NHS: Respiratory Syncytial Virus Infections

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

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

My Lords, I thank the noble Baroness, Lady Ritchie, for raising this subject, not only today but a number of times via an OPQ and a number of Written Questions that I have received. The work she has done to raise awareness adds to the overall awareness, but it is really important that this forces the Government to respond and raise even more awareness.

I also thank the noble Baroness, Lady Ritchie, for sharing a very personal story, and the noble Baroness, Lady Brinton, for sharing her family’s story. Sharing these stories sometimes makes you realise that this is not about just words on a page; it really is about how it affects people’s lives on a day-to-day basis, which makes it real for us in seeking to understand it.

Before I answer all the detailed questions, perhaps I should begin by laying out the Government’s current understanding of RSV. The noble Baroness, Lady Ritchie, has already laid out some of the facts. We know that RSV is a common respiratory virus that usually causes mild, cold-like symptoms. It is widespread in humans, partly due to the lack of long-term immunity after infection. We know that children of under five are the most impacted by RSV. They are at risk of paediatric critical care admission, often linked to bronchiolitis. As has been said, every winter the NHS faces pressure from the increased prevalence of seasonal respiratory viruses. This includes Covid-19 and flu, where the rollout of our immunisation programme is critical in protecting individuals and lessening the burden on the system, but it also includes RSV.

In 2021, in response to the scenarios provided by the UK Health Security Agency, there was a cross-health system response to prepare for a more severe RSV epidemic—starting as early as mid-August—due to the almost complete suppression of the virus after measures were put in place to protect the public from Covid-19. As a result of increased disease activity in September 2021, NHS England and Improvement has estimated that the total cost of paediatric hospitalisations due to RSV was 24% higher in 2021-22 compared to 2019-20. The total estimated cost of paediatric hospital care due to RSV, based on the 2022-23 national tariff, was almost £20 million—£19.9 million in 2021-22.

Typically, the RSV season runs from October to February, with a peak in December. However, one recent complication arising is that, due to measures put in place for the Covid lockdowns, in some ways we now see an unseasonal activity of RSV. The NHS released an estimated £22 million centrally to support the paediatric respiratory surge response. This is focused on a number of issues: first, increasing the resilience of the paediatric transport services and, secondly, bringing forward the annual Palivizumab immunisation programme for at-risk infants from October to July. The cohort of at-risk infants eligible for immunisations was expanded and the doses administered increased in number from five to seven, to ensure protection for the duration of the longer-than-usual RSV season. Thirdly, we also allocated additional funding for the voluntary, community and social enterprise sector. This supported families but was also about that important question of raising awareness in our local communities, as noble Lords referred to, and how to manage respiratory infections.

In addition, the system procured 4,000 specialist paediatric pulse oximeters to be distributed to GP practices to support primary care to help assess sick children. Finally, there has been a development of an online platform and digital skills passport. This has provided additional training to the paediatric and adult workforce to raise awareness, among the workforce and wider. It is important to note that the costs I have mentioned do not consider the cost of urgent care, NHS 111 or primary care presentations due to RSV. But it is clear that Covid-19 and RSV did have an impact on the system, for example the increased requirement for PPE which increased the NHS’s day-to-day running costs, making the delivery of frontline services more expensive.

Having laid that out, allow me to try to respond to some of the points made by noble Lords. One question raised was how the department will ensure that infants receive the right treatment without increasing antibiotic resistance. This is really important. One part of my job is that I do international health diplomacy for the DHSC. This is an issue—particularly AMR—that some people call the coming silent pandemic. How do we make sure we reduce our reliance on antibiotics, not only for humans but for animals and agriculture? Also, how do we make sure we do this globally? We may be able to do it in the richer, more developed countries, but there are other countries where it is the culture or they need to use antibiotics, so we need to make sure there are sufficient alternatives available.

We have committed to a vision where AMR is contained and controlled by 2040 and are halfway through delivery of our five-year national action plan. Optimal antibiotic prescribing is a key theme of this work, and we continue to take steps to better support clinicians to make appropriate prescribing choices. In relation to AMR, or to make sure we are aware of this, we are working globally with a number of countries. Also, RSV is a virus, and we should not—by my understanding—be using antibiotics on viruses.

A number of other questions included what considerations the department made on the treatment. The cross-systems exercise took place in June 2021 and I reassure noble Lords that it involved the devolved Administrations. It focused on resilience planning for the potential increased surge. After the exercise, regional NHS England teams finalised annual paediatric critical care winter surge planning to anticipate any increase in RSV cases, including for paediatric intensive care beds. NHS England and Improvement also signed off on regional plans which were submitted to the national team. This built on local exercises and included equipment requirements.

In June 2021, we saw the UK palivizumab prevention programme, with a central alerting system bulletin issued to inform NHS trusts to initiate the programme as soon as possible in line with updated policy of up to seven doses at monthly intervals, rather than the five previously. This was stood down at the end of January 2022, because palivizumab provides about a month of protection against RSV, with the aim of reducing the risk of hospitalisation.

In addition, the UK Health Security Agency and NHS England and NHS Improvement have led on public-facing communications, including press releases on RSV highlighting the likelihood of a rise in infections and encouraging parents to look out for symptoms of severe infection in at-risk children, which included advice on reducing transmission to others. That is in addition to the work we are doing with civil society and with clinicians at both primary and secondary level.

Noble Lords also asked what solutions we are looking to in future, and the noble Baroness, Lady Wheeler, mentioned a treatment that has potential. There is a key antiviral treatment under development by Enanta Pharmaceuticals, but there are also a number of developments in RSV immunisation innovation, and I shall go through a few of them.

First, there is the infant monoclonal antibody, called nirsevimab, by AstraZeneca and Sanofi, and that is progressing. GSK was looking at a maternal vaccine, but I understand that that is currently paused. Pfizer has a maternal vaccine, which is progressing, as is a Pfizer older-adult vaccine. Johnson & Johnson is also looking at an older adult vaccine, as is Moderna. Some vaccines are currently in phase 3 trials, such as those for older adults. The UK Health Security Agency and the JCVI will continue to monitor the development of those trials. The MHRA will ultimately be responsible for the approval of new vaccines, licensing and marking authorisation for new medicine in the UK.

As for our plans, there is currently an out-of-season rise in RSV cases and we have seen RSV swab positivity increasing to almost 4%, with the highest positivity in the under-fives, at 14%. A lessons learned exercise took place in February 2022 to identify and share learning to inform future responses and strengthen the resilience of paediatric services longer term. There is continued surveillance and the data continues to be monitored. Especially given the experience of the unseasonal paediatric programme, it is really important that we are aware of this all year round. Clearly, some lessons have been learned from Covid, such as the whole-system approach to support surge planning and how we rely on established relationships between and within regions, but also via local community organisations. That is, first, to ensure that all clinicians at all levels are aware of RSV and are looking out for it, as well as working with local voluntary and community organisations to raise awareness in parents, families and communities.

We have also been co-operating internationally to model data from other countries that have experienced it, in particular Australia, New Zealand and South Africa. UKHSA and others have been in contact with them to try to understand what lessons could be learned for the UK. NHS England and NHS Improvement also brought forward critical care planning.

I talked about community investments and some of the preparations. It is really important that we are aware at primary and all care levels. The children and young people’s transformation programme procured 4,000 specialist pulse oximeters from the NHS supply chain, which were used to supply primary care—I think I talked about that. In the workforce, Health Education England is working closely with specialised commissioning teams in the operational delivery network to support more awareness. I talked about the online platform. The numbers here may not mean much, but there are 437 resources uploaded, 3,400 users and 62,000 tailored resources. There is also practical guidance developed by the Royal College of Paediatrics and Child Health and NICE. They have reviewed and updated their guidelines with a focus on improving patient flow and recommendations for early safe discharge.

In addition, there is a children’s safer nurse staffing framework for in-patient care, which includes awareness and more support. I have a number of lines about non-paediatric action, but perhaps it would be better if I wrote to noble Lords after the debate summarising them and picking up any questions that I may not have answered in detail today.

In closing, I thank the noble Baroness, Lady Ritchie, for raising awareness, not only today but more generally—I know that she will, rightly, continue to hold the Government to account—and all noble Lords for their questions. I hope that, if I have not covered them, I shall do so in writing. Be reassured that the health system in England mobilised resources prepared for the surge in RSV cases and hospital admissions. This was essential to protect at-risk groups, including infants and the elderly, but also to work across the four devolved Administrations of the United Kingdom to make sure this action is UK-wide, not just in England. I am grateful to noble Lords for taking part in the debate today.

Neurological Conditions

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

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

My Lords, I thank all noble Lords who took part in this debate, especially the noble Lord, Lord Dubs, for raising this issue. I also thank him and the noble Lord, Lord Monks, for sharing their personal experiences. As the noble Baroness, Lady Wheeler, rightly said, hearing people’s personal experiences, rather than simply reading words on a page, really does bring it home. I also thank the noble Baroness, Lady Murphy, for sharing her experience from the other side, as it were; that was a very valuable contribution for us all.

