Plastics: Health Research

Lord Kamall Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I understand that this is part of the £500 million Blue Planet Fund that we put in place to help developing countries support the marine environment, and we are a contracting party to the OSPAR convention to participate in marine-limited monitoring programmes.

[Lord Kamall (Con)]

As the Department of Health and Social Care moves towards prevention, is my noble friend the Minister aware of initiatives within the National Health Service and across the health and care system to reduce the use of plastic across our system?

[Lord Markham (Con)]

I thank my noble friend. Yes, the NHS is committed to a 10% reduction in clinical single usage by 2045, and these plans are set out in the NHS long-term plan document, Delivering a “Net Zero” National Health Service.

Health Promotion Bill [HL]

Lord Kamall Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[Lord Kamall (Con)]

My Lords, I congratulate the noble Lord, Lord Addington, on securing time to debate the Private Member’s Bill. I approach this debate with three words in mind: apathy, sympathy and empathy.

Let us start with apathy. During the debate on the then Health and Care Bill, I reassured your Lordships of the Government’s commitment to a national plan for sport and physical activity, and that it would be published later this year. I also informed noble Lords that the Government were working across departments—and I referred to the health promotion task force, led by the Health Secretary, and pledged to keep your Lordships up to date on the progress. I believe that it was this commitment that convinced my noble friend Lord Moynihan to withdraw his amendment.

Unfortunately, in response to a recent Written Question, the Department of Health and Social Care explained that the health promotion task force was not a part of an updated Cabinet committee structure. To be fair, the Answer also explained that the Government’s Our Plan for Patients would address preventable ill health through collaboration across government and the National Health Service. However, it gives the impression that the Government’s approach to health promotion now appears to be one of apathy—or, perhaps more kindly, lethargy. One of the ironies is that part of encouraging physical activity is to overcome individuals’ apathy. Whatever the true picture, I am afraid that there is now a perception that the Government cannot be bothered to take health promotion seriously. I hope my noble friend the Minister will be able to address this perception head-on.

However, this is where I also feel sympathy—indeed, sympathy for my noble friend the Minister, since none of this is his fault. These decisions were made way above his pay grade. While noble Lords can attach no blame to him I hope that, by challenging the Government in this debate, they will empower him to raise your Lordships’ concerns with his department and across government.

My disappointment at the Government’s apparent apathy and my sympathy for my noble friend the Minister leads to my empathy, since I completely understand and share the concerns of the noble Lord, Lord Addington, in bringing forward this Private Member’s Bill. I share the noble Lord’s concerns about the lack of progress, but I am afraid that I will have to respectfully disagree with some of his Bill. One reason why I welcomed the establishment of OHID is because I hope that having the word “disparities” in the name of the organisation will force it to do what it says on the tin—that is, to identify and address health disparities, as the noble Baroness, Lady Uddin, said. This reminds me in some ways of the debate when many noble Lords asked for mental health to be explicitly on the face of the then Health and Care Bill, even though health is generally understood as both physical and mental health.

Whether we term it health improvement, health promotion or health creation, I know that noble Lords agree that it is important, but I hope that we can move on from the debate around health improvement, which seems sometimes to be reduced to the question of whether you burn off calories versus reducing calorie intake. It should not be a question of either one or the other. We can argue about the data and whether reducing calorie intake is more effective than physical activity, but surely the important thing is to encourage both. Indeed, some believe that physical activity may lead to less calorie consumption. A 2019 article in the International Journal of Obesity concluded that

“15-week exercise training appeared to motivate young adults to pursue healthier dietary preferences and to regulate their food intake.”

But everyone is different. There are also studies of people with eating disorders doing excessive exercise followed by binge eating, so we really need to understand it at the level of the individual.

I think that most noble Lords would agree that we should all do more to encourage physical activity. Fortunately, a lot has changed since my youth, when it was about selecting the best and forgetting about the rest. If you did not make the first or second team, you were more likely to be discouraged and give up. Unlike the noble Lord, Lord Addington, I am unable to refer noble Lords to the register of my interests, although I really wish I could for this debate. I was still playing five-a-side football into my 50s and playing with people 30 years younger, and my wife expressed some concerns. I needed allies, so I went to see my physiotherapist, hoping that she would be my ally, and she said, “I’m afraid I agree with your wife—you should give up playing football with people 30 years younger than you.” But that does not stop one from doing physical activities. Nowadays we see more clubs in local communities encouraging people to play sport, no matter their ability. We also see an emphasis on physical activity rather than just sport, encouraging individuals to find the physical activities that they enjoy the most—or perhaps dislike the least.

During my brief time in the Department of Health and Social Care, I became interested in the idea of social prescribing, helping people with physical and mental health conditions through the power of music, the environment, arts and physical activity. I recognise that there is scepticism from some clinicians, but I have heard of so many positive stories of people for whom it worked. But with an ageing population and increased pressures on the state, we should also remember that the state cannot do this all or alone. We need to encourage more local neighbourhood civil society groups, which better understand the people in their local communities. By asking the Government to be more involved, we should be wary that they do not squeeze out civil society but better co-operate and co-ordinate cross-government initiatives in partnership with it.

