Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Kamall Excerpts

Wednesday 20th October 2021 Grand Committee

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

My Lords, this has been an excellent and fascinating debate. I thank the noble Lord, Lord Patel, for his chairmanship of the Science and Technology Committee. I have heard the challenges that he faced. I also thank those noble Lords who sit on the committee and all those who contributed to the report. It was in-depth and covered a range of issues, in the fine tradition of reports from the House of Lords. I remember that when I was a Member of the European Parliament a number of reports from this place were read there. The expertise available here was widely acknowledged.

The report covered a number of issues: the trends and challenges, the science of ageing, lifestyle and environmental factors on ageing, the better use of technology and digital services, and the ageing society grand challenge mission. I will come back to those in more detail.

I also thank all those noble Lords who have spoken today for their knowledgeable and insightful contributions, particularly building on their expertise. I have admired many of them from afar for many years. It is a real privilege to be here in the same debate as them.

Promoting good health, enabling people to live long and healthy lives, and improving the health of the whole population are all something we want, but they are also fundamental aims of this Government. We can do this most effectively by harnessing the incredible opportunities provided through innovation, science and technology, as the noble Baroness, Lady Greengross, and other noble Lords mentioned.

Before I respond to the specific points made today, I will return to one of the points that noble Lords rightfully acknowledged: the impact of the Covid-19 pandemic and the subsequent lockdowns on life expectancy. A number of noble Lords quoted the Office for National Statistics, as well as some interesting pages and websites that we could read to learn more about this. They also highlighted that life expectancy at birth in the UK between 2018 and 2020 was 79 years for men and 82.9 years for women, but this saw a decrease of seven weeks for men with almost no change for women compared with 2015-17. However, the committee report mentions that there has been a decrease for females over the past decade.

One of the Government’s current priorities is to clear the backlog resulting from the pandemic. This report rightly acknowledges the devastating impact of the Covid-19 pandemic and its response on people’s lives in this country, but also how the pandemic has exposed existing health inequalities, which the Government will tackle as part of our levelling-up agenda—as many noble Lords have referred to today.

The Office for Health Improvement and Disparities has been tasked with helping more people to live longer lives in good health and reducing health disparities by breaking the link between someone’s background and their chance of living a healthy long life. As noble Lords are aware—indeed, some have mentioned this—while people are living longer, many suffer poor health towards the end of their lives. A notable statistic is that people in the least deprived areas live in good health for almost two decades longer than those in the most deprived areas. The noble Lord, Lord Patel, and others referred to this statistic.

The Medical Research Council is leading a cross-government programme of research to understand the ageing process better and promote health in later life, but also on how to motivate healthier lifestyles to improve healthy life expectancy. Like many noble Lords, I want to see the MRC rely more on evidence-based research to ensure that targeted interventions work and avoid unintended consequences.

Many noble Lords have shown an interest in the ageing society grand challenge mission for additional healthy, independent years of life while narrowing the gap. The noble Baronesses, Lady Young and Lady Greengross, mentioned this challenge in particular; I assure noble Lords that the Government remain committed to it. One of the most effective ways to increase life expectancy and healthy life expectancy is to prevent people getting ill in the first place. The report rightly lists risk factors, including the impact of smoking and excessive alcohol consumption. The noble Viscount, Lord Hanworth, pointed to the impact of alcohol, when interventions are often focused on other substances, such as tobacco. From looking at the statistics, alcohol not only leads to cirrhosis of the liver but is often responsible for other deaths—drownings, murders, et cetera—so it is important to look at the wider impact of alcohol consumption. We should also look at poor diets, nutrition, obesity, physical inactivity and the environmental factors that affect physical, cognitive and mental health as humans age.

The Office for Health Improvement and Disparities will drive this cross-government effort to reduce ill health. As many noble Lords know, part of the title of this office is about health disparities. It will continue to publish the productive healthy ageing profile, which provides data at national, regional and local levels on a range of indicators, including healthy life expectancy, health behaviours, NHS health checks, employment and housing.

As the Minister for Technology, Innovation and Life Sciences, I am hugely excited by the role that all three will play in our economic recovery from the pandemic, as well as in our long-term prosperity and in improving the health of the nation. The Government’s new innovation strategy, announced in July, sets out our vision to make the UK a global hub for innovation by 2035, not only in digital technology but in the exciting area of life sciences.

The Government’s commitment to innovation also applies to social care. In the September announcement on social care reform, the Government were clear that innovation would play an important part. Therefore, we continue to work with care users, providers and other partners to codevelop the reform plans, and will publish further detail in the forthcoming White Paper.

GPs’ surgeries are the first point of contact for many patients. The pandemic rapidly changed how services are provided, moving to telephone and online to complement face-to-face appointments where necessary. We continue to look at ways to improve the experience, as many noble Lords will remember from the discussion yesterday when face-to-face appointments were raised. The Government are clear that you have to leave it between the patient and clinician but, when a patient requests a face-to-face appointment, there has to be a good medical reason for the clinician to turn it down.

Many noble Lords alluded to technology. I will continue to work with NHSX and NHS Digital to drive digitisation and the sharing of appropriate data across our system of healthcare, from GP practices to hospitals, and to the social care sector to complement the proposed reforms in the Health and Care Bill. The noble Lord, Lord Desai, mentioned the issue of data sharing and making sure it is all there, but there are some challenges, as I am sure the noble Lord will acknowledge. Many civil liberties organisations have expressed concerns, and I have been in contact with a few to pledge that I will discuss how we can make sure that data is safe, and appropriate data is digitised and shared in the most appropriate way, so that patients have trust. We are looking at the development of things such as trusted research environments to make sure that patients are reassured.

I will work across government with the Office for Life Sciences, BEIS, the Department for International Trade and No. 10 to make the UK a location of choice and hub for life sciences, not only in the Cambridge-Oxford-London golden triangle but across the UK as part of the levelling-up agenda.

I will try to address some of the specific points made by noble Lords. The noble Lord, Lord Patel, asked a number of specific questions and I will try to respond to some of them. The noble Baroness, Lady Manningham-Buller, talked about overprescribing. There was an overprescribing review published on 22 September, and I thank Dr Ridge and all those who participated for their diligent work, which produced such a thought-provoking document. It sets out a series of practical and cultural changes, including the better use of technology. I hope that this report will be a call to action for everyone, whether a patient, clinician or healthcare leader, to think about what we can do to take forward this vital agenda.

The Government remain committed to extending healthy life expectancy by five years and I repeat that pledge. To deliver on this commitment we will work with the Office for Health Improvement and Disparities, as I have mentioned previously. The office—I will use its acronym OHID, as I know many in healthcare like their acronyms—will set out its future plans for extending healthy life expectancy, including how these plans will be delivered and, crucially, monitored in due course. In addition, the new health promotion taskforce will drive and support the whole of government to go further in improving health and reducing disparities to tackle many of the factors that are critical to good physical and mental health.

The Government are strongly committed to supporting research into dementia, which a number of noble Lords referred to. UK researchers are at the forefront of global efforts to find a cure or disease-modifying treatment by 2025. Sadly, the response to the prevention Green Paper has been delayed by the need to focus on the pandemic response, but we will bring forward a response to the consultation in due course.

Many noble Lords asked about the levelling-up White Paper, which will be published later this year. It will set out policy interventions to improve livelihoods and opportunity in all parts of the UK, especially to improve health outcomes and reduce the gap in healthy life expectancy. Given the very technical nature of some of the remarks made by the noble Lord, Lord Patel, on the biology of ageing, I hope he will not mind if I respond to these points in writing.

A number of noble Lords raised the issue of technology, including the noble Baroness, Lady Young, and the noble Lord, Lord Mair. Once again, the issue of data sharing came up. We welcome the report’s recognition of the role that technology can play and it is really important to drive this. Part of it is data sharing, and part is making sure that the different parts of our system of healthcare work together and that we can learn from best international practice.

Before I entered this House, I used to do a lot of work analysing technology. One of the things I looked at is how the Japanese decided to respond to the changing demographics of their country. Some countries respond by immigration, but others do not want to respond like that and Japan is one of those that is very sceptical of immigration. Therefore, it is focusing on technology and how to improve the lives of people getting older, whether through some of the technologies that other noble Lords mentioned, such as touch-sensitive items and data communicating with clinicians, or through robots and extraskeletal equipment to allow older people to live a more meaningful life.

The NHS is also supporting many people to stay at home for their healthcare with digital tools and remote monitoring, partly helped by the fact that more and more of the population are buying mobile phones, Fitbits and various digital devices, and are able to provide that data. Once again, we have to be very careful and make sure that the public is onside as that data is shared.

The noble Lord, Lord Mair, also talked about AI and robots. The Government are taking action in this area. In August 2019, the Prime Minister announced a £250 million-boost to AI in the healthcare sector. I have been in very interesting conversations with the NHS AI Skunkworks. It is fascinating to see some of the technology that has been looked at there.

