North East Ambulance Service

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

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

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

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

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

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

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

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

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Shipley (LD)]

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

[Lord Kamall (Con)]

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

[Baroness Masham of Ilton (CB)]

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

[Lord Kamall (Con)]

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

[Lord Clark of Windermere (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Berkeley of Knighton (CB)]

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

[Lord Kamall (Con)]

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

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

[Lord Hunt of Kings Heath (Lab)]

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

[Lord Kamall (Con)]

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

[The Lord Bishop of Durham]

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

[Lord Kamall (Con)]

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

[Baroness Foster of Oxton (Con)]

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

[Lord Kamall (Con)]

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

National Institute for Health and Care Excellence

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

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

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

[Baroness Morgan of Drefelin (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Walmsley (LD)]

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

[Lord Kamall (Con)]

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

[Lord Hunt of Kings Heath (Lab)]

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

--- Later in debate ---

[Lord Kamall (Con)]

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

[Lord Lansley (Con)]

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

[Lord Kamall (Con)]

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

[Lord Turnberg (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Naseby (Con)]

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

[Lord Kamall (Con)]

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

[Baroness Wheeler (Lab)]

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

[Lord Kamall (Con)]

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

[Lord McColl of Dulwich (Con)]

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

[Lord Kamall (Con)]

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

[Lord Patel (CB)]

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

[Lord Kamall (Con)]

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

[The Lord Speaker (Lord McFall of Alcluith)]

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

Long Covid

Lord Kamall Excerpts

Monday 23rd May 2022 Lords Chamber

[The Earl of Clancarty]

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

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

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

[The Earl of Clancarty (CB)]

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

[Lord Kamall (Con)]

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

[Lord Wigley (PC)]

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

[Lord Kamall (Con)]

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

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

[Lord Winston (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Suri (Con)]

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

[Lord Kamall (Con)]

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

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

and which

“cannot be explained by an alternative diagnosis.”

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

[Baroness McIntosh of Hudnall (Lab)]

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

[Lord Kamall (Con)]

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

[The Lord Speaker (Lord McFall of Alcluith)]

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

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

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

[Lord Kamall (Con)]

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

[Lord Patel (CB)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

International Healthcare Outcomes

Lord Kamall Excerpts

Thursday 19th May 2022 Lords Chamber

[Baroness Merron (Lab)]

I shall start again. I beg to leave to ask the Question standing in my name on the Order Paper.

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

I assure the noble Baroness that I am only too happy to answer the Question standing in her name.

The Government value the use of robust international comparisons to help improve and reform health services, and work closely with the OECD in compiling such statistics. The Civitas report is based on data already known to the Department of Health and Social Care, which highlights both where the NHS is world-beating as well as where it needs to improve.

[Baroness Merron (Lab)]

My Lords, the recent Civitas report on international health outcomes does not make pretty reading, showing the UK to be the worst for stroke and heart attack survival. With the NHS and patients facing record waiting times and soaring turnover and vacancy rates in the workforce, and no corresponding social care proposals in the Queen’s Speech to alleviate pressure, will the Government finally commit to a proper workforce plan with projections of future need and a proper plan to meet those requirements?

[Lord Kamall (Con)]

I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.

I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.

[Baroness Andrews (Lab)]

My Lords, my noble friend asked a very specific question about workforce. We are 100,000 short of NHS staff. The last NHS workforce plan was 19 years ago in 2003 under a Labour Government. When will we have the next one?

[Lord Kamall (Con)]

As the noble Baroness will be aware, during the debates on the Health and Social Care Bill, we made quite clear the different approaches to the workforce strategy. Indeed, Health Education England has been asked to compile a strategy. The NHS has the people recovery task force, which involves health and well-being and is not only for retention. Also, in our recruitment, we are on track to meet our manifesto commitment of 50,000 nurses. We had over 30,000 more nurses by February 2022. We are looking at different areas, not only from the department but from the ground, bottom up.

[Lord Patel (CB)]

My Lords, does the Minister think that the government target of diagnosing 75% of all cancers at stage 1 and 2 by 2028 needs revising?

[Lord Kamall (Con)]

When one looks at these reports, one sees that one area where the UK clearly needs to improve is on cancer. One of the great issues of this is diagnosis. As many noble Lords will know, when we look at the waiting lists and the backlog, we see that 80% of those people are waiting for diagnosis. It is essential that we tackle that. For children, the one-year survival rate has risen in recent years. We will continue to focus more on diagnosis, including community diagnosis centres.

[Lord McColl of Dulwich (Con)]

My Lords, in discussing the various factors involved, does the Minister agree that one of the main ones is that 71% of the British people are overweight or obese? Obesity impairs the immune system and leaves patients vulnerable to all kinds of illnesses which put an enormous burden on the NHS. Does he agree that the answer is for people to buy fewer calories and put fewer calories into their mouths?

[Lord Kamall (Con)]

The Government are doing a lot on the anti-obesity strategy in conjunction with the Office for Health Improvement and Disparities. We have brought together a number of issues. We have existing actions to halve childhood obesity by 2030 with new interventions. We have invested large amounts in weight management services. However, it is not only about reducing the calories taken in but about burning off those calories and getting the right balance between activity and consumption.

[Lord Reid of Cardowan (Lab)]

My Lords, just over 20 years ago, the waiting list for operations in the National Health Service was around 1 million people. That figure was considered so horrific that there was a massive effort in finance, recruitment and restructuring which over four years reduced the waiting list to 400,000—still too high but significantly better. The waiting list is now 6.1 million people. It cannot be blamed on Covid, because even before Covid it was over 4 million. What are the Government going to do to take those people out of fear and out of pain?

On a lighter note, given the Minister’s previous concern about my spring booster jab, within three days of my birthday, I received an invite and had it two days ago, and it all went very well.

[Lord Kamall (Con)]

I appreciate the fact that the noble Lord has had his spring booster. I would love to take some credit for it, but that must go to our wonderful health and care staff and how they deal with these issues.