To sum up, I am disappointed by the Government’s apparent apathy in promoting better health. I sympathise with my noble friend the Minister, since none of this is his fault, and I empathise with the noble Lord, Lord Addington, and his frustration at the lack of progress, even though I disagree with renaming OHID. I end with a question to my noble friend the Minister. Now that the health promotion task force no longer exists, how will the Department of Health and Social Care drive cross-government action to improve health outcomes?

NHS Waiting Times

Lord Kamall Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. There are a number of areas where we can do this. I point to the possibility for home testing a lot more. Covid was a perfect example, whereby it became commonplace. Rather than samples being sent away to a laboratory, we came up with lateral flow devices and were able to do it cheaply and pretty accurately, although not quite as accurately. That is a perfect example of using technology to do more home-type diagnosis.

[Lord Kamall (Con)]

My Lords, in learning from best practice in other countries, are my noble friend, the department or the NHS aware of the pioneering work of Dr Shetty in Bangalore, who has pioneered production-line surgery for certain procedures? Are the Government considering that at the moment? If not, why not?

[Lord Markham (Con)]

I thank my noble friend for that. While I am not familiar with that exact case, I saw a very good, probably quite similar, example in Chase Farm Hospital, which has four operating theatres in a sort of barn. It has a complete production line for elective hip replacements and so on to get that capacity and efficiency.

Health: Pancreatic Cancer

Lord Kamall Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

My understanding is that we do have the capacity for these research trials. Also, on workforce in the cancer space, we have invested £50 million, so we are actually 200 people over our target on that. This is part of the Chancellor’s announcement about the long-term workforce study, which I know will be welcomed by many in this House, where we will be looking, area by area, at exactly what workforce needs we have—and we have a recruitment plan against that.

[Lord Kamall (Con)]

My Lords, in response to an earlier question, my noble friend the Minister talked about the need for more awareness in advance of identifying appropriate screening methods. Given that it is now Pancreatic Cancer Awareness Month, what else are the Government and the NHS doing outside that to ensure there is more awareness for patients to come forward for potential pancreatic cancer?

[Lord Markham (Con)]

I thank my noble friend. Key to this is the Help Us to Help You campaign, which reaches out to lots of different communities, including a number of minority communities. At the same time, we have rolled out the early cancer diagnosis service to GPs, where they are looking out for some of those warning signs, even when people are there for a regular appointment. Clearly, as has been said by other speakers today, a lot more needs to be done; it is a journey, but awareness is the vital first part of that journey. On that point, I thank the Pancreatic Cancer UK charity, which has been excellent in this field.

GPs: Anti-depressants and Alcohol

Lord Kamall Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

On this occasion, that is probably a question about which I need to write back to the noble Lord to give him the detail on it.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Wheatcroft, alluded to the fact that sometimes patients would be more effectively treated through social prescribing, or cultural and arts prescribing. What advice is given to GPs to make them aware of cultural, art and music therapy in solving or tackling depression?

[Lord Markham (Con)]

I agree that we have to make sure that GPs are equipped with the full range of tools for the job and the full range of knowledge. We are probably all aware of some instances of GPs who are very aware and progressive in this space, and others where they do not have that same level of information. We are putting a £2.3 billion increase in 2023-24 into the mental health space to treat an extra 2 million people. We need to make sure that we have a range of help that we can put in place for these people.

NHS: Backlogs

Lord Kamall Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

[Lord Kamall (Con)]

My Lords, in response to an earlier question about the hospital building programme, my noble friend the Minister mentioned the modern construction techniques of hospitals. I wonder whether he could enlighten the House on some of the leading technology methods we are looking at when it comes to the new hospital programme.

[Lord Markham (Con)]

Absolutely; I look forward to sharing this with the House in a lot more detail shortly. This is a real opportunity to create a world-leadership position. The idea behind it is to have a standardised approach to building hospitals—hospitals 2.0, as I like to call them—where we look as much as possible to have standard processes, procedures and components, so that we can build them quicker, cheaper and more efficiently, and get economies of scale from doing that. I believe that it will not only pioneer the way we build hospitals in this country but give us an opportunity to be a pioneer worldwide and create a major export industry.

NHS: Nurses

Lord Kamall Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

The Nuffield study was very interesting: of the reasons for people leaving, 43% said retirement, 22% said it was for personal reasons, and 18% said it was due to too much pressure. Again, in quoting those figures I accept that there is work we need to do on this. Clearly, 18% leaving due to too much pressure is something we rightly need to be concerned about. I know that is why we set up the 40 mental health and well-being hubs with a £45 million investment, to look at whether we can address some of those pressures. Most of all, though, I completely agree that we need to recruit as many nurses as we can so that we have as big a supply as possible to ensure that we continue to relieve any pressures that exist.

