Personal Protective Equipment: Waste

Lord Kamall Excerpts

Tuesday 14th June 2022 Lords Chamber

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the expenditure on unusable and excess Personal Protective Equipment (PPE), and the reasons for the waste.

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

We have delivered over 19.8 billion items of PPE to keep front-line staff safe. Facing a dangerous virus, and against the background of no vaccine, as well as rising demand, market disruption and panic buying, we procured as much PPE as possible rather than too little. Only around 3% of PPE that the department purchased is unusable, and we are working with waste providers to dispose of unusable stock in the most environmentally friendly and energy-effective way.

[Baroness Merron (Lab)]

My Lords, £9 billion was wasted on PPE due to obscenely inflated prices, irregular payments to intermediaries and faulty kit which is now poised to go up in smoke, along with nearly one in four of the contracts in dispute around products which are not fit for purpose or where allegations of slavery have been made. We know that the Government were responding to an unfolding crisis, but how was this shameful episode allowed to go unchecked and why has the department been allowed to establish a track record for not following public spending rules?

[Lord Kamall (Con)]

We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.

[Baroness Meacher (CB)]

My Lords, I appreciate the very real time pressure at the beginning of the pandemic. However, a few days spent to ensure high-quality PPE through some form of competition would have saved lives. Will the Minister tell the House how many contracts were agreed through a personal contact, without any form of competition at all, in that first year?

[Lord Kamall (Con)]

The noble Baroness will recognise that I was not in post at the time, but I have been advised by officials in the department that they put feelers out to as many people as possible. Government officials, Members of the House of Lords and politicians from all parties were suggesting companies, and that was put through a process whereby the department made an assessment of whether it was able to award contracts.

[Lord Scriven (LD)]

My Lords, the National Audit Office found that the department is currently spending approximately £7 million a month on storing 3.9 billion PPE items that it does not now need. That is the equivalent of employing 2,400 extra nurses a year. Why are Ministers allowing this waste of taxpayers’ money to continue?

[Lord Kamall (Con)]

The noble Lord is absolutely right that we are paying storage costs, and over the last few months there has been a reduction in storage and the Government have been looking at more cost-effective ways. However, the overall strategy—and why we have two lead waste providers looking at the issue—is to ask how we can sell, donate, repurpose or recycle wherever we can. For equipment where complex chains of polymers cannot be broken down—chemists would understand this better—we are looking at how we can dispose of it in the most environmentally friendly way.

[Lord Winston (Lab)]

My Lords, does the Minister agree that it is not just a question of a knee-jerk response at the very last minute of a new pandemic? Various committees, including the Science and Technology Select Committee, had pointed out that a pandemic was almost inevitable and that exactly such preparations were needed some years before it actually occurred.

[Lord Kamall (Con)]

The noble Lord is absolutely right. If we think back to swine flu in 2009 and the pandemic preparedness for that, there were such suggestions at the time and in subsequent years—we should not blame the particular party that was in power at the time—and the Government were urged to buy more and more equipment. The fact is that, had we bought it, it would have been at lower prices, and the cumulative cost of storage over the years would not have been as much as we spent recently.

[The Lord Bishop of London]

My Lords, I recognise the considerable pressure that the Government, the NHS and Ministers were put under, but can the Minister tell us what is being done so that we can learn from this situation and not replicate it in the next pandemic?

[Lord Kamall (Con)]

The right reverend Prelate is absolutely right that we should learn lessons, and there are two things we can learn: one is the benefit of hindsight, and one is the fallacy of hindsight. The fallacy of hindsight is to say that, given the same pressures, I would have acted differently. We can never know whether that is true; that is counterfactual. If we look at the benefit of hindsight, one thing we can learn is that if we buy more than enough in the future, and it is the right thing to do so, we should buy equipment that is as environmentally friendly as possible so that if it needs to be disposed of it can be recycled into other items.

[Lord Young of Norwood Green (Lab)]

My Lords, does the Minister agree that the vast majority of hospitals are using single-use PPE garments which go straight to landfill after one use? There is available on the market a product with RFI tags, which enables it to be simply laundered for 70 different uses. Should we not be investigating that if we are serious about reducing carbon emissions?

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. I am not aware of the product to which he refers, but I should be grateful if he would write to me with more detail and I will pass it on to the department.

[Baroness Manzoor (Con)]

My Lords, it is important that lessons are learned from the PPE purchasing, but will my noble friend the Minister say what action the Government are taking to reduce people’s waiting times for surgery, diagnostic testing and clinical assessment, because that is the follow-on from the delays as a result of Covid-19?