The noble Lord is absolutely right: the waiting list, however big, is too big. However, when we analyse the waiting list on the backlog, we see that 80% of people on it are waiting for diagnosis, not surgery. Of those waiting for surgery, 80% can be seen within a day and do not need to stay overnight. We understand the granularity of the waiting list and are taking targeted action to ensure that it is focused on needs.

[Lord Hamilton of Epsom (Con)]

Does my noble friend the Minister accept that, last year, the United Kingdom spent, as a percentage of GDP, a higher amount than any other country in the EU? Does he, therefore, also accept that all these internationally poor comparisons cannot be attributed to a lack of money?

[Lord Kamall (Con)]

My noble friend makes an important point. When you look at the Civitas report, there are a number of statistics where the UK does quite well, but they were not always highlighted. This comes back to the point that this is not only about money; it is about how you spend that money and ensure that you focus on outcomes. One thing we are looking at is better use of the money, for example by using new technology to identify the waiting list and prioritise based on need, as opposed to waiting time.

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, the Civitas report shows that UK deaths from haemorrhagic strokes have increased by over a third over the last nine years, compared to an average fall of 5% elsewhere, with a stark increase in deaths from 2017 onward. This coincides with the Government’s introduction of category 1 and category 2 calls for ambulance services, and the downgrade of suspected strokes to category 2. South Western Ambulance Service figures have shown that the current ambulance wait for category 2 is now one hour and 20 minutes. Will the Government now move strokes into category 1 as a matter of urgency?

[Lord Kamall (Con)]

When we looked at the statistics, which clearly included data from the OECD, some were repeated from the Civitas report, which ranked the UK as quite good in some places and as needing more work in others. In 2019, the UK was ranked as having the fifth highest mortality rate out of 21 countries. Given that, in a long-term plan published in January 2019, the Government outlined commitments to improving stroke services, including better stroke rehabilitation services. Because we have a better understanding of strokes, we also have new ways of tackling the issue.

[Lord Turnberg (Lab)]

My Lords, I think everyone agrees that primary care is in disarray. I met a young general practitioner, aged 51, who was about to retire because she could not stand the pressures being placed on her. It is not simply a matter of manpower or workforce planning; it is a matter of doing something urgent now. What are the Government’s plans?

[Lord Kamall (Con)]

I had a meeting only a few days ago with the person responsible for primary care—a doctor herself. One of the issues we discussed is how we make more effective use of different levels of primary care. What is interesting here is that primary care has, over time, taken on some of the services that used to be provided by secondary care. At the same time, some of those primary care services are now being contracted out or delegated out to, say, pharmacists or physiotherapists, et cetera. We are looking at a solution-focused way of tackling these issues, rather than focusing on who provides the care.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as part of a solution-focused diagnosis, NICE has recently made a recommendation to reduce the waiting list for breast cancer diagnosis by suggesting the use of magnetic diagnosis. What acceptance will the department give to this proposal from NICE?

[Lord Kamall (Con)]

I regularly read recommendations from NICE, as do the relevant policy officials. Yesterday, for example, I was asked to the review the NICE business plan for the next few years, so the department will review the NICE recommendations. However, if the noble Baroness will allow me, I will have to write to her on the exact details.

St George’s Hospital: Patient Deaths

Lord Kamall Excerpts

Wednesday 18th May 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 in so doing declare an interest as a member of the GMC.

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

NHS England and Improvement will review the coroner’s prevention of future death reports and respond within the agreed timescales. The coroner’s investigations are ongoing. The Government are committed to improving the standard of investigations into serious patient safety incidents in the NHS to create a culture of learning from mistakes and to improve patient safety.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. This is a serious issue. An independent review into cardiac surgery at St George’s Hospital found evidence of shortcomings and a number of avoidable deaths. This finding has been totally contradicted by the senior coroner for inner west London, who found the methodology used in the review completely flawed and said of a particular case that the coroner was dealing with that the doctor’s approach had been without reproach. Given the review that will now be undertaken, does the Minister accept that, if the coroner is right, the whole method used by the NHS for these reviews will come under question?

[Lord Kamall (Con)]

I understand the premise behind the assertion and the Question but, as I explained to the noble Lord yesterday, a number of issues are ongoing—the coroner’s inquest, an employment tribunal and a number of other reviews—which, sadly, I am not allowed to comment on. However, I can say at the moment that we are committed to improving the standard of patient safety investigations. We have set up the independent patient safety investigation service and HSSIB to look at this, as the noble Lord will know from the Bill, and we have a number of independent investigations guidance for standard operating procedures by NHS England and Improvement for teams to use.

[Baroness Finlay of Llandaff (CB)]

In the light of the criticisms levelled by the coroner over the structured judgment review in particular, will the Government undertake to require the royal colleges and the new bodies set up to look at the procedure used? Although it looked at case notes, it included neither full oversight of previous medical history nor direct observation of clinical procedures, surgical technique—including anaesthesia—and post-operative nursing, all of which have an impact on outcomes. We all know that clinical opinion varies; the point at which a procedure is judged as high risk versus futile varies from centre to centre and can vary within them from one surgeon to another.

[Lord Kamall (Con)]

The noble Baroness clearly draws on her own experience of this. First, we have to wait for all the coroners’ inquests to finish; I think 36 have been completed at the moment. There will then be reviews, to which there is a statutory guideline on when they have to be responded to. However, it is also important to recognise the differences between the coroners’ inquests and the work of the independent mortality review, which was not undertaken to determine the cause of death in individual cases or attribute blame to individual clinicians—it was looking at a number of procedures.

[Lord Suri (Con)]

My Lords, it is nice of the noble Lord, Lord Hunt, to put this Question to the House. It is a very serious matter that patient deaths at St George’s Hospital were unnecessary. Having digested the comments, we must take the appropriate steps so that such negligence is not repeated. Hospitals are meant to save the lives of patients, not end them. Human life is very important.

