Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I shall speak more briefly than I had intended, because this has been a very long debate, absolutely full of expertise, about a suite of amendments all of which have considerable merit. I know that both Ministers on the Front Bench have been listening very carefully and have noted the consensus across the Committee that this Bill will not succeed unless it addresses very clearly the disgraceful health inequalities in this country at the moment.

Health inequality affects quality of life, life expectancy and, in particular, healthy life expectancy, which has now stalled across certain demographic groups. As we have heard, it has been analysed brilliantly by Professor Sir Michael Marmot. It affects the well-being of the patient and their family. The really sad thing is that much of it is preventable. These things are particularly rife in the poorer parts of the country, because that is where the social determinants of health such as housing, referred to by my noble friend Lord Shipley and others, have most effect. We have heard a number of statistics about health inequalities, but I shall give your Lordships just one. People living in the most deprived areas of the UK spend almost a third of their lives in poor health, compared to only about a sixth of those living in the least deprived areas. That says it all.

Unfortunately, inequalities were not at the forefront of the Government’s response to the pandemic. They suspended equality impact assessments for legislation, resisted publication of evidence of the impact of the virus on BAME individuals—as pointed out to them eloquently by the noble Baroness, Lady Lawrence—and failed to provide adequate isolation support for those on low incomes, forcing them to go to work. The Covid pandemic has therefore seen the biggest shift in life expectancy in the UK since World War 2: a fall of 1.2 years in males and 0.9 years in females. It is therefore essential to heed Sir Michael Marmot’s words and “build back fairer” and not just “better”.

The noble Baroness, Lady Greengross, kindly mentioned the report of the Science and Technology Committee on healthy ageing. I was a member of that committee under the capable chairmanship of the noble Lord, Lord Patel. It became very clear from our witnesses that unhealthy ageing happens years before the person is old and depends enormously on their demographic and their lifestyle. For their sake and for the sake of the future of the NHS, for which no Government will ever be able to provide enough funding unless something is done on prevention, we must do something to level up the health outcomes of the nation. This Bill is a very good place to start all over again on that agenda.

I have added my name to Amendment 11, so ably introduced by the noble Baroness, Lady Thornton, whom I must congratulate on the way she analysed these issues at the beginning of this debate. I thank her for that. Also crucial is Amendment 14, so ably promoted by the noble Lord, Lord Patel, and my noble friend Lady Tyler. Amendment 11 is an attempt to ensure that NHS England produces guidance about the collection, analysis, reporting and publication of the data which makes transparent the performance of various NHS bodies on health inequalities. Without collecting that, we cannot judge the performance of those organisations. If it is not done consistently, we cannot assess an organisation’s performance in comparison to other similar bodies. That is why such guidance must come from the top. I know that the Government want each ICS to do its own thing in a way which it considers most appropriate for its area. However, for the important objective of levelling up health outcomes across the population, judgment of performance can be made only if the data is comparable between one ICS and another or one trust and another, so we cannot leave it to them to collect the data in any way they like.

Of course, there are big issues about the resources available for the collection and analysis of data, but such information is essential if improvements are to be made. Therefore, a duty to “have regard” to guidance published by NHSE would put pressure on the organisations to so arrange their finances as to ensure adequate resources for this, and, of course, it would be cost-effective.

I also have Amendments 61 and 63 in this group. They would insert “assess and” into new Section 14Z35 inserted by Clause 20, which covers the duty of an integrated care board to reduce inequalities in access to health services across its population and in the health outcomes achieved. Although it is well known that, in general, the lower the demographic the greater the health inequalities, this is by no means uniform, even across a single local authority, let alone across a large ICS area. Indeed, even within a single local government ward, which may be fairly affluent in general, there are often pockets of deprivation. Every local councillor knows where they are. In order to devise policies and deploy services geographically in a way that improves access and outcomes for those deprived communities, the ICS needs to drill down and do the detailed work to identify where they are and what factors are damaging health. It may be poor or overcrowded housing. It may be lack of access to shops selling healthy food. It may be lack of access to leisure and sports facilities in which to take exercise. It may be poorly performing schools or overstretched primary care services. It may simply be poverty, preventing people heating their homes adequately or buying nutritious food. In rural areas, it may be lack of access to pretty well everything, as the right reverend Prelate reminded us. Whatever it is, you cannot fix it until you know what and where it is.

That is one of the reasons why we reject the new power of the Secretary of State to meddle in the reconfiguration of health services locally, but that is a debate for another time. In cases such as this, an overview will not do, and local knowledge is key. That is why we believe it is essential to mandate an ICB to do the detailed research on which to base its commissioning decisions, so that it can fulfil the duty to reduce health inequality put on it by this Bill—once it has been amended by a lot of these amendments.

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

My Lords—

[Noble Lords]

Hear, hear.

[Lord Kamall (Con)]

You have not heard what I am going to say yet.

I thank all noble Lords who have taken part in this debate; it has been fascinating. It has touched on a number of things that I feel strongly about personally. Before we go further, and given my background and that of my right honourable friend the Secretary of State, I want to assure noble Lords that we both feel very strongly about inequalities. I say that as someone who grew up in a working-class immigrant community. I was born at Whittington Hospital; I also accessed North Middlesex hospital and Chase Farm Hospital, with which I know the noble Baroness, Lady Tyler, is associated, though I am not sure I will get any more points for that, to be honest.

One thing I feel strongly about, and saw in many areas when I was an MEP for London, is where the state has failed, whichever Government was in power. I have worked with non-state, local community, bottom-up projects which understood the issues in their communities far better than any national or local politician—there was sometimes even a distance between them and their local ward councillor, as the noble Lord, Lord Mawson, and I were discussing the other day.

I thank the noble Baroness, Lady Thornton, not only for the thoughtful way in which she opened the debate and introduced the amendments but for pointing out some of the people who are often forgotten; for example, the homeless. I have worked with a number of local community homeless projects, such as the Hope Foundation in Acton and Vision Care for Homeless People. Perhaps I may also do a quick advert for the Take One, Leave One project, which is based outside Vauxhall station on Fridays, between 12 pm and 3 pm —people can leave excess clothes and homeless people can pick them up. I urge any noble Lords passing through Vauxhall station on a Friday to support this.

Sex workers, the Traveller community and drug users have been mentioned. Sometimes we think that these issues are remote from us and will not affect us—but everyone is only one of two steps away from homelessness. A broken family, mental health issues, your friends saying, after a while, “Actually, you can’t stay on my sofa any more”—where do you go? When I have met homeless people, they have quite often come from a very different place, not the stereotype that we often hear. They have come from quite a stable family, a good relationship, a good job: but two or three things have gone wrong in their life and suddenly they are homeless. It happens to many people who resort to such desperate measures.

Another thing I am slightly concerned about, if I am honest, is that when I was a young child growing up in immigrant communities, there was a distrust of authority. We see the difficulty, for example with the vaccine schemes, in trying to reach some of those communities. It was not only authority that we were quite suspicious of and concerned about but—I hope noble Lords will forgive me for using this phrase—white, middle-class do-gooders who thought they knew best what was best for us as working-class immigrant people and could tell us what was best for us, rather than listening to us and our real concerns. Quite often we felt that they had captured the agenda, and that was why the money and resources which were supposed to be helping us did not reach the people who needed help: it got captured by the white, middle-class do-gooders.

I pay tribute to the noble Lord, Lord Howarth, and the noble Baronesses, Lady Greengross and Lady McIntosh of Hudnall, for the emphasis on the arts and creative industries. Sometimes, music and the arts are a way of overcoming this distrust, learning about the culture of those communities and also aligning the culture and the issues with some of the very real problems and tensions we face. The noble Lord, Lord Desai, talked about prevention being better than cure. It is an issue we talk about constantly in the department, and the NHS also talks about it. The noble Lord, Lord Desai, as an economist, will acknowledge that economics is often simply about the allocation of scarce resources and finding the most efficient way of achieving that.

My late father once told me, “Never forget where you came from and what you were”, and this is one of the reasons I feel very strongly, as do many noble Lords across the Committee, about the issue of inequalities. How do we tackle this, what is the best way to do it? Will putting it in the Bill solve all the problems? Actually, it will not, but we can discuss how we can make it more effective, and not just feel, “Great, we’ve got it in the Bill, job done”. It has to be more than that. As the noble Lord, Lord Scriven, said, it cannot just be an institutionalised Gladys; it has to be more than that. So, I am deeply grateful that we gave this issue the time it deserves. It is really important for me personally. We want to tackle health inequalities and ensure that everyone has the same opportunity to enjoy a long and healthy life, whoever they are, wherever they live and whatever their background or social circumstances.

I hope I can assure the noble Baroness, Lady Greengross, with whom I have had a number of conversations about music and dementia. I have volunteered, perhaps rather rashly, to organise a fundraiser with my band and other bands for that. I hope that does not give me an excuse to lay the YouTube link to my band in the Library: I shall try to avoid that temptation.

However, to deliver on the commitment on 1 October, we launched the Office of Health Improvement and Disparities within the Department of Health and Social Care—the noble Lord, Lord Scriven, anticipated that I would say this—and we also set up a cross-government ministerial group to identify and tackle the wider determinants of poor health and health disparities. It is important that this cannot be top-down; we have to go to some of the social enterprises and local communities, but also we must not prejudge, prevent or duplicate the work of the integrated care systems in this. NHS England is already tackling health disparities through the NHS long-term plan. That sets out a clear intention to set measurable goals and to make differential allocations targeted at reducing health inequalities and disparities. This has resulted in funding increases to some of the most deprived parts of the country.

As we know, making sure that these deprived areas get the most funding does not mean it will trickle down to those who really need it; it could well be captured by some of the do-gooders I mentioned earlier. The noble Lord, Lord Howarth, talked about those targeted interventions. NHS England and NHS Improvement is also taking forward the Core20PLUS5 initiative as an approach to addressing health inequalities. This will focus on improving outcomes in the poorest 20% of the population, along with inclusion health groups and five priority clinical focus areas.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I congratulate the four noble Lords who have produced this excellent suite of amendments across the Bill to ensure that ICBs procuring or commissioning goods and services on behalf of the NHS are firmly focused on their responsibility for NHS England’s commitment to reaching net zero by 2040. It has been an excellent and informed debate, and one with much enthusiasm to reassure the noble Baroness, Lady Hayman.

We fully support the amendments and have little to add from these Benches following the expert contributions of those proposing the amendments and the other noble Lords who have spoken. I am sorry my noble friend Lady Young, who put her name to the amendments, cannot be here. She was a key member of our team during the recent passage of the Environment Bill, and her expertise and wisdom always guides and reflects our approach. The House is clearly interested in this vital matter, as we saw this week in an important Oral Question on the Prime Minister’s promise for a new, overarching net-zero test for new policies. Assuming the Government fully support the key commitment from NHS England, I hope that, in his response, the Minister will accept the need for the amendments and will not argue that the proposed new clause is unnecessary as NHS England already has a commitment that will percolate down to ICBs.

As we have heard, the power of public sector procurement is a massive issue and there is no bigger part of the public sector than the NHS. The NHS has such an important impact on other environment issues, such as waste, pollution and resource consumption, especially for plastics, paper and water. We should ensure we are on the front foot in using that impact to deliver the net-zero commitment.

The NHS has made a start, but there is much more to do. These amendments would reinforce the importance of action in these areas for the new bodies and processes that the Bill creates. The NHS is a big player and, as noble Lords have stressed, it can play a big role in tackling all of these climate change and environmental challenges. Procurement is a strong lever that the NHS can utilise in key markets, particularly in those areas where it is the sole purchaser. The noble Lord, Lord Stevens, was very eloquent on this issue and I look forward to the Minister’s response in the light of his contribution.

