker (LD)]

My Lords, the telemedical abortion service has been evaluated separately in England, Wales and Scotland and it has proven to be world leading. The US Food and Drug Administration has recently approved telemedical abortion care in America on the basis of the UK studies. Does the Minister agree that women’s access to safe, high-quality abortion care in the UK should be non-negotiable?

--- Later in debate ---

[Lord Kamall (Con)]

I do not think that is in question. There is no doubt that women should have access to abortion services and to the right advice, but as the noble Baroness who spoke earlier indicated, there are some concerns and risks. We have to consider all the factors. Of course, it would be wonderful for some people if it was made easier and was available online; others say you must be prepared for the risks. Whatever happens, if something goes wrong, I am sure that the noble Baroness and others would be back here questioning why we did what we did.

[Lord Winston (Lab)]

My Lords, I declare an interest as a fellow of the Royal College of Obstetricians and Gynaecologists and of the Academy of Medical Sciences. Have the Government considered the evidence from Imperial College London—indeed, from my own laboratory—showing that most human embryos are born with abnormalities which are potentially lethal, and they usually die? They are then aborted by the same process which this Bill causes, only at a later stage of pregnancy. This method of natural abortion, which occurs all the time, is mostly without symptoms to the woman: they do not even know that they have lost an embryo. It is safe and does not cause the medical complications which invariably happen with a late abortion, which a woman is then committed to. What are the Government going to do about this, firmly, to make it avoidable in future?

[Lord Kamall (Con)]

I am grateful to the noble Lord for informing me about that—it is something I have learned today. I will take it back and consider what he has said. To return to the Question, when we made this measure it was clear that it was supposed to be temporary. Will have consulted and will look at the consultation and decide what we will do. If we do go back to what it was like before, we will make sure there is a sufficient period to ensure there is no cliff edge.

[Lord Patel (CB)]

My Lord, to return to the original Question asked by the noble Baroness, Lady Sugg, may I respectfully suggest that the Minister is trying to defend the indefensible? The evidence is quite clear about the safety of the procedure. We can have a debate about alternative views, but the evidence from other countries which routinely use this method of treatment is clear: it is safe and more convenient for women, and it should be implemented immediately. Will he take this back to the Department of Health?

[Lord Kamall (Con)]

I think the noble Lord is being slightly unfair. It is a complicated issue and not as simple as people make out. The noble Baroness said that we should be aware of dangers. These are the issues that we considered during the consultation. Whatever we do, we will be criticised— rightly so—but we want to make sure that when we make a decision it is the right decision.

[Baroness Wheeler (Lab)]

My Lords, RCOG data has shown that complications related to abortion have decreased since the telemedicine for EMA service was introduced. The college has warned that failure to make it permanent could lead to more women accessing an illegal abortion. NICE has recommended the service as best practice, so does not its future urgently need to be secured by making it permanent? It does not have to be temporary.

[Lord Kamall (Con)]

As I said, we are looking at the consultation carefully and considering all views. If we made it permanent, there would be lots of criticism, which we have to be aware of and make sure that we have the answers for. If we continue to expect it to be temporary, there will be plenty of criticism. Whatever we do, we will be damned, but we are going to try our best.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the noble Lord, Lord Patel, talked about convenience of telemedicine for women. The fact is that women from the most disadvantaged backgrounds are three times as likely to need an abortion as those from the wealthiest backgrounds. It is not just an issue of convenience. It is a question of whether childcare is available and affordable; whether someone has a zero-hours contract job and cannot afford to take time off; or whether someone does not have access to public transport. This is very much an equalities issue—that abortion is available to every woman who needs it.

[Lord Kamall (Con)]

I agree with that statement but it is not what the Question is about. The Question is about a temporary measure that was put in place and whether it should be made permanent. It involves the consideration of difficult issues, including ethical issues, and we want to make sure that when we come to a decision, it is justified.

[Baroness Boycott (CB)]

Does the Minister accept that, as this provision is medically supported by all the experts, this decision is a political one that discriminates against women and is not based on sound medical evidence?

[Lord Kamall (Con)]

First, I remind the noble Baroness that we have not made a decision. I completely refute the allegation. It is unfair but I expect that, whatever we do on this issue, people will refer to the wider debate and accusations will fly around. I accept that, but we will concentrate on looking at the data and the consultation and make a decision.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Lord Kamall Excerpts

Thursday 10th February 2022 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 14 December 2021 be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 8 February.

Motion agreed.

Integration White Paper

Lord Kamall Excerpts

Thursday 10th February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice president of the Local Government Association. Both the Statement and the White Paper set out a laudable ambition to integrate health and social care and communities, but I am afraid that we echo the disappointment of the noble Baroness, Lady Thornton, especially at the glaring omission of children, young people and disabled people who need care.

While reading the White Paper, I had a sense of déjà vu, and I dug out my copy of the White Paper Integration and Innovation: Working Together to Improve Health and Social Care for All, which was published on 11 February last year—almost exactly one year ago. The tone and the ambition were remarkably similar. All noble Lords know that the Health and Care Bill we are debating at the moment sets out in part how the Government believe that the White Paper from last year is going to be turned into legislation and changes in practice. The Minister knows the real concerns across the House about that practical implementation, and I do not believe that this new White Paper takes matters further forward.

From these Benches we also ask: where are carers? There is zero mention of carers in the Statement but 13 in the White Paper, two in the index and two as part of headings. The remaining nine in the text relate only to the people carers care for. There is no formal recognition of the role and no mention of support directly for them as carers. It says:

“People will move seamlessly between health and care settings because people and those supporting their health and care, including … unpaid carers, will be able to see and contribute to their care record and care plans.”


Is that the best on offer for carers—that they will actually be able to see the care plans? They can usually see them now, although most, I must confess, are still in paper format.

That was one example; I want to go on now to a couple of other issues. Much of the paper talks about how data will transform care in the future. On page 14 it says:

“A core level of digital capability everywhere will be critical to delivering integrated health and care and enabling transformed models of care.”