[Lord Kamall (Con)]

My Lords—

[Lord Lilley (Con)]

My Lords—

[Lord Kamall (Con)]

I apologise to the noble Lord but it is some time since I have spoken in this part of the House. Given that it was Black History Month last month, does my noble friend the Minister agree that we owe a great deal of gratitude to immigrants from the Commonwealth who helped to save our public services after the war? Now that we have left the EU, can he also assure us that we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans, and treat all equally when we want to recruit health and care staff from abroad?

[Lord Markham (Con)]

I totally agree. My noble friend rightly states that we have had a fine tradition, right back to the beginning of the NHS, of recruiting people from all over the world, predominantly the Commonwealth. I am also delighted to say that, since we moved the cap on visas from people all round the world in 2019, the number of those who have joined has gone up from 25,000 a year to 48,000 a year. That is almost double the number and very much the result of what my noble friend said about making sure that we are welcoming people into the profession from all over the world.

NHS: End-of-life Care

Lord Kamall Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what assessment they have made of the provision of end-of-life care by the NHS, particularly in respect of Archie Battersbee.

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

The Government are committed to providing high-quality end-of-life care, working closely with the NHS and other stakeholders. The Government are commissioning an independent review into the causes of disputes between those with parental responsibility and those responsible for the care or medical treatment of critically ill children such as Archie Battersbee. The requirement was specified in Section 177 of the Health and Care Act 2022 to lay a report before Parliament by 1 October 2023.

[Lord Balfe (Con)]

I thank the Minister for his Answer and for our meeting earlier this week. I stress that what I am looking for is a review, not an inquiry. We are not trying to pin blame and I hope that the review will have a wide range of disciplines and not be dominated by doctors and lawyers. Because although they say they acted in the best interests of the child—I am prepared to agree that—the parental grief will last for the next 50 years, for the rest of their lives, and we need to get this right. I hope the Minister will be able to reassure me that this will be a wide-ranging review that will involve all the disciplines involved in care.

[Lord Kamall (Con)]

I return the favour by thanking my noble friend for the meeting, but also for the frequent conversations we have had about mediation, for example. I know my noble friend is a qualified and experienced mediator. We are quite clear that the review has to attach no blame. We want to hear from as many people as possible. It will investigate the causes of disagreements in the cases of critically ill children between providers of care and persons with parental responsibility. It will look at whether and how these disagreements can be avoided, how we can sensitively handle their resolution, provide strong evidence and inform future recommendations to support end-of-life healthcare environments in the NHS. As much as possible, it will promote collaborative relationships between families, carers and healthcare. We can see it from both sides: as a parent, just put yourself in the shoes of someone who has to make these difficult decisions. Sometimes they feel that the medical profession acts like God; on the other side, there are medical professionals who believe that the parents do not really understand all the details. Let us make sure that we get this right.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too thank the Minister for having met me earlier in the week to discuss this issue. When parents receive devastating news, they are in such a state of shock that communication with them, however sensitively undertaken, risks being misunderstood. Parents are unaware of the limitations on their ability to request interventions or transfer for their child, unlike when the child is at home. So will the Minister confirm that the review will take direct, in-person evidence from parents who have been in this terrible situation and who wish to contribute from their experience—not to apportion blame, but to improve care for others?

[Lord Kamall (Con)]

I thank the noble Baroness, Lady Finlay, for the conversations we have had since the passage of the Health and Care Bill. My officials have been incredibly appreciative of her bringing her expertise to this field and, in fact, for educating them—and me—on some of the sensitive issues that people have to deal with in these environments. We want the review to be as wide as possible; we do not want to cut it off; probably the only thing we want to avoid is blame. We want to do this in a sensitive way; we want to hear from the families; we want to make sure it is a balanced review, and we hope to take evidence for the review from as many people as have a view on this. That is why we are taking our time; we have to publish it by 1 October 2023.

[Baroness Butler-Sloss (CB)]

My Lords, as a family judge I tried a very considerable number of end-of-life cases, in relation to both children and vulnerable adults, so I hope this review will take into account that when the parents and the medical profession are locked in disagreement, there is a way out, where the judge who tries the case actually looks exclusively at the best interests of the child—taking into account, of course, what the parents think and what the doctors and the nurses think. It is crucial to have that ability to go to a family judge, who will deal with these cases sympathetically but firmly.

[Lord Kamall (Con)]

The noble and learned Baroness makes an incredibly important point about getting this right and getting the right balance. We know how difficult and sensitive these cases are when they have come to court. One issue that has been discussed by a number of parties is mediation: can we avoid it going to court in the first place, but also at what stage should mediation take place? It should not just be offered right at the end when everything has ended. We must make sure we really hear the voices of professionals as well as those affected, and families, to get the right balance. So far, we have relied heavily on the courts for some of these cases, sadly, but we just want to make sure we get this right.

[Baroness Brinton (LD)]

My Lords, over the last six years, the provision of palliative care for children and young people has become very patchy. CCGs across England have been closing down palliative care for children. Are the Government taking action to hold integrated care boards to account publicly on implementing their duty to commission palliative care for children and young people?