[Lord Kamall (Con)]

My noble friend makes very important points which I am sure many noble Lords will agree with. It is about understanding what went wrong in places and learning from that. NHS England and Improvement is committed to improving the standard of patient safety investigations. It set up a new patient safety investigations team; as many noble Lords will know, HSSIB and a number of other panels and investigations are also looking to learn. In addition, NHS England and Improvement will have to respond to the coroners’ reports.

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, the coroner noted that the NHSI investigation had not used expert investigators and in some cases used only desktop research, looking at case papers, failing to interview key staff witnesses and take a longer view. Given that HSIB uses independent specialist teams and provides a safe space for staff and whistleblowers to talk, is there not a case for asking HSIB now to do its own investigation into this?

[Lord Kamall (Con)]

The noble Baroness raises a very important question, and it was one of the questions I asked when I was being briefed on this. Unfortunately, when HSIB was established, it did not investigate to historical cases. The future HSSIB will also not be able to investigate such cases; it will undertake only cases that are brought to it in the future.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identifies that the NHS, and indeed all healthcare systems, must be committed to ensuring the best clinical outcomes and securing patient safety. Clinical failings are subjected currently to a number of different potential investigations, such as local employer investigation, professional regulatory investigation, systems regulator investigation, civil litigation and potential criminal prosecution and interrogation. How do Her Majesty’s Government ensure that these multiple routes for investigating a clinical failing are properly co-ordinated to ensure that immediate learnings from such failings are applied to drive system improvement?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord raises a very important point about the complexity of having a number of investigating bodies. When I was being briefed yesterday, I was surprised by the number of ongoing investigations. We acknowledge that there needs to be a consistent approach to establishing and running investigations and inquiries. We are currently looking to develop an effective and user-friendly guide to handling inquiries and involving DHSC policy procurement IT colleagues in the development of a framework. We are working also with the Cabinet Office to ensure consistency across government, so that whatever we do in health is consistent with other investigations.

[Lord Sentamu (CB)]

My Lords, the murder of Stephen Lawrence really caused a lot of trouble. The Met had a review and another review—and another review. The last person to do an apparently thorough review, Sir William Macpherson, turned up at the inquiry and said, “Your evidence is so awful we cannot listen to it any more.” Kent Constabulary carried out a review, but it did not uncover all the stuff that the Stephen Lawrence inquiry found. It was therefore suggested that there must be an independent police inquiry body so that the police are not marking their own homework. I wonder whether the same thing is happening here and whether this new independent review will uncover all that is required.

[Lord Kamall (Con)]

The noble and right reverend Lord raises a number of important points about consistency and the number of investigations. Their remits are often different, which can confuse the picture, and sometimes some of the investigating bodies are seen to extend beyond their remit, causing further confusion. In this case it is important to recognise the difference between the coroner’s inquest and the work of the independent mortality review. Coroners’ inquests are different, and an independent mortality review was not undertaken to determine the cause of death in individual cases or to attribute blame. It was all about processes, procedures and culture.

[Baroness Merron (Lab)]

My Lords, it is hard to imagine the trauma and pain that bereaved families have suffered, and the terrible impact on surgeons, the staff team and patients. It is concerning to read reports that junior doctors have been prevented from returning to work at the unit to keep them out of a toxic culture of inappropriate behaviour. Can the Minister tell your Lordships’ House what is being done to stamp out toxicity, not just in these tragic circumstances but in NHS workplaces more generally, and what assessment has been made of the problem?

[Lord Kamall (Con)]

Let me begin by agreeing with the noble Baroness on how important it is to recognise the impact that this has had on the bereaved families, and the uncertainty they have experienced. They thought it was going in one direction; clearly that was addressed by the coroner and now the coroner may apologise. When I was looking at this in more detail, I was sadly told not to discuss the culture because of ongoing investigations, but I commit to write to the noble Baroness, to make sure that I am not breaking any legal principles and that I give her a proper response rather than an inappropriate one now.

NHS Mental Health Patients in Private Hospitals

Lord Kamall Excerpts

Thursday 28th April 2022 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have, if any, to address the reported £2 billion per year the NHS is paying to private hospitals to take on its mental health patients as a result of bed shortages.

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

Non-NHS providers have always played a role in delivering NHS services for patients since the founding of the NHS. The CQC regulates both NHS and independent providers to deliver care to the highest quality. The Government and the NHS have an ambitious transformation programme to increase investment in community mental health services and to introduce new models of care so that more people are cared for in their communities, reducing reliance on inappropriate in-patient admissions.

[Baroness Thornton (Lab)]

I thank the Minister. I beg the indulgence of the House to record that this is my last outing as opposition health spokesperson—although I shall be taking up other Front-Bench duties so your Lordships have not escaped completely. I wish to record a huge thank you to colleagues across the House with whom I have worked over many years; my especial thanks to the small but perfectly-formed Labour health team, my noble friends Lady Wheeler and Lady Merron and indeed the Back-Benchers; and my thanks to the many Ministers whose well-being I may not always have enhanced over the years.

On this Question, the issue is not whether it is a good use of NHS funding to spend £2 billion a year on privately provided mental health beds. It is about whether, given the parity of esteem for mental health recently reinforced in the brand new Health and Care Act, the Government have a plan to invest in reversing the decline of mental health beds and increasing the number of NHS mental health beds available at community level, as the Minister mentioned, where they are needed, and over what period.

[Lord Kamall (Con)]

I begin, if noble Lords will allow me, by paying tribute to the noble Baroness for her doughty and robust opposition, but also for the advice when I was a new Minister suddenly thrown in at the deep end. It was very comforting to have one of the Opposition help me and give advice—I make no comments about the quality of the advice but I was incredibly grateful. I also pay tribute, to requote her words, to the perfectly formed shadow team. I thank them very much for all their holding us to account.