Can the Minister say—because the White Paper is absolutely silent on this—whether there will be funding for fast broadband across the country, especially in rural areas, to deliver that capacity to every single home? Without it, this entire system will fail before it even starts.

The White Paper also says that

“the data and information required to support them should be available in one place, enabling safe and proactive decision-making … We will aim to have shared care records for all citizens by 2024 that provide a single, functional health and care record which citizens, caregivers and care teams can all safely access.”

Can the Minister say how citizens’ data will be protected so that only those who need access to it will see it? As the Minister knows, this is another area where there is real concern over the Bill.

The paper talks extensively about leaders but in a generic way. There are muddles over NHS leaders, social care leaders and leaders of ICBs. Is it referring to council leaders or just leaders? I have to say that the organogram on page 37 makes the classic assumption of councils being single-tier metropolitan authorities, ignoring the plethora of two-tier council arrangements as well as other key stakeholders such as housing associations. It talks about

“3-5 local authorities within an Integrated Care System”.

Even at upper-tier authorities, that number is way too small with the shadow boards at the moment, and dwarfed when you add in district councils, which have key roles in delivering support for care. Unless this is hiding a proposal from the Secretary of State for Levelling Up, Housing and Communities, this is another massive reorganisation for local government.

Housing is vital to the aims of the Bill. The paper says:

“People’s homes should allow effective care and support to be delivered regardless of their age, condition or health status.”


But housing is not mentioned in the “Next Steps” section. I ask the Minister whether there will be specific funding to ensure that housing can be improved at a local level for people who will need it for the next stages of their lives.

The Statement and White Paper recognise the importance of the workforce—in theory. The section in the White Paper talks about continuous development and joint roles, some of which is very laudable, but what is actually happening in the Health and Care Bill at the moment, where the Government will not commit to proper planning for the workforce, makes this unattainable too.

Above all, from our Benches, we want to know where the resources are that will enable this transformation to take place. Even before this week’s announcement about the patient backlog, the levy for health and social care was already prioritised for the NHS. Every time we have asked the Minister when the social care sector will get the resources it so desperately needs—and what they will be—we are told that it will happen at some point in the future.

We need to know when social care and councils will get the support they need, particularly councils with extra responsibilities in this White Paper and the Bill. The LGA has said, correctly:

“Adult social care is in a fragile position, with councils struggling to balance their budgets … A long-term funding solution is urgently needed.”


Can the Minister tell the House what, where and when resources from both departments will be announced and made available to at least give this White Paper half a chance to get going?

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

I begin by thanking both noble Baronesses for their questions. I will try to answer them within the time and, if I do not, will write to the noble Baronesses or others. I will go through some of the issues, first on place-based models.

As we discussed on the Health and Care Bill, ICBs operate at a system level. They will be working with place-based organisations, including health and well-being boards. We expect several models of place-based alignment and governance to emerge and we are not going to be prescriptive about a single model. We are clear that, whatever model is adopted, in the coming years all places must be characterised by clarity of leadership and accountability; a strong shared mission across the sectors, informed by local citizens; a commitment to integration manifested in removing unnecessary boundaries between services and strengthening connections to agencies able to influence the wider determinants of health and well-being; a strong culture of improvement; and a linked sense of urgency about the need to deliver more integrated care to improve outcomes, particularly care quality.

By that we mean that we do not start thinking in siloed ways—of hospitals or primary care, with social care over there. All these White Papers are building-blocks to help explain some of the intentions behind the Health and Care Bill. The Bill itself creates a flexible framework based on the real experience of making effective change happen locally. This flexibility is designed for a purpose: the stronger integration of health and care services. The White Paper picks up that ambition by making clear the strong commitment of the Government to this agenda and our ambition to make progress. The White Paper will ensure that we go further and faster on health and care integration with local authorities and the NHS to make the most of the forthcoming legislation. It does not contradict the Health and Care Bill.

I will pick up on accountability. Three things are different. There is a wider recognition of the demographic challenges we now face, which will increase. We cannot manage it as just health any more or, even within health, primary, then secondary and care over there. The pandemic showed us that some of the cultural and governance barriers to change that seemed impossible to shift have moved. We have seen this work in lots of places up and down the country. There are some model ICSs, which many noble Lords have drawn my attention to, and case studies; we want to learn best practice without being overprescriptive. The noble Lord, Lord Mawson, has talked effectively about place-based organisations many times and getting the right mix of skills and people for a particular place. What works in east London will not necessarily work in South Yorkshire. Some of it will, but some of it will not. We will learn from best practice.

We can be confident that the approach to accountability set out in the paper will work, because it draws on real examples that are already in place. If you ask local leaders what accountability means to them, they will be able to tell you who can ultimately hire and fire them. That is one version of accountability. They will also give you a list of the people and bodies to which they are accountable—partner organisations, local democratic institutions, staff, patients and service users, as well as regulators. We want to make sure that all that comes together to address accountability.

We hope to have shared care records for all citizens by 2024 but, as noble Lords will remember from the debate about data last night or early this morning, we have to get that balance right to make sure that people trust that data will not be shared unnecessarily or inappropriately. One of the key challenges for any integration is that it needs data across primary, secondary, social care and other agencies but, at the same time, we have to allow people to opt out. When people opt out, they might have to re-register a number of times. We want to avoid people, particularly vulnerable people, being asked the same question time and again. We hope that integration and people speaking to each other will help across the health and social care sector.

On carers, I was in fact having conversations yesterday on that subject, and I am going to be doing a round table with a number of noble Lords. One of the issues is making sure that we professionalise and give real respect to the caring workforce. One of the reasons why we set up the voluntary register was to understand the landscape of care, the different qualifications and levels, so that we can get a clearer understanding of what qualifications carers need and how we can make sure that works across both health and social care, so that staff can move between health and social care without feeling that one is better than the other.

We want to build on existing reforms. We want to talk to a number of partners—the noble Baroness, Lady Brinton, mentioned housing, for example—and in the adult social care White Paper we looked at ideas about people being treated at home, some of the things that will have to be done at home, whether that is done at system level and how to make sure that partners are working together.