[Lord Kamall (Con)]

The noble Baroness will be aware that earlier in the week, when we had the debate on integrated care boards and their responsibilities, we added—thanks to the work, once again, of the noble Baroness, Lady Finlay—palliative care services to the list of services that integrated care boards must commission. Integrated care boards will be accountable to NHS England, but also the CQC will be doing a lot of evaluation and they will be measured against the list of services that they have to commission. Clearly, there will have to be accountability on palliative care services.

[Baroness Merron (Lab)]

My Lords, when a child is at the end of their life, quality palliative care should ensure, of course, both the child’s comfort and managing pain and symptoms, but also provide support and care for the entire family. These are clearly heartbreaking situations for everybody involved, so will the Minister assure your Lordships’ House that the review will take account of the support that is given to the whole staff team, including ancillary workers? They, of course, have a key role to play.

[Lord Kamall (Con)]

One thing that often happens at reviews is that we realise how complicated these issues are. One often cannot pinpoint one key issue, or one silver bullet, as it were. Therefore, quite often—and I was on a call on a different issue yesterday—we thought we had to tackle certain issues but realised there were wider systemic issues. Clearly, that is going to be the case here. NHS England’s palliative and end-of-life care programme is an all-age programme, but there are specific pieces of work focused on children and young people. We have also been working very sympathetically with charities such as Together for Short Lives. It has been commissioned to produce written guidance to provide ICBs and ICSs more detail, as the noble Baroness asked for, but also to make sure we make it a better environment and learn.

[Lord Alton of Liverpool (CB)]

My Lords, in my conversation with the family of Charlie Gard, they were emphatic that adding to the tragedy of the loss of a child, the thing they found hardest was having to go to court and go through an adversarial system. Anything the review can do to prevent the necessity of court action, notwithstanding wonderful judges such as my noble and learned friend, would be welcomed by such families.

[Lord Kamall (Con)]

I think many noble Lords will echo the sentiments of the noble Lord on that. That is why we want the review to be as wide-ranging as possible. People have suggested mediation, but should that be mandated or voluntary? There is also a difference between commercial mediation and family mediation. Commercial mediation is usually binding, whereas family mediation is not always binding. A further question is: at what stage do we offer mediation? One thing we are being told is not to offer it when everything else has failed: we should offer it as soon as possible, to encourage a collaborative approach.

[Baroness Stowell of Beeston (Con)]

My Lords, clearly it is important that the professionals are involved in this review, but I think it is also important—as this review begins and my noble friend considers the terms of reference—that emphasis really is given to families, because these tragic cases are symptomatic of a wider problem that a lot of people face when they engage with officialdom and professionals, which is feeling that they are not being taken seriously. It is even more acute when the situation is the one that these families find themselves in, when they are parents and have important status as parents, and the issue at hand is the life and death of their own child. My noble friend has been very good at reassuring this House, but I ask if he could just give greater emphasis again to the importance of the families in this review.

[Lord Kamall (Con)]

Once again, I thank my noble friend for joining the meeting this week on this issue. It is quite clear that we want to hear from all voices. We encouraged the families to come forward. We have heard a number of cases, including some raised by noble Lords personally, who have been in contact with the families, and raised their concerns. Quite often they felt that their voices were not heard and they did not really understand the issues; they were in a very emotionally difficult time to take some of those issues in and understand the choices that were available. Sometimes they felt rushed into it by medical professionals. I think sometimes medical professionals have to show a bit of humility and not act like God.

Care Homes: Energy Costs

Lord Kamall Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Harries of Pentregarth]

To ask Her Majesty’s Government what assessment they have made of the likely impact of increased energy costs on care homes; and what extra support they intend to provide in response.

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

The Government are committed to working with local authorities to help manage the pressures of inflation, for various reasons, on adult social care. We acknowledge the impact that challenges such as energy price rises will have on residential care providers and right across the system. As noble Lords will be aware, the Prime Minister has stated that a package of support for energy costs is her priority. Sadly, in terms of timing, we expect announcements shortly and will see how that feeds into the social care sector.

[Lord Harries of Pentregarth (CB)]

I thank the Minister for his reply. As he well knows, care homes are already under great financial pressure. In the six years up to 2020, more than 1,600 had to close—many of them rated good or very good—and the rise in energy costs is already absolutely staggering, from something like £660 per bed per year to over £5,000 per bed per year. Of course, some help will be offered this afternoon, but is the Minister confident that the Government have really taken on board the sheer scale and seriousness of this situation for care homes?

[Lord Kamall (Con)]

The noble and right reverend Lord makes a really important point about this issue and the impact on social care. What we are seeing right across government is the impact of this energy crisis: that is why the Prime Minister is making this announcement. We will then have to look into the details of how that affects the different sectors. We have heard from the social care sector, we have heard from care homes and we have heard from patients themselves about their concerns about the cost. I am afraid I cannot give more details at the moment. The Government are working very closely at the moment with local authorities and are in constant conversation about how we can help reduce the burden. Once we have more details of the package, we can look at that in more detail.