On the issue, when I was looking at the future of mental health, one thing we have to look at its granularity. There are different types of mental health; someone suffering from eating disorders, for example, will have a very different need from someone who is schizophrenic. It is really important that we do not just assume that everyone needs to be in a bed. Where appropriate, we should move people out to the community but make sure that they are supported there, not just kicked out the door and left to fend for themselves. We are looking at a massive programme of investment and at how we can have more targeted interventions for those suffering from different mental health issues.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as the recent chair of a major HEE review, recommending ways to improve and deliver the mental health nursing workforce, which was released on 20 April. Can the Minister really drill down on the extent to which the new ILATs will be accountable for both local provision of mental health in-patient beds—services are not enough and some people need admission and care in hospital—and the consideration of workforce needs, not only locally but for the services they purchase in the independent and not-for-profit sector?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how we ensure that those who require services in their community receive them, while ensuring that we have the appropriate workforce. She will know that throughout debate on the Health and Care Bill, we have discussed the fact that Health Education England, as well as NHS England, is developing workforce strategies—as are local trusts at their level, which know their needs and requirements at the same time. In terms of the specific question, I shall have to write to the noble Baroness.

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, I too congratulate the noble Baroness, Lady Thornton, on her outstanding contribution in her health Front-Bench role. From these Benches, it is always a pleasure to work with her and we look forward to continuing with her in her new role. Yesterday, the CQC served the Norfolk and Suffolk mental health trust with an improvement notice, reporting that staffing levels remain unsafe, waiting lists were long and, on average, 49 people per month died within six months of contact with that trust. There are staff shortages across NHS mental health services, so can the Minister say what the Government will do to ensure that there are enough qualified mental health professionals in the NHS?

[Lord Kamall (Con)]

I thank the noble Baroness for the question and for repeating the fact that you can find problems in the independent sector and in NHS providers. What is really important is that we are looking at the HEE workforce plan as well as the NHS workforce plan, while working with trusts at the local level and other providers of care to ensure that we have the most appropriate staff levels to meet local conditions.

[Lord Young of Cookham (Con)]

My Lords, if the £2 billion which the NHS is paying to the private sector is enabling vulnerable mental health patients to get high-quality care, is this not to be welcomed as it takes pressure off the NHS?

[Lord Kamall (Con)]

I should remind noble Lords that the noble Baroness said that she was not against private provision out of principle. Private provision can be very helpful and has always worked with the NHS, ever since it was founded. If we think about responders—for example, the impact of lockdown on many people—we have seen an increase in mental health needs. What do you do to increase the provision of mental health services? Do you wait for a new NHS hospital to be built? No—if there is a private provider out there, or an independent provider that can provide those services, you engage them. That is why the NHS and the independent sector, working together, is a really important partnership.

[Lord Turnberg (Lab)]

My Lords, is the noble Lord aware of the Migration Advisory Committee’s report, which pointed out what we all know: poor pay is driving social care workers, including mental health workers, out of the service and into the private sector? For example, they are losing more through inflation than they can keep up with and their pay certainly runs behind private sector pay. I understand that a social care worker can earn more in an Amazon distribution centre than they can in the social care sector. Can the Minister bring to the notice of the Treasury the damage that this policy is doing?

[Lord Kamall (Con)]

The noble Lord clearly discusses an important point: we have to have the appropriate workforce. The Government have begun a register of social care to work out who is in the workforce, what qualifications they have and what improvements we have to make to social care. We should also remember that social care providers are a mixture of private homes and state provision. At the same time, we have to make sure that we have the right people, locally trained. For example, the visa system encourages people to come and work in our social care system as well.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my declared interests. In view of recent press reports about a young patient who absconded from a private sector mental health unit and subsequently died, and the subsequent coroner’s inquest findings, is the Minister able to confirm that the Department of Health and Social Care will be able to provide guidance on the safety and security arrangements that should attend outside areas at mental health units and subsequently might be used as the basis for CQC inspection?

--- Later in debate ---

[Lord Kamall (Con)]

Can I begin by—if my information is correct—wishing the noble Lord a happy birthday? If it is not his birthday, I have made a fool of myself. I am sure all the House joins me.

Wherever there is a tragedy, we have to learn the lessons. We spoke about this during the Bill, for example with HSSIB and making sure we have a safe space to understand what went wrong and ensure it does not happen again. We have to make sure that, as we move towards different models of care for people suffering from mental health conditions, it is appropriate to their condition. Not all mental health conditions are the same. Some will need in-patient provision and others will need care in the community, but we should make sure they are actually supported in the community.

[Baroness Parminter (LD)]

My Lords, I declare an interest in that I have a daughter currently in a private eating disorder facility out-of-area, which the NHS is paying for—for which I am extremely grateful. Given the increasing numbers of people suffering from eating disorders, both children and young people and adults, what hope can the Minister give families like mine that in future their young people and family members will not be sent far away, when we want to see them? They might be in hospital for four, six or nine months at a time. What hope can the Minister give people that—yes, there are brilliant community services for eating disorders and we need more of them—we will open up more beds in local areas to help families and sufferers of these appalling diseases?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her very personal story. It is important that we understand it is more than stats and figures, which are provided to me by the department. In the community, we understand it is important to make sure that provision is as close to the patient and family as possible. We have to remember that care is not just for the patient; it impacts friends, family and others. We are looking at ways to ensure that care is delivered close to families and those suffering from these conditions.

Health and Care Bill

Lord Kamall Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 29B, to which the Commons have disagreed for their Reason 29C.

29C: Because there is already a clause in the Bill about reporting in relation to workforce and it is not necessary to impose further or different reporting duties on that topic.

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

My Lords, with the leave of the House, in moving Motion A, I will also speak to Motions B, C and D. The amendments being considered today relate to the NHS workforce, reconfigurations, modern slavery risks in NHS supply chains and the adult social care cap.

I turn first to Amendment 29D. The unamended Clause 35 places a duty on the Secretary of State to report on workforce systems. Our report will increase transparency and enhance accountability by describing the workforce planning and supply system for healthcare workers, including those working in the NHS and public health alongside regulated healthcare professions working in social care and public health in England. The existing clause therefore already delivers, by and large, what Amendment 29D seeks to do.

I can confirm that we will be asking Health Education England and NHS England to assist in the preparation of the report. In addition, while the report will be published at a minimum of every five years, it can be published more frequently than that, if required. I can also confirm that, in the preparation of the initial report, we will also seek the views of key stakeholders. The report is in addition to the rest of our expansive work to improve workforce supply and planning, including the Health Education England strategic framework, which will be published in the coming weeks, and the NHS England long-term workforce strategy.