I should start by talking about the overall plan. I will then focus on some of the conditions discussed today. We have to acknowledge that the pandemic affected health and care services, which is why we must have a recovery service. The priority of that recovery is to address the pressures caused by the pandemic. Noble Lords will be aware of the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care, published in February 2022, which sets out a long-term plan to look at bringing that down. It also looks at creating extra capacity, including through partnerships with the independent sector and in the NHS, to undertake more complex work, such as neurosurgery, with improvements for the most clinically urgent patients.

To support the ambitions in the delivery plan, the department has committed more than £8 billion over the next three years, from 2022 to 2025. This investment is in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to the health and care system to push the recovery forward.

We know that there can be significant variation in the services provided for people with neurological conditions. I can confirm that NHS England is currently recruiting for a national clinical director for neurology to tackle this variation and provide national leadership and specialist clinical advice. This will complement existing work to improve neurology services—particularly the work of the neuroscience transformation programme, which will support services to deliver the right service at the right time for neurology patients closer to home. The noble Baroness, Lady Brinton, and others made this point.

NHS England also continues to work closely with the National Neurosciences Advisory Group to ensure continued service improvement and support neurosurgery networks with transformation and implementing changes that could have the highest impact. The National Neurosciences Advisory Group has developed a series of best practice optimal pathways for neurosurgery and neurology. They are being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology. This work is anticipated to be completed during this financial year.

We also know we cannot increase health service capacity and access to treatment without expanding our workforce capacity. As was made clear in many debates during the passage of the Health and Care Act, the Government commissioned Health Education England to come up with a strategy. The Act mandates the Government to publish a workforce strategy and plan every five years, on not only a national level but a bottom-up local level. We want to avoid Soviet Union-style planning which does not understand local communities, local trusts and areas. Bottom-up planning will happen at primary and secondary care level, trust level and ICS level. I will make some more comments about that.

We have made some progress so far with nearly 29,000 more hospital and community health service staff in March 2022 compared to the previous year, which includes nearly 11,000 more nurses and 4,300 more doctors. Working with the NHS, we will continue to identify and address these gaps across key types of staff. To support long-term planning, as I said, we have commissioned Health Education England.

On the social care workforce specifically, we know that many people living with neurological conditions rely on support from care workers. We recognise the challenges the sector faces in recruiting and retaining staff. Noble Lords will be aware that we launched the national register. It was voluntary at first, as some concerns were raised in the initial consultation about people not wanting to register. We want to build that confidence so we can understand the existing landscape and the myriad qualifications. How can we ensure we rationalise it so that it is a more professional service which people will feel attracted to, and what issues will we have to address so that we recruit more? To support local authorities and providers to address workforce pressures, there is the health and care visa and shortage occupation list, alongside work with DWP. We hope to boost recruitment in these areas.

Let me go into some more specific issues. It might be handy for me to discuss how the NHS generally, and the department, look at neurological conditions. When I was being briefed on this, I asked if I could be sent a list of all the neurological conditions. I now realise that was a naive question; apparently there are over 600 types. That shows that awareness is one of the big issues and barriers. If you want change, you have to realise what the issue is. If you think of how we as a society have developed, things that we now consider neurological conditions are things where, in the old days, people were told to pull themselves together. There were quite offensive names for some conditions that people had. We are now far more aware of them, which is really important. They can be broadly categorised into sudden onset conditions, intermittent and unpredictable conditions, progressive conditions and stable neurological conditions.

The noble Lord, Lord Dubs, and the noble Baroness, Lady Wheeler, rightly raised the issue of unpaid carers. During the debate there was consensus on the work that unpaid carers do, often with little reward, and what support should be available. As a result of the pressure rightfully put by noble Lords on the Government, the department and NHS have been interacting with Carers UK. I also put on record our thanks to the noble Baroness, Lady Pitkeathley, for all her work in this area and for pushing the Government to make sure that we first understand what support is needed. Sometimes it can be as simple as respite; at other times, far more support is needed. It is also about awareness and training, and we have the reform funding programme. We want to make sure that we not only recruit more motivated carers, giving them a proper career path, but do not forget the unpaid carers—recognising who is an unpaid carer and what support can be available, working from national government level and at local level.

The noble Lord, Lord Dubs, and my noble friend Lady Fraser also raised the issue of mental health. In addition to managing neurological conditions, we recognise that patients quite often do not get enough mental health support. We are committed to expanding mental health services. We also have the long-term physical health pathway. We are integrating improving access to psychological therapies—IAPT services—and have launched a public call for evidence in developing a new cross-government 10-year plan for mental health. I hope I can encourage all noble Lords to highlight that.

The noble Lords, Lord Dubs and Lord Monks, rightly raised the issue of multiple sclerosis and spoke about their own experiences of it. NICE has updated its guidance on management, diagnosis, treatment, care and support of people with MS. Following diagnosis, and with a management strategy in place, we aim for most people with MS to be cared for through routine access to primary and secondary care. NHS England has commissioned the specialised elements of MS care through the 25 specialised neurological treatment centres across England. The various parts of the NHS systems have also started to implement the guidance set out in the progressive neurological conditions RightCare toolkit, which includes a specific section on MS and was developed in collaboration with key stakeholders, such as the MS Trust and the MS Society. The RightCare toolkit provides the opportunity to assess and benchmark current systems to find out how we can improve. But it also has to be a continuous learning system, not just one set of guidelines that are followed for ages until someone tells you they are out of date.

Another important aspect of this is the research, as my noble friend Lady Fraser rightly raised. The Department of Health and Social Care funds research into neurological conditions through the National Institute for Health and Care Research. In 2019-20 the NIHR spent about £54 million on research through the Medical Research Council and is open to more bids, but it does not assign for particular conditions. Quite often, why NIHR does not assign a pot for certain conditions comes up in debates. It is open to research bids in all areas, including neurological conditions and so far it has given £54 million, but it welcomes more applications. Other areas are really important as well, such as motor neurone disease and others. That is why we urge the research community to come forward.

We also want to make sure that there is more awareness throughout the workforce, as noble Lords rightly said. As a speciality, neurology is popular and generally sees a 100% fill rate for training places. There has been an expansion in neurology posts across England and postgraduate trainees will start in August 2022. The National School of Healthcare Science is recruiting more trainee scientists to its three-year, work-based training programme, which leads to a master’s degree in neurosensory sciences. But the point is taken that it is not only these specialists we need; we also need to make sure that staff across the system are aware of these conditions and how we deal with them.

The noble Lord, Lord Dubs, raised the issue of cannabis. In November 2018 the UK Government legalised cannabis for medical use but imposed strict criteria. Specialist doctors are allowed to prescribe medicinal cannabis but there are still concerns about this not being enough people. I take the point that the noble Lord, Lord Dubs, made: if the patients feel that it benefits them, then it benefits them. That is important. I can offer to write to the noble Lord, Lord Dubs, or to have a further discussion.

We have seen increases in the number of full-time doctors working in this specialty, in neurology, including consultants, but as I have said, it is important that they are not just specialists.

Turning to strategies, there are two at the moment, one for dementia and the other for acquired brain injury. Once again, I am open to suggestions and happy to listen if people want to raise issues about this.

I should just touch on the neurosciences transformation programme. The NSTP itself came up with a new definition for specialised neurology and a model for new neurology services. The clinical pathways and the optimal pathways have been developed and indicators are being designed in partnership with stakeholders to support services delivering the right service at the right time for all neurology patients and, critically, closer to home or in the home. What we hope to see is that this approach will be built in as part of the integrated pathways, through the ICSs being set up.

On some questions that I am unable to give specific answers to—for example, on housing and a number of other issues—I offer to write to noble Lords. I think the noble Lord, Lord Dubs, asked whether I am prepared to have a meeting. Usually I say yes—I am sure noble Lords recognise that I met frequently during the passage of the Health and Care Act—but I just want to make sure I am the relevant Minister. If the relevant Minister is not available, I am very happy to meet, or to meet with the relevant Minister. I would really like to learn more and, either on my own or in partnership with the relevant Minister, to meet with the noble Lord, Lord Dubs—

[Lord Dubs (Lab)]

The task force.

[Lord Kamall (Con)]

The task force, yes—I thank the noble Lord for the prompt.

That is all I will say for now. I apologise if I have not covered all the questions; I will endeavour to write. I will diligently read Hansard and offer to write to noble Lords on those questions I have not answered. I thank the noble Lord, Lord Dubs, for raising this issue and all noble Lords for taking part in the debate and for their questions. It means I have to go back to the department and not only learn more myself but make sure we have some meaningful answers to the questions that noble Lords asked.

Committee adjourned at 4.56 pm.

GP Access

Lord Kamall Excerpts

Tuesday 7th June 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I remind the House of my interest as a member of the General Medical Council.