[Lord Kamall (Con)]

My noble friend is absolutely right that there has been an elective backlog. In analysing the backlog across the system we have found that about 75% to 80% of those waiting are waiting not for surgery but for diagnosis. This is why we have rolled out community diagnosis centres and will continue to do so, not necessarily in NHS settings but also in sports grounds, shopping centres, et cetera. On top of that, about 75% to 80% of those who require surgery do not require an overnight stay. We are trying to work through the elective backlog as quickly and effectively as possible.

[Baroness Watkins of Tavistock (CB)]

My Lords, what investment is being made to ensure that we can make our own PPE in this country in future, because the chief problem was that we were competing in an international market in a crisis?

[Lord Kamall (Con)]

I am not aware of detailed proposals on that but I know that there are many British companies who sourced from abroad and others that tried to manufacture. If you look at the relative costs and skills in the value chain, you will find that for many of the entrepreneurs in this country it is not cost-effective to manufacture here.

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

Returning to the Question and putting it in some perspective, as my noble friend Lady Merron said, £9 billion has been wasted in this exercise. Is the Minister aware that that is half of the cost of Crossrail, the biggest and most complicated civil engineering project in the whole of Europe? Is this not a national scandal?

[Lord Kamall (Con)]

I think we should look at the context of this £9 billion or £12 billion figure. We must remember that, at the time, market prices were inflated. We could not have bought the equipment at the prices you can pay for it today. The Government at the time had to make an estimate. If they had bought too little equipment, they would rightly have been criticised. Given that you can never make absolutely accurate predictions, on balance it is better to procure more than less. I was speaking to a Democrat politician from United States the other day. He said, “I just made the decision to procure as much as possible, but I knew I would get the flak afterwards. Lives were more important.”

[Baroness Walmsley (LD)]

My Lords, at the beginning of the pandemic a great deal of PPE which was in store was already out of date and could not be used. Any homemaker knows that you look at the use-by date of the stuff in your fridge and try to use it before it goes out of date. Can the Minister say whether there is now a proper record-keeping system for the use-by dates of any PPE that is in store in anticipation of any future emergency need?

[Lord Kamall (Con)]

I think that the noble Baroness will recognise from when I was asked a previous Oral Question on this issue that where there was an official sell-by date, we had asked a couple of companies from which we had procured the equipment to look at whether that life could be extended. I am not sure of the details, so I commit to write to the noble Baroness.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, in answer to my noble friend Lord Winston, the Minister said that the storage costs would have been greater than the costs of buying the PPE at the time that we did. Can he substantiate this for the elucidation of the House in general and say what those costs would have been for storage relative to the costs that we paid in the end? Perhaps he can give us those figures. If he has not got the information readily available today, maybe he will give them within a week or so.

[Lord Kamall (Con)]

Had we bought the PPE when it was first suggested that we should be preparing, the initial purchase price would have been lower, probably about £2.4 billion, but there would have been additional costs such as storage, replenishment of expired stock, and disposal of items, because even then there would have been items which had gone beyond their shelf life. That would have pushed the total cost to £13.4 billion.

Health and Social Care Leadership Review

Lord Kamall Excerpts

Thursday 9th June 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we also thank all the staff in the NHS and social care sectors, and specific thanks go to General Sir Gordon Messenger and Dame Linda Pollard for this excellent report. We too support the recommendations in the report.

The Liberal Democrats believe our NHS is in desperate need of support. We need to remember that there are well over 100,000 NHS staff vacancies—and an equally worrying number in the social care sector—and we are concerned about the impact of these vacancies on patient safety.

With millions now waiting for treatment and waiting times increasing, it is more important than ever that the Government address the workforce crisis facing health and social care. We have just come this afternoon from debating two key issues in Grand Committee that the NHS faces: managing RSV and other respiratory infections, and managing neurological conditions.

The two sectors have serious staff shortages in clinical health and that is replicated right across the NHS. After a gruelling couple of years, many staff are considering leaving or retiring early. The Government need to get a grip on this workforce crisis and seriously start planning for the long term, giving the crisis the attention it deserves. I too echo the question from the noble Baroness, Lady Merron, about when the workforce planning draft will first be presented to Parliament. It is urgently needed.

This leadership report is blunt. It highlights the current absence of accepted standards and structures for the managerial cohort within the NHS and says that it has

“long been a profession that compares unfavourably to the clinical careers in the way it is trained, structured and perceived”.

And that is not just inside the NHS. Far too many people—even Ministers—slam managers as unseen, expensive bureaucrats. This report calls that out, as well as recognising that consistent standards and improvement are needed. That is welcome.