A number of noble Lords also mentioned how we make sure that an ageing population is digitally aware. I worked with a number of local civil society projects in a previous life. One of the interesting projects was where we got younger people to come in and teach older people to use technology. Not only did it give a more meaningful life in many ways to the older people learning technology but it was interesting that quite often some of the young people were from deprived backgrounds—sometimes single-parent families—and they were able to connect with the older person they were teaching. In many cases they found a new mentor or a new role model in their life. It was one of those interventions that helped the elderly people and some of the young people from broken families. We have to look in a more joined-up way at how we can make sure that we help more people that way.

The noble Lords, Lord Mair and Lord Sikka, also talked about the internet. There is something about the essential digital certificates that are being funded for digital entitlement and based on new standards. The Government and Ofcom have agreed a set of commitments with the UK’s major broadband and mobile operators to support vulnerable consumers, not only during the pandemic but as we go forward to make sure there is no real digital divide.

The noble Baroness, Lady Young, and the noble Lord, Lord Browne, spoke about inequalities, as did the noble Viscount, Lord Hanworth, the noble Lord, Lord Davies, and my noble friend Lord Balfe. The Office for Health Improvement and Disparities has said that it is time to shift the centre of gravity for the department and the health system from treating disease to building good health. As many noble Lords have said, we should start this at a young age as effectively as possible.

One of the issues that my noble friend Lord Ridley mentioned is that it is all very well having these health education programmes at a young age, but will people listen then? When I was at school we had programmes about smoking, alcohol and other things. I remember my friends saying that they were never going to drink or smoke, but a couple of years later we were all out partying. When is public education effective? Do you just assume it is at childhood and not again? How do we make sure that it continues throughout one’s life? That is why it is important that public health messages are built on evidence and communicated in a way that appeals to those we are trying to reach.

The noble Baroness, Lady Young, also spoke on various other things about public health. I assure her that regional directors of public health will sit within the Office for Health Improvement and Disparities and will join up at the national and local level.

The noble Baroness, Lady Young, and the noble Lord, Lord Davies, spoke about levelling up. The White Paper will look at how we set out bold policy interventions to tackle a number of different inequalities. As many noble Lords will know, there are multidimensional inequalities and many ways of people identifying, if you like.

A number of noble Lords also spoke about obesity. Many noble Lords will be aware that we published our current obesity strategy in July 2020. This sets out an overarching campaign to reduce obesity by taking forward actions from previous chapters of the childhood obesity plan and setting out measures to get the nation fit and healthy.

This will involve a number of interventions; some of them have been controversial. Some, such as the restrictions on advertising of food high in fat, sugar and salt, both on TV and online, will be progressed as part of the Health and Care Bill. We should be aware of the controversy around some of this and make sure that, when we make these interventions, they are based on evidence, and we are able to review the evidence and bring it back to show what difference it has actually made, rather than just make the intervention, hope for the best and feel good that we have made it. Evidence-based research is very important as we make these interventions.

The noble Baroness, Lady Sheehan, mentioned ethnic-minority inequality, and the Better Health campaign that the Government launched will look at how we focus on those most at risk, including those from specific ethnic-minority communities, those living with long-term health conditions and people over the age of 40 from lower socioeconomic groups, looking at particularly targeted interventions for each of those different minority groups. On long Covid, which she also mentioned, OHID will be looking at a range of factors that impact life expectancy as we look to reduce health inequalities, and that includes some of the issues on long Covid.

A number of noble Lords talked about dementia, and we have been implementing the 2020 challenge on dementia, published in February 2015, to make sure that dementia care, support and awareness of research are transformed. We will be setting out our plans for dementia for England for future years in due course. The noble Baronesses, Lady Young and Lady Greenfield, mentioned dementia research and statistics, and I commit to write to them with more details on the questions they asked, given the time.

I already mentioned that the noble Viscount, Lord Ridley, talked about some of his scepticism of the public health agenda, and I mentioned my experience and that of many friends, but one issue that he mentioned was diagnosis. The work of Genomics England is interesting. As it goes forward, it will be able to identify potential diseases that individuals will face in their life. This is not as easy as it sounds, because it also raises a number of ethical issues. At what point do you notify people that they will suffer from particular diseases? Do you intervene early, or do you wait until a particular age? A number of these issues are incredibly difficult, but we will try to get the right balance.

We talked about research and funding, and the National Institute for Health Research is welcoming funding applications for research in a number of different areas, including those who want to look at the issue of healthy ageing. I hope I have talked in detail about the data strategy, but it will be important that we get there.

I apologise to noble Lords for not being able to cover all the points raised. To finish, I say just that it is an insightful and wide-ranging report, and that the Government remained committed to ensuring that as many people as possible enjoy a long and healthy life, whoever they are, wherever they live and whatever their background.

GPs: In-person Appointments

Lord Kamall Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what steps they are taking to ensure all patients can choose to have a telephone or in-person appointment with their GP; and what assessment they have made of the impact of appointments not being in person on the late diagnosis of conditions.

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

We have published a comprehensive new plan to support GPs and make it easier for patients to see or speak to GPs and their teams, based on their choice. The plan is backed up by a new £250 million winter access fund, which will help patients with urgent care needs. As part of this, practices should ensure that they are providing the right proportion of appointments for their registered population that is clinically warranted and takes account of patient preferences.

[Lord Balfe (Con)]

I thank the Minister for his reply but point out that one of the fundamentals of the NHS has been that the patient has decided when they wish to see the doctor. Under Covid, that has been breached many times, with doctors having far more power not to see patients. Can he assure me that the aim of the department will be to get back to a system where the patient decides whether they need to see the doctor?

[Lord Kamall (Con)]

My Lords, I am happy to agree with the sentiment in the question from my noble friend, but it is important to make sure that we are not overly prescriptive. Patients sometimes want face-to-face consultation, but they may also be happy with a telephone call or an online consultation. At the heart of this should be patient choice.

[Baroness Pitkeathley (Lab)]

My Lords, has the Minister heard GPs say, as I have, that the most important question a patient asks is the one as they are leaving—the one as they are walking out of the door? Will the training of GPs be amended to cover the different listening techniques that may be required for online consultations, so that these important questions are not missed?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her expertise in this area, and absolutely agree with the question she asked. I do not have the details of the training of GPs to make sure that they are best prepared for online consultations, but I will write to her.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, does the Minister agree that we are in danger of looking at this issue the wrong way around? Given that there is much ongoing research into clinician and patient experience of virtual appointments, that primary care consists of many more people than just GPs, and that complex diagnoses are usually given by specialist consultants, there are multiple reasons from both the clinical and patient viewpoint for what medium to choose. Can the Minister reassure the House that there will be no blanket targets imposed on professionals for the percentage of appointments that need to be face to face, virtual or by telephone, and that GPs, patients and other clinicians are able to assess between themselves what is the most efficient medium to ensure the best possible outcome for the patient?

[Lord Kamall (Con)]

What is important here is that we leave it to the relationship between the GP and the patient to decide the best form of consultation. Sometimes that will be face to face and, if the patient wants a face-to-face consultation but the GP is unable to provide one, they have to give a good medical reason why not. However, we can balance that with online and telephone appointments.

[Baroness Brinton (LD) [V]]

Many GPs are feeling as if they have been completely thrown to the wolves by Ministers, and even Jeremy Hunt has said that the proposed plan and the £250 million winter access fund to support GPs and reduce the pressures they face is little more than a sticking plaster and will not help, given that the real problem is the shortage of qualified GPs. There are not even locums in many places and no longer applicants for many GP jobs. Has the Minister talked to GPs about their current extensive workload, and will he reconsider the assistance needed to support our exhausted GPs?

[Lord Kamall (Con)]

It is important that we listen to GPs and understand their needs and how we can support them. We have committed to growing and diversifying the workforce and boosting GP recruitment. We have also committed to recruiting an additional 26,000 primary care staff to be embedded in multidisciplinary teams. The details of the training will be left to the trainers themselves.

[Lord Flight (Con)]

My Lords, it was appropriate for GPs to avoid physical contact with their patients when the Covid risk was significant. As this abates, it is surely equally correct for GPs to agree to returning to seeing patients when they so request and where their symptoms invite further investigation. Also, rewarding GPs at a lower rate for telephone appointments and for working three rather than five days a week might serve as an effective incentive to restoring physical appointments.

[Lord Kamall (Con)]

At the centre of what the department requires and expects is that GPs work with their patients to decide the most appropriate form of consultation. In some cases that will be telephone, in some cases that will be online, and in some cases it will be face to face. When the patient requests face to face and the GP refuses, they have to give a good medical reason why.