Moving to reconfigurations, I am very grateful for the constructive debates on these issues across both Houses, and in this place particularly to the noble Lord, Lord Stevens, and my noble friend Lady Cumberlege for their insightful and wise feedback on this power. The first set of changes we have proposed would mean that the NHS had to notify the Secretary of State only about the reconfiguration proposals deemed notifiable, which we will define through regulations. But we intend to align that definition with the existing duty on NHS commissioners to consult local authorities in the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. Similarly, our amendment removes the requirement for commissioners and providers to inform Ministers of

“circumstances that are likely to result in the need for the reconfiguration of NHS services”.—[Official Report, Commons, 25/4/22; col. 522.]

Throughout the Bill’s passage, we have been clear that our intention is to use these powers only in respect of substantial reconfigurations. The vast majority of reconfigurations will be managed without any ministerial intervention. These amendments and our planned regulations reinforce that principle.

Under the Town and Country Planning Act 1990, the Secretary of State for Levelling Up, Housing and Communities has powers to call in any planning application. However, the stated policy for many years has been to be very selective about doing so, and Ministers will, in general, consider the use of call-in powers only if planning issues of more than local importance are involved. I should like to put formally on the record that our intention is that the same principle applies here.

On the Secretary of State’s call-in power, concerns have been raised about patient safety. I want to be clear that these powers should never, and will never, prevent providers making urgent temporary changes where there is a clear and acute risk to the safety of patients or staff.

Secondly, our amendments give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate, a right to make representations to the Secretary of State where he or she has called for a proposal for consideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of representations he or she receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged. In addition, we also want the CQC’s expertise to be taken into account where it is appropriate for relevant reconfigurations. We will therefore look to make clear, in guidance, where information provided by the CQC should be taken into account.

Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the public interest. We are therefore requiring the Secretary of State to provide the reasons for his or her decisions and directions when he or she makes them.

Finally, we have heard throughout these debates that reconfiguration decisions must be made quickly to improve the quality of services received by patients. Our amendment requires that, once he or she has called in a reconfiguration proposal, the Secretary of State must make any decisions within six months. We believe that this set of changes answers many of the key concerns raised in Parliament and I therefore urge noble Lords to consider supporting these amendments.

I now turn to Amendment 48C, particularly on the issue of modern slavery. We clearly share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked to slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong that creates a duty on the Secretary of State to undertake a thorough review of NHS supply chains. Today, I can announce that we will go further than this. The Government’s further amendment in lieu will require the Secretary of State to make regulations with a view to eradicating the use in the NHS in England of goods or services that are tainted by slavery or human trafficking. The regulations can set out steps that the NHS should be taking to assess the level of risk associated with individual suppliers; the basis on which the NHS should exclude them from a tendering process; and what measures should be included in contracts. I am particularly grateful to my noble friend Lord Blencathra and also the noble Lord, Lord Alton of Liverpool, for their campaigning—in fact, their persistence—on this issue, and I welcome their support for the amendment. I will also continue, with other Ministers, to work closely with others across government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.

We must now turn to the issue of the adult social care cap. The Government have announced their plan for a sustainable social care system. It is fair and affordable, and designed to end the pain of unpredictable care costs by capping the amount anyone would need to pay at £86,000. The elected House has once again voted overwhelmingly in favour of our proposals, which are financially privileged—and I would remind the House of its proper role in considering matters that are financially privileged. On the issue of substance, this House will be aware that Governments of all parties, for many years, have considered social care but not implemented reforms due to concerns about the affordability of introducing a cap. I have said previously that reports have gathered dust on shelves but never actually been implemented. Now we have a real opportunity to grasp the nettle. If there are issues or unintended consequences, these will likely be found by the trailblazers, and we can then tweak the system to address any shortcomings. I ask noble Lords to not allow this opportunity once again to slip away.

The existing system is simply not good enough, and our reforms are a vast improvement. Our reforms ensure that more people are eligible for support with the costs of their care; that the amount they spend each week is reduced; and that they can retain more of their savings. At the moment, people get support with the costs of their care only once they have depleted their assets to under £23,250. We are increasing this fourfold, so that people with up to £100,000 in savings, who are currently paying all the costs of their care, will now be eligible for funding support from the state. Under the current system, only once you have depleted your assets to £14,250 do you no longer need to contribute from your assets. We are increasing this to £20,000. Most crucially, at the moment there is no cap. Our reforms mean that people will have more certainty and more peace of mind, and will be able to plan ahead, whatever part of the country they are in.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]

is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

[Lord Kamall (Con)]

I thank all noble Lords who have spoken in this debate. I will turn to the issues as briefly and succinctly as I can.

On workforce planning, I hope I can assure noble Lords that we will engage with stakeholders on the preparation of the report, which will include the regulated workforce in health, social care and public health. I hope your Lordships also understand the work being undertaken by the Government, NHS England and Health Education England to improve workforce planning and to lead the improvements we all seek. This is why we think the amendment is unnecessary. I also remind noble Lords that at local level there is an incredible amount of local planning going on much closer to the ground.

--- Later in debate ---

Moved by

[Lord Kamall]

That this House do not insist on its Amendments 30B and 108B, to which the Commons have disagreed; and do agree with the Commons in their Amendments 30C to 30K in lieu.

30C: Page 197, line 27, after “a” insert “notifiable”

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 48B, to which the Commons have disagreed; and do agree with the Commons in their Amendment 48C in lieu.