The recommendation for a new national entry-level induction for all who join health and social care, as well as national career programmes for managers right across the sector, is very welcome, but what plans do the Government have now for the interim? The crisis is with us—we see it every night on the television news—and the benefits of training and culture change will take some time to bear fruit.

The executive summary advocates a step change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff. It goes on to say that good practice is by no means rare but it is not consistent throughout the NHS, and it raises particular concerns about the experience of those with disabilities or race-protected characteristics. We agree with the report’s proposals that EDI should become a universal indicator of how the system is working.

The fourth recommendation in the report on the simplified standard appraisal system is also welcomed, alongside consistent management standards and consistent accredited training. The talent management recommendations are also excellent.

We welcome any measures that seek to improve the way the NHS works, such as the Government’s pledge to build more hospitals, but many of our senior NHS managers struggle with failing buildings that, rather like our Parliamentary Estate, need urgent repair or replacement—but until then they have to try to make them safe. My own local hospital, Watford General, is a case in point. With that in mind, will the Minister please tell us how he proposes to unblock the delays to meet his Government’s pledge of 40 new hospitals by 2030?

Yesterday, the Secretary of State likened the NHS to the now-defunct video store Blockbuster, saying that the country has a

“Blockbuster healthcare system in the age of Netflix”

and that things would change by 2030. To date, only six projects that predate the Prime Minister’s premiership have started construction, despite the Government’s 2019 election pledge that 40 would be built by 2030.

A core theme of the report is collaboration. It reports pockets of excellent practice but also pockets of stuck and poor practice. The report is clear that a real culture change is needed now. In some parts of the NHS there is still an “ignore if not invented here” approach that must be challenged and changed.

Leadership is indeed key to a well-functioning health service, but having enough staff to care for patients is critical to reducing waiting times and improving patient outcomes. Ministers seem keen only on tinkering with leadership programmes. They seem to be ignoring the huge number of vacancies in the NHS and recently refused to write workforce planning and projections into law. So what additional steps will they take to increase the number of doctors and GPs working in our health service in the next nine months? Workforce shortages across the health and social care sector are leading to long wait times and poor outcomes.

Our NHS leaders have done a sterling job steering the NHS through the pandemic and now they are trying to tackle record-breaking waiting times. Leadership is pivotal to the success of any organisation, and the example set by the head of the organisation plays a huge part in that success.

It is a shame that the report focuses only on the NHS and not on the department, because it is important that we remember that two areas over which the Secretary of State’s predecessor, Matt Hancock, had power were PPE and test and trace, both of which were extremely badly handled in leadership terms. Does the Minister agree that leadership starts with Ministers? In an exchange between the Secretary of State and General Sir Gordon Messenger published yesterday, the Secretary of State said, “Leadership is critical”.

Finally, the most welcome chapter of the report is the final one, chapter 4, on implementation. The authors set out a clear route map for making this happen through the establishment of the review implementation office. I note that, yesterday, the Secretary of State said that he accepted all the recommendations. From these Benches, we will hold him to account for the resources necessary for the review implementation office to deliver them.

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

My Lords, I thank the noble Baronesses for their questions and for their general welcome for the tone of the Messenger report. I also pay tribute, as did the noble Baronesses, to Sir Gordon Messenger and Dame Linda Pollard for their combination of leadership skills as well as clinical and medical knowledge. I pay tribute too to the number of people who were consulted across the system who fed into the report.

I shall try to address some of the questions that were asked. The Messenger report looked at both health and social care. It was interesting that reference was made to reports being published but nothing being acted on. I think we can be proud that, for the first time, we are now aiming, as is set in law following the passing of the Health and Care Act, for a properly integrated health and care system. We can now work to that properly across the system.

In December 2021, the Government published their strategy for the adult social care workforce in the People at the Heart of Care: Adult Social Care Reform White Paper. Our strategy aims to create a well-trained and developed workforce, a healthy and supported workforce, and a sustainable and recognised workforce. Work that has already started includes the review of the existing workforce and the voluntary register to look at the workforce landscape and the various qualifications. We also want to look at how we make sure that the workforce is professionalised and that people feel attracted to it as a career. The strategy is backed up by an historic investment of at least £500 million for new measures over three years—noble Lords will be aware of that.

Both noble Baronesses raised workforce planning. During the debates on the Health and Care Bill, I made it quite clear that where we disagreed with some of the amendments was on the frequency of the reports that was called for. Let me be quite clear about what we are doing in terms of workforce. First, we have the Health Education England strategic framework to support long-term planning. The department commissioned HEE to review and renew the long-term strategic framework for the health and regulated social care workforce—the right skills and the right values and behaviours to deliver world-leading services. The work is nearing its final stages and will be published before the Summer Recess.