Like other speakers today, my noble friend Lady Young wanted to stress that action so far is only the beginning. In the light of the importance of climate change and other environmental challenges, we strongly support such a duty being in place for all the public and private bodies with significant impacts when future legislation comes through Parliament. We did that when inserting a sustainable development duty into the remit of every possible public body from the late 1990s onwards, but this time it has to be not only enacted but managed, delivered, tracked and reported.

As the Minister, the noble Lord, Lord Callanan, told the House this week, every sector of government needs to do its bit, and we need to hold them to that. These amendments are vital, since every public body will have to take further action this decade if we are to restrain temperature rises to two degrees—far less, 1.5 degrees.

Finally, I too thank Peers for the Planet both for its work and, especially for me, its excellent briefing. As noble Lords have stressed, the NHS has committed to net zero and aims to be the world’s first net-zero national health service. It is responsible for around 5% of the UK’s carbon emissions. That is why the NHS’s role and contribution to net-zero targets should be fully integrated into the Bill. I look forward to the Minister’s response and his detailing of how the NHS is to achieve its ambitions. I hope that he will acknowledge that its commitment must be in the Bill. These amendments present a vital opportunity to enshrine in law a commitment that I think most, if not all, would want to see delivered.

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

I thank the noble Lord, Lord Stevens, for the amendments and the noble Baroness, Lady Hayman, for her opening remarks. I also thank the noble Baroness for her suggestion yesterday that it might make my life a lot easier if I just accepted amendments. I understand that advice, having just gone through a two-hour debate on the previous group.

A number of noble Lords referred to how these amendments relate to our previous debate on inequalities. I point out that that is sometimes not quite in the way that we would expect. We might think there is a direct connection, but sometimes the green agenda can be seen to be for those who can afford it—as I explained before, for the white, middle-class, patronising people who tell immigrant working-class communities what to do and push up their costs. Anti-car policies push up costs for those in rural areas, and there are higher fuel costs as we replace gas boilers with potentially more expensive heat pumps. We have to be aware of those issues. In the long term, I am optimistic. I look forward to the day when we have solar power and wind power, with storage capacity, which will reduce costs.

[Baroness Northover (LD)]

Will the Minister look at this globally and recognise that the poorest are affected the worst? When he talks about those in poverty, he should think globally.

[Lord Kamall (Con)]

I accept that point, but I also accept that, sometimes, one can be patronised, and I do not accept being patronised as I was in the earlier debate. One day, there will be cheaper fuel, and we can look forward to it, but we have to make sure that the transition along the way is not seen to push up costs for working people, because we all feel passionately about this green agenda.

[Baroness Bennett of Manor Castle (GP)]

The Minister was talking about the impact of policies on the poor. Does he agree that many of the products—the fabrics, the chemicals—are manufactured in the poorest areas of the world, producing pollution that has disastrous impacts on some of the poorest people?

[Lord Kamall (Con)]

I was going to come to the noble Baroness’s points, and I am grateful to her for raising these issues directly with me previously.

Turning to the amendments, I thank the noble Baronesses, Lady Hayman and Lady Young of Old Scone, and the noble Lords, Lord Stevens and Lord Prior, for bringing this debate before the Committee. There is no doubt that the NHS has a significant carbon footprint. There is no doubt that a poor environment has direct and immediate consequence for our patients, the public and the NHS. There is no doubt that it has an impact on the health of the nation. As the noble Baroness, Lady Hayman, pointed out, the NHS accounts for around 4% to 5% of UK emissions. If we go further, as the noble Baroness, Lady Bennett, said, that is 40% of public service emissions. Noble Lords are right to highlight the critical role that the NHS has to play in achieving net zero.

To support that work, NHS England—thanks in part to work already started by the noble Lord, Lord Stevens, who I know has had conversations with my right honourable friend the Secretary of State for Health and Social Care—is leading the way through a dedicated programme of work, as many noble Lords acknowledged. This includes ambitious targets for achieving net zero for the NHS carbon footprint by 2045 and for its direct emissions by 2040. This is ahead of the target set by Section 1 of the Climate Change Act 2008; we welcome that ambition and will continue to support the NHS in that.

--- Later in debate ---

[Lord Mawson (CB)]

I thank the Minister. Can I just give an illustration about the local on this issue? I am certainly not an expert on climate change, but I am a practical person who worries a lot about granularity and the gap between a lot of talk I have heard over many years on all sides of this Chamber—with very large amounts of money cited, et cetera—and the realities in this building.

I am trying to buy an electric car at the moment, as a responsible citizen. When I went to have a look at the multi-storey car park below this building—the local—and wondered where I am going to plug it in when it arrives here, I ended up talking to one of the facilities managers, who was a very nice man. I asked him how many plug-in points there were underneath this building—again, the local. He said, “I don’t know, Lord Mawson, but I will look into this”.

He was diligent and came back to me. We started to have a conversation about it, and he began to suggest that I need to carry a cable in my car with a three-pin plug. I pointed out that my office is across St Margaret Street, in Old Palace Yard, on the third floor, so maybe I should run it across there with a carpet over it and up to the third floor to plug it in there. We had this amusing conversation. I said, “Well, go on then, tell me: how many are there in this building, where all this chatter and talk is taking place?” His answer was that there are two. I suggest that the gap between reality and rhetoric is very large indeed. If we are really going to deal with these issues—as we must—we must now become intensely interested in the NHS and in all the systems of government about practicality and the procurement machinery, which I suggest is not working.

I talked to one of the facilities people yesterday about my office, which has a light switch with a notice over the top of it telling you how to use it. It is completely ludicrous. She told me that that system is going to be different to all the systems here in the Palace of Westminster; none of it is joined up.

I think the Minister is right. The clue is in the local, but all our systems and our civil servants must now become interested in practicality and the local if we are really going to get serious about these matters. It is absolutely crucial to get procurement right, because without that, we will never deliver this.

[Lord Kamall (Con)]

I thank the noble Lord, Lord Mawson, for that intervention, and I completely agree. There are some incredibly inspirational projects going on in our local communities, tackling and addressing the green agenda, and sometimes, top-down, we may feel good about it in this place, but it really affects working people and those who face higher costs and we have to be very careful.

On the specific question of procurement, the NHS is already publicly committed to purchasing only from suppliers which are aligned with its net-zero ambitions by 2030, and last year, NHS England set out its roadmap giving further details to suppliers to 2030. This is supported by a broad range of further action on NHS net zero and we hope that by pushing this through at NHS England level, but also with ICSs, we can see some of that local innovation as local trusts and local care systems and even health and well-being boards respond to those local challenges—others could learn nationally. To respond to the question of the noble Baroness, Lady Walmsley, NHS England will publish the world’s first net-zero healthcare building standard; this will apply to all projects being taken forward through the Government’s new hospital programme, which will see 48 new hospital facilities built across England by 2030.

There is political consensus on green issues. and we should pay tribute to the noble Baroness, Lady Bennett, and the Green Party for making sure, over the years, that the green agenda has been put at the centre of British politics. We find green policies in all the election manifestos of the mainstream parties: that is in no small part due to the noble Baroness’s party and to the noble Baroness herself. So, even while we may disagree on how to achieve some of these things, there is no doubt that we are not going to reverse on our commitment. Whatever Governments are elected in future, all are committed to a carbon net-zero strategy and a cleaner environment. So, I must gently disagree with her that these amendments are necessary.

I would like to have further conversations with the noble Lord, Lord Stevens, given his experience, on why he feels that, despite all the great work that the NHS has been doing, these amendments are still necessary. I would like to have further conversations with him and others, but at this stage, I ask the noble Baroness to withdraw the amendment. Across the political spectrum, we must make sure that we are pushing the NHS to deliver, not only at the national level but at the ICS level and even lower, at the place level that the noble Lord, Lord Mawson, speaks so eloquently about.

[Baroness Bennett of Manor Castle (GP)]

Before the noble Lord sits down, will he respond to the question, of which I gave him prior notice, about the document?

[Lord Kamall (Con)]

I apologise to the noble Baroness—I am so sorry, but I am trying to juggle 300 devices. That is a slight exaggeration, if I am honest. We recognise the importance of ensuring that all chemicals in the NHS supply chain are appropriate and properly managed as part of the net-zero strategy. I think the noble Lord, Lord Stevens, even touched upon some of the chemicals that were used and some of the issues he looked at during his time at the NHS when it comes to chemicals. The NHS must also comply fully with the Control of Substances Hazardous to Health Regulations, the CoSHH regulations.

More broadly, although Defra is the lead department for harmful chemicals, the UK Health Security Agency feeds in its expertise in relation to restricting and banning chemicals, and we are grateful to it for that work. The UKHSA is also looking at each of those chemicals, which we hope in future can be replaced by less harmful materials and chemicals. I undertake to write to the noble Baroness in more detail than the short answer I have given her at this stage.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, like the noble Baroness, Lady Thornton, I shall start with those who I think should not be on the board before I turn to those who I think should. To a great extent I support the noble Baroness’s Amendment 29, but with a small caveat that, if she wished to press it, might require a bit of redrafting. I will explain.

Additional provider medical services are very useful in many areas to fill gaps in primary care capacity. They may provide additional services from which other NHS primary care services have opted out, such as out-of-hours services or enhanced services beyond the capacity of local NHS GPs to deliver. In some areas they have taken over primary care services where NHS GP practices have become too small to be viable or all the partners have retired.

Some APMS services are commercial businesses with a responsibility to their shareholders to make a profit, and I do not think these should be on the board. However, some APMS contracts go to NHS entities, and I would not want to exclude those. Of course, we must remember that for many years GP practices have also been small businesses, sort of, operating within the umbrella and ethos of the NHS. They too need to clear their costs or they will close down.

That is all well and good. However, if the Government are serious that they want to exclude private sector interests from ICBs, they must surely agree to include in that ban non-NHS entities that hold APMS contracts. A failure to accept the amendment of the noble Baroness, Lady Thornton, must surely make us a little suspicious about the Government’s claim that their amendment inserted in another place would successfully exclude private interests from the board.

Amendment 29 would extend the range of those involved in commercial enterprises from being members of the board of an ICS beyond those that we have just discussed in relation to the noble Baroness’s Amendment 28. Amendment 29 would specifically exclude NHS GP practices and voluntary or not-for-profit organisations from the ban. There are many types of organisations that would be included in the ban, although they could be heard on the board of the integrated care partnerships. Those include: pharmaceutical companies; providers of medical devices, equipment or premises; people who own care homes; and many other essential services without which our NHS could not survive. However, their importance should not entitle them to influence the constitution, strategy or commissioning principles of the board of the ICS. They are important providers that will be appropriately involved in planning at other levels, but they should not be able to steer fundamental decisions without the suspicion that they might have a commercial interest in such decisions. Indeed, the ban proposed in the amendment would protect such companies from such a suspicion, so perhaps it would be welcomed by them.

Turning to those who should be on the board, I will not repeat what the noble Baroness, Lady Hollins, said in introducing her amendments, because she has done it extremely well, particularly emphasising the impact of integrated services on people with learning difficulties and people with autism and how they could benefit from better integrated services if we got it right. So, I support her amendments.

I turn to Amendment 37, to which I have added my name to those of the noble Baroness, Lady Thornton, and the noble Lord, Lord Patel, for the following reasons. According to the Explanatory Notes, each ICB and its partner local authorities will be required to establish an integrated care partnership, bringing together health, social care and public health. The constitution of the ICB as it stands in the Bill specifies that the board must include only a minimum of three types of people who the Government clearly believe are essential to the effective operation of the board. They are someone from NHS health trusts or foundation trusts, someone from primary care, and someone from one of the local authorities in the area. If it is okay to prescribe these members, would it not also be wise to prescribe a few other key people with appropriate knowledge in order to achieve the ICB’s objectives of bringing together health, social care and public health? This amendment therefore suggests five other nominees—not 15, bearing in mind the Government’s wish to keep the ICB to a manageable size. But given the powers of the board, I would think it essential to have people nominated from mental health, public health, social care, health trade unions, patients and carers to bring their knowledge to strategic decisions.