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

The Government remain committed to improving access to general practice. This will be done by increasing capacity to deliver appointments. We spent £520 million to improve access and expand general practice capacity during the pandemic. This was in addition to £1.5 billion announced in 2020 to create an additional 50 million general practice appointments by 2024. To help manage demand and help patients to get timely access, we have improved the telephone system available for all practices. This improved functionality has helped them to free up existing phone lines for incoming calls and is available at no additional costs to practices until the end of April 2023 while we work on long-term solutions.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister’s Answer seems a long way from the reality. Every day, patients have great difficulty in getting access to their GPs. It is also clear that the profession is highly demoralised, with many wanting to retire early. Only a few weeks ago, this House voted to ask the Government to develop a long-term workforce strategy, funded for the NHS. Why did the Government consistently turn that down?

[Lord Kamall (Con)]

I am sure the noble Lord will remember from the debates on the Health and Care Bill that that Act provides for workforce plans every five years. In addition, Health Education England has been commissioned to do work on workforce needs of a much more decentralised nature, rather than top-down from Whitehall and Westminster: at the trust level and the CCG level and, in future, at the ICS level to look at needs and the mix of skills that are needed to serve local populations.

[Lord Patel (CB)]

My Lords, following on from the Question asked by the noble Lord, Lord Hunt, does the Minister agree that there is a need to rethink the model of primary and community care in the light of shortages, and considering that more and more GPs are now providing only private healthcare—at the last count, there were 1,500 of them—and 57% of GPs are working three days a week or fewer?

[Lord Kamall (Con)]

There are indeed a number of challenges. One is that many GPs are nearing retirement age and some are worried that their pension will be affected if they carry on working. Also, as an IPPR report recently said, the nature of illness and patient expectations have changed but the model of care has remained the same throughout. We expect five-minute appointments with referrals, but what we need in primary care is a much more networked model, with GPs, nurses, mental health officials, pharmacists, link workers and charities providing a joined-up service so that it does not always have to be the GP.

[Baroness Jolly (LD)]

My Lords, since 2016 the number of GPs in Devon has fallen by 7%, whereas the number of patients has increased by 14%. When does the Minister expect the 2016 GP/patient ratio to be the norm?

[Lord Kamall (Con)]

I apologise, I did not exactly get the nature of the noble Baroness’s question, but I understand about some issues in Devon. Clearly, there are areas of the country where there is more of a challenge. One solution being looked at is how we make sure that doctors are trained close to areas where there are shortages. Research has shown in some cases that people tend to stay in the area in which they were trained, and we have opened new medical schools. However, that will not be an overnight solution as we have to wait for doctors to be trained. Some solutions will be short-term and some will be long-term.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I am pleased to see that since last July there have already been 1 million scans, tests and checks delivered by the new community diagnostic centres. Can the Minister give us some idea of how these centres are going to improve capacity and the quality of care in our GP services, which we have already heard are under so much pressure?

[Lord Kamall (Con)]

I thank my noble friend for that question and for highlighting the role of community diagnostic centres. When we look at the backlog and the waiting lists, about 80% of the waiting list is for diagnosis, not necessarily surgery. Of course, once they have been diagnosed, some of those people will require surgery. After that, about 80% of those who require surgery will not require an overnight stay. They can be daily in-patients, as it were. The role that CDCs will play in trying to tackle that backlog is to encourage more diagnosis in the community, so rather than people having to go to NHS settings, diagnosis will go to the people in shopping centres and football stadiums.

[Baroness Wheeler (Lab)]

My Lords, this is national Carers Week, and I am sure the whole House will want to pay tribute to the tremendous work our 6 million unpaid carers do, often at great cost to their own health and well-being. This week’s Carers UK survey highlights the alarming neglect by carers of their own health, be it mental health conditions, long-term illness or disabilities, or putting off treatment because of their caring duties, like the carer who delayed a hysterectomy for five months because of the urgent care needs of the loved one she was caring for. The Carers UK survey shows that only 23% of carers are offered health checks for themselves when they phone the GP’s surgery to make their loved one’s appointments. Rather than just flagging up on the system that a person is a carer, what action will the Government take to ensure that GP surgeries are able to do much more to monitor carers’ health and well-being and what guidance will be issued on this important matter?

[Lord Kamall (Con)]

The noble Baroness raises a very important point, as does the noble Baroness, Lady Pitkeathley, who frequently champions the role of unpaid carers. The new model of primary care is taking on some of the services that were previously provided by secondary care, and it will be a more modern, networked service. Clearly, part of that mix, not only in primary care but at the ICS level, will be how we make sure that we have a proper integrated health and care system and how we can help carers and make sure that they are looked after while they provide a service for people.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Masham of Ilton.

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

My Lords, is the Minister aware that many GPs’ surgeries made it clear during Covid-19 that they did not want patients who might have coronavirus coming to them? Does the Minister realise that many early diagnoses of seriously ill patients, including those with cancer, have been missed, putting extra pressure on everyone involved at present?

[Lord Kamall (Con)]

The noble Baroness makes an important point. Because of the focus on Covid and making sure we were keeping everyone safe, especially before we had a vaccine, precautions clearly had to be put in place. Of course, at the time it seemed eminently sensible to make sure that doctors and patients were protected. As the noble Baroness rightly highlights, the unintended consequence of this has been a backlog in seeing other patients. One of the things we are doing is making sure that, as we roll out these community diagnostic centres and modernise primary care, we can see patients in a more timely way. The GP does not necessarily have to be the first point of contact.

[Lord Stirrup (CB)]

My Lords, how are the Government measuring and reporting retention levels of clinical staff in the NHS? This is one of the ways that will enable us to assess the effectiveness of the measures the Minister has said the Government are putting in place.

[Lord Kamall (Con)]

I thank the noble and gallant Lord for the question. The important point is that sometimes the assessment is done at a local level, sometimes it is done at an overall level and sometimes the department gathers the statistics. As we modernise and digitise the system, a lot more of that information will be able to be processed centrally, so that we can understand where we need to have better planning and to redeploy resources to meet the needs in certain areas.

[Baroness Altmann (Con)]

My Lords, my noble friend mentioned pensions. I urge him to speak to his colleagues in the Treasury about the own goal being created by the pension rules. Doctors are being hit with an annual allowance, but the lifetime allowance is then driving early retirement, with a simple 20-times multiple making it worth while for them to retire in their 50s, as soon as they can, rather than wait for a penal tax charge on a higher pension later.

[Lord Kamall (Con)]

I thank my noble friend for the question. A request I have often had at this Dispatch Box is to go and speak to my colleagues in the Treasury. We understand that early retirements are a key factor impacting GP retention. If you look at the demographics of the workforce, there are people close to retirement age who are saying, “I’m burnt out after Covid, and therefore I want an easier life.” Clearly, the other issue we are looking at is the lifetime allowance. There are some instances where the GPs may be better off staying in, but we have to make that quite clear. There has not yet been communication. We continue to engage with the Treasury on a variety of issues, and I hope to continue doing so.

[Baroness Brinton (LD)]

My Lords—

--- Later in debate ---

[Baroness Brinton (LD)]

My Lords, over the last five years the number of registered patients in England has increased, while the number of GPs has dropped by 5%. That has now resulted in a 12% increase in the number of patients per GP. No wonder there is pressure. I return to the original Question from the noble Lord, Lord Hunt: when will the Government provide proper workforce planning for GPs?

[Lord Kamall (Con)]

I acknowledge the noble Lord for giving way to the noble Baroness, Lady Brinton, and at the same time I welcome the noble Baroness in person. I hope I will not regret saying that. We had these debates on the workforce during the passage of the Health and Care Act. In that Act there are provisions for workforce planning. At the same time, Health Education England is also putting together plans, and at a local level—rather than a top-down, almost Soviet-style planning system—we are looking at local workforce challenges.

Children: Cancer

Lord Kamall Excerpts

Thursday 26th May 2022 Lords Chamber

[Lord Lancaster of Kimbolton]

To ask Her Majesty’s Government what steps they are taking to improve cancer outcomes for children.

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

Cancer in children is thankfully rare, accounting for less than 1% of cancer cases each year. The Government are dedicated to improving cancer outcomes and our new 10-year cancer plan will further our efforts to improve childhood cancer diagnosis rates and outcomes. We continue to invest in research, including with the paediatric experimental cancer research centres network, which is dedicated to early-phase research on childhood cancers.

[Lord Lancaster of Kimbolton (Con)]

My Lords, childhood cancer is not rare; it is the biggest killer by disease of children under 14 in the United Kingdom. Sadly, it is often diagnosed late and one in five children who get it will die. The issue was highlighted in the House of Commons last month in an excellent debate led by Caroline Dinenage. There, there was a cross-party consensus that, with just 3% of funding spent on children’s cancer, there needs to be greater emphasis on research, detection and treatment. Will childhood cancer be a priority for the Government’s 10-year cancer strategy and will the requested childhood cancer mission become a reality?