Building on this, we have also commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. We will share the key conclusions of this work as soon as it is ready. Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at a minimum of every five years describing the NHS workforce planning and supply system. The report provided for in that section will increase the transparency and accountability of the workforce planning process. On top of this, rather than everything simply being top down—the person in Whitehall or Westminster telling local services what to do—there is also the bottom-up planning, at trust level and ICS level, looking at the right workforce and skills mixes required on the boards and in the services to deliver the right services to patients.

The noble Baroness referred to the North East Ambulance Service. This highlights why this report was so badly needed. My right honourable friend the Secretary of State for Health and Social Care said yesterday in the other place that he was very concerned by what he has heard about the ambulance service and that he is not satisfied with the review that has already been done. He said that we need a much broader and more powerful review; he will have more to say about this very shortly.

We welcome the report. We have rightly said, as both noble Baronesses have said, that we welcome all the recommendations. To ensure that these are delivered as quickly as possible and with the right impact, an implementation plan co-created across the whole health and social sector is required. This report will therefore be followed by a plan with clear timelines and deadlines for delivery.

I am grateful to both noble Baronesses for raising the issue of discrimination and lack of diversity. It is interesting that our public services post war were rescued by immigrants from Commonwealth countries—from Africa, Asia and the Caribbean—yet, amazingly, we do not see them at the top of these organisations. Why is that? Frankly, we must move away from this position of white people stopping black and Asian people from being promoted and fobbing them off as “diversity officers”. They do not want to be diversity officers. We are good enough to be leaders and we must ensure that this is instilled right through our health and social care system, not just at the bottom level but all the way up. That will be the test of true diversity and true openness to equality.

There has been some positive movement towards tackling discrimination. The NHS people plan established a set of robust and comprehensive initiatives thought to imbed equality, diversity and inclusion. The recruitment and promotion practices have been overhauled and there will be named equality champions, but we must ensure that this is not just fobbing off. We need to see more diversity right at the top of our health and care system.

If I have not answered the noble Baronesses, I will write to them.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Masham of Ilton, wishes to take part remotely, and this seems a convenient moment to call her.

--- Later in debate ---

[Baroness Masham of Ilton (CB)]

It is tragic that so many babies and mothers have died when they should have been safe in hospital. What happened to the standards of care which were required? Fresh young enthusiastic people joining the NHS and those in care should be safe from bullying, harassment and discrimination. If something goes wrong with patients’ treatment and care, should there not be a duty of candour, with openness and honesty? Surely this should be incorporated in leadership education. I hope that it will be.

[Lord Kamall (Con)]

The noble Baroness is absolutely right that there should be a duty of candour. Noble Lords will remember that during the Health and Care Bill debates there was the debate around the openness of HSIB process. Here we have a difficult balance. On one hand, if someone has acted inappropriately or caused damage, you would want them to be brought to justice but, on the other hand, we know that the NHS has a culture of cover-up when things go wrong. It is great that we praise the NHS when things go well but I have heard too many stories of when things go wrong and clinicians close ranks and cover up.

Sometimes, they gaslight. I was talking about this the other day to a young official in the department and she told me about her friend, a young Afro-Caribbean female, whose baby died during birth. When she complained, the papers suddenly, magically disappeared. How can that happen? We have to make sure that there is real justice, but we have to get the right balance. HSIB makes sure that there is a safe space so people can feel free to come forward, so that we learn from that. Sometimes there may not be justice for the individual, but we can make sure that we avoid a repeat of these incidents. The Ockenden report clearly showed the role that the culture of the organisation played. We must be careful: there should not always be a focus just on numbers; we do not want to train people within the wrong culture and do more damage. We have to tackle all these issues at the same time.

[Lord Lilley (Con)]

My Lords, I would congratulate the Secretary of State Sajid Javid on presenting this report if it called for fewer full-time equality, diversity and inclusion officers and devoting resources, intention and focus to patients. Sadly, on reading the report, it does not; quite the reverse. It is totally obsessed with EDI. EDI is mentioned three times as frequently as patients. There is no mention of waiting lists, whistleblowers, cover-ups or value for money, and only one reference to efficiency. There is nothing about the lessons of Staffordshire or the failures in the health service—nothing at all. It is about EDI only. Worst of all, it states that demonstrating a commitment to EDI is more important than just technical skills.