If the board is to comply with the ambition of parity of esteem for physical and mental health—which we talked about two days ago—it will be important to have someone with the knowledge of how mental health services are working, as my noble friend Lady Tyler emphasised. Public health is a very particular discipline, the importance of which has been amply shown during the pandemic, which also has a vital role to play if we are to improve the health of local people and level up inequalities. Social care provision should never be separate from or subsidiary to health, as it is intrinsic to the functioning of health services in every area, so it is inconceivable that any ICB should ever be without someone from that sector.

The NHS is a people business, which is why those who deliver the services and the patients who are on the receiving end should have a voice at the top. Similarly, those thousands of unpaid carers, without whom vulnerable people would use up more of the NHS’s scarce resources than they currently do, should be represented at the very top of these new organisations. Their contribution to the efficient use of the board’s financial resources is crucial.

If the objective is to encourage more integration and collaboration, how could it be right not to have these additional five or six groups of people helping to make the strategic decisions? If that is not the case, as has been said by other noble Lords, the board could be dominated by the large acute hospitals and primary care, and the integration objective of the Government, which I endorse, would fail. I look forward to the Minister’s reply.

[Lord Kamall (Con)]

My Lords, this has been an excellent and wide-ranging debate, and I really am grateful to all noble Lords who tabled amendments today.

With your Lordships’ leave, I turn first to Amendment 18 in the name of the noble Baroness, Lady Thornton. This amendment would mean that the relevant ICB and ICP would need to be consulted before NHS England is able to provide support and assistance to bodies other than NHS bodies. The NHS has, under successive Governments of all political colours—indeed, since its foundation in 1948—commissioned care from various sectors to help it be more responsive to patients’ needs, and particularly to help deliver the commitments set out in the NHS constitution.

The vast majority of NHS care has been—and will rightly continue to be—provided by taxpayer-funded public sector organisations. But experience before and during the pandemic has demonstrated how important it is for NHS England to have the power, as the Trust Development Authority currently does, to provide support and assistance to any providers of services on behalf of the NHS. This will ensure that independent providers can, if necessary, be commissioned to provide important additional capacity where needed.

[Baroness Thornton (Lab)]

I really rather hoped the Minister would not go into whether or not I was suggesting that we should or should not be using private services. This is about who commissions services; this is not about who provides services. In my opening remarks, I said that a variety of providers is exactly what we have and will continue to have.

[Lord Kamall (Con)]

I thank the noble Baroness for that clarification.

The amendment seeks to exclude individuals whose GP practices hold an alternative provider of medical services, or APMS, contract from being a member of an integrated care board. While APMS contracts may not be appropriate for all GPs, they offer the ICBs, as commissioners, greater flexibility than other general practice contract types. As the noble Baroness, Lady Walmsley, acknowledged, the APMS framework allows commissioners to contract specific primary medical care services to meet local needs. APMS contractors include some private and third sector social enterprises and GP partnerships, which provide outreach health services for homeless people, asylum seekers and others. It is quite clear that none of this diminishes the commitment to ensure that care is provided free at the point of use, paid for by taxpayers.

All contract holders providing NHS core primary medical services are subject to the same requirements, regulations and standards, regardless of the type of contract. The Care Quality Commission, as the independent regulator, ensures that all contracts meet these standards.

Some GP partnerships concurrently hold a general medical services contract for core medical provision, as well as an APMS contract. Some individual GPs provide services for a range of practices. The concern is that this amendment would exclude GPs working for one or multiple practices which operate under APMS contracts from being members of the ICB.

NHS England’s draft guidance states that nominated members of an ICB will be full members of the unitary board, bringing knowledge and a perspective from their sectors, but not acting as delegates of those sectors.

This amendment would prevent some individuals being on integrated care boards, based on what type of NHS GP contract their practice holds. This could limit the ability of primary medical service providers to appoint an ICB member who understands the health requirements of the local population. This could reduce the diversity of GPs who could be appointed, based on their contract type. If we think of the unintended consequences, this may inadvertently exclude representatives with much-needed expertise in serving specific local populations and addressing their health needs.

Earlier, we talked about tackling inequalities. I feel very strongly that there are sometimes unintended consequences, where people think that they know better what is best for their communities. It would be unfortunate to exclude APMS contracts, or anyone who had an APMS contract and who had the expertise needed for those communities that are not receiving an adequate service, or for poor, immigrant communities. This could go against the goal that we all want to see of tackling inequalities.

I now turn to Amendments 29 and 30. I am grateful to the noble Baroness, Lady Merron, and the noble Lord, Lord Davies, for bringing this issue before the Committee. I understand the interest in the role of independent providers in the integrated care boards. I also understand the concern across the Committee to ensure that independent providers, including companies seeking to produce health and care products, should not be appointed to the board of ICBs. We agree. Integrated care boards will be NHS bodies whose board membership consists of a minimum of individuals nominated by NHS providers, GP services and local authorities whose areas coincide with that of the ICB.

Although, as has been acknowledged, service provision by the independent and voluntary sectors has been an important and valuable feature of the system under successive Governments, it has never been the intention for independent providers as corporate entities to sit on integrated care boards, nor for an individual appointed to be there as a representative of an individual provider, in any capacity. People must therefore be assured that the work of ICBs will be driven by health outcomes, not profit. However, we recognise that this is a matter of concern to many noble Lords, as well as to the other place. We have been keen to put this beyond doubt, which is why we brought forward the amendment on this very point at Report stage in the other place. This amendment makes clear that no one may be appointed to an ICB who would undermine the independence of the NHS as a result of their interests in the private healthcare sector, social enterprise or elsewhere, including the public sector.

--- Later in debate ---

[Baroness Walmsley (LD)]

I apologise for interrupting the Minister, but I want to ask him a question going back to Amendment 28 and the APMS contracts. If we were to bring forward an amendment that made it very clear that we had no objection to NHS entities or not-for-profit organisations with APMS contracts being on the ICB, would he take a more friendly approach? It would just eliminate those that take profit out of the NHS.

[Lord Kamall (Con)]

I thank the noble Baroness for that suggestion and for trying to narrow the gap that there clearly is. If an amendment were put forward, we would look at it very carefully and consider the unintended consequences from the way it is drafted. We will consider it but, as I am sure the noble Baroness appreciates, I can make no promises at this stage.

I turn to the point made by my noble friend Lord Hunt of Wirral about how provider input in the work of an ICB will be reconciled with assessing both the suitability and performance of providers. As my noble friend correctly noted, each ICB must make arrangements on managing the conflict of interest and potential conflicts of interest, such that they do not and do not appear to affect the integrity of the board’s decision-making processes. Furthermore, each appointee to the ICB is expected to act in the interests of the ICB. They are not delegates of their organisations, but are there to contribute their experience and expertise for the effective running of the ICB—a point made most eloquently by the noble Lord, Lord Mawson, my noble friend Lady Harding and the right reverend Prelate the Bishop of London. It is important that this is about expertise, not the trust or organisation that they are taken from, or their skills and knowledge, as the noble Lord, Lord Mawson, said.

We are also keen to allow ICBs to develop their own governance arrangements, which best take their local circumstances into account. We want to give them the flexibility to learn and develop as their best practice evolves, so that other ICBs could learn from that best practice where there are concerns.

To support ICBs, NHS England is working with them to issue guidance and to develop and make clear our expectations of ICB leaders—expectations that have been reflected in the discussions and fantastic contributions from many noble Lords. For these reasons, I regret that the Government cannot accept these amendments at this stage. However, I hope I have given noble Lords such reassurance that they feel able to withdraw their amendments.

Turning to the membership of integrated care boards, I will begin with Amendments 27, 37, 38, 39, 40 and 41. I am grateful to all noble Lords who have brought forward these amendments today. I understand the interest from all sides in this membership. Schedule 2 sets out the minimum membership of the integrated care board; it will need to include members nominated by NHS trusts and NHS foundation trusts, by persons who provide primary medical services and by local authorities of areas that coincide with or include the whole or any part of the ICB’s area.

I take the point of the noble Lord, Lord Bradley, about mental health. I am sure he recalls the debate on Tuesday, when noble Lords felt very strongly about this. I have offered to meet many noble Lords from across the Committee who indicated that they want to see this parity with mental health, which they do not believe is implicit at the moment, even if we believe that “health” refers to physical and mental health. Indeed, it refers to spiritual health in many ways. But we understand that we have to close that gap and I will make sure that the noble Lord, Lord Bradley, is invited to those meetings.

It is important for us that we are not overprescriptive, which is especially true of any membership requirement. Any extension beyond the proposed statutory minimum will risk undermining local flexibility to design a board, as my noble friends Lord Mawson and Lady Harding and others have said, in the most suitable way for each area’s unique needs, drawing on the best expertise, but not where they are from. It may also make the boards less nimble and less able to make important decisions rapidly if we overprescribe.

It is important to remind the Committee—I apologise if noble Lords do not appreciate the repetition—that we set a floor and not a ceiling. The ICB can appoint board members if it wishes. Local areas can, by agreement, go beyond the legislative minimum requirements. They will want to ensure they appoint individuals with the experience and expertise to address the needs and fulfil the functions. Areas are already doing this. For example, in south-east London the ICB is proposing to include three provider members—acute, community and mental health—and six place members, one for each borough. This approach is exactly how we want ICBs to use the flexibility available to them.

If, in time, some of the concerns expressed today by noble Lords become clear—such as issues being skated over, ignored or elbowed out by others with louder voices—we may need to add further requirements that relate to ICB membership, and there are regulation-making powers in place in Schedule 2 to allow the Secretary of State to do so. Furthermore, NHS England has the power to issue statutory guidance to ICBs. It could, for example, use this to recommend that each ICB should consider appointing a learning disability and autism senior responsible officer, as I know the noble Baroness, Lady Hollins, has asked for and has spoken about most eloquently many times, most recently in a debate a few weeks ago.

Taken together, our approach reflects our view and, I reiterate, the view of the NHS that we should not attempt to overlegislate for the composition of ICBs and instead let them evolve as effective local entities to reflect local need. Let us get the right balance between the top-down and bottom-up approach, and make sure that they are relevant to their local areas. I am afraid that these amendments are seen to take a different approach, by adding more people to the minimum requirements for the ICB, making them larger but not necessarily better. They also add additional complexity by introducing a significant number of members who are responsible for activity outside the NHS. We think these would be better represented on the integrated care partnerships, which have a broader remit. I come back to the point that it is about expertise, not which trust.

I will consider the comments made by noble Lords very carefully if some of the concerns have not been met, and will have future conversations, between this stage and the next, if they feel that we have not addressed their concerns completely. I regret that the Government cannot accept these amendments. I hope that I have given your Lordships some, if not complete, reassurance and that noble Lords will feel able at this stage to withdraw and not press their amendments.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for his detailed response. I was disappointed with the first remarks he made because he resorted to the mantra that the Government tend to go to when the question of private sector interests in delivering healthcare is raised by this side of the House. That is a shame, because the questions that we have raised are legitimate. In fact, his friends in the Commons accepted the conflicts of interest that could arise from private sector interests being represented on ICBs. We were seeking to make sure that that is watertight and there is no way of it changing. That is a legitimate question to ask.