[Lord Kamall (Con)]

I thank my noble friend for the question and for discussing the issue with me previously. As he rightly says, even though it is rare, cancer is the biggest killer of children aged up to about the age of 15. The Government’s new 10-year plan for cancer care is under development. It will address the cancer needs of the entire population, including those of children. We also recognise the severe impact that cancer has on not only the patient but their family and friends, and are focusing in particular on interventions that support patients through difficult journeys of diagnosis, treatment and aftercare.

[Lord Patel (CB)]

My Lords, research for finding new treatments for cancers, particularly childhood cancers, where the numbers are small, requires international collaboration. Some 42% of current CRUK clinical trials have international partners. The Government are consulting on clinical trials regulation and we have data sharing and protection legislation going through Parliament. Does the Minister agree that it is important that neither the regulation related to clinical trials nor the legislation related to data sharing should in any way jeopardise our international role in clinical trials collaboration?

[Lord Kamall (Con)]

I thank the noble Lord for the question, which cuts across three of the priority areas in my ministerial portfolio: data sharing, the life sciences industry—in which clinical trials and research play a huge part—and international collaboration. It is really important that we continue international collaboration. However, one of the challenges we face is that we have to make sure that patients are comfortable with researchers having access to their data. As part of that work, we have called in civil liberties organisations to help us along that journey. So, while we encourage more people to share data, we have to make sure that they have those protections. We can have the best systems in the world, but, if people opt out, they are useless.

[Lord Watts (Lab)]

My Lords, many families of children with cancer have to travel a long distance to get treatment for their child. Those families face financial problems. Will the Government do more to help families who have children with cancer and who are feeling financial pressures because they need to travel and cannot continue to work because of the pressure the family is under?

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point about support. One of the things we are looking at in the research is how to help not just the patient but their family and their wider support network. I will take his specific question about assistance back to my department and write to the noble Lord.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I declare my interest as chair of Genomics England. I am pleased to report to the House that whole-genome sequencing is now improving care for children with cancer as part of the NHS Genomic Medicine Service. In fact, Great Ormond Street recently found that WGS has reclassified diagnosis in 14% of cases, changed management of the condition in 24% of cases and improved diagnosis in 81% of cases. Will the Minister join me in thanking those at Genomics England and in the NHS who worked so hard during the pandemic to get this service up and running? Will he also pledge today to do whatever he can to scale this service so that we can play our full part in tackling this pernicious disease head-on?

[Lord Kamall (Con)]

I thank my noble friend for that. It is really important that we look at the huge potential of genomic research and the information it can give us. It is also important that, as we move towards the newly born programme, we do genomic sequencing of newly born babies so we have that data and are aware of the issues that could arise in their lifetime. In addition, we are looking at technology on testing—some research trials show that there are blood tests that could identify up to 50 different types of cancer early—so there is a lot of work going on in this area.

--- Later in debate ---

[Baroness Brinton (LD) [V]]

My Lords, too often people think only of outcomes that are about survival. Children with cancer are treated with therapies that were tested on and designed principally for adults. Cancer Research UK knows that these treatments can and do have serious long-term impacts on these young growing bodies and that parents often struggle to get the support they need. What is being done to improve follow-up care for childhood cancer survivors: for their education, their health and in particular their mental health?

[Lord Kamall (Con)]

All these issues are being looked at as we understand more about childhood cancer and also in the context of wider support. That is important not only during the time they are receiving treatment; as the noble Baroness rightly says, it is not just about the cancer itself but about some of the poor patients and their families, because when they get the bad news it affects their mental health. We have to look at this in a holistic way and there are a number of initiatives. I will write to the noble Baroness with some more detail.

[Lord Stirrup (CB)]

My Lords, early diagnosis is key to successful outcomes in all kinds of cancer. In the long-term plan the Government set out an ambitious target for increasing the early diagnosis of most cancers. Can the Minister tell the House what impact Covid, the subsequent backlog and the shortage of clinicians in the NHS is having on the achievement of this target, how progress towards it is being measured and how it is being reported?

[Lord Kamall (Con)]

I thank the noble and gallant Lord for that question. I am really sorry—I have completely forgotten what it was. Can he remind me?

[Lord Stirrup (CB)]

Could the Minister tell us what impact Covid, with its backlog and the shortage of NHS clinicians, is having on how the target is being measured and reported?

[Lord Kamall (Con)]

I completely apologise to all noble Lords. It is important that we look at this issue; I am afraid I will have to write to the noble and gallant Lord with more detail.

[Baroness Merron (Lab)]

Following on from the question of the noble and gallant Lord about the matter of significant improvements being made in the lives of children with cancer by detecting cancer early and avoiding delays in care, there are of course three components to early diagnosis, with the first being awareness of symptoms by families and primary caregivers. Can the Minister tell your Lordships’ House what assessment has been made of the level of awareness and what is being done to promote that awareness among families and primary caregivers?

[Lord Kamall (Con)]

The noble Baroness raises an important point about how we raise awareness, and that goes right across not only the population but patients themselves. NHS England and NHS Improvement are developing plans for future phases of their Help Us Help You campaign to raise awareness of key cancer symptoms. To date, the campaign has contributed to the record high levels of urgent cancer referrals that the NHS has seen since March 2021.

Perhaps I may take the opportunity to address the question from the noble and gallant Lord. Covid clearly affected the backlog. One of the things about the waiting list is that now 80% of people on it are waiting for diagnosis. One of the issues we are looking at is how you push out more community diagnosis centres around the country, not only in hospitals but in shopping centres and sports arenas, so that effectively we go to the patient and detect as early as possible. We hope that all that, in conjunction with things such as blood testing and genomic sequencing, will lead to earlier diagnosis.

[Lord Herbert of South Downs (Con)]

My Lords, brain tumours are the single biggest cause of death among children and adults under the age of 40 of any cancer. The Government made a generous commitment to increase funding, which is absolutely essential for brain tumour cancer research, but, so far, they have not met the target that they themselves set. Will my noble friend undertake to review this situation, given the seriousness of the position?

[Lord Kamall (Con)]

One of the things about answering a question like that is that we are now aware of so many different types of cancer. For example, a blood test that has been trialled identifies 50 different types of cancer. Sadly, my mother-in-law died of a brain tumour, and I have asked questions about that in the department. If my noble friend will allow me, rather than read out a short answer I will write to him in more detail.

Sugar Reduction Programme: Bread

Lord Kamall Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government why the recent sugar reduction programme, which challenged businesses to reduce the amount of sugar in food, did not include bread.

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

The sugar reduction programme focuses on those products which contribute the most to children’s intakes of sugar. Sweeter bread products such as buns, fruit loaves and bagels are within scope of the programme. Plain and savoury breads—for example, garlic bread—are included in the salt reduction programme, as these products make greater contributions to salt intakes than sugar intakes. Garlic breads are also included in the calorie reduction programme.

[Lord Brooke of Alverthorpe (Lab)]

I thank the Minister for that reply. Sugar is in so many products these days and is so damaging. As the Minister knows, we have a crisis with diabetes and with obesity. Does he not agree that we should endeavour to remove sugar wherever we can? There was no sugar in bread 60 years ago. Why is there sugar now? Why do the Government not look at this again and stop it?

[Lord Kamall (Con)]

I pay tribute to the noble Lord. Since my first day at the Dispatch Box, he has challenged me on both sugar reduction and alcohol abuse. There comes a stage where it is diminishing returns. I know that the noble Lord and I are very keen on puns and dad jokes. When bread is being made, sugar is needed—kneaded; excuse the pun—because it extends shelf life by reducing the oxidation which causes food to deteriorate, it reduces the rate at which bread becomes stale, it activates yeast for fermentation, it adds the colour during the baking process, and it adds to the texture. The sugar contributes only about 2% of free sugars intakes in children. Therefore, it is much more worth while and targeted to focus on products that are higher in sugar.

[Baroness Walmsley (LD)]

My Lords, will the Minister join me in congratulating Tesco and Sainsbury’s? They have announced that, even though the Government are backtracking on the proposed ban on volume promotion offers of foods high in sugar, salt and fat, they will do it voluntarily anyway, and on time, to support the anti-obesity campaign. Will he encourage other retailers to join them and to work with their suppliers to reformulate and reduce sugar?

[Lord Kamall (Con)]

We should welcome moves by those in the industry, including retailers; if they can meet deadlines earlier, that is all to be welcomed. Perhaps I might correct the noble Baroness on one inaccuracy. The Government have not backtracked; we have delayed location measures until October 2022.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

Delaying is different from backtracking.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

Next time I will bring a copy of the Oxford English Dictionary. Volume price will come in in October 2023 and advertising in 2024. We did that in full consultation with industry, and it is welcome when industry asks for deadlines and is able to meet them early.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, if the Minister is right that the Government are not backtracking but delaying, perhaps he could persuade the supermarkets that, instead of reducing the price of foods that are bad for you, they should reduce the price of good foods such as fruit and vegetables.