[Lord Scriven (LD)]

My Lords, heating costs are just the tip of the iceberg for care homes. What does the Minister have to say to people such as June, a care home worker in Sheffield of 24 years, who is now having to leave the sector that she loves, just to get enough money to be able to feed her family?

[Lord Kamall (Con)]

The Government recognise that for a long time the social care sector has been treated like Cinderella: a poor relation of the health system. That is why we had the Health and Care Bill, to make sure that we have care right through people’s lives. One thing about social care is how disparate and fragmented it is. One reason we have the register is to understand who is out there—who is doing what, their qualifications and their levels of pay, but also how we can make sure that they feel it is a rewarding vocation and career.

[Lord Howell of Guildford (Con)]

My Lords, is my noble friend aware that many care homes and, indeed, even more retirement homes and retirement communities are serviced by what are called heat networks. These are combined systems; we used to call them combined heat and power, but heat networks are the modern description. These were not covered at all by the previous energy cap. Could the Minister be assured, and assure his friends, that in the coming arrangements they are properly covered as well?

[Lord Kamall (Con)]

As my noble friend will be aware, many care homes are privately owned and run. Quite often, we do not get into that level of detail but I will take the question back to my department once we are aware of the package that is announced.

[Baroness Pitkeathley (Lab)]

My Lords, to add to the problems of care homes to which noble Lords have referred is the report in today’s newspapers that the new Secretary of State for Health intends to use them as places to discharge people who cannot have a social care package in their own homes. Can the Minister assure the House that, if this happens, all attention will be paid to the huge problem that care homes already have in recruiting enough staff to carry out their existing functions?

[Lord Kamall (Con)]

All noble Lords will be aware of the challenges facing care homes and their owners, including recruiting sufficient staff. People have referred to a number of different issues; one is vocation and feeling valued—quite often they feel as if they are poor relations. Another issue is supply, which is one reason we have looked at a visa to try to encourage more workers from overseas. If we make it a proper vocation, people will want to train in it, get those qualifications and feel they have a valued career.

[The Lord Bishop of Durham]

My Lords, I was going to ask a very similar question; the Minister did not answer the specific question about the Secretary of State’s proposal that she may move people from hospitals into care homes and ensuring that that is joined up. Will he comment on that proposal?

[Lord Kamall (Con)]

I am afraid I was so busy swotting for these Questions and the three-hour debate afterwards that I missed the news, so I will have to take that back to the department and make sure that we give an answer. I will not avoid giving one.

[Baroness Brown of Cambridge (CB)]

My Lords, have the Government considered the impact of increased energy costs on our major scientific facilities, such as the Diamond Light Source? If increased energy costs eat up the increases in UKRI budgets, this will severely impact our ability to deliver the Government’s ambition of the UK becoming a science and technology superpower.

[Lord Kamall (Con)]

That is a really important angle that I had not considered, to be honest. We recognise that, across government, many Ministers in many departments will be waiting at the moment with bated breath for the Prime Minister’s announcement to work out the impact on those stakeholders who have been contacting Ministers and others about the impact of energy costs. Clearly, something has to be done. The Prime Minister will announce it and then we will have to work through its impact. If I am still in post, I can come back to say how that will impact the health and care sector.

[Baroness Altmann (Con)]

My Lords, will my noble friend look into the situation of care homes, whether they are in the private sector or not, that have not currently participated in the government handouts to help with energy costs? Second home owners have had discounts on their bills, but there has been no per-bed contribution from the Government to help care homes which are already struggling and for which many families are paying enormous sums.

[Lord Kamall (Con)]

My noble friend makes a point that I was not aware of, so I am afraid I will have to take it back to the department. However, it appears a very reasonable point.

[Baroness Wheeler (Lab)]

My Lords, what support will the Government specifically give those care homes whose pre-Covid Care Quality Commission ratings have been downgraded from good to inadequate as a result of staff shortages? This is on top of their deep concerns over energy costs. Recent press reports say that up to three-quarters of care homes in England have been reassessed in this way.

[Lord Kamall (Con)]

Clearly, one of the issues in the overall review of the social care sector is that, when the CQC and others report on care homes and other places, action is taken. One of the things we will do is talk to the right stakeholders and individuals, but we also have to work in partnership with local authorities—as quite often it is their responsibility—to try to make sure we raise the standard.

[Baroness Hussein-Ece (LD)]

My noble friend Lord Scriven asked a specific question on what the Government are doing about pay. The Minister will be aware that there is a crisis in the care sector in recruiting and retaining staff. I declare an interest as I have a family member in a residential care home and am acutely aware of the situation. What is being done to make sure that they are properly funded so that we can retain and recruit much-needed care staff in all residential homes?

[Lord Kamall (Con)]

When I speak to officials in the care part of my department about this issue, one of the things they say, in consultation with a number of individuals in the care sector—not only employees but owners—is that morale is clearly low, partly because of pay but also because they feel they do not have a proper vocation. It is very confusing to have all these qualifications; they are not recognised elsewhere and there is no clear career path. One reason we are putting together this register is that we want to understand the landscape out there—it is incredible that this has not yet been done—including the number of qualifications, the issues and what sort of career structure can be offered.