One thing I will say is that the vast majority of care workers are employed by the private sector. The increase the national living wage means that they will benefit from a pay rise, but we have also put in money. Some private providers feel that they are using private profits to subsidise others. We are making sure there is more money to make sure that we get a better quality of service right across. What we really want to do is say, “Tell us where it doesn’t work and where it breaks down” and to make sure that at the place-based level they are able to work together. We will speak to as many stakeholders as possible and we will continue to ask them to inform us.

I will try not to run over time, but I shall talk about the single accountable person. This will be agreed by the local authority and the integrated care board. An increase in long-term conditions and an increase in the number of people being treated for them means that, increasingly, the co-ordination between the range of services looking after them can fall apart; we know that too many people fall between the cracks. That is why we want to have the single accountable person—so that we can make sure that people are no longer falling through the cracks.

I know I have gone on a bit long, so I will allow other questions to come in, but I hope that addresses some of the concerns.

[Baroness Finlay of Llandaff (CB)]

My Lords, before I ask my question, perhaps I might formally apologise to the House for an error I made last night in Committee on the Health and Care Bill in responding to the debate on my Amendment 287 on dispute resolution and children’s palliative care. I had missed email correspondence from Together for Short Lives prior to the debate, in which the organisation had offered to discuss my amendment with me. I hope the House can accept my sincere apologies and regret at my inaccuracy. I have had helpful correspondence with the charity today.

I turn to today’s Statement. In my role as chair of the Mental Capacity Forum, I welcome the mention in item 5.14 of training in mental capacity, because there is a tremendous need for training at every level.

I also welcome the concept of personalised care, but I am concerned that the paper before us just does not go far enough. We need to document what matters to a person, and that needs to be an ongoing dialogue, not a tick-box exercise. If we know what matters to a person, that can inform best-interest decisions if the person loses capacity, and it is important for informal carers and family members to know that beforehand. Personalised care must include emotional care.

I am also concerned that there is nothing here about training the unpaid carers. They do not just need training in physical aspects of care; they need emotional training and training in how to de-escalate their own emotional stress, particularly when dealing with mental health issues in the person that they are caring for. There is nothing here about child carers and how information goes to a school that a child is a carer and may be under tremendous stress—or it may be that I have missed it in the documentation.

I hope the paper will stress the importance of people being listened to, which will inform decisions when deterioration happens. I would welcome the Government’s comment on how they are going to train enough people and instigate training across the board, both in sensitive listening skills and in achieving the high aspirations that I think the paper has attempted to set out.

[Lord Kamall (Con)]

I thank the noble Baroness for her clarification and for notifying me earlier about the issue that she apologised for. One of the issues for us is that we want to make sure that if all the parts of the healthcare and social care systems are talking to each other, and there are accountable people, we hope that people will not fall through the cracks and that there is a multi-agency approach. It will be difficult to be overly prescriptive here, because what would work in one area might not work in another.

The point that the noble Baroness makes about training is critical. In many debates in this House, we have understood that we need to take the social care workforce seriously and give support to unpaid carers of whatever age, whether they are children or family members. Sometimes they are doing it because they do not want their loved ones to go into a home and sometimes they just need a bit of respite. We are looking at a number of issues around carers—first, unpaid carers but, secondly, making sure that being a carer is a rewarding career and is not seen as being at a lower level than, say, a nurse in the health service.

One reason for having a voluntary register, for example, is to understand the landscape and then put in place proper and different educational pathways, and other pathways, into care. Having national qualifications at levels 4, 5 and 6 and so on will show parity of esteem and that this is a worthwhile career. We have the Made with Care campaign to start to encourage more people back. We are looking at a number of different ways to make sure that carers are not just forgotten. If they work in care homes, that is fine, but we want to make sure that there is a real career structure for them, and also that they can move between health and social care, both ways. There may well be nurses or doctors who want to move across. We have to make sure that going from one place to another is not seen as disadvantageous in any way and that the system is truly joined up.

Of course, this is all top level and shows our ambition to integrate. We do not want to be overly prescriptive; decisions have to be made at place level.

[The Lord Bishop of St Albans]

My Lords, I declare my interests as a vice-president of the Local Government Association and president of the Rural Coalition. I want to pick up very briefly on what the noble Baroness, Lady Brinton, said about rural issues. It is disappointing that there are no explicit references to rural health. One of the concerns of the APPG on Rural Health and Social Care parliamentary inquiry was the way in which inappropriate data, metrics and funding formulas can disadvantage rural areas. National programmes are one thing, but when they are delegated to local areas how are we going to ensure that they are properly rural-proofed and will integrate both health and care?

[Lord Kamall (Con)]

It is important to stress once again that the key to this is that we cannot overly prescribe from here in Westminster and Whitehall. We must make sure that at whatever place, whether it is rural or urban, the people and patients who are cared for in the system are being understood. One reason why we want one person to be accountable, whether in urban or rural areas, is the fact that they must take responsibility for ensuring that all these things are joined up—not only health and social care as we understand them but technology, housing and all those other issues. I know that the right reverend Prelate and my noble friend Lady McIntosh have often raised this issue. We think that the proposal is flexible enough, whether in an urban or a rural area, to make sure that one person really understands the local area of integration.

[Lord Lansley (Con)]

My Lords, paragraph 1.11 of the White Paper states:

“Our focus in this document is at place level.”


Paragraph 3.11 goes on to state:

“Success will depend on making rapid progress towards clarity of governance and clarity of scope in place-based arrangements.”


As far as I can see, the Government are proposing that by spring next year such place-based arrangements will be put in place across the country, with a single accountable person to whom my noble friend referred. There is no reference at all to place-based arrangements in the Health and Care Bill. For years, the NHS has been saying, “We are creating integrated care systems but they don’t have statutory cover, so we want legislation that reflects our way of working”. The Government are now proposing legislation that creates a way of working with no legislative cover. I am afraid that this will not work unless the Bill changes to reflect place-based arrangements and a single accountable person, and defines adequately who they are, what their powers are and how their accountability works.

[Lord Kamall (Con)]

I thank my noble friend for that helpful intervention.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

I respect my noble friend for his willingness to pass on the benefit of his many years of advice to me.