[Baroness Stuart of Edgbaston (CB)]

My Lords, healthcare depends crucially on the relationship between patient and professional. A recent study of Norwegian records found that the longer the relationship between an individual GP and a patient, the more you reduce the need for out-of-hours care and the likelihood of being admitted to hospital. Face-to-face consultation is important but even more important is the case manager function of the general practitioner. Can the Government make a similar study in England in terms of individual GP and patient relationships and medical outcomes, and encourage the devolved Administrations to do similar work so we can compare data?

[Lord Kamall (Con)]

The relationship between the patient and the GP is important, so we have made sure that choice is at its centre. As they develop the relationship, they can decide on the most appropriate way to be consulted and to give advice.

[Baroness Thornton (Lab)]

The Government have consistently promised and failed to increase the number of GPs. Instead of the 5,000 additional ones promised in 2015, this year we have 1,300 fewer GPs. When the Health Secretary announced the £250 million winter access fund to enable GP practices to improve the availability of services to patients, where did he think those GPs would come from? Where is the magic locum tree? It is a seven-year pipeline to produce a GP. Does the Minister agree that rubbishing and attacking GPs is not going to attract medics to take up this profession?

[Lord Kamall (Con)]

I think we all agree that we should appreciate the work that GPs did during Covid; they were often the front line. It is important that we continue to make sure that we recruit more GPs. Some 3,793 doctors—the highest ever number—accepted a place on GP training in 2020, so I do not recognise the criticism.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, I take this opportunity to welcome the noble Lord to his new position; it is the first chance I have had to do that. Does he agree that virtual appointments increase the number of patients dealt with but not the quality of the consultation? Now that we are coming out of extreme measures, what are the Government doing to level up the worst GP practices to the standards of those undeniably excellent ones in some areas? Will he now encourage GPs to have more face-to-face appointments?

[Lord Kamall (Con)]

I thank the noble Lord for his warm welcome to me in my new role. As other noble Lords have expressed, it is really important to make sure that the relationship between patient and doctor or GP is respected. That will not always mean being seen face to face, but when a patient asks for this there has to be a good medical reason if the appointment is not. Speaking from personal experience, I have found online consultations as good as, if not sometimes better than, face-to-face appointments.

[Baroness Smith of Newnham (LD)]

My Lords, I declare an interest. Last November, my father turned yellow. He rang to get a doctor’s appointment and was given a telephone consultation. He does not have a smartphone. The GP said, “It’s jaundice, but it might be pancreatic cancer.” No other suggestion was made and there was no suggestion that he could go in to see the GP. He did not know that he had a choice. He is still with us 11 months later; it clearly was not pancreatic cancer. The idea that people have choice does not work if they are not strong and vocal enough to be able to tell the GP practice, “I need a face-to-face appointment.” What will the Minister do to make patients aware that this is possible?

[Lord Kamall (Con)]

I sympathise with the case that the noble Baroness communicated. It is important that GPs and patients work that relationship out between themselves. If a patient asks for a face-to-face appointment and the GP refuses to give one, the GP has to have a good medical reason.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Drugs: Black Review

Lord Kamall Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Moylan]

To ask Her Majesty’s Government what assessment they have made of Dame Carol Black’s Review of drugs part two: prevention, treatment and recovery, published on 8 July.

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

On 27 July, the Government published an initial response to Dame Carol Black’s review, welcoming all 32 recommendations and setting out a clear cross-government commitment to the agenda. The Government have also committed to respond to the review in full by the end of the year and to set out a long-term drug strategy which will present our whole-government response to drive down drug supply and demand.

[Lord Moylan (Con)]

My Lords, I also welcome my noble friend to his place on the Front Bench. With entrenched drug use driving half of the nation’s crime and people with serious drug addiction occupying one in three prison places, does he accept Dame Carol Black’s finding that the current public provision for drug misuse, prevention, treatment and recovery is not fit for purpose and that Her Majesty’s Government face an unavoidable choice: invest in tackling the problem or keep paying for the consequences?

[Lord Kamall (Con)]

I thank my noble friend for the question and the point he made so forcefully. In January, the Government announced a £148 million crime package for 2021-22, which has been allocated to local authorities for drug treatment and recovery services, with a focus on improving services for offenders and reducing deaths. This is the largest increase in drug treatment funding for 15 years.

[Lord McConnell of Glenscorrodale (Lab)]

My Lords, we have a very good example inside the UK of the short-term impact of cutbacks in rehabilitation and treatment. In Scotland, we now have the highest level of drug-related deaths in Europe, partly as a result of cutbacks in treatment and rehabilitation made over the past decade by the Scottish Government. The UK Government share some responsibilities on drug policy with the Scottish Government under the devolution settlement, so will they guarantee to work with the Scottish Government to try to turn around this devastating situation?

[Lord Kamall (Con)]

In September 2020, Kit Malthouse and Jo Churchill, the then Minister for Prevention, Public Health and Primary Care, co-chaired a UK ministerial meeting focusing on UK-wide approaches to drugs misuse. The second UK drugs ministerial took place at Hillsborough Castle in Belfast on 11 October. The Government maintain a commitment to consulting the devolved Administrations—or devolved Governments in many cases—as well as a number of expert speakers.

[Baroness Brinton (LD) [V]]

My Lords, the Government’s initial response welcoming Dame Carol Black’s recommendation to create a cross-departmental approach to tackling drugs misuse and related harm is welcome. However, they have not responded to many of the key recommendations, of which the most important is the introduction of multi-year ring-fenced funding for treatment services, distributed by local need, with at least £552 million invested in the treatment system annually by the end of year 5. When will the Government’s full response be published? Will Dame Carol’s recommendations be fully funded?

[Lord Kamall (Con)]

The Government have committed to giving a full response to Dame Carol Black’s review by the end of the year and have already taken action. Since part 1 of her review, the Government have announced £148 million of investment to tackle drugs misuse, supply and county-lines activity. That also includes £80 million for drug treatment and recovery services.

[Lord Hannan of Kingsclere (Con)]

My Lords, will my noble friend the Minister consider the third option, not mentioned by my noble friend Lord Moylan; namely, a partial decriminalisation? The evidence from those European countries and US states that have pursued this course is that not only does it relieve pressure on the police, the criminal justice system and the taxpayer but it leads to a decline in the number of drugs-related deaths. I appreciate that this is a complex issue and that there are strong views on all sides, so perhaps my noble friend the Minister will consider a temporary experimental change in the laws, as Parliament did over changing our time zone, where we lift the restrictions for a year, and then at the end of that we have a vote.

[Lord Kamall (Con)]

I thank my noble friend for reminding us of the third option—or the third way, as some might say. It is really important that we consider all views, and I have read, over the years, many arguments in favour of liberalisation. At the same time, however, I have also read many criticisms from drug treatment charities, saying that it is not as simple as that. At this point, the Government are not committed to any trials on the basis suggested.

[Baroness Hoey (Non-Afl)]

My Lords, I refer the Minister to Dame Carol Black’s assertion that

“we can no longer, as a society, turn a blind eye to recreational drug use.”

Will the Minister make it very clear that the downgrading of cannabis—the making of cannabis legal—would send out a message that it is fine? But it is not fine for those millions of young people all over the country who get caught up with cannabis. It is a gateway drug, and the Government should not be thinking of doing anything like what the noble Lord, Lord Hannan, has suggested.

[Lord Kamall (Con)]

I thank the noble Baroness for her question and for her point that it is important to continue to invest in drug treatment services, but also to make sure that we stop drug users from engaging with drugs in the first place.

[Baroness Merron (Lab)]

My Lords, among some 32 recommendations, Dame Carol stressed the importance of getting more people into treatment who require it, diverting people away from the criminal justice system, and ensuring that service users are given a wider package of support for housing, employment and mental health. With drug-related deaths in England and Wales rising for the eighth year in a row in 2020, what conclusions might be drawn about the effectiveness or otherwise of the current cross-government approach to tackling addiction? Can the Minister assure the House that wisdom will prevail such that funding for substantive health support services to tackle addiction will be announced in the comprehensive spending review?

[Lord Kamall (Con)]

The Government have committed to answering in full the recommendations of Dame Carol Black’s review. In terms of joined-up thinking across government, the Government established the new Joint Combating Drugs Unit—the JCDU—in July 2021 to co-ordinate, and drive a genuinely cross-government approach to, drugs policy. The JCDU brings together different government departments, including those that the noble Baroness mentioned—the Department for Health and Social Care, the Home Office, the Department for Levelling Up, Housing and Communities, the Department for Work and Pensions, the Department for Education and the Ministry of Justice—to help tackle drugs misuse across society by adopting a cross-government approach.

[Baroness Walmsley (LD)]

My Lords, the drug treatment and recovery workforce has deteriorated in quantity, quality and morale in recent years, with excessive case loads, decreased training and lack of clinical supervision. How do the Government plan to increase the number of professionally qualified drug treatment staff and improve occupational standards and training requirements?

[Lord Kamall (Con)]

The Government will answer all the recommendations in Dame Carol Black’s review by the end of the year. In response to the noble Baroness’s specific question, I shall write to her.