I thank the noble Lord, Lord Patel, and the noble Baronesses, Lady Walmsley and Lady Meacher, for supporting Amendment 37, which is the key amendment in this group as to who may or may not be members of the board.

The noble Baroness, Lady Hollins, made a powerful case for the interests of people with learning disabilities and autism being represented. We know that where health systems make the health of people with learning disabilities a central priority, the whole health system benefits from it. That has happened in some places—for example, in Manchester—and it demonstrates how we improve the whole system. It is an important point.

My noble friend Lady Bakewell made the point about Centene and Operose, and that is partly why I put forward my amendment on APMS. The Minister may recall that we raised this matter in Questions a few weeks ago, when I asked him to write to me about what system had been used to give that contract to Centene, or Operose, in Camden, the area where I live. Having served on the CCG in Camden, I was aware of the importance of who runs primary care and of who the GPs in our surgeries are. Having right and proper people and organisations running our primary care was one of the criteria that you would use as a commissioner when you were looking at who was running, and who might wish to run, primary care and GP surgeries. I was involved in that process. As I learn about the history and background of this organisation now running primary care and GP surgeries in the UK, I do not think they are right and proper people to be doing that.

If this amendment does not serve the purpose of stopping that happening, I ask the Minister and the Bill team to reflect on what we might need to do to ensure that those from the private sector, social enterprises and charities whom we commission to run parts of our health service are right and proper people to do so. The remarks made in that regard by the noble Lord, Lord Hunt, were very interesting and useful, as they often are.

The noble Baroness, Lady Meacher, made the point about public health. That is the theme running through this Bill: the need for public health to be represented. She was also absolutely correct to bring us back to the idea that clinical leadership is very important. Of course it is. The right reverend Prelate the Bishop of London asked some pertinent questions.

My noble friend Lady Pitkeathley raised the issue of social enterprises, which is close to my heart. I am the honorary secretary of the All-Party Group for Social Enterprise, which I helped to found 20-odd years ago. The APPG has just completed an inquiry, chaired by the noble Earl, Lord Devon, about the impact of Covid on social enterprises, which absolutely illustrates the points made by my noble friend and which I will share with the Minister when it is available.

The noble Baroness, Lady Finlay, made relevant points about Allied Healthcare. I think that the noble Baroness, Lady Walmsley, and I agree that the problem with APMS is that there is a lack of clarity and it is a bit of a loophole, and we need to look at it again. This may not be the Bill to do it in, but it might be.

With those remarks, and hopeful that the issue of who the members of the ICBs will be will run through our discussions for the next few weeks, I beg leave to withdraw the amendment.

Respiratory Viruses

Lord Kamall Excerpts

Tuesday 11th January 2022 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the risks posed by respiratory viruses this winter to (1) children, (2) young people, and (3) the elderly; and what further medical protection measures they will put in place to tackle (a) respiratory syncytial virus, and (b) influenza.

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

Influenza remains a health threat, which is why the Government are offering flu vaccinations to more people this winter, including older people and, for the first time, all schoolchildren up to year 11. Reduced transmission of respiratory syncytial virus, or RSV, last winter led to a summer surge, particularly in child cases—there were few among elderly adults—which is now diminishing. Seasonal RSV preventive monoclonal antibodies for highly vulnerable children were authorised from June 2021.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, measures taken to combat Covid-19 over the last year have resulted in the epidemiology of seasonal viruses being out of sync with usual patterns. Last year, Public Health England reported concerns about rising rates of RSV infections in infants following the Covid-19 lockdowns, and reduced immunity levels combined with an already stretched health service. Given the continued pressures on the NHS, can the Minister outline what evaluation the Government have made of the NHS’s capacity to handle a potentially extended RSV season, and will they work with the devolved Administrations in that regard?

[Lord Kamall (Con)]

There was an unseasonal surge in RSV activity during the summer of 2021, which peaked in late July at about 15.7% swab positivity and a hospital admission rate of 2.5%. But, following the summer surge, RSV activity declined and positivity currently sits below seasonally expected levels. As a consequence, the RSV hospitalisation rate has declined since the summer surge.

[Lord Clark of Windermere (Lab)]

My Lords, thankfully, influenza is low again this winter, largely on account of the most effective way to counter flu: hand washing, covering one’s mouth and vaccination. The House will recognise that those are the identical solutions for fighting Covid. So I urge the Minister and his colleagues to keep hammering those three simple messages in their anti-Covid approach, because at the same time that will reduce many deaths by keeping flu down.

[Lord Kamall (Con)]

The noble Lord makes a very important point that we should acknowledge. The fact is that the preventive messages against Covid are equally valid against influenza. Indeed, the reduction in social contact since the pandemic has led to a reduction in seasonal flu, as we would expect, compared with previous years. I take the noble Lord’s point and will make sure that I repeat it when I can.

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. We have her on screen. This is a convenient point to call her.

[Baroness Brinton (LD) [V]]

My Lords, government data show that more children have been admitted to hospital with Covid in the last three weeks than in the whole of the nine months of the first wave. Many clinically extremely vulnerable children are still expected to go to school, even though they still await their vaccines and guidance on how to manage the risks they face, including RSV and influenza. Can the Minister say when these children and their families will get the vaccines and guidance they need? If he cannot, will he please write to me with the answer?

[Lord Kamall (Con)]

The Government have put in place a range of measures to protect children from RSV this winter, including expanding the passive immunisation programme for all at-risk infants, ensuring that the NHS has surge plans in place to respond to any increasing cases, raising awareness among parents and at schools of the symptoms of RSV and when to seek medical help, and increasing our out-of-season surveillance capacity.

[Baroness Altmann (Con)]

My Lords, given that the elderly are more susceptible to respiratory viruses in the cold, and given the number of excess winter deaths we have already seen in recent years, the reduction in the earnings link for the triple lock and the lack of availability of any increase in the cold weather support for older people, will my noble friend consider whether the Government might introduce any emergency measures to help pensioners keep warm through the winter?

[Lord Kamall (Con)]

My noble friend makes a very important point that during the winter people quite often need some help and assistance with winter fuel and other issues. For RSV and influenza, this winter we have had the continued offer of vaccination for 50 to 64 year-olds for the first time, and to additional cohorts. By 19 December, 82% of people aged 65 years and over and 48% of people under 65 years in risk groups had received a flu vaccine.

[Baroness Thornton (Lab)]

My Lords, in July last year my right honourable friend Jonathan Ashworth anticipated the risk of co-infection with both viruses—popularly known as “flurona”—being likely to compound the impact of Covid. He asked then whether the Prime Minister would invest now in testing capacity so that, alongside a Covid test, it would be possible to test for flu and RSV. Is there a plan to take up multipathogen testing for the future—it is obviously too late for this winter—as we learn to live with Covid?

[Lord Kamall (Con)]

There are a number of innovations when it comes to vaccines and testing for vaccines. Indeed, some of the companies and organisations we spoke to recently about future testing requirements, for example, have looked at multiple tests or tests where you can identify multiple conditions. It is one of the things that the department and the NHS are continuing to have conversations on with suppliers.

[Lord Naseby (Con)]

I congratulate my noble friend on the success of the flu jab and the way it has worked this year through general practice. In passing, I also reflect on the pre-testing of children going back to school and having a test just before school. There remains a concern, though, about the elderly who are housebound. There was a problem with ensuring extra Covid jabs for that category. Will my noble friend ensure that general practices check on a regular basis where appropriate that there are such jabs as are necessary for the housebound who are eligible?

[Lord Kamall (Con)]

I thank my noble friend for congratulating me, but I should not take any credit for this; it is thanks to the dedication of all the people who work in our health and social care system, and the innovation we have seen in the public and private sectors over many years to tackle many of these conditions. I will look into access for elderly people at home and commit to write to my noble friend.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, at the outset of this pandemic, the emphasis appeared to be on hands and touching for transmission of Covid. This appears to have changed to contamination by airborne particles and wearing masks, which makes more sense for a respiratory virus. Can the Minister tell your Lordships’ House whether this analysis is correct and publish the evidence showing the efficacy of face coverings?

[Lord Kamall (Con)]

As the noble Lord will know, there has been a debate on the efficacy of face coverings. The Government believe that they do contribute, along with a number of other measures. One of the things we have to be careful of, when we talk about one measure, is not to diminish the importance of other measures. As a noble Lord who spoke earlier said, all these measures are important—washing hands, opening windows and making sure you are socially distanced—as well as wearing masks. Rather than isolating one preventive measure, we think they all contribute together.

[Lord Pickles (Con)]

My Lords, can my noble friend tell the House what progress has been made on the provision for the visually impaired of lateral flow tests capable of being used without the help of a third party?

[Lord Kamall (Con)]

I thank my noble friend for that question. I am not aware of the answer, and I will commit to writing to him.

[Lord Patel (CB)]

My Lords, there is good evidence through a randomised trial of 300,000 people that shows the efficacy of mask wearing, but that is not my question. We should be pleased that RSV infections in children are lower this year—I am sorry, I should have taken my mask off; surgeons are used to speaking with masks on. We should be pleased that RSV infections and bronchiolitis in children are significantly lower this year, but there are lessons to be learned both for epidemiological studies and for research. Are the Government or the Department of Health engaging in that?

[Lord Kamall (Con)]

I thank the noble Lord for removing his face mask; I know it is supposed to be a preventive measure, but it prevented me hearing his question. We are following the epidemiological picture for RSV and are regularly updated, both in the NHS and in the department.

Health and Care Bill

Lord Kamall Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Lord Cormack (Con)]

My Lords, in the absence of the noble and learned Lord, Lord Judge, I take it upon myself to echo the trenchant observations of the noble Baroness, Lady Walmsley. What do the Government think Parliament is? What do they think it is for? Again and again, we have these Bills—skeleton Bills, Christmas tree Bills, call them what you like, but one thing is abundantly plain: Henry VIII is sitting firmly on his throne issuing his diktats.

This is no way for a democratic Government to treat Parliament, especially the elected House. However, if the elected House will not fully protect itself, we have a duty to speak up for it. There are many who, because of the circumstance of their election recently in Parliament, perhaps feel a bit diffident, but we have a duty not to be diffident. We in this House have a duty to say, “This is no way to treat Parliament”, because we are in effect creating executive departments with dictatorial powers. That is inimical to a parliamentary democracy. It is plain wrong. I do not know how often I shall intervene in the debate on this Bill, but what I do know is that I do not like what I see.

I have enormous and genuine respect for my noble friend the Minister. He has already, very rightly, earned himself a reputation in this House as somebody who is anxious to learn about parliamentary customs and practices, and to listen and reflect. I beg him, as I look at him now, to please talk to his colleagues in the other place who have greater power within the department and say to them that there is real concern in this House—I am delighted to see my noble friend Lady Cumberlege nodding at this point—which has within it many medical experts, such as my noble friend Lord Ribeiro, the noble Lord, Lord Winston, who does not seem to be here this afternoon, my noble friend Lord Kakkar and many others who know about medicine and how things should be organised and who do not see it as their prime purpose to help a Secretary of State hang his baubles on the Christmas tree.

We have a chance—we have done it before in other Bills—to try to improve on this skeleton, this Christmas tree, and to put Henry VIII back in his box, which is where he should be put. I hope that as this Bill goes through your Lordships’ House it will be probed, scrutinised and improved.

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

I start by thanking the noble Baroness, and indeed all noble Lords who have spoken thus far. I will make a general point in response to my noble friend Lord Cormack. I recognise that I am relatively new to this House and that I have much to learn. I hope to learn much, not only from noble Lords who have more experience of the procedures of this House and of holding the Government to account but from many noble Lords from across the House with medical expertise and management expertise in the health and social care sector.