We do not want to get overly prescriptive. We have talked about health and well-being boards and I know that my noble friend has talked about their importance. In the papers I laid in the Library the other day, where we looked at integrated care boards and integrated care partnerships it was quite clear that, in some places where the health and well-being boards may well completely overlap with the ICPs in a smaller area, that will continue to be the place-based level. Where there is a larger system, we expect the integrated care board and integrated care partnership to work with the local place-based organisations underneath them at a more local level. That is what we have been saying all the way through. We want to make use of existing fora. In some places they will overlap and may well end up as the same thing. We will update the health and well-being board guidance in due course to reflect the implications of policies set out in the White Paper and what comes out of the Health and Care Bill when it passes.

[Baroness Donaghy (Lab)]

My Lords, mine is a simple question. We have two separate pieces of legislation on the same area. How does the Minister guarantee that we will not end up with two contradictory systems?

[Lord Kamall (Con)]

The only legislation I am aware of is the Health and Care Bill; this White Paper complements that, just as the adult social White Paper does. This is not legislation.

[Lord Mawson (CB)]

My Lords, I welcome the White Paper and the direction of travel. I thank the Minister and his colleagues for being willing to listen to me and colleagues in the NHS who are involved in actual practical pieces of innovation in this space. It is good to see real examples of the implications for real people in this White Paper. There is also lots of focus on practical and detailed changes—for example, streamlining training and qualifications and shared outcomes. I wonder whether sufficient attention is paid to the social determinants of health and getting upstream with regard to prevention. Is there still too much assumption that the state is doing all the work? The private and voluntary sectors are the major delivers of care. Does the model of partnership proposed fully reflect this? The Minister might like to reflect on that.

Finally, as always, the devil is in the detail and will be all about implementation. One of the ways of achieving this focus is, as I have said before, through establishing innovation platforms that embody the ideas of not only the White Paper but the Health and Care Bill, levelling up and many other current initiatives. Innovation platforms can start to bring together some of these initiatives. It is our experience on the ground that a lot of the public sector systems and processes are not in place and are not fit for purpose. There needs to be innovation in this space. The problem could be an opportunity if we start to join some of this up. How do the Government intend to join up these various initiatives?

[Lord Kamall (Con)]

In many ways, the answer is not what the Government intend to do but what happens at the place-based level. As the noble Lord has reminded me on a number of occasions, some of the projects that he has been involved in and other social enterprises have been really good at bringing people together. Sometimes it has been led by local councils; sometimes it has been led by social enterprises; sometimes it has been led by networks. I completely understand the premise of the question and agree that it has to be a partnership. It is not just a state, but social enterprises, co-operatives, local movements and local civil society all working together with common aims. Go to any part of this country and you will see a number of these people working together. We have to make sure that there is no overlapping or duplication. This is the real aim of what we are trying to get, making sure that people talk about health and social care but well-being as well.

[Lord Davies of Brixton (Lab)]

My Lords, the one thing I admire about the document is the way in which the meaningless term “levelling up” has been shoehorned into the text. I want to raise the bundle of issues which have been grouped under the heading of parity of esteem between physical and mental health. It is not an issue we need just to have in the back of our minds; it needs always to be front and centre in the development of policy. More could be covered than is in the White Paper. One of the examples given in the White Paper is of Mandeep. It is well chosen. It is a case of someone with mental health problems and diabetes where there is a success to point to: where joined-up working has reduced the differential in suffering from diabetes experienced by people with and without mental health problems. That is a good example of what can be achieved. I hope that parity of esteem will be central in what the Minister is doing.

[Lord Kamall (Con)]

I thank the noble Lord for raising the issue of mental health and parity of esteem, not only here but in our debates on the Health and Care Bill, and for our continuing conversations. We hope that we will be able to find a solution to make sure that mental health has parity of esteem. In previous Bills, health has meant physical and mental health, but I recognise the mood of the House when noble Lords ask for it to be stated explicitly somewhere, even in the triple aim. We are looking at solutions for that. He is absolutely right that it is not just about physical health; it is about mental health, about well-being, about tackling inequalities and about disparities. However, we cannot do that from here. We have to make sure that the place-based organisations, working in partnership with integrated care systems, really understand what is happening locally and are best placed to do that.

[Baroness Jolly (LD)]

My Lords, I welcome the White Paper. How will adults with a learning disability and their carers see a difference in their care and support as a result of it?

[Lord Kamall (Con)]

That is a really important issue. A single point of responsibility will make sure that these things do not fall between the cracks. It ensures that physical health, mental health and well-being all come together. A number of noble Lords have spoken about social prescribing, for example, and where that has been tried and where it might not work in other places. It is important that by talking about integration we get people thinking about integration at the place-based and the system level, but also that we can learn from good examples of what works elsewhere. That is what we hope to see. Sometimes, you just have to put in on the tin and say, “Think in an integrated way.”

Covid-19: Lockdowns

Lord Kamall Excerpts

Wednesday 9th February 2022 Lords Chamber

[Lord Robathan]

To ask Her Majesty’s Government what assessment they have made of the paper A Literature Review and Meta-Analysis of the Effects of Lockdowns on COVID-19 Mortality, published in January; and in particular, the conclusions that (1) lockdown measures during the pandemic reduced COVID-19 mortality by 0.2 per cent on average, and (2) the public health benefits of such measures were outweighed by their economic and social costs.

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

The paper has yet to be peer-reviewed and there are important methodological issues that we would expect the reviewers to address. For example, the figure of 0.2% reduction in Covid-19 mortality from lockdown comes mainly from one of the 34 studies reviewed, while other studies report a reduction in mortality of up to 35%. To examine the trade-off between the public health benefits of lockdown and the economic and social costs requires a wider examination of the evidence.