[Lord Kamall (Con)]

That is a very sensible suggestion. Across government, and with the Office for Health Improvement and Disparities, we are trying to work with both the food-supply industry and retailers to look at how we can pull customers towards healthier products and work with companies to reduce sugar, salt and other bad things in terms of food reformulation to make sure that we have a healthier population in the longer term.

[Baroness Boycott (CB)]

My Lords, in respect of the cost of living crisis and healthy food, why do the Government not make automatic enrolment in Healthy Start vouchers immediately happen? At the moment, only about 60% of people take up this good measure to spend on healthy food. This would certainly be a good counteraction to the delay in banning two for the price of one on sugary foods.

[Lord Kamall (Con)]

On the direct question that the noble Baroness asked, I will have to go back to find out more and will write to her. The Government are very keen on some campaigns that she will be aware of, such as the Better Health campaign, launched in July 2020. In January 2022 it took over from Change4Life. We now have the NHS Food Scanner app; with a quick scan of a barcode, families can see how much sugar, saturated fat and salt is in their everyday food and drink. There is also a campaign on on-demand video, as well as on YouTube, and we encourage people to download the app from the App Store or Google Play. More campaign resources are available, and I am sure that noble Lords would like to help promote them.

[Lord Suri (Con)]

My Lords, the staple food of many people’s day is bread. The sugar content in the average slice of processed bread varies but can be up to 3 grams. Sugar is formed naturally in the baking process, but it is often added into it. The benefits of adding sugar are favourable for the bread-making process but not for the people consuming it. Bread can be baked without adding sugar and, yes, that will indeed alter its texture, taste, freshness and the speed of its rise. If we look at the ancient history of bread, we see that making it uses grain and wheat flour; chapatis, naans and numerous Middle Eastern flatbreads usually do not have sugar added. These recipes are healthy and are still being consumed today. Health is wealth; take care of it.

[Lord Kamall (Con)]

Right. I begin by thanking my noble friend for that very comprehensive question. As I said earlier, some sugar is needed in the process, but he makes an important point about how we reduce the unneeded additional sugar that is added. I have already given the reasons why there is some sugar, and no doubt the chemical processes will be improved over time: as mankind’s innovation and ingenuity increase, we will see more substitutes for sugar. I was also interested in the point made by the noble Lord about chapatis; next time I go to a restaurant I will ask about their sugar content.

[Baroness Merron (Lab)]

My Lords, with the UK attending the 75th World Health Assembly in Geneva as we speak, it is concerning that the Government have delayed their planned measures to encourage a move away from foods that are high in fat, sugar and salt. To compensate for this, particularly for those who are experiencing higher levels of deprivation, can the Minister tell your Lordships’ House in what specific ways the Government intend to show the leadership that is so urgently needed?

[Lord Kamall (Con)]

I thank the noble Baroness for raising that point. Part of my role is in international health diplomacy, where other countries come to the UK wanting to learn from us. It is very interesting that a number of other countries are asking to learn from our sugar and salt reduction programmes, our alcohol and anti-tobacco programmes and our campaigns for healthy eating—not just telling people they should not do things but encouraging them to have a healthier lifestyle

[Baroness Hayman (CB)]

My Lords, the Minister has said that the Government accept the need for sugar in bread, which is controversial with many authorities and Members of this House, but they seem to be taking an extraordinarily long time to accept the fortification with folic acid of the flour used for bread. As the Minister has heard many times, this would have undoubted health benefits. Since the noble Lord, Lord Rooker, is not in his place, I felt the need to ask the question.

[Lord Kamall (Con)]

I would have hoped that the noble Baroness would have lined up the noble Lord, Lord Rooker, to be in his place. Only yesterday, I had a meeting with him, the noble Lord, Lord Patel, and a number of other noble Lords, together with departmental officials.

We have to do this within the general picture of the Bread and Flour Regulations. At one stage, the dispute was about the upper limit of folic acid. We have agreed that we will push forward as quickly as possible. We were waiting for the Northern Ireland elections. It has now been confirmed that the Northern Ireland Minister will remain in place until a new Executive is formed. He has promised to push his officials to give approval so that we can get on with the consultation and get this measure in place as soon as possible. I hope that the noble Lord, Lord Rooker, was happy with the progress we made yesterday. I am sure he will tell us in due course.

[Baroness Uddin (Non-Afl)]

My Lords, addiction to sugar begins very early. It is included in baby foods. Will the Minister ensure that manufacturers attend to this sector as a critical component of the Government’s strategy? Does he accept that many people who are digitally excluded may not have adequate access to these campaigns and information from the Government?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. Following our commitment in the Advancing Our Health: Prevention in the 2020s Green Paper, we launched a consultation on baby food. We are aware how important it is to reduce sugar intake. Those aged four to six should have no more than 19 grams of sugar—five cubes—per day. From the age of 11, this increases slightly to seven cubes. This shows the importance of addressing this issue at a very early age, and we are speaking to manufacturers about possible formulations.

Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Lord Kamall Excerpts

Wednesday 25th May 2022 Lords Chamber

Moved by

[Lord Kamall]

That the draft Order laid before the House on 28 April be approved. Considered in Grand Committee on 23 May.

Motion agreed.

NHS Dental Services

Lord Kamall Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Young of Cookham]

To ask Her Majesty’s Government what plans they have to improve access to NHS dental services.

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

The Government are working with NHS England and the British Dental Association to reform the current NHS dental system and to improve access for patients, tackling the challenges of the pandemic. We have also provided an extra £50 million for additional activity and patient appointments. We are working to return quickly to pre-pandemic levels of activity. For this quarter, a new activity threshold for NHS dentists has been set at 95% to increase patient access.

[Lord Young of Cookham (Con)]

I am grateful to my noble friend, but with 86% of NHS dentists closed to new patients, do we still have a national dental service? The current dental contract was deemed unfit for purpose 14 years ago by the Health Select Committee in another place. Will my noble friend, as a matter of urgency, introduce a new dental contract which reverses the decline in NHS dentistry? As his fellow Minister has said,

“there is a shortage … not of dentists but of dentists taking on NHS work.”—[Official Report, Commons, 19/4/22; col. 7.]

Will my noble friend negotiate a contract with private dentists in the meantime to address the NHS backlog?

[Lord Kamall (Con)]

I half-thank my noble friend for giving me advance notice of one of his questions. I will try to answer that one. Many dentists who provide NHS treatment also already work in a private care capacity, and all dentists who provide NHS care must be registered on the performers list. The NHS uses the list to ensure high quality and safety standards in NHS dentistry.

On the UDA and negotiations, NHS England is in conversations with the BDA concerning both short-term changes and longer-term changes given the concerns that have existed since they were introduced in 2006.

[Lord Harris of Haringey (Lab)]

My Lords, I declare my interest as chair of the General Dental Council. The noble Lord, Lord Young of Cookham, has correctly highlighted the importance of the negotiations on the NHS contract for dentists, but there is another element to the problem. That is the long-term expectation in terms of how many of each of the various dental professions and the various dental specialties we need in this country. What is the flow in people leaving and what is the flow in recruiting dentists, including those from overseas? Do we have enough places and enough experience coming in? Does the Minister agree that we should do a proper study of what the long-term requirements are for dentistry and how they are to be met?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point about how we must look at this holistically and not just try to solve one problem or plug one gap while ignoring others. The important thing is what NHS England is doing in conversations about the new contracts. It is looking at how we incentivise dentists to offer services in those areas which are so-called dental deserts. It is also looking at how all the roles have changed over the years. We have certainly seen primary medical care taking on more secondary care. We have also seen pharmacies and others taking on more, so we are looking at different roles around dentists and whether they can take on more of that.

[Baroness Barker (LD)]

My Lords, the Government announced £50 million in extra support for dental practices earlier this year. How many of the practices which received some of that money are in rural areas, which are particularly hit and facing a crisis where about 20% of their dentists are due to retire?

[Lord Kamall (Con)]

The noble Baroness highlights one of the issues that must be addressed: those areas, particularly low-population areas, but also coastal and some rural areas which are so-called dental deserts. It should also be noted that a person is not necessarily permanently registered with a dental practice. You only have to register for as long as your treatment lasts, and if you cannot get treatment at one practice, you should be able to try other practices. You can try 111. I have heard various reports. Some people have told me that 111 is incredibly effective, while others have told me that there are still dental deserts in their local area.

[Baroness Bull (CB)]

My Lords, maternity exemption certificates provide free NHS dental treatment and check-ups for mothers during pregnancy and for a full year after birth. However, mothers who live in so-called dental deserts are denied this right, exacerbating health inequalities between different regions. Will the Government consider extending the duration of the maternity exemption certificate during this crisis of provision, so that more mothers can take advantage of their right to free dental care?

[Lord Kamall (Con)]

On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

[Baroness Merron (Lab)]

My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?