[Baroness Jones of Moulsecoomb (GP)]

It is hard to legislate to prevent drug use when it is such big business for organised crime globally. Many equatorial countries destroy their rainforests so that they can grow drugs, because that is part of their economy. Are the Government looking at those two things: global organised crime syndicates and environmental devastation from drug growth?

[Lord Kamall (Con)]

The noble Baroness raises a very important point: we should look at this more globally, not just look at our country’s drug strategy in isolation. Various departments across government are looking at that and working with partners across the world, but I shall write to the noble Baroness in more detail.

[Baroness Wilcox of Newport (Lab)]

The recurring theme in the report of the importance of holistic care—supporting individuals who use drugs with their health and well-being, housing needs and opportunities for education, training and employment—is very pleasing. It is also good that there is testimony in the report from people with lived experience, who can help to shape the support needed. Building on the question from my noble friend Lord McConnell, can the Minister explain how there will be a commitment to essential funding to put many of these excellent recommendations into practice, both in the UK and in the devolved Governments?

[Lord Kamall (Con)]

The Government will respond to the Dame Carol Black review by the end of the year, and that includes how much funding will be committed. The Government are committed to looking at the review’s distinct proposals to see what resources will be needed and to make that bid.

[Baroness Uddin (Non-Afl)]

My Lords, we as a family have experienced the state of mental health services in the past six weeks, and I had the privilege of meeting numerous in-patients and the anguished, distraught parents of young people with drug-induced psychosis being looked after by the least-trained or well-equipped staff, often in the absence of adequate numbers of doctors and nurses in the ward, as well as in the community. In welcoming the noble Lord to his role, I ask him whether he will respond to Dame Carol Black’s call for £500 million for drug services. Will he argue for that and do his best to ensure that it is available to all those who need it, and will he agree to meet some of us to discuss this?

[Lord Kamall (Con)]

I thank the noble Baroness for her question; we have known each other for a number of years, and I have always admired the work she has done in local communities in Tower Hamlets. In response to her specific question, I will commit to meet her and others who want to discuss this issue in more detail, but we have to wait until the end of the year for the Government’s response to Dame Carol Black’s review.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked and we now move to the next Question.

HIV Action Plan

Lord Kamall Excerpts

Monday 18th October 2021 Lords Chamber

[Lord Cashman (Non-Afl)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I record that I am a member of the APPG on HIV/AIDS and a patron of the Terrence Higgins Trust.

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

The Government remain committed to reaching zero new HIV transmissions in England by 2030, and we continue to make good progress towards this target. In September, the Government committed £36 billion over the next three years for the NHS and social care, but decisions on future funding for non-NHS and social care budgets, including for the new HIV action plan, are being taken as part of the comprehensive spending review.

[Lord Cashman (Non-Afl)]

I thank the Minister for his Answer. He hits the nail right on the head. He will be aware of concerns by NGOs, the Elton John AIDS Foundation, the National AIDS Trust and the Terrence Higgins Trust that the Government will back down on their financial commitments on HIV/AIDS. We need greater commitment to ending transmissions now, not less. Will the Minister therefore ensure that the Government keep their commitments, made at the height of the Covid pandemic in December 2020, by the Chancellor, to end new HIV/AIDS transmissions by 2030? Will he further commit to implement opt-out HIV testing in high incidence areas in England?

[Lord Kamall (Con)]

I start by paying tribute to the noble Lord, Lord Cashman. We served in the European Parliament together for many years, where he was always a champion of LGBTQ+ issues and made sure that people were aware of the issue of tackling HIV. Funding for HIV treatment and care services is provided by NHS England and NHS Improvement through specialised commissioning. HIV testing and prevention is funded by local government through the ring-fenced public health grant. In March 2020, the Government announced that the HIV prevention drug PrEP would be routinely available across England. The public health grant in 2021-22 includes £23 million to cover local authority costs of routine commissioning, in addition to the £11 million made available in 2021. I give the noble Lord that statement.

[Lord Fowler (CB)]

Is not one of the chief challenges for the Government to combat the stigma and prejudice that still surround HIV and AIDS? Is it not therefore important that there should be a strong public education campaign, run by the Government, to improve public understanding and dispel the myths? Surely, countering stigma must be a key to ending the HIV epidemic.

[Lord Kamall (Con)]

As noble Lords will have seen, there is agreement with the noble Lord’s point. As part of the Government’s commitment to reaching zero new HIV transmissions in England by 2030, the department is currently developing a new sexual and reproductive health strategy and an HIV action plan. Officials will continue to engage in discussions with the Department for Education during the development of these publications to relate them to how HIV is covered in the statutory curriculum in schools and as part of the intimate and sexual relationships lessons under personal health and social education.

[Baroness Merron (Lab)]

My Lords, HIV can affect anyone, as we know. Despite the success in combating it, further reducing the number of people who remain undiagnosed with HIV will become very challenging unless testing uptake is improved, as my noble friend Lord Cashman said. This is particularly the case for heterosexuals who do not consider themselves at risk of HIV. What assessment has the Minister made of why people who visit a sexual health clinic may leave without testing for HIV? Will he make it a priority to ensure that all those attending sexual health clinics are offered, and encouraged to accept, an HIV test?

--- Later in debate ---

[Lord Kamall (Con)]

I am afraid I do not have a detailed answer to the question from the noble Baroness, but I commit to write to her.

[Baroness Brinton (LD) [V]]

My Lords, the Minister was right to highlight the fact that sexual health funding comes from public health budgets through local authorities. The Terrence Higgins Trust and British Association for Sexual Health and HIV report from 2019 showed that five years of cuts to public health and sexual health funding have had a direct impact on access to sexual health services. So can I push the Minister to confirm that there will be a real-terms cash increase, to fully fund the HIV action plan, to local authorities’ public health budgets for the next three years?

[Lord Kamall (Con)]

I thank the noble Baroness for her question. The department is currently developing a new sexual and reproductive health strategy and an HIV action plan, as she referred to. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December. The action plan will set out clear actions to achieve the interim target of reaching an 80% reduction in HIV transmissions in England by 2025. Publication of the detailed sexual and reproductive health strategy will follow shortly afterwards.

[Lord Lexden (Con)]

Do the Government accept that their forthcoming action plan should have four key features: the expansion of testing; greater support for those living with HIV; increased funding for HIV prevention; and new national prevention programmes? Will the Government provide sufficient resources to achieve all four aims and so enhance their reputation as a global leader in combating HIV?

[Lord Kamall (Con)]

I thank my noble friend for his question. The four features he referred to are aligned with the independent HIV Commission’s recommendations. The Government have welcomed the HIV Commission’s report and are currently considering its recommendations to inform the development of the forthcoming HIV action plan. Our specific decisions regarding resources for the HIV action plan are being taken as part of the ongoing comprehensive spending review.

[Lord Scriven (LD)]

My Lords, over a year and a half ago, Jo Churchill, the previous Parliamentary Under-Secretary of State for Health, said that the Government were seriously considering access to pre-exposure prophylaxis for HIV in community pharmacies and GP practices. Will the Minister say when this will happen, and, if he cannot, what is holding this up?

[Lord Kamall (Con)]

As the noble Lord says, in March 2020 the Government announced that the HIV prevention drug PrEP would be routinely available across England in 2020-21. It is now routinely available in specialist sexual services throughout the country. The settings in which PrEP could be made available outside these health services, such as pharmacies, will be considered as part of the ongoing work on the development of the sexual and reproductive health strategy and the HIV action plan. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December, and the sexual and reproductive health strategy shortly thereafter.

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

My Lords, I welcome the Minister to the fight against HIV/AIDS. Will he agree with me that NHS England, public health, local authorities and voluntary organisations should work together to fight against HIV infection so that it does not become fragmented? Because of the coronavirus infection, many people think that HIV/AIDS has gone away: it has not.

[Lord Kamall (Con)]

I thank the noble Baroness for reminding us that HIV has not gone away. This is why the Government have an action plan. All noble Lords will agree on how important it is to tackle HIV and to raise awareness. The Government hope, in their plan and strategy, to be able to do this as soon as possible, and we remain committed to the goals previously set out.

Social Care in England

Lord Kamall Excerpts

Thursday 14th October 2021 Lords Chamber

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

My Lords, I thank the noble Baroness, Lady Pitkeathley, for securing a debate on such an important subject. I also thank the noble Baroness, Lady Donaghy, for her commiserations on my having this post. I pay tribute to the noble Baroness, Lady Pitkeathley, for the experience she brings to the debate today, including her contribution to carers as former chief executive of Carers UK and her work in the voluntary sector, being a founding member of the Association of Chief Executives of Voluntary Organisations and chair of the New Opportunities Fund—one of the National Lottery distributors.

I am sure we all wish to recognise and thank the social care workforce, both paid and unpaid, and many noble Lords have done so in their tributes today. We should thank them for the work they do in care homes, in people’s homes and in day services, day after day, week after week and month after month.