[Lord Robathan (Con)]

My Lords, I am grateful to my noble friend for that reasoned Answer. I have absolutely no idea whether these conclusions are correct, but does my noble friend think that the formulation of government medical policy should be influenced by a wider range of scientific advice, such as that from the authors of this paper, rather than by the narrow focus of SAGE? This is epitomised by the discredited Neil Ferguson. Is he an ex-member? I cannot quite remember. He is still dragged out by the BBC to spread inaccurate gloom and doom. Can my noble friend also confirm that the Chief Medical Officer, at the Cabinet meeting on 8 December, predicted that without further lockdown by new year London would be like Lombardy was in March 2020?

--- Later in debate ---

[Lord Kamall (Con)]

Before I answer any further questions, I should draw Members’ attention to my registered interests and more specifically to the fact that, when I was the academic research director of a think tank, I invited one of the authors of the paper to speak at an academic webinar. In fact, he did not speak on this issue; he spoke on Lebanese currency—quite different issues, as noble Lords can imagine.

I say in response to my noble friend that what is important is that we look not only at the epidemiological evidence and the medical evidence but, in considering government policy, at the wider range of social, economic and other factors. For example, even within clinical decisions, there were some asking for lockdown in order to prevent hospitals from being overwhelmed, but that was counterbalanced by mental health experts who were very concerned about the impact on mental health. As my noble friend will know, there are also trade-offs with the economy and other issues.

[Lord Patel (CB)]

Would the Minister agree that smoking causes cancer, that the earth is round and that, in a pandemic caused by a respiratory virus, asking people to stay at home at the height of the pandemic reduces transmission of infection? Furthermore, would he agree that meta-analysis is the right way to look at randomised control trials and how they perform but not the ideal method to look at observational studies, as referred to in the Question?

[Lord Kamall (Con)]

The noble Lord makes important points. If we look at the history of the debate about the world being round, at one time scientists believed that the world was flat. Because of scepticism and contestability in science, we have been able to come to the conclusion that the world is round. That shows the importance of science being contestable and of having an open debate.

[Lord Rooker (Lab)]

On the issue of Covid and mortality, does the Minister have a view about the allegations made in the BBC2 documentary last night that there were hundreds of thousands of excess deaths because of the business and political attacks on the AstraZeneca vaccine in the early days? The fact is that its non-profit system did not suit the drug industry’s business plan. The massive allegation that, because of this failure, hundreds of thousands of extra people died, clearly ought to be investigated.

[Lord Kamall (Con)]

I apologise to the noble Lord. I did not see the programme last night. I was swatting up for the Health and Social Care Bill debate today and for this Question. The noble Lord refers to an important point. We should not forget not only the contribution that the research community made towards those vaccines, but also that AstraZeneca was prepared to supply, commercialise and distribute them on a not-for-profit basis. Sadly, it was attacked for doing so, not just for commercial reasons, but also by other countries that engaged in vaccine nationalism and disparaged the efficacy of the vaccine. Unfortunately, people in other countries have lost out. I hope that we do not see this in future.

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[Baroness Brinton (LD) [V]]

My Lords, this paper’s economist authors admit that it reflects their opinions. Extraordinarily, they chose to exclude the most recognised epidemiological research on excess deaths. It is not even peer-reviewed. The conclusions are contradictory to the established annual excess death protocols, published for years by the ONS and other national statistical agencies around the world. Which data should scientists advising the Government and Ministers rely on when making decisions about lockdown?

[Lord Kamall (Con)]

The noble Baroness makes some important points about the meta-analysis in the paper. Undue attention has been given to one paper out of 34 studies. While I am answering the noble Baroness, I will refer to an earlier question. In academia there is a huge debate about meta-analysis in all sorts of fields. The question is what other research should be analysed with meta-analysis. This continues to be an issue of debate among academics in many disciplines.

[Baroness Wheeler (Lab)]

My Lords, I want to follow on from what the noble Lord, Lord Patel, said. The World Health Organization’s authoritative and in-depth research shows the effectiveness of large-scale social distancing measures and movement restrictions—ie lockdown—in slowing down Covid-19 transmissions because they limit contacts between people. Is it not far better to work on the basis of this evidence, as well as our own much-respected evidence from the CMO and his team, rather than a non-peer-reviewed paper from an American think tank?

[Lord Kamall (Con)]

Once again, the noble Baroness makes the point that this paper has not been peer-reviewed. That is an important consideration. The Government were quite clear that they introduced measures including lockdown—in the face of some opposition, but with the support of the Benches opposite—because, on the balance of epidemiological and other evidence, it was important to prevent and reduce the risk of transmission of the disease.

[Baroness Foster of Oxton (Con)]

My Lords, many decisions taken during this pandemic led to unintended consequences across the board. Apart from the devastating economic impact on business and industry, the children of the United Kingdom were most badly affected. Mental health problems escalated, particularly due to lockdowns. I hope that I never live to see another lockdown in this country. Can the Minister tell the House exactly what the NHS is doing to address this particular issue?

[Lord Kamall (Con)]

My noble friend raises an important issue about the trade-offs that had to be considered when the Government announced the lockdown and plan A measures. They also announced measures to restrict the transmission of the disease. Costs and benefits had to be weighed up. It was often a nuanced decision. We are clear about the backlog in tackling mental health issues. In debates on the Health and Social Care Bill, many noble Lords across the House have expressed the importance of tackling mental health issues in this country. We hope to put that at the forefront of future health policy.

[Lord Scriven (LD)]

My Lords, all papers with modelled counterfactuals are excluded from the report mentioned in the noble Lord’s Question. As this is the most common method used in infectious disease assessments, does the Minister agree that this has the practical effect of excluding most epidemiological research from the review?

[Lord Kamall (Con)]

Had I still been in academia and was asked to referee this paper for a journal, I would have pointed out a number of issues, including the focus and bias on one particular study, for example, and the studies that were excluded without justifying why.

[Lord Davies of Brixton (Lab)]

My Lords, I understand that the rules on replying to Questions mean that there is not enough time for the Minister to explain everything which is wrong with this particular paper. Does he agree that it would be useful to draw your Lordships’ attention to the work of the Science Media Centre, which has provided a comprehensive explanation of its deficiencies?

[Lord Kamall (Con)]

If the noble Lord would like to write to me with details of that paper, I would be happy to share it with other noble Lords.