It is important that we eliminate discrimination from the health service, but when I am treated, it is the technical skills of the medical staff I am worried about, as it is when those whom I love are being treated. The report sets goals for increasing the representation of underrepresented groups, but no goals for improving outcomes for patients. Worst of all, it proposes using the everyday discrimination scale as an objective tool of management, yet it is entirely subjective and all the academic literature I have found suggests it is completely worthless. Will my noble friend commission another report that will deal with people’s real concerns about the NHS?

[Lord Kamall (Con)]

I thank my noble friend for the question. It is important that we recognise that not only do we have more doctors and nurses than ever before, but we need staff to be good leaders. That includes understanding diverse workforces and, as I said earlier, making sure that we have good leaders at the top. Why do we have a diverse workforce? In fact, that diversity is not represented right at the top, in the leadership. Sometimes, when you want to change an organisation—I am sorry, but I did an PhD in organisational change—there are a number of aspects and one of them is the culture and the leadership. Sometimes a new leadership comes in that can drive that change in the organisation. It is not just about structures but about making sure that we improve the standard of care we give to people. This issue came up in the report, because we have to have the right leadership and focus on patient care and on making sure that we have a proper integrated health and social care system for patients all the way through their lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the report, and particular work needs to be done in the area the Minister has just described. The NHS is very diverse, more than most public sector groupings. Therefore, if there is a problem there, it needs addressing and it should be given high priority.

First, the real issue that worries the public at the moment concerns the little statement sneaked out by the Secretary of State that he has now agreed to a 15-year work strategy being prepared. The public are worried about the great number of unfilled vacancies in the National Health Service. That number continues to rise, and we now have more than 100,000 vacancies. The public expect the Government to move in a number of ways to try to fill those vacancies, rather than simply waiting for a long-term strategy. Will the Minister tell the House what new ideas the Government have to fill the vacancies? I know that is not an easy question to answer.

Secondly, I suggest that the Government have conversations with the agencies, which supply staff to so many different places in the NHS at such high costs, to see whether some accommodation could not be reached with them. Thirdly, I have personally had experience recently of being treated in the private sector. I spent some time talking to the staff, many of whom were ex-NHS and said they would never return to it. I would like to know what work has been done by the Government in exploring the views held by those people who have left NHS service to establish why they have gone, and what they would need to see change in the NHS to encourage them to return to it.

[Lord Kamall (Con)]

I thank the noble Lord for that question. We should look at the context of the different environment and the challenges that our health service and health and social care system is facing compared to in earlier years. A number of different factors have come together. One is that we have an ageing population and people are living longer but not necessarily living longer well, and therefore, where before the focus was mainly on physical treatments, we are now far more aware of issues like dementia and the challenges presented by ageing populations. On top of that, we are simply aware of more conditions. I have just come out of a debate on neurological conditions, of which I was told that there are probably 600. When I was a child, that probably would have been dismissed—no one would have thought that there were such a number—so there is more awareness of the issues to be treated.

Mental health is now treated more seriously. It was never taken seriously before; it was always about “pull yourself together” or the stiff upper lip, but now we understand that people have mental health conditions. We need to make sure that we have a health and care system, including private and independent, that can meet those needs.

One of the challenges is that we need more doctors and nurses. The funny thing is that we actually have more NHS doctors and nurses than ever before, but we recognise that on top of that we still need more. Investing in the workforce is therefore a key priority.

There is the 15-year plan, as I have said. The NHS also has the people recovery task force to make sure that all NHS staff are not only kept safe but retained. There are a number of initiatives, which I am happy to write to the noble Lord about, about helping staff who feel burned out, as well as retention programmes.

On top of that, we have increased the number of medical school places. We have found that students are sometimes more likely to stay close to areas where they have studied, so new medical schools have opened in some of those places which have found it hard to recruit. We also have more new nurses coming through the system but, despite that, there is still demand for more. We are looking at various ways to improve retention but also attract new staff.

--- Later in debate ---

[Lord Young of Norwood Green (Lab)]

I have posed one question, and I will pose a couple more. I will move to further questions and my criticism of the report. First, I agree with a lot that the noble Lord, Lord Lilley, said. On diversity, we recently had a situation, on which I would welcome a comment from the Minister, where the NHS could not bring itself to define a woman in gynaecological circumstances—I find that somewhat unbelievable.

What are we doing about fixing the situation in A&Es where paramedics stand by trolleys for hours on end while people are dying of strokes outside? I have raised this question with the noble Lord a number of times. It can be fixed, but you have to be determined. If the noble Lord wants an example of best practice, I recommend that he look at Wolverhampton, where he will find an example. There is no mention of best practice in this report, which I find astonishing. I also note the importance of new technology being adopted in a coherent way. I look forward to the Minister’s answers to those questions.