I also thank the noble Baroness for her thoughtful comments and the well-argued case she has put before the House. We have heard many moving testimonies from across the Chamber. As noble Baronesses have said, this pandemic has provided a once-in-a-generation challenge for this country. There is no getting away from the fact that the past 18 months have been incredibly tough for social care. The challenges have been unprecedented—what Nassim Nicholas Taleb would describe as a black swan event. Many people, not only in the UK but in many other countries, have lost loved ones because of the virus. Our hearts go out to each and every one of them. It demonstrates the importance of this debate today.

I thank the noble Baroness for summing up the numbers that we should all be aware of: 9 million unpaid carers before Covid, 4.5 million new carers, totalling 13.5 million—including 2.5 million who are holding down jobs. I also thank the right reverend Prelate the Bishop of Oxford for his quote from one of the 10 commandments. I am sure he will agree that people of many other faiths and no faith also agree very strongly with the importance of parents and looking after our loved ones as they get older.

Many have said that it has been a real challenge, and we agree. As the Prime Minister said,

“we are … committed to learning lessons”—[Official Report, Commons, 12/5/21; col. 138.]

from the pandemic. When the pandemic hit, the Government worked hard to ensure that the sector got the support it needed as quickly as possible. The Government published guidance tailored to care homes and care providers, domiciliary care, unpaid workers and local authorities on how to continue to safely provide care during the Covid-19 outbreak. We rolled out regular testing for the sector and have sent more than 42 million PCR swab test kits and 117 million lateral flow devices to care homes to date. We set up a massive PPE supply chain from scratch and, through the PPE portal, have provided over 3.6 billion items of free PPE for providers’ Covid-19 needs, and, since April 2020, more than 478 million items through local resilience forums and local authorities.

The Government also moved as quickly as possible to provide financial support to the sector, making available almost £2.4 billion in specific funding for adult social care throughout the pandemic. This is in addition to over £6 billion that has been made available to local authorities to address pressures on their services. Many noble Lords spoke about the importance of local authority funding.

Crucially, we have provided health and care workers and older residents with vaccines. From 11 November, vaccinations will be a condition of deployment for care home staff. I know many will want to reflect on this point. It is worth noting that many staff—the vast majority of care home staff—have been vaccinated. It is our responsibility to do as much as we can to encourage others to be vaccinated to reduce the risk in our care homes. I know if I had a relative in a care home, I would feel much better if they were cared for by someone who had been vaccinated. I hope that across the House we can encourage more care workers to be vaccinated. Of course, there are some who are unable to be vaccinated for medical reasons and we should address their concerns too. Those people should call 119 to apply for a medical exemption.

As noble Lords can see, the Government have provided a huge number of resources to the sector to deliver better care. Of course there will always be a debate on whether the spending is enough. I have heard from across the House how many have responded to the numbers suggested. Looking to the future, the Government will maintain support, both in the short term to address the impact of Covid-19 and, more crucially, in the longer term through the social care reforms. In the short term, the sector will be supported by continuing to be provided with free PPE to protect against Covid-19 until the end of March 2022. This is also extended in designated settings, backed by the extension of the designated settings indemnity support scheme, to March 2022, so that no patient who has tested positive for Covid in the past 14 days is discharged from hospital to a care home.

In addition, in September, the Government announced an additional £388 million to prevent the spread of infection in social care settings. This package includes funding for infection control measures, as some have spoken about, £25 million to support care workers to access Covid-19 and flu vaccines over the winter months, and funding for testing costs, allowing testing to continue for staff, residents and visitors, to ensure that residents can see their loved ones as safely as possible. As part of the preparations for winter, plans are being developed in conjunction with the NHS and social care sector stakeholders. This will draw on the recommendations of Sir David Pearson’s review of last year’s winter plan, advice from SAGE and UK HSE, and—more importantly—on the lessons learned so far in the pandemic.

Our country’s social healthcare system has never been under such pressure as it has been over the past year. Many noble Lords have spoken about the pressure. The coronavirus pandemic posed unprecedented challenges to the sector, so we all agree that we must address the long-term future of social care in this country.

Many people have said that this issue has been live for a number of years. The noble Baroness, Lady Tyler, spoke of social care having been “in the shadows” for many years; the noble Baroness, Lady Warwick, said that people have been talking about this for years; the noble Lord, Lord Lipsey, spoke of the 1999 minority report. However, this debate has been going on for much longer. It has been decades—I think someone said 50 years. If we are honest about it, various experts have warned for decades that the combination of an ageing population and increased life expectancy poses a real challenge to social care. What happened? The debate continued, more think tank reports were produced, other reports were produced, and parties published suggestions in their manifestos. But in reality, all of these were placed on the shelf and just gathered dust, while successive Governments, of all colours, kicked the proverbial can down the road.

The Prime Minister decided that his Government would not shirk the responsibility and stepped up to publish a plan, Build Back Better: Our Plan for Health and Social Care, pledging an extra £5.4 billion over three years for social care. I also thank my noble friend Lord Astor for his comments on a bolder programme of reform. We need to make sure that, whatever additional funds are provided, there is reform, so that the public can have confidence that the additional funds will be well spent.

The Prime Minister’s September announcement was an important step on the journey to reforming adult social care. Of course there will be debate—any reform or change leads to debate. I worked for many years in organisational change and know that any change always generates a large debate. There are some short-term winners and losers—many people will clearly claim that they have lost out and others will gain, but, quite often, the gainers are not as vocal as those who have lost out, and rightly so. We should address those who have genuine concerns. It is really important that we learn from many of the concerns across the House today.

The Prime Minister’s announcement showed a real commitment to delivering world-leading health and social care across the whole of the UK. As we speak, details are being discussed in preparation for a White Paper on reforming adult social care, to be published later this year, as the noble Baroness, Lady Wheeler, pointed out in her intervention. We hope that the reforms will make a real difference to front-line adult social care. This includes both care users and the dedicated care workforce, who have been so brilliant throughout the pandemic.

We also know that there has been a debate over whether funding should come from general taxation or national insurance contributions. Having looked at this debate when I was head of research at a think tank, I have seen a range of views across the political spectrum—there are even some who have asked why people should not sell their homes to fund their care. So you can imagine the range of views that we have heard and read over many years. We really hope that these reforms will make a difference. While there is a range of views, I will outline some of the proposed reforms that we hope will deliver better care for adults of all ages.

First, the £86,000 cap on care costs, funded by a health and care levy, means that, for the first time, everyone will have protection from unlimited costs. There are those who have prudently saved for their old age and who have been hit hard by the unpredictable costs associated with their health and care needs; currently, one in seven faces fees of over £100,000.

Secondly, individuals with limited or no savings will be safeguarded by a more generous means test. The increase in the upper capital limit from £23,250 to £100,000, and in the lower capital limit from £14,250 to £20,000, means that the number of adults receiving some state support will increase from around half to two-thirds. In short, some people who need care, and their loved ones, will have the certainty of support when it is needed and will not have to live in fear of unpredictable costs.

In wanting to propose the fairest reforms possible, the Government decided to fund these measures with a new UK-wide health and social care levy. The Government are absolutely clear that we should not pass on the costs to future generations and increase public debt even further. There is much debate over this, but, by using national insurance contributions, the Government are ensuring that both businesses and individuals contribute. Those who are earning more will pay more. It has a clear UK-wide approach, meaning that everyone pays the same, wherever they live in the UK. In addition, by extending the levy to those working over the state pension age from April 2023—many will of course complain, and I understand that—the Government have listened to those concerns and balanced them with intergenerational justice. Many young people have asked why they are being asked to pay for people. We need to make sure that individuals of all ages play their part.

However, we should also recognise that this is not just about the over-65s. In adult social care currently, over half of all state spending goes towards under-65s—so working-age people will also benefit from limits on what they have to pay if they need care for themselves in later life. This was considered consistent with the contributory principle for national insurance contributions, whereby working-age employees pay these NICs and this gives them access to contributory benefits when out of work, including the state pension.

I will turn to the paid social care workforce, which many of us have paid tribute to. We have listened to the sector and prioritised the adult social care workforce, recognising their tireless commitment and dedication during the pandemic. The noble Baroness, Lady Finlay, spoke movingly about the hospice movement and the work/life balance that we want to see. Many people have asked what is being done to ensure that working carers can balance their caring responsibilities with work. The Government are committed to promoting the benefits of retaining unpaid carers in the workforce, for both the carer and the employer. The Government’s response to the consultation on carers’ leave confirms their intention to deliver on the manifesto commitment to introduce a new entitlement to one week of leave for unpaid carers. This will be a day 1 right, available to all employees who are providing care to a dependant with long-term care needs. I will obviously send more details to any noble Lords who would like them.