[Lord Kamall (Con)]

I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

[Lord Sikka (Lab)]

My Lords, in England, only a third of adults and half of children have access to an NHS dentist. There are reports of people extracting their own teeth because they cannot find a dentist. As a precursor to any reforms, can the Minister explain which government policies have created this dire state of affairs?

[Lord Kamall (Con)]

It depends which Government the noble Lord is referring to. I was listening to a podcast today in which there was an interview with the BDA, which said that some of these problems go back to 2006 and the UDA. We have to look at these concerns and what we have learned from the mistakes of the Government at that time, and make sure that we address them, particularly in areas that are dental deserts.

[Baroness Boycott (CB)]

My Lords, I want to follow up on the question about the delay to restrictions on “two for the price of one” sales and advertising. The prime reason that children under 10 go into hospital and have anaesthetics is to have all their teeth out, due to sugary drinks and too many sweets. Does the Minister not agree that this is a false idea, from the point of view of both obesity and dentistry? Could he clarify what he means by “delay”?

[Lord Kamall (Con)]

“Delay” means not the same date that was originally proposed. We clearly understand the children’s issues. During the pandemic, NHS dental practices were asked to meet as many priority needs as possible. One of the reasons that £50 million of additional funding was put in was to target them at those most in need of urgent dental treatment, including children.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not true that many of these deserts are in fact areas that need levelling up? I come from one of those areas originally and, when I was a child, a dentist visited the school to check all the children annually. Why do we not have a programme to ensure that schools in these deserts are visited by a dentist per annum?

[Lord Kamall (Con)]

It is important for any review to look at out-of-the-box thinking and to learn from the past. The suggestion made by the noble Lord may indeed be sensible and affordable, so I will take it back to the department. There are clearly concerns about the dental deserts, some of which may be resolved by negotiations with the British Dental Association, work practices, incentives and training. Can you train dentists and dental technicians close to those dental deserts, so that they stay there afterwards?

[Baroness Uddin (Non-Afl)]

My Lords, access to dental services for those with learning and other disabilities has been dire. What assessments and actions will the Government take to ensure that clear pathways are laid for them to access those services? They are not getting the kinds of services they rightly deserve.

[Lord Kamall (Con)]

The noble Baroness is absolutely right that everyone—not just people from deprived areas—should have as much access as they can to dental care. As I said, we are looking at the picture at the moment. During the pandemic, 700 urgent dental care centres were set up. As more dentists have come back on stream after the pandemic, the number has been reduced to 550. If someone is not getting care, they can ring 111 and be signposted to an NHS dentist.

Long Covid

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

[The Earl of Clancarty]

To ask Her Majesty’s Government what steps they are taking to support sufferers of long Covid.

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

The Government are committed to supporting people with long Covid and are spending £224 million on long Covid care, establishing 90 specialised services for adults and 14 paediatric services for children and young people across England. Those assess people with long Covid and direct them into care pathways that provide appropriate support, treatment and rehabilitation. We are also spending £50 million on research better to understand long Covid and how to treat it.

[The Earl of Clancarty (CB)]

My Lords, the ONS reports that more than 1.1 million sufferers of long Covid in the UK are unable properly to undertake day-to-day activities as a result of their condition. Asthma + Lung UK has seen a doubling of those seeking help with long Covid in the last six months. Will the Government ensure that specialist clinics are provided across the whole country and that sufferers receive appropriate treatment without enduring long waiting times, as often appears to be the case at present?

[Lord Kamall (Con)]

I thank the noble Lord for his question. We have established 90 services and 14 paediatric services. We are at the forefront of research on this. A number of countries are asking about and looking at what are doing on so-called long Covid. I should be clear that long Covid is not an accepted medical term. There are three terms: acute Covid-19, which lasts up to four weeks; ongoing symptomatic Covid-19, which lasts between four and 12 weeks; and post-Covid-19 syndrome, which has lasted for more than 12 weeks. Each patient will have different forms and symptoms, and we are seeking to understand that through further research.

[Lord Wigley (PC)]

The Minister referred to £50 million being allocated to research. How much of that is for studies on affected children, estimated to number some 120,000, and what steps is he taking to ensure timely access to support for children with long Covid?

[Lord Kamall (Con)]

The noble Lord is absolutely right that we have to look particularly at the issue of paediatric care, as well as other long Covid sufferers. The research is varied in terms of the different medical definitions I just gave. Of the three categories, the latter two loosely tie in with what we understand long Covid to be. They are also in line with the WHO definitions. We have established specialised paediatric services, and the research will look across age groups to see what the most appropriate interventions will be.

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, following on from the question of the noble Lord, Lord Wigley, some of the paediatric long Covid clinics are only treating children for fatigue, and not for respiratory, neurological or blood problems. Will the Minister meet with me and the Long Covid Kids support group to hear some of the problems they face?

[Lord Kamall (Con)]

I thank the noble Baroness for making us aware of that. I know that there has been extensive stakeholder engagement to understand what the particular issues are. I am happy to commit to a meeting with the noble Baroness.

[Lord Winston (Lab)]

My Lords, would the Minister be kind enough to let the House know through which body the funding for this research is being undertaken? Is it through UKRI or some other body? How is it split up between different funding bodies? What has been achieved so far with the research that has been done?

[Lord Kamall (Con)]

The NHS is working with the wider scientific community to better understand both Covid-19 and its long-term health impacts. The £50 million in research is to understand, first, the actual condition—and, as I said earlier, it is not necessarily a medical condition—and how we map and treat it. In addition, we have had 22 research studies to examine the cause of long Covid, to diagnose the condition and to optimise the design of healthcare systems. A lot of this has been done by the National Institute for Health and Care Research, which continues to welcome applications for further research.

[Lord Suri (Con)]

My Lords, long Covid must be taken seriously, as it is a sickness that has different degrees of symptoms for everyone recovering from coronavirus. Although most people recover quickly, there are those who have symptoms which last weeks or months after the infection has gone. There is also a burden on the people who must look after, and take care of, those suffering from long Covid, as it impacts people across all age groups. I request that Her Majesty’s Government take the necessary steps for research into long Covid so that people do not continue to suffer for such lengthy periods following the infection stage.

[Lord Kamall (Con)]

My noble friend is absolutely right that we must take this seriously. This is why, first, we have tried to map it to the three medical conditions I mentioned earlier: acute Covid-19, ongoing symptomatic Covid-19 and post-Covid-19 syndrome. We are also looking at the WHO definition, which defines post-Covid-19 condition as the condition that

“occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms … that last for at least two months”

and which

“cannot be explained by an alternative diagnosis.”

In my meetings with other Health Ministers from across the world, they want to learn from us what we are doing on long Covid and how we can co-operate better.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has stressed the fact that the diagnosis of long Covid is quite tricky and variable, according to the period of time over which people have suffered from it. Can he tell the House what support the NHS is able to provide for GPs to understand how to look at people who are presenting with an unspecified collection of symptoms which might be long Covid? Can he also say what is being done to help employers to understand this?

[Lord Kamall (Con)]

The noble Baroness makes an important point because there have been some reports that patients feel that GPs have not taken their concerns seriously. In response, NHS England has worked with the Royal College of General Practitioners to provide advice for GPs on the identification and management of long Covid. They have also worked with Health Education England to produce e-learning modules on Covid-19 recovery and rehabilitation. Rather than take up too much time, I commit to writing to the noble Baroness on her second question.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Harris of Richmond.

[Baroness Harris of Richmond (LD) [V]]

My Lords, my 15 year-old grandson has long Covid and has not been able to go to school since November. His school has been fantastic at trying to assist him, but there is only so much that it can do. What are the Government doing to help schools to support these pupils?

[Lord Kamall (Con)]

The noble Baroness emphasises just how wide, varying and diverse the symptoms of long Covid are. We know that children and young people can develop long Covid, just as adults can. NHS England has therefore not only established specialised paediatric services to provide care for children and young people, but is looking at providing specialist advice and support to general paediatric services as we learn more, as well as co-operating with international partners to learn from their experience.

[Lord Patel (CB)]

My Lords, the Minister quite rightly referred to the correct definition for people who suffer from long Covid as having a post-Covid-19 syndrome. That implies that people may suffer from multi-organ conditions and, in that respect, training is important. Does the Minister agree that NICE should be asked to publish guidelines for all professionals to recognise this condition?

[Lord Kamall (Con)]

The NICE guidelines start with the definitions as I have laid out previously, and the NICE definitions are aligned with the World Health Organization. On the noble Lord’s specific question, I will have to write to him.

[Baroness Merron (Lab)]

My Lords, the Equality and Human Rights Commission made an announcement on Twitter that it recommended that long Covid should not be treated as a disability. That would mean that those suffering from the condition would have to take their employer to a tribunal if they felt that they were being discriminated against. Can the Minister tell your Lordships’ House what his view is on how reasonable or not this is? What steps are being taken to promote understanding by employers of this debilitating condition and to encourage and guide them to be open to making changes in the workplace to support sufferers in continuing to work?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are learning more about the different types of long Covid, how to treat them and what interventions they need. People will not always need to go to a primary or secondary care centre for their treatment; in fact, there is an app to help people who can be supported at home. In terms of general advice about disability or to employers, we are working across government as we learn more about this in order to give appropriate advice to employers.