[Lord Farmer (Con)]

My Lords, 54 health professionals have urged the Commons Public Administration Committee to conduct an inquiry into government use of covert psychological strategies, particularly in Covid messaging, which raise significant ethical issues, including the need to obtain consent. What is the Government’s response to growing evidence of fear inflation and social division due to the equating of compliance with virtue and use of peer pressure to ensure conformity with lockdown and other Covid restrictions?

[Lord Kamall (Con)]

I thank my noble friend for giving me advance warning of his question. The British Psychological Society’s ethics committee has been approached on this topic and has provided a response that has been published in online articles by the authors of the recent letter. Overall, the BPS concludes that it believes that the contribution of psychologists in response to the pandemic was entirely consistent with the BPS code of ethics and conduct, demonstrating social responsibility and the competent and responsible employment of psychological experience.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

Relevant documents: 15th, 16th and 19th Reports from the Delegated Powers Committee, 9th Report from the Constitution Committee

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

My Lords, I should like to update the House on a matter that has generated significant concern. I have noted the strength of feeling in the House on the issue of, and draft guidance on, elected councillors being appointed to integrated care boards. I discussed this matter with NHS England and can confirm that it will revise its draft guidance to remove the proposed blanket exclusion of local authority members sitting on integrated care boards. I am informed that, although ICB members from local authorities are normally likely to be officials, local councillors will not be disqualified for selection and appointment to an integrated care board.

I welcome this development and hope that it demonstrates that the department and NHS England are actively listening and responding to scrutiny and debate in this House. I have also informed the noble Baroness, Lady Thornton, and asked for a meeting between the Labour Front Bench and NHS England on its preparations.

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

I thank the noble Lord for that information. Before we continue with the Committee on the Bill, I wanted to raise my concerns on the Floor of the House as to the importance of always treating each other with respect and courtesy. It is not the fault of anyone in this House that despite a majority of 80 in the other place, the Government have taken longer than expected to present several Bills to this House for our consideration. Although backed by the other place—I fully accept that—the Bills are very controversial in nature and quite properly attract considerable attention.

On a few occasions when considering the Nationality and Borders Bill last night and into the early hours of the morning, our standards slipped. We have another long day ahead of us today and another tomorrow before we all have a well-deserved break in the Recess. I hope that Members on all sides of the House, no matter what position they hold, will respect and pay proper attention to the advice and guidance as set out in the Companion. Committee is a conversation, different from both Question Time and Report. Shouting “question, question, question” from a sedentary position is unacceptable in Committee. Chapter 4 on the conduct of the House and Chapter 8 on Public Bills in the Companion are helpful and informative. I respectfully suggest that all Members regard it as essential reading.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, very briefly, we welcome the Government’s proposals on mandatory disclosure of payments, a companion piece to the previous debate that we had, as has been pointed out.

As noble Lords have always stressed, greater transparency is highly desirable and a very good thing. I am grateful to the Minister for listening to the voices of stakeholders and parliamentarians on this. Indeed, nine out of 10 medical professional bodies think that patients have a right to know if their doctor has financial or other links with pharmaceutical or medical device companies and they support stronger reporting arrangements, as contained in the amendments. I am grateful for the briefing I have received from the ABPI, which, as we have heard, also supports mandatory disclosure.

I also note that Amendment 312D refers specifically to the consultation with the devolved Administrations in Scotland, Wales and Northern Ireland and to obtaining the

“consent of the Scottish Ministers, the Welsh Ministers or the Department of Health in Northern Ireland … before making provision within devolved legislative competence in regulations relating to information about payments etc to persons in the health care sector.”

We would welcome the Minister reassuring us that full consultation is under way and setting out the timescales involved.

On Amendment 284, the non-government amendment leading this group, the intention of the amendment and the arguments put forward by noble Lords are extremely persuasive. The requirement for companies involved in the production, buying or selling of pharmaceutical products or medical devices to publish any payments made to teaching hospitals, research institutions or individual clinicians is a sensible measure that would complement the Government’s package, and I await the Minister’s thoughts on it, including on the one glitch underlined by the noble Baroness, Lady Cumberlege, on moving from “may” to “shall”.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords who took part in this debate, especially my noble friend Lady Cumberlege for her work on the independent review of medicines and medical devices, and other noble Lords who were involved in that. I know that she worked tirelessly to make sure that patients and their families have been heard and I pay tribute to her and her team. I also thank her for her lobbying—or reminding—me of the pledge that I made when I first became a Minister on championing the patient.

I welcome my noble friend’s amendment to increase transparency and promote public confidence in the healthcare system. The Government fully support the intention behind the amendment. That is why I will be moving Amendments 312B, 312C, 312D, 313B, 313C and 314ZB in my name. Before I do so, let me answer some of the questions.

All these amendments relate to the transparency of payments made to the healthcare sector. The Independent Medicines and Medical Devices Safety Review led by my noble friend Lady Cumberlege listened to the brave testimony of over 700 people to understand where improvements needed to be made to make the healthcare system safer for all patients, especially women. The Government have given the review deep consideration and accepted the majority of its nine strategic recommendations and 50 actions for improvement.

To improve transparency, the review recommended that

“there should be mandatory reporting for pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians”.

The amendments deliver on this recommendation by enabling the Secretary of State to make regulations requiring companies to publish or report information about their payments to the healthcare sector. The clause covers any person performing healthcare as part of their duties, benefiting patients and building on initiatives by regulators and industry. I hope that partly answers the questions raised by the noble Lord, Lord Stevens.

The amendment also allows for the Secretary of State to make regulations requiring that the information be made public and make further provision about when and how the information must be published. This could include requiring self-publication or publication in a central database. That ensures that we can adapt the system to improve reporting as necessary. To ensure that companies fulfil the obligation, requirements introduced by the regulations can be enforced using civil penalties.

There are benefits to this duty applying UK-wide, aligning with the approach taken by the pharmaceutical industry with its Disclosure UK system. As the noble Baroness, Lady Wheeler, referred to, the clause contains a statutory consent requirement, so we will work closely with the devolved Governments to develop regulations following the passage of the Bill. We will also work with patients, industry and healthcare providers to create a system that enhances patient confidence while maintaining a collaborative, world-leading UK life sciences sector.