[Lord Kamall (Con)]

I thank the noble Lord for his questions. I say up front that I am not a fan of Twitter, even though I am still on it. Frankly, I do not like social media and I try not to look at it too much—but I welcome that the noble Lord shared some of his concerns.

The noble Lord is absolutely right on bullying and harassment; they are not acceptable in any form and should not be tolerated—this is part of the NHS people plan. This goes to the heart of the review: it is about leadership and culture. We have to make sure that there is a culture where bullying and discrimination are not tolerated. Frankly, it is about not diversity officers but greater diversity, which are not always the same. As I said, we have a diverse workforce, but why do we not see more diversity in the upper echelons of our health service? It is important that bullying is tackled and that we have that culture—but this also comes from local leadership.

I am grateful to the noble Lord for the number of times that he has suggested thinking outside the box on A&E. We have looked at various pressures on it; sometimes people go to it because they cannot get a GP—how do we address that? Sometimes, people do not want to go to A&E and try other routes but end up there—so how do we make sure that those other routes are available? We are looking at how to triage better and how people can use 111 instead. There are a number of issues and, as the noble Lord rightly said, technology can play a role.

House adjourned at 5.59 pm.

NHS: Respiratory Syncytial Virus Infections

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Neurological Conditions

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Lord Dubs (Lab)]

The task force.

[Lord Kamall (Con)]

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

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

Committee adjourned at 4.56 pm.

GP Access

Lord Kamall Excerpts

Tuesday 7th June 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

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

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

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

[Lord Hunt of Kings Heath (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Patel (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Jolly (LD)]

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

[Lord Kamall (Con)]

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

[Baroness Blackwood of North Oxford (Con)]

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

[Lord Kamall (Con)]

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

[Baroness Wheeler (Lab)]

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

[Lord Kamall (Con)]

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

[The Lord Speaker (Lord McFall of Alcluith)]

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

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

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

[Lord Kamall (Con)]

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

[Lord Stirrup (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Altmann (Con)]

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

[Lord Kamall (Con)]

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

[Baroness Brinton (LD)]

My Lords—

--- Later in debate ---

[Baroness Brinton (LD)]

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

[Lord Kamall (Con)]

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

Children: Cancer

Lord Kamall Excerpts

Thursday 26th May 2022 Lords Chamber

[Lord Lancaster of Kimbolton]

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

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

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

[Lord Lancaster of Kimbolton (Con)]

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

[Lord Kamall (Con)]

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

[Lord Patel (CB)]

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

[Lord Kamall (Con)]

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

[Lord Watts (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Blackwood of North Oxford (Con)]

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

[Lord Kamall (Con)]

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

--- Later in debate ---

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

[Lord Stirrup (CB)]

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

[Lord Kamall (Con)]

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

[Lord Stirrup (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

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

[Lord Herbert of South Downs (Con)]

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

[Lord Kamall (Con)]

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

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

Lord Kamall Excerpts

Wednesday 25th May 2022 Lords Chamber

Moved by

[Lord Kamall]

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

Motion agreed.

Sugar Reduction Programme: Bread

Lord Kamall Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

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

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

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

[Lord Brooke of Alverthorpe (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Walmsley (LD)]

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

[Lord Kamall (Con)]

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

[Noble Lords]

Oh!

[Lord Kamall (Con)]

Delaying is different from backtracking.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

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

[Lord Mackenzie of Framwellgate (Non-Afl)]

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

[Lord Kamall (Con)]

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

[Baroness Boycott (CB)]

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

[Lord Kamall (Con)]

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

[Lord Suri (Con)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Hayman (CB)]

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

[Lord Kamall (Con)]

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

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

[Baroness Uddin (Non-Afl)]

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

[Lord Kamall (Con)]

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

NHS Dental Services

Lord Kamall Excerpts

Tuesday 24th May 2022 Lords Chamber

[Lord Young of Cookham]

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

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

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

[Lord Young of Cookham (Con)]

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

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

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

[Lord Kamall (Con)]

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

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

[Lord Harris of Haringey (Lab)]

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

--- Later in debate ---

[Lord Kamall (Con)]

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

[Baroness Barker (LD)]

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

[Lord Kamall (Con)]

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

[Baroness Bull (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Sikka (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Boycott (CB)]

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

[Lord Kamall (Con)]

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

[Lord Brooke of Alverthorpe (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Uddin (Non-Afl)]

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

[Lord Kamall (Con)]

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

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

Lord Kamall Excerpts

Monday 23rd May 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022.