I also thank the noble Baroness, Lady Thornton, for bringing this debate before the Committee. Amendment 1 would mean that we could not commence the change of legal name from the National Commissioning Board to NHS England until after an impact assessment for each of the clauses in Part 1 of the Bill is published, while Amendment 315 would mean that we could not commence Part 1 until after the publication of an impact assessment for each clause’s impact on the risks, costs and benefits to patients.

I hope I can reassure the noble Baroness that my department has published the impact assessments. She acknowledged this and I accept that they were not published in the most timely way. I will endeavour to do my best to make sure that we publish these assessments with as much notice as possible. They are available for noble Lords to review on GOV.UK. I am very happy for the noble Baroness to take credit for the first impact assessment. We will endeavour to do better. We will also commit to publishing further impact assessments for secondary legislation made under the powers contained in the Bill, where those regulations will have significant impact on the health and care system or private businesses, to provide transparency and clarity to the system.

The amendment would also delay the commencement of Part 1 until at least six months after commencement regulations were laid before your Lordships’ House. This would delay the implementation of the key provisions contained in Part 1.

The NHS put forward its recommendations for legislation in 2019. It is preparing, subject to parliamentary passage, to implement the ICB provisions of the Bill from July 2022. We know that ICBs in effect exist in many areas, in whatever form of development, and it is essential that we put these on a statutory footing as soon as possible. The development of ICBs builds on years of development work in local systems to improve partnership working. Delaying the implementation risks a loss of momentum in establishing statutory integrated care boards and the benefits that they are intended to deliver. For these reasons, I ask the noble Baroness to withdraw her amendment.

[Baroness Thornton (Lab)]

I thank the Minister for that very gracious answer and start to our deliberations. I also thank in particular the noble Baroness, Lady Walmsley, and the noble Lord, Lord Cormack. I really was rather hoping that the noble Lord, Lord Cormack, would come in, as this is absolutely what he knows about. He is quite right. I hope that noble Lords who are experts in this will look carefully at the Bill and at the two reports I referred to, because they will need to guide us in our deliberations over the next few weeks.

Let us see what the impact assessment says—whether it works or not—and see whether we need to review certain parts of the Bill with a view to looking at the Constitution Committee’s report, for example, which also was published only yesterday. With that, and with the warning that this is the beginning and not the end of the discussion, I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I feel that today’s debate on this important group of amendments should carry much weight because, at its core, this is about treating people as whole people and seeing them as physical, mental and social beings. Our welfare on each of those fronts is absolutely key to the others. It is not possible simply to treat one without regard to the others, and it is crucial that we enhance people’s well-being across our whole complexity as human beings.

I am glad to speak to this group of amendments because, as we have heard across all sides of the Committee throughout today’s debate, the reality is that, despite the best efforts encapsulated in the mandate, and many times in policy, we find that competing priorities, an avalanche of guidance and instructions, and events—the pandemic has been referred to several times, of course—mean that mental health services can be, and indeed have been, relatively left behind. As the Centre for Mental Health reports:

“Mental health problems account for 28% of the burden of disease but only 13% of NHS spending.”


In the debate today we have also asked ourselves: where is the accountability? For example, we know that in many clinical commissioning groups the actual spend on mental health was below what it was supposed to be, yet there have been no consequences. We need to address not just the finances but the mechanisms around it and the impact on individuals.

The founding National Health Service Act 1946 rightly spoke of a comprehensive health service that secured the improvement of both physical and mental health, and subsequent Acts, quite rightly, have confirmed this. In operational terms, the Government require NHS England to work for parity of esteem for mental and physical health through this NHS mandate, but we know, and have heard again today, that this requirement falls down when we go to a local level.

One way or another, we will all be familiar with a whole range of stories of people who have not been able to access treatment in a timely manner or who find that they are pushed around a system with very little effect and discharged from care before it is appropriate, with consequences that are all too clear to see. It is difficult to overestimate just how challenging this is, not just for the individuals but for local commissioners, because they face competing pressures in trying to deal with this.

As has been emphasised, this group of amendments is about not just getting on the road to financial parity, important though that is, but changing the culture and the whole means of monitoring and implementation, so that disparities can be addressed—indeed, if possible, so that difficulties can be headed off at the pass. It is a well-worn phrase, but it sometimes seems that mental health is a Cinderella service—the one that can be cut first, to the benefit of the more visible services. Some of the recent statistics show that one in four mental health beds has been cut in the last decade, while just last year 37% of children referred by a professional to mental health services were turned away. That is a shocking statistic that we need to move away from.

I thank noble Lords for promoting these amendments and for their contributions illustrating what they mean and the reason we need them today. The noble Lords, Lord Stevens and Lord Patel, made timely points about the impact of the pandemic. If this is not a moment for focusing more on mental health, I do not know what is. The challenge we have and the difficulty presented by the pandemic is that while there is a focus on cutting waits for operations—and we know that is important—this could be a reason for mental health services to get somewhat lost, when in fact the pandemic reminds us of the importance of mental health and the need for the NHS to meet the needs that there now are.

The amendment by the noble Lord, Lord Stevens, encourages and directs the actions necessary for transparency on expenditure. I recall that they were referred to in the debate as legislative levers, and that is indeed what they can be. For me, they encourage not just accountability and transparency but actual action and change—the change we need to see.

The noble Baroness, Lady Hollins, referred to parity of esteem having to be applied locally, not just at a higher level. That is the only way we will see a difference in mental health services and improve the mental health of people in this country.

The noble Lord, Lord Crisp, made reference to the fact that legislation is trying to catch up with where we are as a society, and the noble Lord, Lord Warner, referring back to the meeting he attended, said that the public are well ahead of the game. I believe that is true. Indeed, as the noble Baroness, Lady Watkins, said, we have to prepare for tomorrow. It is not satisfactory that we stay stuck in today, or indeed in the past.

In my view, these amendments move us on. They bring mental health services into real parity with physical health services, but they also connect mental and physical together. I hope they will find favour from the Minister.

[Lord Kamall (Con)]

I begin by thanking all your Lordships for the wide-ranging debate. I want to say how much more I learn, listening to the contributions in each of these debates, before I stand up to speak. I thank all noble Lords for their contributions. As the noble Baroness, Lady Merron, says, this debate carries some weight for our understanding that social, mental and physical well-being are equally important. We should not seek to suggest that one takes precedence over another. I also thank the noble Lord, Lord Stevens, for kicking off this debate with his encouraging and not critical amendments; I take them in that spirit.

Following on from that, and before I go to some of the specific amendments, I will just reflect on some of the contributions made thus far. I first thank the noble Lord, Lord Howarth, for raising social prescribing. I know we have discussed this a number of times since I became the Minister, with particular contributions from the noble Baroness, Lady Greengross, on the importance of art and music in helping to unlock the mind and touch the soul.

As has been made clear, social prescribing is a key component of the NHS’s universal personalised care, and I know that, crucially, this can work well for those who are socially isolated or whose well-being is impacted by non-medical issues. The NHS has mechanisms to ensure that social prescribing is embedded across England: for example, the primary care network directed at enhanced services specification outlines that all PCNs must provide access to a social prescribing service.

I also thank the noble Lord, Lord Patel, for raising the importance of the mental health of children and for making sure that we do not forget, even within mental health, that many sections of our society can quite easily be forgotten.

I agree with the right reverend Prelate the Bishop of London: we have come a long way. I remember as a child in the 1970s going to visit my uncle who was a psychiatric nurse at Claybury Hospital and looking at the patients, with the innocence of a child, and thinking, “These people don’t look ill to me.” We have come far since then. I remember the Rampton hospital scandal in the late 1970s, where the patients were treated appallingly, almost not as humans, and with a lack of dignity. The fact that today we are discussing the parity of mental with physical health shows how far we have come as a society.

We also spoke about loneliness and isolation. The noble Baroness, Lady Watkins, and I have had conversations about loneliness and some of the civil society projects that, for example, bring together lonely older people with children from broken homes so that both can benefit and learn from each other. I remember a story that I have mentioned in the past: in one of the projects I visited, a rather old man said, “I lost my wife five years ago and I had almost given up on life. The fact that I am now working with children from broken families and am almost being a mentor to them gives me a purpose to live—a reason to get up in the morning. I have no longer given up on life.” There are so many of these civil society projects, and no matter how we legislate, sometimes those local projects get to the nub of the problem in their local communities.

I have to pay attention when not only two former NHS chief executive officers but the former Chief Nursing Officer speak in the debate. The noble Lord, Lord Crisp, talked about the focus on outcomes, not inputs and how it is important to make sure that we are not gaming the system, mentioning mental illness and mental health but not doing anything effective about it.

Autism was mentioned by the noble Lord, Lord Warner, a former Health Minister. We are fully committed to improving access to and provision of health and care services for autistic people and people with a learning disability. I know that we have had at least one debate on the treatment of patients with autism and sometimes the terrible conditions they experience. That just shows how important this is.

I am trying to say that in many ways that the Government are absolutely committed to supporting everyone’s mental health and well-being and to ensuring that the right support is in place for all who need it. I therefore welcome the amendments which look to ensure parity of esteem across physical and mental health. I assure noble Lords that we support the sentiments behind these amendments and take mental health seriously.

Indeed, one of the considerations in weighing up the many arguments for further measures in response to Covid—from those who were asking for lockdown, for example—is that we also had to recognise that there was a mental health impact to lockdown. As a Government, we had to look not only at the societal and economic impacts but the mental health impacts within health considerations.

On the amendments, I will first address those tabled by the noble Baroness, Lady Hollins—I add my voice to those of the many noble Lords who have paid tribute to her work over many years in promoting this issue and ensuring that we take it seriously. I also pay tribute to the noble Baroness, Lady Walmsley, for making sure that we are informed about this. These amendments would explicitly reference both mental and physical health and illness in certain provisions of the Bill. I understand that the intention is to ensure that due attention is given to both “mental and physical health” and “mental and physical illness”. Indeed, you cannot separate mental and physical illness, as the noble Baroness, Lady Jones, said. We have moved way beyond “Pull yourself together, man” or a stiff upper lip attitude. We see how mental health plays a role, for example, in terrorism, with those who are recruited to be terrorists, or in those with eating disorders, or the number of people in prison who suffer from mental health issues. It is important that we fully recognise that.

Care Workers: Professional Register

Lord Kamall Excerpts

Monday 10th January 2022 Lords Chamber

[Lord Young of Cookham]

To ask Her Majesty’s Government what plans they have to introduce a professional register for care workers.

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

We will invest at least £500 million in the social care workforce over the next three years. The major investment includes the introduction of a digital care workforce hub. This hub will help identify people working in social care and provide them with access to resources to help them in their careers. It will also include a skills passport to provide staff with a permanent record of their training and development over their career.

[Lord Young of Cookham (Con)]

My Lords, I am grateful for that reply. In his letter to us today on NHS resilience, the Secretary of State says:

“Social care is vital for our success in managing Covid-19, working as part of a single system with the NHS.”


We all agree that we need to integrate the NHS and social care and provide a high-quality, seamless service to users, but as long as those in the social care profession are seen as the undervalued poor relations of those in the health sector, such integration is going to be very difficult. Scotland, Wales and Northern Ireland have already introduced a registration scheme, offering professional skills and better working conditions for those in social care and making it a more attractive career profession. When will England do the same?

[Lord Kamall (Con)]

As my noble friend rightly points out, the devolved Administrations have registers in place in Scotland, Wales and Northern Ireland and they have taken a phased approach over the years to registers of staff working in a variety of roles across social care, because of the complexity of the sector. This is why our first priority is to embed a knowledge and skills framework to clearly understand the current layout of the workforce and the skills required in their roles and to look at potential pathways before we consider mandatory regulation.