National Institute for Health and Care Excellence

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

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

A key priority for NICE this year is to increase the flexibility and capacity of its technology appraisal programmes through a more proportionate approach to assessments that will enable it to continue to consistently deliver timely guidance on new medicines. From April 2023, NICE aims to expand its capacity for technology appraisals by 20% to respond to increasing numbers of new medicines.

[Baroness Morgan of Drefelin (CB)]

I thank the Minister for his Answer and for writing to me on this. NICE does a really important job in our health system and I pay tribute to it for that. However, one thing that I have observed recently is that, in some of the more tricky technology appraisals, sometimes you have a first rejection, then another committee meeting, then possibly another reappraisal. This puts a huge amount of stress on patients, often at the end of life, when they are really worrying about whether they will have access to the treatments under review. Is there anything more that the Government can do to help ease the passage of these interim access agreements that patients can have?

[Lord Kamall (Con)]

I am sure that the noble Baroness appreciates that this was a new process, because of the Orbis trial. In some ways, NICE was not exactly prepared for that. NICE has learned from that lesson and 100% of its guidelines are issued within 90 days of licensing. It has learned the lesson but, sadly, there was a confluence of factors: one was Orbis and the other was that the committee meeting regarding recommendations ran over because there were a number of other cancer drugs that it was trying to look at. It has put this on the agenda for the next meeting.

[Baroness Walmsley (LD)]

One of the ambitions in the life sciences vision is to enable early diagnosis and treatment, including immunotherapies such as cancer vaccines. However, last year, 20 treatment evaluations were paused because of lack of capacity at NICE. If successful R&D cannot be translated into treatments because of lack of NICE evaluations, how will that impact on commercial incentives and the ambitions set out in the life sciences vision?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how this fits into the life sciences vision, and NICE is very aware of it. In fact, only last week, I saw a draft business case for NICE for future years, and it takes on board the very point the noble Baroness refers to. NICE is looking at making sure that is has more timely advice and that it can respond quickly; it has also increased capacity, not only for conditions like this but for more digital devices.

[Lord Hunt of Kings Heath (Lab)]

Can the noble Lord explain what he means by a more proportionate response? Does that mean that NICE is reducing the number of stages that are involved in this process? Is it going to increase the capacity it has? How is it going to actually deliver the improvements that the noble Lord has explained?

--- Later in debate ---

[Lord Kamall (Con)]

NICE has recently concluded a comprehensive review of its methods. It wants to introduce greater flexibility in the appraisal of medicines for more severe diseases but is also reviewing the criteria for highly specialised technologies, to make them clearer and more specific. We hope this will benefit medicines for patients with rare diseases and improve equitable access to new and innovative treatment. On the exact detail, I am afraid I am going to have to write to the noble Lord.

[Lord Lansley (Con)]

My Lords, would my noble friend agree with me that the publication by NICE last month, about its work on evaluating new treatments for severe drug-resistant infection, was really valuable, in that it looked at the benefits across the health system as a whole as the basis for an assessment of what an annual subscription for such drugs might be? Can my noble friend say how the Government are taking this work—which is a world first—and working with other countries to try to ensure that, collectively, that kind of subscription can incentivise the drugs industry to bring new treatments for antimicrobial resistance to the market?

[Lord Kamall (Con)]

I thank my noble friend for the question but also for highlighting the fact that NICE is trying to change the way it works to be more flexible and responsive. The new subscription-style payment model that the NHS is developing has been designed to try to address the lack of new antimicrobials being developed and the growing threat posed by antimicrobial resistance, or AMR. The recent guidance from NICE on the two new AMRs is a world first and an important step forward. What NHS England has now got to do is enter into negotiations with the manufacturer, with a view to making them available to NHS patients.

[Lord Turnberg (Lab)]

My Lords, NICE is a remarkably effective organisation, but is the Minister aware of the gross inefficiencies in the system which operates in order for health technology assessment approvals to occur? There is a huge number of committees through which this process has to go. Is there any way of reducing this nightmare?

[Lord Kamall (Con)]

I am aware of some of those issues, but I wonder whether the noble Lord could write to me with some more specific examples. In my meetings with various organisations, including the Health Technology Alliance and others, wherever they have raised these issues we have looked at them. The NHS, the department, NICE and others are trying to work with suppliers, manufacturers and providers to see how it can be more responsive. If we are going to realise the life sciences vision, we have to make sure that we make the best of the NHS as a global centre of excellence and show that we are at the forefront of research.

[Lord Naseby (Con)]

While we all understand the importance of NICE, can my noble friend reassure us that NICE is working within a fixed budget at this difficult financial time?

[Lord Kamall (Con)]

I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.

[Baroness Wheeler (Lab)]

My Lords, NICE is a critical participant in the Innovative Licensing and Access Pathway, launched over a year ago. It aims to make use of regulatory freedoms post Brexit to speed up access for NHS patients to new drugs, including cancer treatments. Can the Minister tell the House how many treatments have been or are being considered through ILAP and when we might expect to see the first ILAP treatment being made available on the NHS?

[Lord Kamall (Con)]

I know I have the answer here somewhere but I cannot find it, so I commit to write to the noble Baroness.

[Lord McColl of Dulwich (Con)]

My Lords, can the Minister kindly inform NICE and the Department of Health that they are misleading the nation and have done for years in telling them that all the calories we eat are used up in exercise? That is not true and has never been true. Only a fraction of the calories we eat are used up in exercise. Could the Minister do something about NICE and the Department of Health?

[Lord Kamall (Con)]

I will try my best. If I may, I shall use this opportunity to respond to the noble Baroness’s earlier question. We have seen horizon scanning in regulatory science, which means that ILAP is at the forefront of cutting-edge developments. It is open to commercial and non-commercial, and UK-based and global developers of medicines. As I said, I will write to the noble Baroness with more detail. On doing something about NICE and the NHS, I have constant meetings with the NHS, as do other Ministers. One of the challenges that came up during the passage of the Health and Care Bill—I know that noble Lords who have been Ministers previously made this point—was that Ministers here have to respond on issues but decisions are quite often taken at NHS level.

[Lord Patel (CB)]

My Lords, I am yet another doctor. In defence of NICE, it has, despite the financial constraint, delivered 50% more appraisals in 2020-21 and is likely to do an extra 20% this year. The important point I want to make is the point made by the noble Baroness, Lady Morgan of Drefelin: patients need to have access to effective treatment sooner. If the appraisals are causing delay, for whatever reason, that is the place where NICE needs help, to get patients early access. For instance, a breast cancer drug that treats patients with triple-negative breast cancers, with a higher mortality, is available in one part of the United Kingdom now, but it is not available in England.

[Lord Kamall (Con)]

The noble Lord makes a very important point. One of the things we are looking at, so that we will not only be a centre for life sciences but make sure that our NHS is at the forefront of healthcare worldwide, is to make sure that we look at the different stages of medicines when they are approved, if they have conditional marketing, and the different stages of approval to see whether we can get them to patients earlier. As the noble Lord says, we should share the good news about NICE. It issued guidance within 90 days for licensing of 100% of new active substances in 2021-22 and has the highest number of technology appraisals in any year since appraisals began. There is some good news, but NICE recognises that it has to do more and we are in conversation about that.

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Lord, Lord Howarth of Newport, who is contributing virtually, to ask the fourth Oral Question.

North East Ambulance Service

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

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

My Lords, I shall repeat an Answer to an Urgent Question given in the other place:

“Mr Speaker, I was horrified to read the concerns raised about the North East Ambulance Service in reports over the weekend. My thoughts are, first and foremost, with the families affected by the tragic events they describe. I cannot imagine the distress they are going through. They have my unreserved sympathy and support.

In healthcare, a willingness to learn from mistakes can be the difference between life and death. It is because of this that, as a Government, we place such a high value on a culture of openness and a commitment to learning across our NHS. That is why allegations raised by the Sunday Times are so concerning. As was made abundantly clear by the Secretary of State’s predecessor almost a decade ago, NDAs have no place in the NHS, and reputation management is never more important than the safety of patients.

The Government are wholly supportive of the right of staff working in the NHS to raise their concerns. Speaking up is vital for ensuring patient safety and improving the quality of services, and should be a routine part of business in the NHS. That is why, over the past decade, substantial measures have been introduced to support the NHS in England to reduce patient harm and improve the response to harmed patients, including legal protections for whistleblowers, along with a statutory duty of candour and the establishment of the Health Services Safety Investigations Body and medical examiners across the NHS. It is also why, in response to a recommendation of the Sir Robert Francis Freedom to Speak Up review of 2015, the Government established an independent national guardian to help drive positive cultural change across the NHS so that speaking up becomes business as usual. However, when it comes to patient safety, we cannot afford to be complacent. Patient safety remains a top priority for the Government, and we continue to place enormous emphasis on making our NHS as safe as possible for patients.