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

My Lords, the Pharmacy (Preparation and Dispensing Errors—Hospitals and Other Pharmacy Services) Order 2022 was laid before Parliament on 28 April. This draft order extends to the United Kingdom. I note that the noble Lord, Lord Hunt, has submitted a Motion to Regret in relation to the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022. This will now be subject to a separate debate.

The draft order before your Lordships has been in development for a long time under the auspices of the Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board, whose members include representatives from across the pharmacy sector and professional and regulatory bodies. The draft order is welcomed by pharmacy professionals working in hospitals and relevant pharmacy services, and has the support of the four Chief Pharmaceutical Officers of the UK.

I apologise for the parliamentary time taken to progress this order. The Government had to make some difficult decisions to deprioritise non-urgent legislation following the general election in 2019, EU exit and the Covid-19 pandemic. We are now returning to more business-as-usual matters.

The purpose of the order is to extend the defences already available to pharmacy workers in community pharmacy premises made under the Pharmacy (Preparation and Dispensing Errors—Registered Pharmacies) Order 2018 to ensure that registered pharmacy professionals working in hospitals and other settings, such as prisons and care homes, have access to the same defences. This would provide them with access to the defences to the criminal offences set out in Sections 63 and 64 of the Medicines Act 1968, which concern the adulteration of medicinal products in Section 63 and the sale of any medicinal product which is not of the nature or quality demanded by the purchaser in Section 64. The order makes these defences available in defined circumstances and, importantly, incentivises the reporting of errors where pharmacy professionals make genuine dispensing errors, improving learning to prevent such errors occurring.

In summary, the order will support improved patient safety by encouraging a culture of candid and fulsome contributions from those involved when things go wrong. This is a culture we want to see right across the NHS. Within this culture, pharmacy professionals can increase their learning from dispensing errors and identify mitigating action to make recurrence less likely in the future. I therefore commend the draft order to the Committee.

[Baroness Walmsley (LD)]

My Lords, I have always thought that the purpose of highlighting errors in the health service should be to learn and to avoid repeats, rather than to lay blame. That is why I supported the HSSIB, which was made mandatory in the recent Health and Care Act 2022. For that reason, I also support this order, which can contribute to patient safety by extending the removal of the threat of criminal sanctions for inadvertent dispensing errors beyond current community pharmacies and into other places where medicines are legitimately dispensed. These will include hospitals, care homes, prisons and detention centres. Anything which deters people shining a light on errors is a bad thing and should be addressed; anything which enables learning from them is welcome. However, although the order is welcome, I ask the Minister whether there has been evidence that staff have been deterred from exposing or informing patients about a mistake that has been made.

It is vital that the duty of candour that applies to all health professionals is upheld. I welcome the news from the General Pharmaceutical Council that it plans to develop new learning resources to help pharmacists understand how to fulfil this duty and, crucially, why they should do so. Of course, the duty already appears in the Standards for Pharmacy Professionals. This is where actual offences come into the picture. It is right that pharmacists could still be prosecuted if they can be shown to have had deliberate disregard for patient safety, as such a person would not be acting in the course of his profession, so patient protection still applies.

Identifying such a situation would probably rely on whistleblowers, who need protection and confidence that they would not be penalised for revealing information. Will the Minister say who would be responsible for making this judgment? Would it be the General Pharmaceutical Council or a magistrate with professional advice?

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I welcome the Minister’s helpful introduction and his acknowledgment of the delay in bringing this statutory instrument before us. These Benches welcomed the initial preparation and dispensing errors instrument when it came before Parliament in 2017. That welcome was in line with that of a number of organisations, including the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. Today, we are very happy again to give that welcome to this statutory instrument, not least because it is entirely focused on patient safety and on improving safety for patients. It also brings parity across the pharmacy profession, something that has been much called for.

There were some 1 billion prescriptions dispensed last year. At this volume, it is, of course, impossible to avoid all errors, and it is certainly a credit to the pharmacy profession that they are statistically very few and far between. Most professional groups in the health service do not face criminal conviction and potential imprisonment for an inadvertent dispensing error, and therefore it would be quite wrong for pharmacists to be the only ones who do. It is therefore very welcome that this SI extends legal protections to pharmacists working in a range of locations, such as prisons, hospitals and care homes.