The noble Baronesses, Lady Pitkeathley and Lady Finlay, and my noble friend Lord Astor and others mentioned spending. We need to make sure that the Build Back Better plan for health and social care sets out an intention to make care work a more rewarding vocation. Many noble Lords have spoken about this. We need to offer a career where people can develop new skills and take on new challenges as they become more experienced. The Government are committed to spending at least £500 million over three years to deliver hundreds and thousands of training places and certifications, pathways, and well-being and mental health support. This workforce package is a significant investment that will support the development and well-being of the workforce. I hope that that partly answers some of the questions of the noble Lords, Lord Bichard and Lord Sikka, and the noble Baroness, Lady Pitkeathley.

We will continue to support the social work fast-track programmes Step Up to Social Work and Think Ahead, designed to support those wanting to change specialism to become a social worker and make a real difference to people’s lives. As one noble Lord said today, this is an incredibly noble profession. We will continue to introduce further reforms to improve recruiting and support for social care, with more details in the forthcoming White Paper. I am as eager as anyone in this House to see that paper, so that we can have a proper cross-party discussion on the reforms that are much needed.

Speaking as Minister for Technology, I will touch on one of the points that many have raised. I have made digitisation and data sharing one of my key priorities, as Minister for Technology, Innovation and Life Sciences. I hope that digital technology will play a key role in helping adult social care workers to do their jobs even more effectively.

However, we should also recognise the vital role of unpaid carers, as many have said, including the noble Baronesses, Lady Warwick and Lady Tyler. We want to build a system of care to better support unpaid carers, as well as helping recipients of care to have more choice and control over their lives, what they do and how they choose to live. Throughout the pandemic, the Government have taken a number of steps to support unpaid carers, such as funding charities that support carers, producing Covid-19 guidance tailored for carers, helping carers self-identify and ensuring access to and priority for PPE and vaccinations. The Government will work with representatives across the sector, including those who represent carers, to develop more detailed plans for social care reform together, ensuring that unpaid carers receive the support, advice and respite that they need.

As the noble Baroness, Lady Wheeler, said, there is an incredible amount of expertise in this House, and that has come through in the many contributions to today’s debate. I will work with noble Lords across the House as the health and social care Bill goes through it.

I am not sure how much longer I have.

[Baroness Chisholm of Owlpen (Con)]

Three minutes.

[Lord Kamall (Con)]

Thank you. Noble Lords will have to forgive the new boy. Now someone is saying I have two minutes—there we are.

There are many questions I wanted to go through in detail, so I hope noble Lords will accept my apologies for being too verbose in many ways and not answering the detailed issues. I will write to noble Lords on any particular points. Clearly, I do not have a realistic estimate of my speaking time—let us put it that way.

Once again, I thank the noble Baroness, Lady Pitkeathley—

[Lord Birt (CB)]

The Minister has, understandably, focused largely on the funding issues. However, does he accept that unless there is fundamental organisational reform at the front line, we will not continue, whatever the level of funding, to deliver services in the most appropriate way?

[Lord Kamall (Con)]

I thank the noble Lord, Lord Birt, for his question. Yes, I agree.

The Government have provided support to our fantastic social care sector; many will debate whether it is enough and what more can be done, and we recognise that. However, we want to continue to address the many challenges. We will work with stakeholders on the plans for reform that we have set out, publishing more details in a White Paper later this year, when I hope we will have more discussions and debates.

I have spoken far too slowly but, finally, I know that we are all deeply committed to supporting the social care sector. I think we would all want to join together, whatever our views on various parts of the debate, in thanking all the amazing people on the front line providing care, who go the extra mile each day, week, month and year, some for those they love and others because it is a noble profession. As we have an ageing population, it is important that we tackle this issue, which has, as I say, been kicked down the road for many generations. Not all proposals will be perfect and any proposal will of course have its critics —that is the nature of political debate. However, I hope very much that in producing the proposals—and producing something rather more than a blank sheet of paper—that we can all debate, I will learn from the expertise and the points made in today’s debate from across the House to make the forthcoming Bill a more successful and more appropriate Bill that recognises the hard work and dedication of all care workers, whether paid or unpaid.

Health: Chronic Fatigue Syndrome

Lord Kamall Excerpts

Tuesday 12th October 2021 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government, further to the decision to delay the planned new guidelines on the diagnosis and management of ME/CFS, what assessment they have made of the ability of the National Institute for Health and Care Excellence to carry out its functions; and when they expect such guidance to be published.

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

NICE is seen as a world leader in the translation of research into authoritative, evidence-based clinical guidelines, and the Government have confidence in NICE’s ability to carry out its functions effectively. We all know that ME/CFS is a complex condition and, as we understand, a range of views about its management have been expressed during the development of the updated guidelines. To address as wide a range of views as possible, NICE is holding a round table with stakeholders next Monday to discuss these issues and will then take a decision on the next steps.

[Baroness Thornton (Lab)]

First, of course, I welcome the Minister to his place and his job. There is nothing like hitting the ground running, since he has got to do three Questions in a row—that does not often happen. My Question was prompted by two important issues. First, public confidence in NICE’s methodology, and indeed NICE’s own confidence in its methodology, are vital. If the Minister says that the Government have confidence in NICE, it begs the question why the Government are not demanding that the ME/CFS guidance, three years in the writing and with patient support, is not being published immediately.

Secondly, I will quote from one of the many emails that I have had about this issue: “Thank you in advance for speaking up for ME patients. No treatment is better than harmful treatment. My daughter is now bedbound with severe ME due to GET”. GET is the current medical treatment regime for ME/CFS sufferers, which these guidelines say should be reformed. Did NICE come under pressure to pull these guidelines because of medical vested interests in the delivery of GET, particularly since they believe that this is the treatment for long Covid?

[Lord Kamall (Con)]

First, I thank the noble Baroness for her warm welcome. I look forward to many exchanges with her and to learning from Ministers across the House and those who have been in the Department of Health and Social Care before. I know that the noble Baroness is recognised as a champion of the 250,000 people who are living with ME/CFS. As the noble Baroness knows, there are a number of complex symptoms, and experts disagree over the multifaceted way to address this.

As the noble Baroness knows, the NICE guidelines were delayed twice. They were first delayed because it wanted to make sure that it had taken on board all the various submissions that had been made; they were delayed a second time because, just as they were about to be announced, concerns were raised by clinicians and other stakeholders. If you are going to have guidelines, it is important that they are accepted and recognised by as wide a range of stakeholders as possible; otherwise, they might lose their authority.

We want to make sure that, whenever we have this situation and there are people with a range of views, we get them around a table and have a conversation, as common sense tells us, to see if we can agree on a way forward. I very much hope that, once we have had this round table, we will be able to agree a way forward.

[Lord Bethell (Con)]

My Lords, I welcome my noble friend to the Dispatch Box as a Minister for the Department of Health and Social Care and Minister for Life Sciences. It is, without doubt, the best job in government, and I know that he will acquit himself extremely well.

We are making huge progress on the syndrome called “long Covid”, and I note the encouraging progress that NICE is making on guidance for post-Covid syndrome. But does the Minister accept that this shines a clear spotlight on how far behind and wrongheaded we are with the diagnosis and management of ME and CFS? In particular, does he accept that, in the interests of health equality and national productivity, we need to rethink the way that people are got back on their feet after they have been hit by these horrible viruses?

--- Later in debate ---

[Lord Kamall (Con)]

I thank my noble friend—my predecessor—for his warm words and his offer of advice to me, as I find my feet and find myself swimming at the deep end, if you like, in this job. Usually, when I get a question like this, I say, “I will ask my predecessor” but clearly, he has a question for me.

My noble friend is absolutely right that we have to be concerned about how we help those who are suffering from ME and chronic fatigue syndrome, but he will recognise that there is a range of views on this issue. If we want these guidelines to be widely accepted and respected, it is important that we get as many stakeholders around the table as possible. NICE has agreed to this round table; hopefully, we can then move forward.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too welcome the Minister to his post. I declare that I have been vice chair of the NICE committee that produced the revised guidelines on ME/CFS over the past three years, through consensus agreement in the committee. This was fully compliant with NICE’s rigorous processes. Will the Government work with commissioners to ensure that appropriate specialist services for patients with ME are developed and continue, and that services monitor accounts of harms as well as benefits?

[Lord Kamall (Con)]

I thank the noble Baroness for her warm welcome. I am new to this and, as you can imagine, I am still learning the ropes and learning about NICE and its processes. However, I agree with the noble Baroness: it is really important that we address the issues she raises and if she writes to me, I will ask for some advice and respond to her.

[Baroness Pitkeathley (Lab)]

Does the Minister agree that patient groups and charities are key in providing support to these patients? They are very concerned about the absence of guidelines, particularly as they have been involved in their production. Could the Minister offer them any reassurance about the timing of the guidelines?