[Lord Laming (CB)]

My Lords, I am sure the Minister will agree that if the pandemic has taught us anything, it has confirmed that those in need of social care are much more dependent now and much more vulnerable. They require very intensive personal care. That being so, is it not time that we recognised carers for what they are, because apart from their commitment, they display enormous skills, day in and day out, and people at the end of their life are dependent upon them?

[Lord Kamall (Con)]

I am sure all noble Lords will agree with those sentiments, and that is why we have published the White Paper on social care. We are investing an additional £5.4 billion over three years and we want to make sure it is a career that people feel valued in. We also have £3.6 billion to reform the social care charging system, to make sure that all local authorities can move towards paying care providers a fair rate for their care, and a further £1.7 billion to begin major improvements across the whole social care system in England.

[Lord Watts (Lab)]

My Lords, I suggest that the Minister introduces a national pay system that reflects the work that these people do and rewards them for their efforts. Unless he addresses the issue of pay, the rest will not make any difference.

[Lord Kamall (Con)]

As the noble Lord says, pay is one of the important issues when people consider what career to take, but also how much that career is valued. One of the reasons we are looking at this voluntary register, but also the skills passport, is to understand the current layout of the sector. There are a number of different qualifications at the moment and before we consider what should be mandatory and make sure that everybody is aligned in terms of qualifications, we want to understand the care force out there. Some 56% of those in the care sector, for example, do not have any qualifications and we want to make sure that we address that.

[Lord Forsyth of Drumlean (Con)]

My Lords, the Economic Affairs Committee report of some two years ago estimated that £8.6 billion was needed just to get back to where we were 10 years ago. This money, which the Government are promising, is not available now. The need is now and the Government themselves have said that they want to deal with the problem of beds that are blocked in the NHS. That can happen only if the care workers are there and encouraged to be so, and that is about training and pay. At the moment, really good, wonderful people get paid more for stacking shelves in Tesco than they get for carrying out this work. Will my noble friend persuade the Treasury that this money needs to be made available now?

[Lord Kamall (Con)]

My noble friend makes a very important point that we need to make sure that this is an attractive career and that people feel valued. One of the reasons we launched the Made with Care campaign in November, which is running over five months, is to attract more people to the sector. Some of the money we have made available is to make sure that the sector is more attractive to people who want to work in it and that people in local authorities push the care home owners to pay their staff more.

[Lord Scriven (LD)]

When providing care for some of the most vulnerable in our communities, staff such as art therapists and occupational therapists have to have mandatory registration to practise. What is so different for social care staff who provide professional care as part of a multi-disciplinary team to such vulnerable people?

[Lord Kamall (Con)]

Only last week we opened a consultation on whether or not to make registration mandatory and to move towards it. When I spoke to people in the department about why it is currently voluntary and not mandatory, they said it was because they did not want to inadvertently put people off registering. They were worried that some people might leave the sector if registration was mandatory now. The noble Lord can shake his head, but this is a very real concern. We want to make sure it is voluntary first and we are consulting on the steps towards mandatory registration.

[Baroness Wheeler (Lab)]

My Lords, the noble Lord’s Question is timely, with the Government’s consultation on future statutory regulation and the criteria that could form the basis of assessing whether regulation is appropriate. We all want to see care workers given the professional status that they deserve, but, as has been said, this needs a whole suite of key improvements on pay, training, career structure and development. Does the Minister agree that paying staff a wage that truly reflects the importance and value of their work is an essential first step and what action are the Government taking to ensure this?

[Lord Kamall (Con)]

As the noble Baroness will appreciate, many people who work in social care are employed by private care home owners and other bits of the sector. If she looks at the minimum wage, there has been an announcement of 6.6%, effective from 1 April, which means that workers will be paid more, but one of the bases of some of the additional funding that we have announced is to convince local authorities to put pressure on private care home owners and others to make sure that they pay staff more.

[Baroness Finlay of Llandaff (CB)]

Given that the Government have clearly expressed the view that social care must be adequately valued, which is to be welcomed, and the comments about pay scales, what is the Government’s attitude to those employers in the private sector who do not hand on pay at time-and-a-half on bank holidays and so on, to their front-line staff? These front-line staff feel exploited and do not receive any pay or reimbursement for travel time between clients, even though they may spend quite a lot of time on the road. They are paid only while they are actually in somebody’s home in the community.

[Lord Kamall (Con)]

Issues such as the way private care home owners treat their staff are all part of the consultation that we launched on 6 January. We are working across government and with the devolved Administrations to seek views on the proposed criteria on which the profession should be regulated, whether there are regulated professions that no longer require statutory regulation, and whether there are unregulated professions that should be brought into statutory regulation. The consultation will run for 12 weeks until 31 March, when we will look at the results before taking further action.

[Lord Hamilton of Epsom (Con)]

My Lords, was the Spectator right when it said that 25% of people over 65 were worth more than £1 million, and is it right that these people should have capped care costs of £86,000, which means that taxpayers on much lower incomes have to pitch in and support them?

[Lord Kamall (Con)]

As my noble friend will appreciate and probably anticipate, there will be debate on the Health and Care Bill for the next few weeks. I am sure that that is one of the issues that will come up.

[Lord Jones (Lab)]

My Lords, can the Minister tell us how many care workers there are at work on a given day? Does he agree that it would be a good idea to have a considered, perpetual publicity campaign persuading those in the care service of the importance of gaining qualifications?

[Lord Kamall (Con)]

To ensure that the profession is attractive, we want to focus not only on making sure that social care staff are paid a decent wage but that they are recognised. The idea behind the skills passport is, first, that we want to understand all the different qualifications that there are with regard to the social care sector; and, secondly, we want to make sure that they can transport that when they move from one employer to another. That is the important thing that we want to look at.

Hospital Beds and Social Care

Lord Kamall Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what estimate they have made of the number of people occupying hospital beds because (1) there are not enough places in care homes to accommodate them, or (2) there is insufficient domiciliary social care support.

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

Although the number of people continually changes, there are approximately 10,000 people in hospital who do not currently meet the criteria to reside and have not yet been discharged. To drive progress and to support local system arrangements, we have established a national discharge task force to monitor and address the causes of delayed discharges. We have also provided £462.5 million via local authorities over winter to support care providers to increase recruitment and existing care support.

[Lord Dubs (Lab)]

My Lords, I appreciate the Minister’s Answer, but is it not the case that this bed-blocking has been happening for a long time, and that health service hospitals are under enormous pressure because of it? Can he give us some idea of when anything will happen as a result of his proposals? Can he comment on another representation that I have had—that there are empty places in care homes not being used?

[Lord Kamall (Con)]

I begin by wishing the noble Lord and all your Lordships a happy new year. We have started the national discharge task force, with membership from local government, the NHS and national government, and we have looked at the different pathways. There are four pathways: one is direct discharge, one is interim discharge, and one is for those who need a bit more support. But then sometimes individual cases are quite different; sometimes a place is offered, but the family may not be happy, so we have to find other ways. One thing that the national discharge task force has been doing is to look for spaces, wherever they may be, across the health and social care system to see whether they would be suitable for interim—but we are looking at all sorts of solutions in partnership with local authorities.

[Lord Forsyth of Drumlean (Con)]

My Lords, while I welcome the very substantial additional resources given to the health service, will my noble friend revisit the decision to delay making money available for social care purposes? That money is needed now to finance the care workers and finance those places in care homes. Without it, we will continue to see bed-blocking, so it is a policy that is self-defeating.

[Lord Kamall (Con)]

My noble friend makes an important point. In the White Paper, People at the Heart of Care, we have set out our vision for adult social care and outlined our priorities. Throughout the pandemic, we made available nearly £2.9 billion in specific funding for adult social care—£1.75 billion for infection prevention and control, £523 million for testing and £583 million to support workforce capacity and recruitment, as well as all the other measures that I have previously referred to as part of the task force.

[Baroness Greengross (CB)]

What assessment have the Government made of NHS or other publicly owned land that is currently unused and could be converted into accommodation for people who are rehabilitating and no longer need to be in hospital but cannot be discharged into their own home? Does the Minister agree that rehabilitation accommodation, commonly used throughout Scandinavia and other parts of Europe, could ease the pressure on both the NHS and the social care providers?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this issue previously with me in private, and for looking into it. One issue that is very clear to us is that effective use of the NHS estates is a top priority for the Government. We have not yet considered the benefits of using vacant hospital land or unused buildings, but we are committed to utilising the estates to their maximum capacity. Rehabilitation is a critical element of the health and care system, and there are a number of areas that we are looking into, including some of the suggestions made by the noble Baroness—but also best practice from other parts of the world.

[Lord Ashton of Hyde (Con)]

My Lords, I think it is the turn of the Liberal Democrats. The noble Lord, Lord Jones of Cheltenham, wishes to speak virtually, so I think that this is a convenient moment to call him.

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

According to the Alzheimer’s Society, nearly two-thirds of all hospital admissions for people living with dementia are unnecessary and could be prevented with high-quality personalised social care. Does the Minister agree that providing such care will reduce pressure on our NHS? If so, can he outline the steps that the Government are taking to deliver high-quality personalised care to people with dementia?

[Lord Kamall (Con)]

The noble Lord raises an important point about dementia. We have had many debates and discussions in this Chamber about dementia and increasing awareness of the issue, right across educating the workforce in the health and social care sector, and in how we can address specific issues on dementia and healthy living. As part of the reforms under social care, there will be more training and more specific focus on issues including dementia, to ensure that all inhabitants of care homes or recipients of domiciliary care receive appropriate care.

[Baroness Wheeler (Lab)]

My Lords, with today’s reports of hundreds of care homes closing their doors to new admissions because of the rapid spread of omicron, adding to the huge pressure on hospitals, can the Minister explain in more detail why urgent priority funding is not being directed to the provision of step-down facilities to address the escalating crisis? We are told that we have new diagnostic units and resurrected Nightingale hospitals, but step-down facilities in local NHS and community settings, where patients medically fit for discharge can be monitored and properly assessed, have been shown to be working very successfully. Would not that provide the right care at the right time, as promised in last month’s social care White Paper?

[Lord Kamall (Con)]

We have been looking at different pathways out of hospitals, and one of the discharge pathways is step-down care. One issue that the task force has looked at is how we improve and increase accessibility to appropriate step-down care when a patient is unable to go straight to their home.

[Baroness Finlay of Llandaff (CB)]

I will follow on from the question from the Labour Front Bench. Who is taking responsibility for actively recruiting staff so that any step-down beds can be staffed and managed? We have a workforce problem; without actively recruiting back into the workforce people who have experience but currently have left, we will not bridge that gap in manpower and womanpower provision.

[Lord Kamall (Con)]

All noble Lords will appreciate the work and dedication of all our social care workers, especially in these challenging times and with the extra pressure that omicron has brought. Throughout the pandemic, we have provided different types of funding. In December 2021, we announced an extra £300 million to support local authorities working with care providers to recruit and retain staff throughout the winter. This funding is in addition to the £162.5 million announced in October 2021. We recognise the issue, and it is about working with local authorities and others to make sure that this money gets into the system and achieves what it is intended to do.

[Baroness Pitkeathley (Lab)]

My Lords, following on from the question from the noble Lord, Lord Jones of Cheltenham, does the Minister agree that it will be important for the discharge team to also look at the reasons for admission, since many people would not have been in hospital at all—they would never have been admitted—if there had been adequate domiciliary care services? Will the task force focus on those issues as well as the issues for not discharging?