A question was raised about the issue of “shall” versus “may”. The Government have not tabled these amendments in bad faith; we would not have tabled these amendments if we did not intend to work with them. It is the intention of my right honourable friend the Secretary of State to bring forward regulations under the clause to make sure that there is transparency. If that is not reassuring enough, perhaps between this stage and Report there can be some conversations to make sure that noble Lords are assured. It is for these reasons that I ask your Lordships’ Committee to support these amendments.

[Lord Patel (CB)]

Can the Minister confirm what he just said: that it is the intention to bring regulations? How strong is that intention? The “may” creates a problem.

[Baroness Bennett of Manor Castle (GP)]

My Lords, can I add a question about timeframes to that? When can we expect the regulations?

[Lord Kamall (Con)]

I have two points to make to the noble Lord. First, I have been advised that this is standard wording. Secondly, I have made the assurance at the Dispatch Box. It is here; it is on public record that the Government intend to bring forward regulations. On the timeframe, I will either write to noble Lords or arrange a follow-up meeting. I will make sure that there is some communication to bridge that gap.

[Baroness Cumberlege (Con)]

My Lords, I thank everybody who has taken part in this debate, particularly my noble friend the Minister for the work he and his officials have done to bring this into the Government’s remit. That is so important, because I learned through the passage of the Medicines and Medical Devices Act that we could incorporate the patient safety commissioner and some of the other things we wanted to achieve only through government amendments. My heart leaped when I saw these amendments and I thank the Minister.

I still think these amendments could be improved and it is important that we get the word “shall” in, or “might” or whatever others have said, rather than “may”. I was looking at the Oxford English Dictionary. My father-in-law was the publisher to the Oxford University Press, so the dictionary is very close to my heart. The dictionary says that the verb “shall” relates to the right or sensible thing to do, whereas the verb “may” is defined as a possibility.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I thank my noble friend Lady Chakrabarti for raising the crucial matter of countries and peoples left behind in terms of the opportunity to have a necessary vaccination programme available to them. My noble friend Lord Campbell-Savours spoke of the importance of supporting innovation, which is one of the ways in which we can ensure that, while my noble friend Lord Howarth rightly said that the subject requires exploration outside of the Health and Care Bill—something also commented on by the noble Lord, Lord Crisp, who emphasised, as do I, the need for the political will to make progress.

There is no doubt, as we have heard today, about the gravity of the issues at stake and the need to resolve them. It is the case that where public funding is provided there must be conditionality, although of course that may be complex to refine into legislation. There are of course additional issues when funding is also coming from the private sector along with a need to ensure a balance of interests. It would certainly be helpful to have a stipulation that avoided placing undue bureaucracy and restraint on smaller developments and small-scale research. We do not want to see the pace of research slowed down with researchers tied up in lengthy proposal writing, contract negotiations and legal agreements.

As my noble friend Lady Lawrence has said, we know that the pandemic is not over until it is over everywhere, so the amendment raises the opportunity to explore whether the immediate waiver of intellectual property rights would mean an end to the pandemic everywhere. It is relevant to assess what contribution or otherwise intellectual property rights make to the promotion of technological innovation and the transfer and dissemination of technology. There is an advantage for producers and users of technological knowledge and the consideration of rights and obligations, and that needs to be considered in the round.

In respect of the response and actions to a pandemic declared by the World Health Organization, while I understand the intention behind the amendment, in order to be consistent I would comment with some caution about the Secretary of State being compelled to immediately take actions, particularly without any form of oversight—something that we will return to later in Committee.

However, I hope that today we can obtain some reassurances from the Minister about the Government’s intentions and plans in order that we can find a way forward so that low-income countries and their peoples have access to vaccines both now and in future.

[Lord Kamall (Con)]

I thank the noble Baroness, Lady Chakrabarti, for bringing this debate before the Committee today and for the heartfelt speech that she gave. The noble Baroness will be aware of the view of this Government following her recent Question in the House on the subject of patient waivers. As my noble friend Lord Grimstone set out, the Government remain open to all initiatives that would have a demonstrably positive impact on vaccine production and distribution. However, we believe that waiving intellectual property rights would have the opposite effect. Doing so would dismantle the very framework that helped to develop and produce Covid-19 vaccines at the pace and scale now seen. It would risk undermining the continued innovation in vaccines and technological health products that is required to tackle a virus, especially as it mutates and evolves, so we believe that doing so would be a mistake.

Instead, the success of the Covid-19 vaccine rollout vindicates the value of public and private co-operation. While university research departments are great at research, large-scale manufacturing and global distribution are not their function, so we recognise the importance of their working with partners with expertise in this area.

The intellectual property framework is key to those efforts. It has incentivised the research and development that has led to the development of Covid-19 vaccines. It has given innovators the confidence to form more than 300 partnerships, an unprecedented number, and has contributed to the production and dissemination of vaccines and other health products and technologies across the world, with global Covid vaccine production now at nearly 1.5 billion doses per month.

I share the noble Baroness’s intention that research funded through taxpayer finances should benefit the taxpayer, but we do not consider that that is best achieved through particular constraints in primary legislation. Research contracts afford greater flexibility and more powerful levers than the amendment, through provisions such as those requiring the dissemination of intellectual property for patient benefit, revenue sharing with the Government of commercialised intellectual property, and requirements around access to medicines in the developing world. Contractual protection mechanisms in funding arrangements can also ensure that intellectual property funded by taxpayers results in the creation of taxpayer benefit.

[The remainder of today’s proceedings will be published tomorrow.]

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Lord Kamall Excerpts

Tuesday 8th February 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, this statutory instrument will amend the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The 2014 regulations are currently due to expire after 31 March this year, and this statutory instrument will amend the expiry date to 31 March 2025. This is the only change this statutory instrument makes; it does not change any existing policy. The 2014 regulations set out the activities that are regulated by the Care Quality Commission and the fundamental standards that all CQC-registered providers need to comply with. These activities and standards will not be amended by this instrument.