[Lord Kamall (Con)]

I understand that NICE wants to publish these guidelines as quickly as possible. It is very aware that there have been two delays: first, to make sure that it took on board the various comments; and secondly, the current delay because of issues raised by some clinician groups. As noble Lords will understand, NICE is independent from the Government. It hopes to progress this issue by having the roundtable, hearing all the different views and seeing if some consensus can be reached before the guidelines are published.

[Baroness Scott of Needham Market (LD)]

Does the Minister accept that the prevailing view in some quarters that ME is a psychological disease is causing untold harm, including to children and young people, who are being forced to accept treatments which are damaging to them, and to their parents, who are sometimes accused of abuse? Taking time to achieve consensus is one thing, but the Minister should be aware that there is a huge cost to this.

[Lord Kamall (Con)]

It is always important to recognise the unintended consequences and the costs of any delay. I can understand the frustration of many who have ME/CFS at the delay to the publication of the guidelines. It is important that we try to get as much consensus as possible. If noble Lords feel that there are further delays, I hope they will write to and put pressure on me and wider stakeholders, so that we can put pressure on NICE, but it is important that we try to achieve as much consensus as possible.

[Baroness Ritchie of Downpatrick (Non-Afl)]

My Lords, what issues were raised during the pre-publication period for the final guidelines which merited a pause in publication?

[Lord Kamall (Con)]

I thank the noble Baroness for her question. The issues related to some of the guidelines concerning GET. There was a concern that these would be deleted. Some groups and stakeholders expressed the concern that, while some patients clearly found these damaging, others might find them helpful, or partly helpful—not as a cure in themselves but as part of their treatment. That is why NICE convened this roundtable to ensure that it hears a wide range of views. Hopefully, this can achieve some sort of consensus and help stakeholders to understand where others are coming from, so that some sort of agreement can be reached.

[Baroness Cumberlege (Con)]

Those who have had the opportunity—and, indeed, the fortitude—to read the report First Do No Harm have been struck by the treatment of women, who have suffered greatly at the hands of a minority of members of the medical profession. Today, we have another example. Patients have been dismissed, ignored and not believed, and the majority of them are women. Can my noble friend give an assurance that women will be listened to and not treated in the way that many of us, men and women, have found appalling?

[Lord Kamall (Con)]

I thank my noble friend for her question and for making time to meet with me in the early days of my job and give me the benefit of her experience, particularly on the issues she covered in the Cumberlege review. It is absolutely right that we praise our health service when it does well, but we should also be able to acknowledge when mistakes are made or when patients do not receive the kind of service we expect them to. It is important that my noble friend and others push me, as the Minister, and the Department of Health and Social Care to make sure that we are addressing the genuine needs of patients and that patients are not ignored. I pledge that I will be a champion of patients.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Virginity Testing

Lord Kamall Excerpts

Tuesday 12th October 2021 Lords Chamber

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

My Lords, they said today would be a baptism of fire, and I did expect this, I will be honest.

The Government are committed to safeguarding women and girls, which is why in the tackling violence against women and girls, or VAWG, strategy—as noble Lords know, DHSE loves acronyms—we announced our intention to ban virginity testing. It is widely acknowledged that such tests have no scientific merit or clinical indication, are a violation of human rights and have an adverse impact on girls’ and women’s well-being. Details of any offence are being carefully considered and the Government will make virginity testing illegal when parliamentary time allows.

[Baroness Sugg (Con)]

My Lords, I join others in welcoming my noble friend to his ministerial position and wish him all the best in his important brief. I am very encouraged by the clear indication in the violence against women and girls strategy that the Government intend to ban virginity testing when parliamentary time allows. The Health and Care Bill allows just that, and I hope that the Government will accept the amendments in the other place.

Virginity testing is inextricably linked with hymenoplasty, and any commitment to ban virginity testing will be undermined if we do not ban them both together. I am aware of an expert panel that has been convened on this, but I do not believe that it is necessary, as experts are aligned that there is no clinical or ethical reason for either invasive or harmful practice. Can the Minister tell me when that panel will report back so that action can be taken as quickly as possible, and we do not miss the opportunity to ban hymenoplasty in the Health and Care Bill at the same time as banning virginity testing?

[Lord Kamall (Con)]

We completely agree with my noble friend’s sentiments. It is really important that we ban virginity testing and hymenoplasty as soon as possible. The issue on hymenoplasty in particular is that, unfortunately, because it is classified as a cosmetic procedure, introducing legislation in this space might take away the right for women to make decisions about procedures that they wish to have and be counter to current regulation on cosmetic surgery. It is important that we work out how we can ban this practice, but those objections have been raised—and if those legal objections have been raised, we have to be careful that we work properly to make sure that we ban these procedures.

I give the commitment that I shall push as much as possible to make sure that we ban both virginity testing and hymenoplasty as soon as possible. My noble friend mentioned the amendments in the other place. The Member who submitted those amendments has been in consultation with the Department for Health and Social Care, and we hope to be able to introduce those changes, particularly those bans, as soon as possible.

[Baroness Brinton (LD) [V]]

My Lords, I also welcome the noble Lord, Lord Kamall, to the Dispatch Box. I want to pick up on points that the noble Baroness, Lady Sugg, raised. Some private clinics advertise these procedures to women, which perpetuate myths around virginity, falling way below the standards of honesty and integrity that are rightly expected of doctors. Indeed, the GMC ethical guidance on communicating information explicitly outlines that, when advertising your services, you must make sure that the information that you publish is factual, can be checked, and does not exploit patients. We have waited far too long for this to be made illegal. Can the Minister please press to make this happen sooner rather than later?

[Lord Kamall (Con)]

I thank the noble Baroness for her question, but also for having a meeting with me to discuss some of the issues that we will debate in future weeks and months. All preparation and revision are welcome.

I give a pledge that I will push back at my department and push to have both these practices banned as quickly as possible. However, as I said, some concerns have been raised from a legal perspective, given that hymenoplasty is a cosmetic procedure. All of us would agree that this is an awful thing and that it should be banned, but I want to make sure that in doing it we are very careful. A few years ago, I was a research director for a think tank, and one issue that I always considered with any change of law was unintended consequences. We have to be clear that we do this in a proper way, and I hope that we can introduce these bans as soon as possible.

[Baroness Hodgson of Abinger (Con)]

My Lords, I join others in welcoming my noble friend to the Dispatch Box. Virginity testing is such a demeaning process and, as has already been mentioned, an abuse against women. In October 2018, the UN human rights office, UN Women and the World Health Organization issued a joint statement calling for the end of this horrid practice, saying that it was a

“medically unnecessary, and oftentimes painful, humiliating and traumatic practice”.

What is the UK doing to support the World Health Organization, UN Women and the UN human rights office to ban this across the world and to mobilise other countries to outlaw this practice domestically?

[Lord Kamall (Con)]

I thank my noble friend for her warm welcome. In answer to her specific question, the Government absolutely agree with the World Health Organization’s view that virginity testing is a violation of the victim’s human rights and is associated with immediate and long-term consequences that are detrimental to physical, psychological and social well-being—as well as, in simple terms, being demeaning.

On my noble friend’s specific question about what we are doing with the World Health Organization, I shall write to her with more details.

[Baroness Bryan of Partick (Lab)]

My Lords, virginity testing is an abuse of women and a denial of their rights over their own body. The same private clinics can offer virginity testing and, once they have decided that a woman or a girl is not a virgin, they can then offer hymen repair procedure. Does the Minister agree that this should be illegal and that it is a total abuse of that clinic’s profession? Having listened, as I can hear he has, to campaigners and professionals, will he give a stronger assurance that something will be done in the Health and Care Bill?

[Lord Kamall (Con)]

The noble Baroness makes a valid point; I do not think anyone in this House would disagree with what she said. Virginity testing is demeaning and hymenoplasty is not only demeaning but damaging to women’s and girls’ health and we want it to be banned as soon as possible. I give a pledge that I will push for this to be introduced as soon as possible. Whenever noble Lords are told that the Government will find parliamentary time to do something, I understand why there might be some scepticism about that, but I will push to make sure that we can introduce it as soon as possible.

[Baroness Stuart of Edgbaston (CB)]

My Lords, virginity testing and hymenoplasty have to be made illegal at the same time, and rather than talking about it as a cosmetic procedure, it should be seen as a form of abuse. When I read the guidance from the Royal College of Obstetricians and Gynaecologists, it is rather limp. I encourage the Minister to ensure that the medical professions recognise that they will have an integral part in reporting and preventing any of this, just as they had when we started in the early days with FGM, because it is no good creating an offence without it being enforced and actually punished.

[Lord Kamall (Con)]

I give the noble Baroness the assurance that I agree—I do not think anyone disagrees—that we should try to ban both these practices as soon as possible. The issue is that although I do not personally consider it a cosmetic procedure, legally it is considered as such, and that is why we have to be a little more careful about how we address the issue in legal terms, and the exact drafting of the ban. Of course, any medical professional who carries out these procedures following a ban will be breaking the law, and that is absolutely right. The other issue we then have to consider is what penalty those who break the law in this way will face.