48C: Page 64, line 38, at end insert the following new Clause—
“Eradicating slavery and human trafficking in supply chains
(1) The National Health Service Act 2006 is amended as follows.
(2) After section 12ZB insert—
“12ZC Eradicating slavery and human trafficking in supply chains
(1) The Secretary of State must by regulations make such provision as the Secretary of State thinks appropriate with a view to eradicating the use in the health service in England of goods or services that are tainted by slavery and human trafficking.
(2) The regulations may, in particular, include—
(a) provision in connection with the processes to be followed by public bodies in the procurement of goods or services for the purposes of the health service in England (including provision as to circumstances in which a supplier is excluded from consideration for the award of a contract);
(b) provision as to steps that must be taken by public bodies for assessing and addressing the risk of slavery and human trafficking taking place in relation to people involved in health service supply chains;
(c) provision as to matters for which provision must be made in contracts for goods or services entered into by public bodies for the purposes of the health service in England.
(3) In this section—
“health service supply chains” means supply chains for providing goods or services for the purposes of the health service in England;
“public body” means a body exercising functions of a public nature;
“slavery and human trafficking” has the meaning given by section 54(12) of the Modern Slavery Act 2015;
“tainted”: goods or services are “tainted” by slavery and human trafficking if slavery and human trafficking takes place in relation to anyone involved in the supply chain for providing those goods or services.”
(3) In section 272 (orders, regulations, rules and directions), in subsection (6), after paragraph (zze), insert—
“(zzf) regulations under section 12ZC,”.”

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Moved by

[Lord Kamall]

That this House do not insist on Lords Amendment 80 in respect of which the Commons have insisted on their disagreement; do not insist on its disagreement with the Commons in their Amendments 80A to 80N in lieu; and do not insist on its Amendments 80P and 80Q instead of the words so left out of the Bill to which the Commons have disagreed for their Reason 80R.

80R: Because the Lords amendments and the disagreements by the Lords to Commons amendments could affect financial arrangements to be made by the Commons, and the Commons do not offer any further reason, trusting that this Reason may be deemed sufficient.

[Lord Kamall (Con)]

I have already spoken to Motion D. I beg to move.

Motion D1 (as an amendment to Motion D)

Moved by

Folic Acid Fortification

Lord Kamall Excerpts

Wednesday 6th April 2022 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government when they intend to introduce draft legislation to replace the Bread and Flour Regulations, following their decision to implement folic acid fortification announced in September 2021.

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

I pay tribute to the noble Lord for his tireless advocacy of this important policy. Substantial progress has been made since September 2021, including working with the devolved Administrations to establish a cross-industry Bread and Flour Technical Working Group engaging stakeholders to move forward to the regulatory review. Proposed changes are being finalised and impacts assessed by a whole-UK working group for a consultation once the Northern Ireland Assembly elections have concluded.

[Lord Rooker (Lab)]

I thank the Minister. This is taking a long time. I have only one question for him. Given that it is now more than 30 years since the medical research councils connected up the difficulties of neural tube defects and that more than 80 countries have operated the policy, will he commit to using the best possible science? People have spent decades on this, and scientists tell me this can prevent up to 80% of neural tube defects. It has advanced since the original science 30 years ago.

[Lord Kamall (Con)]

The noble Lord is absolutely right: our scientific knowledge increases as scientists challenge each other and come to other conclusions. We have to be aware that there is no off-the-shelf solution. For example, I am sure the noble Lord will be aware that in Australia they can divide the flour and fortify only flour used to make bread. That cannot be done in this country, which is why we are working with stakeholders including heritage millers, for example, to make sure that we have the right solution. It has all been delayed due to a number of elections.

[Lord Patel (CB)]

My Lords, the United Kingdom has a high incidence of babies born with neural tube defects. What evidence have the Government collected as to the decrease in the incidence of neural tube defects in babies that would occur if an appropriate daily amount of folic acid was available in the nutrition of United Kingdom citizens?

[Lord Kamall (Con)]

I think the noble Lord will be aware that pregnant women are advised to take 400 micrograms of folic acid. That high level cannot be put into other foods because there are some unintended consequences. For example, it disguises some other traits and conditions in the older population. Therefore, one needs to get the right balance and proportion for the wider population.

[Lord Cunningham of Felling (Lab)]

My Lords, why did the Minister not say—or give some indication—as to when this working group will report, first to the Government and secondly to this House? It has had long enough since my noble friend succeeded in moving this policy change. When does the Minister expect the report, and when can we see some action?

[Lord Kamall (Con)]

I understand the complete frustration with the delays. When I asked the departmental officials about them, they said, “Funnily enough, usually we are people who support democracy, but democratic elections have got in the way.” Delays are due, for example, to the 2019 general election, the Scottish and Welsh parliamentary elections and the Northern Ireland elections.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

It is not fair to have a go at officials over this. Once the Northern Ireland Assembly election period is out of the way, they can get on with it.

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, I too commend the noble Lord, Lord Rooker, for his tireless campaign. The continuing consequences of Ministers not introducing the new legislation are that around 430 children in the UK will be born with spina bifida each year until folic acid is added to bread flour. What will the Minister—not his officials—say to the families of these babies to explain why this was just not urgent enough to put into legislation, despite the Government’s decision to do so and despite elections? Officials are not always side-tracked by elections. What will the Minister say given that those children will need continuing health support for life?

[Lord Kamall (Con)]

I think the noble Baroness is being a little unfair. It is quite clear that some of the delay has been due to elections, particularly when it has been necessary to consult across the devolved Administrations. Let there be no doubt. The Government are not against this; we are in favour of it. We are having to cover a number of issues—for example, the level of folic acid fortification to ensure that we add an appropriate amount without the side-effects that have been found in older people. We need to standardise the minimum levels of the existing four fortifications—calcium, iron, niacin and thiamine—and to consider exemptions from fortification for products that have minimal amounts of flour. Provisions have to be made for flour used to manufacture ingredients. We have to consider potential exemptions, for example, for micro-businesses and heritage millers. This consultation will start in earnest once the Northern Ireland elections are out of the way.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that the early MRC trial and all subsequent trials have shown that folic acid must be taken before a woman becomes pregnant? Giving supplementation once someone is pregnant is too late because of the formation of the neural tube. Now, with modern haematological techniques, the problem of pernicious anaemia and the confusion with B12 deficiency does not apply nearly as much, because it is easy to measure the levels.