The extension of the 2014 regulations to 31 March 2025 will ensure that the current regulations relating to CQC-registered providers, including which activities are regulated by the CQC, will continue to apply. There will be no change to how the CQC carries out its regulatory functions. The Government see the CQC’s role as critical in ensuring that the care received by patients is of high quality and delivered to standards that promote patient safety.

I should highlight that if we do not extend the expiry date, the 2014 regulations will automatically expire and there will be no regulated activities for the CQC to regulate, so providers who are currently required to register with the CQC will no longer be required to do so. Providers that are currently required to register with the CQC will also no longer be required to comply with the fundamental standards set out in the 2014 regulations, which help to ensure that services are carried out safely and to a high quality. The impact of not extending the regulations would be a risk to patient safety, as it would compromise the CQC’s ability to monitor providers against those fundamental standards.

In short, this SI will amend the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by extending the expiry date by a further three years to 31 March 2025. This means that health and care providers in England that carry out any of the regulated activities set out in the 2014 regulations will continue to be required to register with the CQC and will be bound by the obligations and standards set out in the 2014 regulations. This will help to ensure that patients continue to receive safe and good-quality care.

[The Deputy Chairman of Committees (Baroness Healy of Primrose Hill) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for introducing this SI on Care Quality Commission registration, somewhat at the 11th hour before the current 2014 regulations run out on 31 March 2022. Of course, we fully support their extension beyond that date so that all providers of health and social care in England will continue to be required to register with the commission and to comply with the high patient safety and care quality standards it sets.

The SI is very brief and to the point, with the proposed extension to 31 March 2025 the only amendment to the 2014 regulations, and the activities regulated by the CQC and the fundamental standards with which all CQC-registered providers must comply all unamended and unchanged.

Like the noble Baroness, Lady Brinton, I fully understand the impact of the pandemic on the CQC’s capacity to undertake the full range of its work, but the Minister needs to explain why the extension of the regulations is for another three years, to 31 March 2025. Why so long? The Explanatory Memorandum says the extension is to

“allow the Government to review the 2014 Regulations to determine”

whether the scope of its current regulated activities

“is still proportionate to ensure that regulated activities are delivered safely to a high standard.”

The CQC’s role as regulator and the fundamental standards that it sets to ensure high-quality care are crucial. According to the Minister proposing the SI in the Commons on 26 January, time is needed

“to reform and consider the regulations more fully”.—[Official Report, Commons, 26/1/22; col. 8.]

This is a major review being undertaken by government, and we need to know much more about its extent and purpose. Why are three more years necessary to undertake this review? Can the Minister explain why, given its vital importance, the review cannot be undertaken in a shorter timeframe? What are the timescale, scope and terms of reference of the review? How are all stakeholders, including providers and patient organisations, to be consulted and involved?

As the Minister knows, under the Health and Care Bill currently in your Lordships’ House, the CQC is to take on the not inconsiderable additional duties of reviewing and assessing ICBs and the performance of local authorities in the delivery of adult social care. To what extent will consideration of the impact of this extended role be included in the review, including the significant additional resources that the CQC will need to undertake these new areas of responsibility?

We are less than two months away from when the current regulations expire, and we fully recognise the urgent necessity of this SI to ensure that the CQC’s vital role and that work will continue. I also look forward to the update that the noble Lord will provide on the questions raised by the noble Baroness, Lady Brinton, about care homes and last week’s decision on the mandatory vaccination of staff.

[Lord Kamall (Con)]

My Lords, I thank both noble Baronesses for their questions and I must say how grateful I am that we were able to find a way for the noble Baroness, Lady Brinton, to join us after a technical fault. I turn now to the questions asked and, if I do not have the answers, I will commit to writing to the noble Baronesses.

The noble Baroness, Lady Brinton, asked why it had taken time to lay these amending regulations to extend the date of expiry of the regulations. They came into force in 2014 and a further amendment was made in 2015 to include an expiry date for them. Once it was identified that the 2014 regulations needed to be amended to extend the expiry date, the department took the appropriate action to make the necessary change. However, to make that change there was a long lead-in time, involving a consultation process and securing parliamentary dates to debate the amendment. The department is aware that, since the 2014 regulations came into force, there have been a number of changes in the health and care sector, and any wider review will be subject to a public consultation.

The noble Baroness, Lady Brinton, also asked about vaccination as a condition of deployment policy in adult social care settings. Let me turn, first, to her specific question. After the debate the other day, the noble Lord, Lord Scriven, told me that he needed to clarify a question he asked of me. He very kindly emailed me, clarifying that what he had said in the Chamber was not necessarily absolutely correct, and I sent his email on to my officials. I am sorry, I had not realised that a response had not been given. All I can do is apologise, go back to the department and make sure that we get an answer to him as soon as possible. That is why, to be perfectly frank, I am not in a good position here, because I really did think that this had been dealt with, and I apologise for that.

The noble Baroness, Lady Wheeler, asked several questions about the department’s intention to carry out a post-implementation review of the 2014 regulations. The department intends to carry out such a review and is currently working with the CQC to develop the review questionnaire, which will be shared with health and social care providers. The department is in the early stages of undertaking work to carry out the review, and we have already started working with the CQC. Once we have the responses to the questionnaire, we will publish a post-implementation report setting out the department’s findings.

The noble Baroness, Lady Brinton, also asked about VCOD. One of things we should stress—I know all noble Lords agree on this—is that patient safety is key. We always put the safety of vulnerable people first. I am very grateful to noble Lords for their support for the VCOD policy.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his response. Specifically on the review into the CQC’s work, I did ask for the terms of reference. I know there is going to be a consultation and a questionnaire, et cetera, and I would like to know what the terms of reference are: the timeframes and the scope of the review, and how stakeholders will be involved—I hope it will be not just by a questionnaire.

[Lord Kamall (Con)]

The noble Baroness asks a very reasonable question. I think what I will have to do is look at Hansard and respond to her detailed questions, and also share a copy with the Library, because I do not have the detailed answers with me today.

Motion agreed.