[Lord Whitty (Lab)]

My Lords, several noble Lords have referred to the terrible financial situation of the whole social care sector and its employees. I recall the last Prime Minister said he was going fix social care. Nothing happened. Does the current Government recognise that a step to help out the social care sector, over and above other businesses, would be at least a first step towards fixing the sector?

[Lord Kamall (Con)]

One reason we brought forward the Health and Care Bill was that we wanted to make sure that social care was given proper status. Social care has been seen as the poor relation to healthcare for far too long by successive Governments. What we want is a proper health and social care system, properly integrated. Sometimes social care workers leave the social care workforce and move to the health side because they feel it is more valued as a profession. We want to make sure the same is true of social care providers.

[Baroness Manzoor (Con)]

My Lords, the NHS has a great history of running great campaigns. I am thinking of “Clunk, click” and the campaigns against smoking and alcohol. Can the Minister say, because not only the cost but the supply of energy is very important, how the department is co-ordinating to ensure that there is a campaign to reduce the energy used in homes, particularly those in the higher income brackets?

[Lord Kamall (Con)]

I thank my noble friend for the question. The issue is much wider than just health. We are working with local authorities to understand the impact on the care sector, but there is also a huge cross-government approach on education and energy efficiency. We have to wait and see the package before we can look at this in detail with the sector, and at what measures can be offered.

Primary and Community Care: Improving Patient Outcomes

Lord Kamall Excerpts

Thursday 8th September 2022 Lords Chamber

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

My Lords, before I begin the response to the noble Lord, Lord Patel, and other noble Lords, I am sure that all noble Lords will be concerned by the news from Buckingham Palace about concerns over the health of Her Majesty. I am sure that the thoughts of all noble Lords are with Her Majesty and her family at this time.

I begin by thanking once again the noble Lord, Lord Patel, not only for introducing this debate but for our many conversations and his advice. In fact, he has given me so much advice, I sometimes think about calling him “uncle”. It has all been part of my learning—understanding the processes and the whole range of our health service, as well as some of the challenges. That was very well demonstrated in the noble Lord’s opening remarks and in some of the issues he has raised with me over time.

What has been interesting in this debate is that lots of people have different views on answers. We agree that there are problems and that they have to be fixed, and we want to see better integration. Some say that we need a revolution; others say that it should not be a revolution but evolution; and others would criticise evolution as piecemeal. We have to be very careful about that. Some say GPs are central to primary care; others say that it should be not only GPs but a range of workers. In fact, a number of GPs complain that they spend far too much time on things that could be done by other professionals in their practice.

The noble Baroness, Lady Watkins, rightly said that we should be careful about a one-size-fits-all approach and trying to suggest or impose one model that would work everywhere. It has to be community led, in many ways. In answering, it is really important to address these issues. I suppose the final debate we had was of some saying that we need a clear distinction between primary and secondary care, and others saying that we do not, as the lines are blurry and what is important is that patients are able to access the health and care services they need. All of that is part of this whole debate, which I found fascinating.

The noble Baroness, Lady Pitkeathley, reminded us that we are now talking about an integrated health and social care system. It is absolutely right that we look to make sure that its social care aspect has parity with the rest of health. I pay tribute to the noble Baroness for consistently reminding me and the Government about that.

We all agree that primary and community care are essential services. As a Government, we recognise that they are under significant pressure, as do noble Lords. My noble friend Lord Eccles asked why this is. There are a number of reasons. At the moment, we have more doctors and nurses than ever before but, as many noble Lords reminded me, demand is outstripping supply. Think about our awareness. During the passage of the Health and Care Bill, we spoke about the importance of mental health and about it having parity. Think about how seriously we took mental health only 30 years ago: many syndromes—post-traumatic stress disorder, for example, and others—were not even recognised until the 1980s. Before then, people were just told to pull themselves together or have a stiff upper lip. Now we recognise how important it is to tackle people’s mental well-being.

Some noble Lords will remember a debate I took part in recently on neurological disorders. When I asked my team for a briefing, I asked them to list all the neurological disorders so that I could understand this. They said, “Minister, do you realise that there are 600 of them?” Imagine that awareness of 600 disorders and how many people are needed right across the country. That shows the challenge we face in demand outstripping supply. It also highlights one of the points behind the question from the noble Lord, Lord Patel: given that all this demand is outstripping supply, is it really appropriate to continue with a model from 70-odd years ago, as the noble Lord, Lord Kakkar, rightly said? The debate we are having is on whether it should be revolution or evolution, and how we ensure it is patient centred.

Another important point mentioned by a number of noble Lords was prevention. It should not be about waiting for people to get ill and then, hopefully, curing them; it should be about prevention in the first place. Individuals, bodies and organisations can all play a key role in that. As the noble Baroness, Lady Brinton, said, it is right that the voice of patients is heard. No one should ever say again to the noble Baroness—I would not dare to—that patients know too much. We want patients to have a partnership with their health and care professionals, so that they understand the issues and so the patient feels valued and understood—a number of noble Lords mentioned this when it comes to named GPs, for example.