[Lord Kamall (Con)]

In the brief which I received yesterday the recommendation is for a daily supplement of 400 micrograms of folic acid during the first 12 weeks of pregnancy. I am told that this advice will remain. Certain women with a higher risk of an NTD-affected pregnancy are advised to take a higher, 5-milligram supplement. This is why we have to get the right level. Increasing folic acid in flour alone will not solve the issue.

[Lord Dodds of Duncairn (DUP)]

My Lords, I commend the Government for reaching this position and for being the Government who have brought this matter to this stage. On a couple of occasions, the Minister mentioned the Northern Ireland elections. We know that there are some concerns about what might happen after those elections in terms of a Government being formed. This is a UK-wide matter. Can the Minister assure me that it will progress regardless of the state of devolution in Northern Ireland?

[Lord Kamall (Con)]

Call me old-fashioned, but I anticipated that there would be questions about further delays. When I asked the officials about this, I was advised that once the Northern Ireland elections were out of the way, they could get on with the consultation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to come back to the level of fortification. There are rumours that the Government are going for a minimal level which will not be very effective. My understanding is that the most up-to-date research shows that folic acid is not at all harmful. Therefore, will he assure me that the technical working group that he is going to take forward at some point will look to implement a level that is going to be effective?

[Lord Kamall (Con)]

I understand the noble Lord’s question but the expert Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has advised on the level of fortification needed to prevent neural tube defects. It wants a level that is not considered to pose a risk to health. The advice it has at the moment is that supplementation of folic acid can mask underlying vitamin B12 deficiencies, particularly in older adults. If noble Lords with medical experience disagree, I will be very happy to facilitate a meeting with my officials.

[Baroness Hayman (CB)]

My Lords, I think the House would be grateful for such a meeting. Perhaps the noble Lord, Lord Patel, could take part. It is extremely depressing to hear the Minister today go backwards in time to the arguments, which have all—one by one—been disproved, against this policy. It would be much more helpful to hear of a timetable going forward for implementing it. Does the Minister accept that it is a matter of embarrassment, shame and distress to many of us that, more than 30 years after UK research did this and with 80 other countries that should be able to help us in getting levels and procedures right, there are still families facing distress and the termination of wanted pregnancies because we have not made progress?

[Lord Kamall (Con)]

I understand the frustration that noble Lords have expressed. The same frustration is shared by officials in the department. When I asked officials, “What are the issues that you really need to get to the bottom of?”, one was the appropriate level of fortification. It is interesting that noble Lords seem to disagree with the department’s advice. Therefore, I will facilitate a conversation. Another issue is how that appears compared to other additions and fortifications put into flour. We want to get the right balance. The Government are committed to doing this and we will start as soon as the Northern Ireland elections are over.

[Baroness Merron (Lab)]

My Lords, all the research on adding folic acid to flour, including that by the Government’s independent Scientific Advisory Committee on Nutrition, shows that it is a completely safe measure with no unintended health consequences. In preparation for going down this route to protect newborn babies—which I really would urge the Minister to progress as soon as possible—what plans do the Government have to communicate the benefits of these measures and to reassure those who may have concerns, including parents, and parents-to-be?

[Lord Kamall (Con)]

This will all be part of the consultation, but once the policy has been decided on and fortification starts, clearly, we will be communicating to parents, families and others. If there is a risk—which noble Lords in their expertise seem to disagree with—we will have to identify that. The history of good intentions is littered with unintended consequences. We must be aware of those in our pursuit of increased folic acid in flour.

[Baroness Walmsley (LD)]

My Lords, over the past two years, the Government have made urgent decisions about Covid-19 to save lives and save sickness. Why can they not, in light of the strength of the evidence we already have, make a similarly urgent decision on this issue to save harm to 400 babies a year?

--- Later in debate ---

[Lord Kamall (Con)]

We all want to save harm to 400 babies a year; indeed, we want to save harm to more babies. The issue is that we have to do it in a proper way. When I speak to the officials, they are quite clear that we all want this to happen—there have been delays, which I have mentioned—but we have to get the right level of folic acid. Noble Lords in their wisdom are saying that all the evidence that the department has been presented with is worthless. If they believe that, they should talk to my officials. I will be happy to facilitate that.

NHS: Abuse of Nurses

Lord Kamall Excerpts

Tuesday 5th April 2022 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what steps they are taking to reduce the abuse of nurses in the NHS.

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

Abuse directed towards nurses is unacceptable, and we are determined to tackle this. NHS England has established a violence reduction programme to address deliberate violence and aggression towards NHS staff and to ensure that offenders are punished quickly and effectively. This includes implementing the NHS violence prevention and reduction standard, which requires employers to implement plans to tackle violence in the workplace. In addition, the Government are legislating to double the sentences of those who are violent towards NHS staff.

[Lord Clark of Windermere (Lab)]

I thank the noble Lord for his Answer. He is clearly aware of the problem, which is indeed growing. Nurses and other NHS staff are abused daily and many are being reduced to tears. As the retention of nurses is at a critical stage, with abuse being a key contributing factor, what specific plans have the Government to tackle this problem as a matter of urgency in trying to build up the key respect in which the general public used to hold NHS workers?

[Lord Kamall (Con)]

The noble Lord is absolutely right that we have identified the issue, and the NHS is working on a number of plans. All of us abhor any abuse of nurses or indeed any other NHS staff. The NHS has looked into this and has seen that many cases of violence against NHS staff are committed by individuals who are in a mental health crisis, or suffering from dementia or other neurological conditions, rather than the classic perception of attacks on staff by the public. The NHS has not only the violence prevention and reduction programme but a number of other initiatives to try to tackle this unwarranted issue.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register. I particularly want to raise the issue of nurses on shifts who are having difficulty parking both near the hospital for a reasonable cost—that cost was removed during Covid, which made life much easier for them—and in the community, where we have reports of them being abused for parking near patients’ homes. What strategy will the Government achieve to reduce this stress and the associated verbal violence?