[Lord Kamall (Con)]

The noble Baroness makes an important point. The task force, working with all the various partners, is looking at the different pathways. Most patients can be discharged from hospital to their own home, but a number are held back because they should be discharged from hospital to their own homes but with a new additional or restarted package, which may take time. Patients might be discharged to residential care within the independent and community sector, but one issue is that a number of our care homes are owned privately and are not necessarily as joined up in the system. Patients may also have been discharged to a care home, but sometimes the family may not appreciate or approve of the first venue given and may push back and ask for another one. There are a number of issues that we are looking at; it is very complicated, which I am sure all noble Lords understand. We are trying to really push and get to the bottom of this. Another thing is to make sure that there is education across health and social care staff so that they really understand the needs of particular patients.

[Lord Ashton of Hyde (Con)]

My Lords, the noble Baroness, Lady Masham, wishes to speak virtually, so I think this is a convenient point to call her.

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

My Lords, as president of the Spinal Injuries Association, I ask the Minister whether he realises that there are many people who are severely paralysed, some of whom need two or three carers each day living in their own homes. Is he aware that the skilled labour market of carers from Europe has dried up since Brexit, leaving many people in a state of fear and anxiety of being at risk? The Government can help. Will they?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. One thing that the Government announced before Christmas was on visas and encouraging more care workers to come to this country. Where she and I might disagree is that we are going to approach the best in the world, not just Europe—we want the best staff possible.

Public Health: Night-time Working

Lord Kamall Excerpts

Thursday 6th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle]

To ask Her Majesty’s Government what assessment they have made of the effects of increased night-time working on public health; and what steps they intend to take to mitigate the negative effects of such working arrangements.

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

Health and safety at work is covered by the Health and Safety at Work etc. Act 1974 and corresponding regulations. The Working Time Regulations also impose requirements on employers regarding the number of hours worked and scheduled. The Government commissioned a review of sleep and health in 2020-21. While this did not directly address the effects of increased night-time working on health, it covered the impact of shift work, including night-time work. The findings will be published in summer 2022.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for his Answer, but many people will be surprised to learn that one in nine British workers now works at night. The medical evidence is that this is bad for health, whatever ameliorating steps are taken, with higher levels of cancer, heart disease, diabetes, pre-term births and premature births, as well as the impact on family and social life. Are the Government really considering monitoring directly the impacts of that huge increase in night-time working? Are they considering ways to ameliorate it? Are they considering ways to reduce what is clearly an undesirable economic trend?

[Lord Kamall (Con)]

I start by thanking the noble Baroness for the article that she sent a link to, which addressed some of the issues around her Question. The sleep review is looking at all these issues. As she rightly says, there are some links between fatigue and certain ailments and diseases. On some of them, the academics are still challenging each other, but that is all part of the review.

[Lord Scriven (LD)]

My Lords, a wide body of research has revealed that a number of health conditions are related to night-shift working. In the Netherlands, breast cancer is now recognised as an industrial disease for female night-shift workers. What policies are the Government undertaking to deal with this body of research that points to health for night-shift workers being unequal?

[Lord Kamall (Con)]

The Government commissioned a review of sleep and health from the former Public Health England for 2020-21. That reported just before Christmas and is now being considered by Ministers and other officials. We are hoping that the Office for Health Improvement and Disparities will publish the findings in 2022. The review looked at a number of different things, including trends over time, optimal levels of sleep, links between mental and physical health, the economic impact and factors that hinder interventions to promote sleep. As the noble Lord rightly says, there is research out there about how workers can experience gastrointestinal disturbance and sleeping disorders and the possible association with breast cancer, cardiovascular disease and diabetes. All that will come out in the review, I hope.

[Baroness Lister of Burtersett (Lab)]

My Lords, does not the evidence about the poor conditions experienced by night workers underline the need for stronger employment rights for those in the so-called gig economy, in which many night workers work? When, therefore, will the Government finally publish their long-promised employment Bill?

[Lord Kamall (Con)]

The noble Baroness makes an important point. Indeed, the article the noble Baroness, Lady Bennett, sent me talked about the impact on delivery drivers of not being allowed to rest or take shelter in restaurants and takeaways—being sent away and not having access to bathrooms and other facilities. The Government are looking at getting the balance right on this, in terms of flexibility, because some people value zero-hours contracts as long as they are not exclusive and they can work around them. We are looking at the various categories of workers. Because this is employment, I have been trying to get more answers; I apologise that I do not have all of them, but I will write to the noble Baroness.

[Baroness Merron (Lab)]

My Lords, night working can place a strain on people’s health through increased incidents of depression, diabetes and cardiovascular disease. Can the Minister tell the House what work the Government are doing with unions and employers to reduce this link between night working and ill health, and what account they are taking of the TUC report which calls for greater attention to the pressure of night working on home life and relationships?

[Lord Kamall (Con)]

A number of noble Lords have made the very important point that there is clearly an impact on individuals of working at night, including fatigue, wider pressures and disruption to family life. The sleep review has looked at this and reported just before Christmas, after consulting a wide range of stakeholders. The Office for Health Improvement and Disparities will publish its report in the summer of 2022, I hope.

[Lord Grocott (Lab)]

My Lords, given that so few people work night shifts from choice—some do but most do not—is it not ironic that, very often, these night-time jobs are quite low paid? Is it not a strange commentary on our society that, all too often, the people working in the least popular and more difficult and challenging jobs are also the lowest paid?

[Lord Kamall (Con)]

One of the issues of technology is how it has changed the nature of work. We have seen over time how older jobs have disappeared and new types of jobs and industries and different working practices have appeared. It is really important to make sure that workers, wherever and whatever times they work, get the best facilities and conditions possible. Sometimes that is done directly by unions, which work with employers and companies, and other times it is done directly, but it is important. One of the things we are looking at in the review is how deprivation of sleep affects many people, especially those who work at night.

[Lord Hamilton of Epsom (Con)]

My Lords, I totally accept that night work may affect the health of many night workers, but the noble Baroness, Lady Bennett, said that it is bad for the economy. Surely if night work increases, this should increase productivity.

[Lord Kamall (Con)]

It depends on why people are working at night—it really ranges. For example, when I was a student, I did a night shift from 10 pm to 8 am to pack the shelves for the next day. Sometimes drivers decide to work at night; some Uber or Bolt drivers tell me that they prefer night-time working because the roads are clearer then. There are different reasons—as the noble Lord indicated, sometimes it is the only job available to some people. It is really important to make sure both that customers and others are getting the services they want and that workers are treated decently and with dignity.

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

Does the Minister agree that if the start time of this House on Tuesdays and Wednesdays were brought forward to 11 am, it would save some elderly people from late-night work?

--- Later in debate ---

[Lord Kamall (Con)]

This is why I was so looking forward to coming back here today. The noble Lord makes an incredibly important point about the effects of night-time working on noble Lords. It is really important that we push the Government to understand the impact it is having on our health.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, many of those who work at night are nurses, doctors and care workers because their jobs demand and require it. Their situation has been exacerbated during the Covid pandemic. Can the Minister indicate what work the Government are doing to look into ways of ameliorating and mitigating their situation, so that they can continue to carry out their work unhindered and unencumbered, as they are exposed daily and nightly to the ravages of Covid and other diseases?

[Lord Kamall (Con)]

I think all your Lordships would agree on the incredible dedication of our medical and health and social care staff, before and particularly during the pandemic. We have to remember that a lot of these conditions are governed by the Health and Safety Executive guidance on managing health and safety risks, which includes guidance on shift work and fatigue, to make sure employees are treated with as much dignity and respect as possible.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Wilf Ward Family Trust is a charity that looks after severely disabled adults in north Yorkshire. Following the court case last year over pay for sleep-in shifts, it has had great difficulty in filling these roles and reaching an accommodation with the staff. Could my noble friend look into this—perhaps I could have a word with him afterwards—to see if that situation has been resolved to the satisfaction of both the adults in care and those providing that care?

[Lord Kamall (Con)]

As my noble friend will appreciate, I cannot comment on the details of a specific case, but I would welcome a conversation with my noble friend. The general issue has to be that we make sure that patients are treated as well as possible but that staff and employers are treated with as much as dignity as they deserve.

[Lord Flight (Con)]

Approximately what proportion of total working is represented by night working?

[Lord Kamall (Con)]

There are various surveys and debates, and it depends on whether you work purely at night-time or sometimes your shift might involve working at night-time. One estimate is that, at the moment, as many as one in nine workers works at night, but it depends on where you draw that definition.

Health and Care Bill

Lord Kamall Excerpts

Wednesday 5th January 2022 Lords Chamber

Moved by

[Lord Kamall]

That the Bill be considered in Committee in the following order: Clause 1, Schedule 1, Clauses 2 and 3, Clauses 5 to 14, Schedule 2, Clauses 15 to 17, Schedule 3, Clauses 18 to 27, Schedule 4, Clause 28, Schedule 5, Clauses 29 to 40, Schedule 6, Clauses 41 to 43, Schedule 7, Clauses 44 to 61, Schedule 8, Clauses 62 and 63, Schedule 9, Clauses 64 to 68, Schedule 10, Clause 69, Schedule 11, Clauses 70 to 74, Schedule 12, Clauses 75 to 80, Clause 4, Clauses 88 to 94, Clauses 135 to 144, Schedule 17, Clauses 145 to 148, Clauses 81 to 87, Clause 95, Schedule 13, Clauses 96 to 109, Schedule 14, Clauses 110 to 120, Schedule 15, Clauses 121 to 134, Schedule 16, Clauses 149 to 154, Title.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Lord Kamall Excerpts

Wednesday 15th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 13 December be approved.

Relevant document: Instrument not yet reported by the Joint Committee on Statutory Instruments

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

My Lords, I beg to move that the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021 be approved and shall also be moving the Health Protection (Coronavirus, Wearing of Face Coverings) (England) (Amendment) Regulations 2021 and the Health Protection (Coronavirus, Restrictions) (Entry to Venues and Events) (England) Regulations 2021.

Despite our progress so far and our investment in treatments, the omicron variant has been designated a variant of concern and so we must act now, as quickly as possible, to slow its spread. The UK Health Security Agency predicts that omicron will become the dominant strain within one to two weeks across the whole country. In response, the UK’s four Chief Medical Officers have raised the Covid alert level to 4, its second-highest level.

Although we do not yet have a complete picture of omicron’s severity, it has become increasingly clear that omicron is growing much faster than the previous delta variant and is spreading rapidly all around the world, so its higher transmissibility means it still threatens to overwhelm the NHS. We are seeing increased transmission rates reflected currently in case rates, and the current doubling time for omicron cases is now between two and three days. We need to act now to help slow the spread of the variant and reduce the chances of the NHS coming under unsustainable pressure, while buying time to deliver more boosters.

On 8 December, the Government announced that it was now necessary to implement plan B measures in England in response to the risks of the omicron variant. This includes: extending regulations on face coverings to make them mandatory in most indoor public settings from 10 December; asking those who can work from home to do so from 13 December; and making vaccine or test certification mandatory for entry to certain venues and events from this morning.

Today, we are debating the regulations that bring about the legal requirements for face coverings and certification. These regulations are sunsetted or due to expire on 26 January 2022, but they will be reviewed by the Government in early January. We are also debating regulations that bring important changes to self-isolation requirements to enable fully vaccinated contacts to take part in daily contact testing.

From 10 December, face coverings have been mandatory in most indoor public spaces in England. However, they are not required in hospitality settings such as cafés, restaurants and pubs, or in nightclubs. Exemptions apply—including for children aged under 11 and for those unable to wear a face covering for health or disability reasons. Evidence from the UK Health Security Agency respiratory evidence panel suggests that all types of face covering are, to some extent, effective in reducing transmission.

From today, showing the NHS Covid pass is mandatory as a condition of entry to certain settings in England. This is not a vaccination passport, and people will have different ways to show that they are eligible. Negative test results provide some assurance that an individual is not infectious when the test is taken and for a short time afterwards.