I note that the concerns raised in this weekend’s reports have been subject to thorough review at trust level, including through an external investigation, and that the trust’s coronial reporting is subject to ongoing independent external audit and quarterly review by an executive director. I also note that, as the appropriate independent regulator, the Care Quality Commission has been closely involved. However, given the seriousness of the claims reported over the weekend, we will of course be investigating more thoroughly and will not hesitate to take any action necessary and appropriate to protect patients.

The Government are also committed to supporting the ambulance service to manage the pressures it is facing, ensuring that people receive the treatment that they need when they need it. We have made significant investments in the ambulance workforce: the number of NHS ambulance and support staff has increased by 38% since July 2010, and Health Education England has a mandated target to train 3,000 paramedic graduates nationally per annum from 2021 to 2024, further increasing the domestic paramedic workforce to meet future demands on the service. Furthermore, 999 call handler numbers were boosted to over 2,400 at the end of March 2022, about 500 more than September 2021, with potential for services to increase capacity further during 2022-23.

I fully appreciate the concerns of Members across this House and would be pleased to meet with those whose constituents have been affected.”

[Baroness Merron (Lab)]

My Lords, human tragedy permeates this scandal, which has seen up to 90 unnecessary deaths, gross negligence, cover-ups and public money buying the silence of staff. Quinn Beadle, who was just 17 when she tragically committed suicide, died because an ambulance worker failed to perform proper resuscitation. In the report that was then made to the coroner, North East Ambulance Service managers removed this detail. The Secretary of State said today that this and dozens more injustices will be investigated more fully. Will the Minister confirm that this will take the form of a formal inquiry, as it surely must? Will questions be asked of the Care Quality Commission, which, despite being tipped off two years ago, failed to flag or even spot this outrage?

[Lord Kamall (Con)]

I thank the noble Baroness for raising those concerns. I completely agree with the sentiments she expressed; this is completely uncalled for. As I said previously, my honourable friend Maria Caulfield pledged that there would be an investigation into this. As to whether it will be a formal inquiry, it is too early for me to give a direct answer, but I will go back to the department and as soon as I have more information I will write to the noble Baroness. I understand that these are historic incidents and that the CQC has said that its service is improving, but as more information is still coming out—even today when I had the briefing, not all the information was there—I will of course commit to write to the noble Baroness.

[Lord Shipley (LD)]

My Lords, in 2019, Matt Hancock MP, the then Secretary of State for Health and Social Care, vowed to end non-disclosure agreements in the NHS, yet earlier this year bosses at the North East Ambulance Service used non-disclosure agreements for the brave whistleblowers in return for settlement. What action will the Minister take with the North East Ambulance Service for flouting the very clear guidance and regulations relating to non-disclosure agreements?

[Lord Kamall (Con)]

As was said in the other place earlier today, the fact is that non-disclosure agreements have no place in the NHS, and the Government have been absolutely clear about that. I am afraid that I cannot give exact details, because it is obviously very recent, but I know that that is one of the issues that will be looked at. We are investigating, and all aspects will be looked at thoroughly.

[Baroness Masham of Ilton (CB)]

My Lords, will the Government do their best to stop cover-ups, which there have been over this matter, so that this does not happen in future?

[Lord Kamall (Con)]

Absolutely. It is really important that we have a duty of candour and that people can be open. We saw this during the passage of the Health and Care Act, with HSSIB. Although there might be an initial reaction to find the culprit, or whatever the issue is, it is really important that we learn from mistakes made. It is a difficult balance, but we have to make sure that we have an open environment and culture so that people feel safe to come forward and explain what happened, and to make sure that these services learn from what went wrong. We have been absolutely clear that there is a cultural issue that has to be addressed, but also that NDAs have no place in the NHS.

[Lord Clark of Windermere (Lab)]

My Lords, we really must learn the lessons, having witnessed this cover-up in one of the most deprived parts of the UK. I say to the Minister that he should not look at the case, for example, of the ambulance drivers in isolation. Will the Government announce now that they are prepared to have a proper workforce plan for the NHS?

[Lord Kamall (Con)]

I take the noble Lord’s point that you cannot look at things in isolation; we have to take a systemic view. Are these issues confined to the ambulance service or is it the wider NHS or the wider trust? These are all issues that have to be looked at. On the workforce plan, I assure the noble Lord that I have tried, but clearly there are issues. Health Education England has been mandated to come forward with workforce strategies, and there are workforce strategies at trust level as well.

[Lord Berkeley of Knighton (CB)]

My Lords, does the Minister agree that we have to be much more proactive in encouraging people to have the courage to be whistleblowers? It is the only way we are going to learn. Secondly, should we not outlaw NDAs of this sort, so that they cannot suppress information that is vital to the well-being of society? I agree with the previous speaker who said that we need to change the culture around this, not just small points.

[Lord Kamall (Con)]

Noble Lords are absolutely right to talk about the culture. Years ago, during my academic career, I looked at organisational change; one of the very difficult issues is that while you can change structures and processes, it is about how you address the culture. Quite often in organisational change, or any change, there is a cultural lag. Sometimes the lag is due to individual values and sometimes it is much more widespread than that, and there are questions about how the culture grew in the first place and how to address those roots. Sometimes it is about personnel change and sometimes it is about retraining. There are a number of issues when it comes to changing culture, which is quite often more difficult than structural change.

The Government have been clear, as has the NHS, that there are clear guidelines around the use of NDAs by the NHS, including that it should not prevent staff speaking up about concerns relating to the quality or safety of care. It will be important for us to discuss all the issues further with the trust, the CQC and others, to determine the appropriate steps to take from here, including on NDAs.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister makes a very interesting point about culture but does he not think that, whatever review is undertaken, it needs to look further? If this is proven to be so, what are the reasons why management would seek to take the action that it did, and to what extent is pressure on managers from higher up the system causing them to cover up because of punitive action? In other words, does he agree that the culture is set by Ministers at the top? If they deal with the health service in a punitive way, as they have often done over many years, they should not be surprised if the system responds by seeking to cover up what has been happening.

[Lord Kamall (Con)]

I recognise that the noble Lord was a Health Minister but I must say that, in my time as a Health Minister, I have never found it to be an adversarial relationship but always quite co-operative. In conversations that I have had with individuals I have met in the NHS, they have been quite clear that I have no power over them, as it were, but that we can discuss concerns—although, clearly, the Secretary of State does exercise certain powers. However, the culture goes deeper than this and the noble Lord is absolutely right to suggest that we have to understand the roots of that culture and the incentives and disincentives to certain behaviour. I am sure that this will all be looked at as we try to learn what went wrong in this case.

[The Lord Bishop of Durham]

My Lords, I should declare that NEAS serves the area that I live in; indeed, I shall be in Shildon on other business later this week. Will the Minister take the opportunity to applaud the work—on the ground and in the vehicles—of members of the ambulance service? They seek to do their best under incredible pressure, day in and day out. This is an opportunity to thank them, I think, even in the face of such tragedy.

[Lord Kamall (Con)]

I completely agree with the sentiment expressed. We should be grateful to all public service workers. They were put under immense strain during the early days of Covid and beyond, and still face some of those issues. There is no doubt that the extra pressure that people face in the workforce can have an impact on their behaviour. Going back to the point made about culture by the noble Lord, Lord Hunt, we have to look at incentives and disincentives, and why people behave in a certain way. We have to not only question that but ask what we can do better in the future. That is the point of learning. We want people to be as transparent as possible, and to feel free to come forward and explain where things have gone wrong.

[Baroness Foster of Oxton (Con)]

My Lords, this is not just about the ambulance service; it is about a culture that is endemic throughout the NHS. I have spent most of my life dealing with the aviation industry, which learned decades ago that if you cover things up, whether deliberately or not, you will never get to the source of the problem. This is why we have such high standards in that industry. Does my noble friend agree that, until and unless we take a fresh look at this and have a no-blame culture, which will then encourage people to come forward if they see things that are not working, we will not get past where we are today?

[Lord Kamall (Con)]

I begin by paying respect to my noble friend’s experience in the aviation sector. Noble Lords who took part in the debate on the Health and Care Bill will know that, when we spoke about HSSIB and safe space, that concept came from learning from the air transport industry and—I hope I get this right—the air transport accidents board, with respect to transparency. When that industry was able to have a frank, open culture and people felt free to step forward without fear of prosecution, it was found that people were frank and could learn from mistakes. This is what we are hoping to do with HSSIB, in the same way—to let people come forward, have a frank and open discussion about what went wrong, and make sure we learn from our mistakes. This is the important thing that we want to learn from the air transport industry; we hope that it will help us to improve the culture for health and care workers.