It is critical that we look at prevention. That shows that it does not always have to be the GP. I am sure that if the noble Lord, Lord Mawson, had been here, he would have talked about the Bromley by Bow Centre and how there are a range of skills and individuals there. It is not about only the GP but about making sure people have healthier lifestyles. I think the website of the Bromley by Bow Centre and others is about creating health. In his book, Turning the World Upside Down, the noble Lord, Lord Crisp, says that we have to shift away from cures to prevention, not just curing people but creating health. We have seen a lot of progress in the thinking about how we get that into the system.

I will respond to some of the general points that a number of noble Lords made. To draw again on the noble Lord, Lord Crisp, he said that we should also look to other countries. We have this view—not just the United Kingdom but the whole western world— that the rest of the world can learn from us. However, as he said, if you go to some of these countries which have challenges such as resource challenges, they have some very innovative solutions. Some of them have defined completely new roles which would not be recognised here. These people are trained for shorter times and are more specialised, and although the doctors’ lobbies in those countries have railed against them, he said that it gives you effective outcomes. Perhaps we have to look at some of the traditional roles, such as doctors and nurses—we are seeing physicians’ assistants, for example, and specialists. I hope that the rest of the medical profession will be open to completely new hybrid roles, which are not the same as those of 70 years ago.

My noble friends Lady Hodgson and Lord Eccles talked about the right to see a named GP. We understand that, but not every patient will want a named GP. We have to get the balance, because the technology gives us a better service but it is not just about that; it is about people’s first interface. They want to speak to someone who understands their condition. Clearly, however, in other cases it will be important to see a named GP. At the moment, all practices are required to assign their registered patients to an accountable GP but, as my noble friend Lady Hodgson reminded us when we debated the Health and Care Act, that does not mean that the individual always responds. In theory, they should be responding, so one thing we want to look at in more detail is why that is not happening in many places.

A number of noble Lords, including the noble Baroness, Lady Finlay, talked about how we are growing the GP workforce. There are concerns. One of the things I promised in previous debates—I have not had the answer yet; I hope I get it before I leave office, whether that is this week or whenever—is on this cap on training numbers. Yes, we are training more GPs, but at the same time we are losing an awful number of them. Programmes on retention are in place, and the issue of pensions is clearly important. Sadly, I am not able to update the noble Baroness, Lady Meacher, on this; I have asked the question but, let us put it this way: discussions are taking place with another government department. When I worked in other areas of commerce and elsewhere, quite often people reminded me that the price of acquisition is often more expensive than the cost of retention., so we should be investing in the retention of people who still want to work. However, we do not want any of these artificial retirement dates; people are all living healthier lives. We are increasing the number of trainees but we also have to look at morale and retention. A number of proposals are there, but how do we make sure that they get out?

The GP business model is changing—it should not be one size fits all. I talked about the Bromley by Bow Centre; I speak to some GPs who are concerned that their practice is seen as too small. They say, “I am under pressure to go into a practice, but I give a personalised service and I worry about the service we are getting.” At the other end, you get these large health centres that are taking on some functions which were previously secondary care. I understand that challenge, therefore we agree that the primary care entry point should be about multidisciplinary teams. It should be making use of the best capacity we have and looking at alternative sources of expertise, such as dieticians, a physiotherapist or social prescribing, which a number of noble Lords mentioned during the passage of the Health and Care Act.

We made an announcement in July about reforms to dentistry. These are not the complete reforms; there are still conversations around the UDA, for example, and what is felt to be fair remuneration, but we have at least made some progress in those conversations and now have a collaborative discussion. For some people, that is not enough and we have to speed up; I completely understand that, but at least we are making some progress. Up to now they have just been at loggerheads, and we have had others saying, “You’ve got to look at the UDA, which is the source of all these problems.” We are now looking at that, and I pay tribute to the BDA and others for those collaborative conversations.

My noble friend Lady McIntosh of Pickering always raises the issue of rural practices—and rightly so; it is critical that we are reminded of it. We recognise that there are issues with retention in certain areas, and one thing we have been doing with the new medical schools is understanding that people are more likely to stay where, or close to where, they are trained. That is why we have been looking to open some schools in those areas. That will not solve everything. My noble friend also talked about rural connectivity. That issue is widely recognised at the top of the NHS, which is looking at connectivity to be managed locally and the availability of networks. I had a meeting earlier this week with a number of different suppliers on telecare. The meeting was about the switch from analogue to digital, but an issue that came up was the poor provision in many rural communities. One conversation we must have is with the broadband suppliers. Fortunately, technology will fill in a lot of this—we are seeing the cost of satellite coverage dropping and more support for fill-in systems—so I hope we will be able to improve on that. We want to recruit more people in rural areas.

Let me just make sure that I have tackled all the points raised. The noble Baroness, Lady Masham, talked about the steps to discharge patients. It is the Government’s priority to make sure that people are safely discharged. The moment the previous Secretary of State came into office just before the summer, he got together the heads of the various parts of the NHS and spoke to particular trusts and said, “What can we do to clear the pipeline to make sure that people can leave quickly to the community, and what challenges are there?” I know that my new boss, my right honourable friend the Secretary of State for Health, will look at that.