[Lord Black of Brentwood (Con)]

My Lords, I welcome the Government’s renewed commitment to making virginity testing illegal, but I hope the fate of similar commitments in the health and care sector does not befall it. It is now four years since the Government made a similar pledge to end another degrading and cruel practice, that of so-called gay conversion therapy, and we are no nearer action to making it illegal than we were in 2017. Does my noble friend understand the frustration of those who want to see this repulsive practice banned but are having to wait for endless consultations and a failure to find parliamentary time? Is not the Health and Care Bill the perfect vehicle to fulfil this long-standing government commitment?

[Lord Kamall (Con)]

I thank my noble friend for that question. I think we all agree, as he said, that conversion therapy is an awful practice and should be outlawed. The Government have made a commitment to outlaw it. There is an interesting thing, when we talk about the history of various commitments from the Front Bench and whether they were implemented: around Christmas time, we often see advertisements saying, “A dog—or a puppy—is for life, not just for Christmas”. As we know, with ministerial life, it is the opposite: a ministerial portfolio is for Christmas, not for life. However, when I look back at my time, I would ask people to judge me on my actions.

[Baroness Merron (Lab)]

My Lords, I welcome the Minister to his place and wish him well. In addition to private examinations performed by gynaecologists and other medical professionals, campaigners report that victims are often subject to extremely crude examinations performed at home by family members, involving such means as inserting fingers into the vagina to check if the hymen is intact. What steps are the Government taking to tackle such hidden forms of abuse?

[Lord Kamall (Con)]

One issue we have to think about whenever we bring in any new law or ban is the unintended consequences. One unintended consequence that has been raised is that doing so might drive this practice not only into the home but underground. If we make it illegal, it is illegal; we must make sure that, when someone subjects a woman or girl to that awful experience, everyone knows it is illegal and that they will face the full force of the law.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Health: Type 2 Diabetes

Lord Kamall Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what assessment they have made of the data analysis by Diabetes UK, published on 6 October, which suggests that one in three adults in the United Kingdom could be at increased risk of developing type 2 diabetes by 2030.

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

I thank noble Lords for giving me a pause for breath; I appreciate the patience they have shown me today. The Government welcome Diabetes UK’s research in increasing our understanding of diabetes and are committed to reducing and preventing type 2 diabetes, particularly in those groups who are more at risk of developing it and face poorer outcomes. This is why the Government launched the NHS diabetes prevention programme and the healthy weight strategy to look at ways to tackle weight gain and reduce children’s exposure to high-fat and high-sugar foods, including using digital tools to reach key groups.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that reply and welcome him to his new post. He has had a baptism of fire today and has come through reasonably well—so far. We wish him well and good health too. Does he agree that one of the major and most successful initiatives of recent years was Mrs May’s move in 2018 to introduce a sugar tax on fizzy drinks? Employers have been persuaded to reformulate their product. Will the Government now extend that taxation over a wider front on food and drinks? Can they start giving some thought to possibly following the substance of that approach on fat and see whether we can move towards taxing it?

[Lord Kamall (Con)]

I first thank the noble Lord very much for his warm welcome and his modest appraisal of my performance thus far. I am told that, coming from him, that is high praise indeed; he may disagree afterwards. As he knows, the Government are committed to this, but one thing we always have to look at in introducing new laws, bans or taxes is unintended consequences. Before I came to this role, I read some research which said that there were unintended consequences of some of the sugar taxes; for example, did they force people from poorer families or poorer communities to buy alternative, cheaper brands of the same drinks with the same sugar content, or did they just take the hit to their pockets and pay more? Were the outcomes any better? When looking at some of the programmes being put in place to tackle type 2 diabetes and the taxes proposed, it is important that we make sure it is all evidence-based and work out whether there are unintended consequences. If there are, we must find other ways to make sure we tackle obesity and some of the other issues that lead to type 2 diabetes.

[Lord Davies of Brixton (Lab)]

My Lords, the figures in the report are shocking, so I hope the Minister understands that with diabetes, as much as or more than other conditions, there is a need for close and consistent monitoring, not just for the patient’s sake but to avoid greater subsequent demand on the NHS. Is he therefore concerned by reports that in too many areas the essential regular reviews of patients’ conditions are simply not happening because of pressure on clinics or even a shortage of the equipment required to undertake the necessary tests?

[Lord Kamall (Con)]

I take a personal interest in diabetes; I have two very close family members with diabetes, one type 1 and one type 2. I noticed during the Covid lockdown the different approaches in meeting their clinicians—telephone calls rather than meeting in person, and reviewing their charts and sugar graphs over time, which is regularly done at these reviews. I agree completely that it is really important that we now try to address this backlog as much as possible. I know that the Secretary of State is committed to making sure that, with the uplift, we try to tackle as much of the backlog as possible, including for patients with type 2 and type 1 diabetes.

[Baroness Jenkin of Kennington (Con)]

My Lords, I associate myself with the remarks of the noble Lord, Lord Brooke. I think everybody in the Chamber will appreciate the challenges that my noble friend has faced today with all these questions. My noble friend will probably know that 10% of NHS spending is currently on type 2 diabetes. That is £25,000 a minute, £1.5 million an hour, and rising. He will be aware that diabetes is reversible by diet. I am not sure whether he is also aware that, under the leadership of Jonathan Valabhji, the NHS has now endorsed a 12-week programme which has put many patients into remission rather than having to go on to medication.

[Lord Kamall (Con)]

I thank my noble friend. I have done my homework and I have read a little about what has been happening up to now, especially about the NHS diabetes prevention programme, which identifies those most at high risk of developing diabetes and refers them on to behavioural change programmes and personalised education to reduce their risk of developing diabetes, including things such as bespoke exercise programmes and learning about healthy eating and lifestyle. The programme achieved full national rollout in 2018 and 2019, with services available to patients in every system in England.

As we know, tackling diabetes is multifactorial. Nevertheless, the NHS long-term plan sets out plans for increased action on diabetes and related issues. I shall mention just a few, including the healthy weight strategy launched in July 2020 to help adults and children maintain a healthy weight, and the restrictions on the promotion and advertising of foods high in fat, sugar and salt, as was mentioned earlier. It is really important with programmes such as this that we look at these studies on a longitudinal basis and look at the evidence. Some of these programmes will work, and some will not. That is just the way the world is. We have to make sure that we tackle unintended consequences first of all, and that any future policy is very heavily based on evidence rather than a wish. That will be the most effective way of tackling diabetes.

[Baroness Merron (Lab)]

My Lords, the rise in diabetes means that millions of people are at risk of devastating complications, including heart attacks. In 2009, to improve heart health, checks were introduced for the over-40s. However, by 2019, only half of those invited actually received those checks, and the checks were paused during the pandemic. Does the Minister agree that it is vital that these preventive checks are relaunched, and will he commit to putting in place a plan to ensure that people are able and willing to attend them?

[Lord Kamall (Con)]

I do not think anyone will disagree on the importance of making sure that these checks are reinitiated, or on what is being put in place to make sure either that patients are able to continue with or that new patients can start some of these programmes. Also, as noble Lords can imagine, there has been better use of technology in all fields during the Covid lockdown. For example, the NHS used Facebook to reach millions of men aged 40 or over who were at risk of developing type 2 diabetes. We also know that, in some cases, there are online consultations between patients and medical experts. Of course, with better tools, such as remote monitoring and flash blood readers, it is important that information can reach clinicians and be reviewed remotely. But there is no substitute for face-to-face meetings, and we hope very much that many of these can be resumed as soon as possible.

[Lord Dubs (Lab)]

My Lords, given the clear links between obesity and type 2 diabetes, does the Minister agree that more can be done to tackle obesity among children and young people? May I commend to him some of the practices being followed in Amsterdam, where this has really been tackled in a holistic manner? Could we not do likewise?

[Lord Kamall (Con)]

I hope the noble Lord will forgive me, but I am not yet aware of the practices in Amsterdam. I would very much like to look into those and learn more. We can learn. It is really important that we learn from best practice around the world, and I would very much welcome it if he could write to me with some details.

[Baroness McDonagh (Lab)]

There are not many questions left for the Minister now—it will soon be over. Can I ask again the question that some of my noble friends have asked, as I have not specifically understood the answer? What impact assessment have the Government done to understand the implications of the reduction of face-to-face GP and nurse appointments and the reduction in eye appointments, footcare appointments and nutrition appointments for the diagnosis and management of diabetes? We know that this is a progressive illness, and failure to act makes people much sicker and makes it very hard for the NHS to reverse the problems that diabetes causes. What assessment has been made of this impact?

[Lord Kamall (Con)]

I thank the noble Baroness. I do not have the detailed assessments of that but I commit to writing to her with more details.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, that concludes Oral Questions for today.