There is evidence to suggest that vaccination reduces the likelihood of infection or transmission to a small degree with delta, which continues to circulate. Early evidence suggests that vaccine effectiveness against symptomatic infection after two doses is significantly lower against omicron than against delta. Nevertheless, a moderate to high vaccine effectiveness is seen in the early period after a booster dose. Vaccine effectiveness is also likely to be higher in preventing severe, rather than mild, disease, and it continues to be vital in response to the high levels of delta cases that continue to circulate.

Covid status can also be shown through proof of a negative test taken in the previous 48 hours, which demonstrates that you are less likely to be infectious, as well as proof of medical exemption or evidence of participation in a clinical trial.

Certification will apply in a limited number of settings, including venues acting like nightclubs; indoor events with 500 or more attendees likely to stand and move around; outdoor events with 4,000 or more attendees likely to stand and move around; and all events with more than 10,000 attendees. Vaccine or test certification will not eliminate the possibility of infectious people attending or transmitting the virus in these settings, but it will help to reduce the risks.

The test, trace and self-isolate system continues to be one of the key ways to control the virus and to protect our nation. Yesterday, the Government introduced a policy of daily testing for all fully vaccinated contacts of people who have tested positive for Covid-19. This will identify—or help to identify—the virus quickly and help to break chains of transmission without requiring large numbers of people to self-isolate. To support this, we have removed the requirement in the self-isolation regulations for all close contacts of suspected or confirmed omicron cases to self-isolate, regardless of their age or vaccination status. This was introduced as a temporary measure on 30 November. Unvaccinated adult contacts will continue to be legally required to self-isolate, unless they are participating in an approved workplace daily contact testing scheme. We will constantly monitor and review the data.

Lastly, let us all urge everyone who can have the vaccine to get boosted now. More than 24 million booster or third doses have already been administered across the UK. Our target is to offer this to every eligible adult in England by the end of December.

I thank everyone involved in the vaccination programme for their continued efforts to maintain this tremendous progress over the important weeks ahead. I understand that there are concerns among noble Lords across the House about these regulations. It is always a difficult balance and we hope we have got the balance right. I look forward to continued scrutiny by noble Lords and to their valuable contributions to this debate.

[Lord Robathan (Con)]

My Lords, I will start with a quote:

“It always suits Governments … to scarify the population.”


This was specifically about the ID cards Bill in 2005, when

“only a handful of principled Tories stuck up for liberty, and they were duly overwhelmed by the Government.”

The same person promised to “eat” his ID card if asked to show it to an official—so I expect that noble Lords will recognise the author of the quotes, who was then the Member of Parliament for Henley and editor of the Spectator.

Roosevelt famously said in his 1933 inaugural speech during the Depression—others had said it before—that

“the only thing we have to fear is fear itself”.

So what is going on? Why are the Government scarifying the population and stoking fear?

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, this has been a proper House of Lords debate and I thank the Minister for introducing the regulations with such clarity. I need to declare an interest as a non-executive director of an NHS hospital.

I would like to start my remarks by quoting my honourable friend Wes Streeting, the shadow Secretary of State for Health and Social Care, who said yesterday that

“it should not be for me, as shadow Secretary of State, to point out”

to some Conservative MPs, following remarks made in the media in recent days,

“that we are not living in the 1930s and that the Secretary of State and his team are not Nazis.”—[Official Report, Commons, 14/12/21; col 954.]

It is sad that my honourable friend felt that he needed to say that. Our history is peppered with examples of where we required citizens to act in a way that served both their own self-interest and the interests of others. That does not make us a totalitarian state. I believe that the public are less outraged by the fact that some obligations are being placed on them than by the antics of those who blatantly and arrogantly imagine that the obligations do not apply to them.

On these Benches we will be supporting the Government today, as we did yesterday, and we will vote with the Government if the noble Lord, Lord Robathan, chooses to test the opinion of the House on either of the fatal amendments before us. Actually, the noble Lord said that these Benches would go further than the Motions before us. That is not true—but what is certainly true is that we have tended to be two or three weeks ahead of the Government. We have said “We think you need to do this, that or the other”—and I can testify to this, having been here for nearly two years, saying this —and the Government have said “No, no, no”, and two or three weeks later that is exactly what happens.

We will act in the national interest, as we have done throughout the pandemic, putting public health before party politics, by supporting the Motions under consideration now. Our task today—as it has been throughout the pandemic—is to consider what is best for the health of our nation and how to discharge our responsibility to protect our NHS.

The noble Lord, Lord Fowler, absolutely nailed it when he said that we had to listen to the CMO, the CSO, the other scientists and the public health experts, and follow the course of action that they were recommending. This was echoed by the noble Baroness, Lady Hayman, who said that we should be listening to the advice we are given. My noble friend Lord Davies put these regulations into proportion in terms of what they are seeking to achieve. There is no doubt that sacrifices have impacted on lives, livelihoods and liberties; that is why noble Lords need to scrutinise and question how the Government are dealing with this issue, or indeed mishandling it. I say to the noble Lord, Lord Robathan, and other noble Lords that we would be having this debate today whether or not he had put down his amendments.

On Sunday the Prime Minister made a totally unnecessary broadcast which served to panic people and create worry and confusion. Presumably he was trying to re-establish leadership credibility for himself, which clearly did not work with his own Conservative Benches. The broadcast was irresponsible in its lack of preparedness and clarity. As well as displeasing Mr Speaker, as the Prime Minister tends to do, it held Parliament in contempt yet again.

The lack of clarity is clear, for example, as NHS England and the Prime Minister have made conflicting promises on the booster rollout, leaving plans to deal with the rapid spread of omicron mired in chaos and confusion. On Sunday evening, the Prime Minister said:

“Everyone eligible aged 18 and over in England will have the chance to get their booster before the New Year.”


However, the NHS has promised a different target, pledging to offer all adults the chance to book a booster rather than receive one. Pressed on the conflicting advice, NHS England said:

“The NHS vaccination programme will offer every adult the chance to book a COVID-19 booster vaccine by the end of the year”.


Perhaps the Minister could clarify for the House which it is. If the Prime Minister has promised 1 million vaccinations a day, how is that supposed to be achieved?

I think it was even worse for local government than for the NHS. A local council leader in London, with a London-wide strategic role, said that 72 hours’ notice would have been helpful. It is not the need to up the vax and testing capability but the lack of planning—hence no tests, no testing ability and vaccinations not available. There was not one mention of local government in the Statement we heard on Monday. Had the relevant Government departments talked to local government, and when did they do that? It begs the question: did the NHS even know about Sunday’s statement before it was made?

We cannot yet be sure about the severity of the omicron variant, but we can be certain, as many noble Lords have said, that it is spreading faster than any other variant. Even if a smaller proportion of omicron victims are hospitalised, the rapid advance of the virus through the population could see large numbers of people admitted to hospital during the months in which the NHS is already under the greatest pressure. The winter months present pressures on the NHS in any normal year, and we know that this is far from a normal year.

The NHS is contending with winter pressures, a serious backlog, the delta variant and now this variant. Many of the challenges are understandable, given the unprecedented challenge of the Covid-19 pandemic, but we have got to be honest and acknowledge that confronting them has been made much harder because the country went into the pandemic with waiting lists already at 4.5 million, 100,000 NHS staff vacancies and a shortage of 112,000 staff in social care. My noble friend Lord Rooker was quite correct on that. We support the NHS and care services in the task they have been set. Let me say from these Benches to every NHS worker, every GP, every pharmacist, every public health official in local government, every member of the Armed Forces and every volunteer stepping up to meet this enormous task that we are with them 100% and thank them again.

The measures put forward for consideration today are an attempt to slow the spread of the virus, while trying to protect Christmas so that people can enjoy the festive season. They are about limiting interactions in the workplace, wearing face coverings in settings where the virus finds it easiest to spread, testing before we attend large indoor gatherings, and getting behind the booster rollout to ensure that everyone who can be protected is protected.

The goal in the end must be to learn to live with the virus. That means effective vaccination, antiviral treatments and public health measures that have a minimal impact on our lives, jobs and businesses. No one enjoys wearing a mask, but it is nothing compared with the costs that more draconian restrictions have for our lives, livelihoods and liberties. Masks are simply a price worth paying for our freedom to go out and live our lives during this pandemic.

On the introduction of a Covid pass for large indoor gatherings, the Labour Party argued against vaccine passports without the option of showing a negative test. Further, we argued that such passes should not be required for access to essential services. On both counts, I am pleased to say that the Government listened and amended the proposals, so we will support this measure today. I regret that colleagues on the Liberal Democrat Benches do not feel able to do so, but let me be clear: we in the Labour Party support Covid passes because we support British businesses. We want to give people the confidence to go out and about—to go to venues and to the theatre—despite the presence of this virus.

With passes and lateral flow tests, venues can operate at 100% capacity. Look at Italy, France and Denmark—countries with strict Covid rules. All have seen their retail and recreation sectors fare far better than those in the UK. However, for the passes to work, people must be able to access tests readily and easily. We cannot continue in this situation where tests are out of stock, so I ask the Minister whether this has been resolved or when it will be.

For months, we have called for workers to be given the flexibility to work from home and we support the guidance to work from home where possible. However, how does the Minister explain the contradiction that many noble Lords have asked about, which is why, at the same time, the Government are allowing them to go to Christmas parties? By limiting the interactions people have at work and by lowering infections, we hope to preserve their ability to go ahead with social events anyway.

Noble Lords have talked about ventilation in schools. We know that young people have borne the brunt of this pandemic, and we owe it to them and their education to support them and staff to make sure our schools are properly ventilated. The Christmas holidays seem to us to be an ideal time to get young people vaccinated. When does the Minister expect to know about this matter and share it with the House?

I hope this is my last contribution on Covid this year. I therefore end by wishing all noble Lords a safe and happy Christmas.

[Lord Kamall (Con)]

I start by thanking noble Lords for their valuable contributions to this debate. They showed the very best of debate in this place, in the range of views covered—some political, some scientific and some challenging the Government on constitutional issues. This demonstrates the importance of these discussions and I welcome all contributions, whether or not I agree with them. That is the purpose of debate and discussion.

I remind some of my noble friends behind me and other noble Lords why we have acted now and gone to plan B. We want to slow the spread of the virus, after looking at the replication rate; we want to buy time for more people, especially the older and more vulnerable, to get their booster dose; and we want to give our experts crucial time to gather and understand the data about omicron.

Noble Lords, and indeed noble friends, look at the experience of South Africa. As the noble Lord, Lord Birt, and others have said, its experience is different. It has a younger population, with an average age of about 29, when our average age is in the mid to high 40s. Given our experience at the beginning of the Covid pandemic, when a disproportionate number of older people died, surely it is right that we collect data to make sure that the most vulnerable people are safe before we go forward.

I turn to some specific points raised by noble Lords. As I said, my noble friend Lord Robathan asked about the data from Africa, which we will continue to monitor. We will monitor whether it is different or milder here.

The noble Baroness, Lady Bennett, mentioned the risk of exponential growth and I thank her for making that point. We do not want to see waiting times and patient numbers starting to overwhelm hospitals. By the time we had waited for exact data, it might be too late. The noble Lord, Lord Davies, rightly spoke about the limited data available. I assure the House that we will continue to review the data as it comes in.

Health Protection (Coronavirus, Restrictions) (Entry to Venues and Events) (England) Regulations 2021

Lord Kamall Excerpts

Wednesday 15th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 13 December be approved.

Relevant documents: Instrument not yet reported by the Joint Committee on Statutory Instruments

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

My Lords, I beg to move.

Amendment to the Motion

Moved by