A number of noble Lords raised the issue of seeing a GP in person, and technology. One challenge we have had is that sometimes there is too much technology. We want the NHS app to be the gateway. The noble Lord, Lord Patel, referred to the recent report by Policy Exchange, and I thank Policy Exchange and the other experts who sent us all notes to help us with this debate. When you go on the NHS app, you can, in theory, book an appointment—but you cannot. Then I go to my GP’s website, which says, “You can book an appointment”, but when I go to book one, it says, “You can’t book that appointment; you have to phone us up.” Then we get back to the problem of 8 o’clock in the morning—and not just Monday, but all the way through the week.

One very sensible question is why you have to phone that day for the appointment. Can we look at a way to ensure that you can book today for up to, say, seven days in advance? We have gone backwards. When I was ill as a child, my mother could pick up the phone, phone the local GP and if they could not see you that day, if it was not that urgent, they would say, “How about next Tuesday?” How do we get back to that situation? We are still trying to understand those challenges and why that cannot be done. It says on the website that you can book an appointment, but when you press it, you cannot do so.

We are trying to make the NHS app the gateway. If I get an appointment at my local hospital, I think, “Oh great, I will just look at the appointment on my NHS app.” It does not appear there. I then get a text from that hospital that says, “Please go on to our portal.” So I have the NHS app, my GP website and my hospital website. This is the challenge. They have all said, “Yes, we want technology”, but it is about the processes behind that. On top of that, we all have to know how to make sure it works and to plug the gaps. I was asked to go to have an ECG at a primary care centre. I thought, “That’s very clever. Good, that works much better”, and was told that the consultant would phone me a week later for a conversation. I am quite relaxed about having a phone consultation, but when the consultant phoned me a week later and started talking, I asked, “Sorry, did you see my ECG from last week?” He said, “What ECG?” Then I said, “I tell you what, I can tell you the exact time and date, you can get it and then we can have the conversation.” He said, “Oh, don’t worry about that, I will make a new appointment for you.” We can have all the technology in place, but how do we ensure that the people processes are in place too?

This shows that we all have a role to play in this. The noble Baroness, Lady Merron, often brings up, rightly, the amendment on workforce planning. We talked about this during the debate. There is local-level workforce planning in the ICS. Individual practices and centres have their workforce planning. Many noble Lords will know that regarding the long-term, the department commissioned Health Education England to look at and report on those drivers. We have also commissioned NHS England to develop the long-term workforce plan for the next 15 years, including long-term supply projections. Also, under the Health and Care Act 2022, the Secretary of State has a duty to report every five years at minimum describing the NHS workforce planning and supply system. A lot is being done on workforce planning. One reason we did not accept the amendment at the time was the timeframes, and whether they would change between one report and another. We wanted to look at it in the long term, and for it to come from the NHS and to be from the bottom up.

I have gone on for far too long, but I really hope that this debate has shown everyone not only that all political parties are committed to reform but that at the same time, we must ask ourselves some very big questions. In some ways, it is a valid criticism that we are tinkering with a system that was designed 70 years ago. We must evolve a system rather than tinker with a system. We must tackle the supply of workforce, and we must look at the roles as defined today and whether there are newer roles. Can we learn from overseas, from some of the new roles that are defined elsewhere? Is everyone ready for change? Sometimes, I am not entirely convinced that every player in this system is ready for change. I have had GPs say, “I can take on more patients in my area, but the problem is that the system does not incentivise me to take on a patient elsewhere. They must deregister then re-register with me.” I hope that some of the primary care network initiatives we have will help that, but we all must accept that the current system has just been tinkered with for the last 70 years.

I am not necessarily concerned about the distinction between primary and secondary. It is important that the patient speaks to the right person when they need to, whether in person or remotely, and that they get the right follow-up care. I have had conversations about the model with the noble Lord, Lord Patel. As it is, if you can see a GP, you get five to 10 minutes. Noble Lords rightly expressed the pressures of that. You then hope for a referral. There must be a better way. Some patients are voting with their feet and getting direct referrals to consultants, and others are not. We do not want that two-tier service. We want everyone to have the same access.

The Government must do more. We clearly understand that. Maybe we are not doing it quickly enough, but we must look at the whole system and the roles as defined, while ensuring that it is not “one size fits all”. What is appropriate for one area and one population is not the same as what is appropriate for others. One of the really interesting things that the noble Lord, Lord Crisp, said, when talking about community workers, was that these are people who know about 120 people in their location. They know the families, they are trusted, they go out and knock on the doors of families to ensure that they are all right and help them with their diets and lifestyle. That is being tried in a couple of wards in London. We look forward to the results, but it might be revolutionary in terms of prevention.

I thank the noble Lord, Lord Patel, and all noble Lords. There were more specific questions that I did not answer. I will read the Official Report and write to noble Lords in response to those questions that I have been unable to answer today.