Those working in these settings are often under increased stress, and this has been exacerbated by the challenges of the pandemic. The Pharmaceutical Journal has found an approximate doubling of pharmacists reporting that they feel extremely stressed compared with recent years. In often very pressured circumstances, it is right that we, in the way we are discussing today, protect pharmacists—who are often people’s first point of contact with the healthcare system and too often victims of abuse—from unintended mistakes. Ensuring the right to legal defence against prosecution in cases relating to inadvertent error will undoubtedly remove some of the fear these clinicians feel when it comes to admitting errors. It will help to prevent and reduce patient harm through taking the wrong medication or dosage.

It will also assist in promoting a culture of transparency, as has been referred to already. That will help to inform future learning and improve protocols for the dispensing and preparation of medicines. I agree that this is very much a helpful step towards cultural change and towards a more positive and candid workforce, which, as we have already referred to, can only serve to make patients safer.

Of course, again, it is right that this SI extends only to inadvertent errors. Where they are wilfully negligent or intent on causing deliberate harm, those who are responsible will continue to face criminal prosecution. This is critically important and we certainly support that.

I move on to my outstanding questions on the SI. I am concerned that, of the 523,000 dispensing errors that occur each year, only 5% are reported. Does this not suggest that the 2017 legislation increasing protection for inadvertent errors has been largely unsuccessful in encouraging honesty? What more are the Government doing to increase that number? How will the Government further encourage individual pharmacists to feel safe to come forward if they have dispensed the wrong medication? I should like to understand further how the professionals affected by this legislation, especially those who are more isolated than those who have the benefit of a network of pharmacists easily accessible to them, are informed about these changes.

There is always so much more to do when it comes to patient safety, but this is a very welcome step forward. I look forward to the Minister bringing forward further improvements in due course.

[Lord Kamall (Con)]

I begin by thanking noble Lords for their questions. I shall try to answer as many as I can and, in the usual way, if I have missed any of them, I will go through Hansard and make sure I respond in more detail. The noble Baroness, Lady Walmsley, asked about deterrence. I have some statistics here. In 2021, a survey of community pharmacists found that 95% of pharmacists said that they report errors to improve practice and 80% to learn from mistakes. In response to her specific question about fear of prosecution as a reason not to report an error, it dropped from 40% in 2016 to 18% in 2021, largely attributed to the 2018 change in law. Therefore, we expect a similar drop in the fear of being prosecuted for the pharmacists covered by this order.

The noble Baroness also asked about the chief pharmacist. This is a statutory role that mirrors the statutory role of the superintendent pharmacist in registered retail pharmacies. This aims to strengthen the governance of pharmacy services by incentivising the creation of this role, if a hospital, prison or care home does not already have one, in order to benefit from these defences. However, to reflect the diverse arrangements in different health settings, organisations do not necessarily need a specific chief pharmacist role, but should ensure that the statutory functions of a chief pharmacist are included in the relevant individual’s job responsibilities if they want to benefit from the defences.

There was a specific question about where there is no chief pharmacist officer. I understand that, at the moment, existing pharmacists can have that duty extended to them, but I shall have to write to the noble Baroness with more detail. What is really important, as she acknowledged, is the duty of candour. We want to encourage an environment where people do not feel afraid to come forward in order to learn. Of course, there is always the right balance between those who have acted maliciously compared to those who have made a mistake. As the noble Baroness, Lady Merron, rightly said, when you are dispensing this number of prescriptions, statistically and probability-wise, there is probably bound to be some error.

To go back to the point about the chief pharmacist officer, given the flexibility, people do not need to adopt the statutory term of chief pharmacist as a job title; they can have the role of chief pharmacist assigned them. I just wanted to clarify that; if I have not been clear, I shall write to the noble Baroness.

I just want quickly to give a bit of a flavour of the errors to show how something might not necessarily be malicious but could be an error. A medicine intended for another patient could be dispensed to the wrong patient. The wrong medicine could be dispensed. An ingredient could have inadvertently been omitted or added when making up a medicine. A medicine could be dispensed at the wrong strength or in the wrong dosage form. These things happen, not intentionally but unintentionally, which is why we want to make sure that we learn from such mistakes.

Given that we have already introduced these offences for the majority of pharmacy professionals in the retail sector, it is right that we extend them to colleagues working in hospitals. By introducing this order, we are not only removing the fear factor for pharmacy professionals but helping to protect the patient under their care. We know from patients that it is important for them to know that, when an error is made, responsibility is taken and the service learns lessons. This legislation supports and incentivises that principle.

I am not clear whether I have answered every question, but I will check and write to the noble Baronesses as appropriate. I thank noble Lords for their interest and the positive debate today. I commend this draft order to the Committee.

Motion agreed.