--- Later in debate ---

[Lord Kamall (Con)]

The NHS is looking at a number of different ways of tackling violence towards staff, as well as supporting them in how to handle difficult situations and giving them well-being support. On the specific issue that the noble Baroness raises, it is probably better if I commit to writing to her.

[Lord Scriven (LD)]

My Lords, the individuals who abuse healthcare staff should understand and then pay for the harm they cause and be helped to change their behaviour. To augment existing arrangements, will the Government therefore look at implementing an NHS restorative justice scheme?

[Lord Kamall (Con)]

We are looking at the way in which abusers are treated. On 13 November 2018, the Assaults on Emergency Workers (Offences) Act 2018 came into force, and since 2020 we have also been working with the Ministry of Justice in consulting on doubling the sentence for such assaults to two years. The Government are now legislating for this through the Police, Crime, Sentencing and Courts Bill. In addition, a Joint Agreement on Offences Against Emergency Workers was agreed between NHS England and NHS Improvement and the Crown Prosecution Service in January 2020.

[Baroness Pitkeathley (Lab)]

My Lords, will the Minister outline how the training of nurses is being adjusted or extended to take account of this regrettable violence towards them? Does he agree that when we are thinking about training, we must include all nurses—not just those who work in hospitals but, most especially, those who work in communities and therefore go individually into people’s homes?

[Lord Kamall (Con)]

As well as various programmes such as the NHS violence prevention and reduction standard, against which trusts are measured and held accountable, there are a number of different local initiatives to see what works and what does not in different places. There are a number of innovative ones, and I will give one example, rather than take up too much time. The No Force First initiative at Mersey Care NHS Foundation Trust has resulted in a 46% reduction in physical assaults against staff. There are a number of other examples that I could lay out in detail.

[Lord Bird (CB)]

There are many opportunities to stop the violence. My nephew is involved in security in a major hospital, and he says the pressure they are under is enormous. They have to work very long hours to make the necessary money. We must look at those kinds of policing operations within our major hospitals.

[Lord Kamall (Con)]

The noble Lord is absolutely right: it is not a simple issue, and people abuse for lots of different reasons. We are looking at different ways to deal with this, including training staff to deal with violence from patients with dementia or mental illness. We are also looking at various security measures. Money is being made available for trusts and primary care to take security measures, including the installation of cameras and screens for receptionists.

[Lord Hamilton of Epsom (Con)]

My Lords, does my noble friend have any idea who the people are who are abusing nurses, how many of them are drunk and how many of them are mentally ill?

[Lord Kamall (Con)]

I thank my noble friend for his question. When the NHS started investigating and digging deeper into this issue, the assumption was that it was often just members of the public. It is finding that it is individuals who have had a mental health crisis or are suffering from dementia or another neurological condition, rather than the classic perception of members of staff being abused by the public.

[Baroness Merron (Lab)]

My Lords, yesterday’s Health and Social Care Committee report emphasised that earlier diagnosis and prompt cancer treatment will not be possible without a plan to address gaps in the cancer workforce, including the need for nearly 3,500 additional specialist cancer nurses by 2030. Does the Minister accept that a workforce plan is essential to improving cancer diagnosis, research and treatment, and how will the Government attract new staff and improve staff retention by improving day-to-day working conditions, which must include preventing abuse and giving support where it does occur?

[Lord Kamall (Con)]

I hope the noble Baroness will appreciate that I have laid out some of the initiatives that are taking place, and which are not only trying to prevent abuses against members of staff and nursing staff but supporting staff to de-escalate them. On well-being and getting more nurses, the Government are committed to continuing to grow the NHS workforce. We are still committed to the figure of 50,000 more nurses and to putting the NHS on a trajectory towards a sustainable long-term supply in the future. We are working on a number of well-being schemes to ensure that nurses are supported and feel safer and more willing to stay in service.

[Lord Laming (CB)]

My Lords, does the Minister agree that sometimes, nurses find themselves in this difficult situation because, as the most junior staff, they are required to give unwelcome messages about the limitations of resources? There are a lot of managers in the health service, but they put nurses forward to give that unwelcome message to patients and their relatives. Can the Minister see whether there are better ways to protect the most junior staff in the organisation?

[Lord Kamall (Con)]

I must admit that I was not aware of that, but I will take it back to the department to investigate and will write to the noble Lord. We have been looking at how to train staff not only to deal with abusers but to handle different situations and to de-escalate. There are also a number of staff health and well-being support programmes, including website session support lines, certain apps, well-being seminars and coaching seminars.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, abuse and violence is increasing towards not just nurses but others providing frontline services, such as shopworkers, teachers and police officers. The abusers are usually bullies and a minority in the community. I remember years ago as a rookie police officer being assaulted. The cavalry came to rescue me in the form of members of the public, led by a bus driver who turned out to be a special constable. This exemplifies the importance of voluntary public service. Does the Minister agree with this analysis, and what are the Government doing to encourage voluntary organisations such as the special constabulary to increase their numbers?

[Lord Kamall (Con)]

The noble Lord makes a very important point—it is not just about nurses but people right across the care sector, including doctors and receptionists, and public services. My father was a bus driver and he used to come home once or twice with a knife that he had taken off an attacker, having had to defend himself. This has been going on for years, and it is really important that we work in partnership with trade unions and others to ensure that we look after all our staff, particularly those in vital public services.

Health and Care Bill

Lord Kamall Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 11 and do agree with the Commons in their Amendment 11A in lieu.

11A: Page 138, line 35, at end insert—
“(4) If the constitution includes provision under this paragraph allowing committees or sub-committees to exercise commissioning functions, the constitution must—
(a) provide for the members of any such committee or subcommittee to be approved or appointed by the chair of the integrated care board, and
(b) prohibit the chair from approving or appointing someone as a member of any such committee or sub-committee (“the candidate”) if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.
(5) In sub-paragraph (4) “commissioning functions” means the functions of an integrated care board in arranging for the provision of services as part of the health service.”.

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

My Lords, I start with the amendments on ICB membership, children’s palliative care, hospital discharge and adult social care.

On integrated care boards, I hope noble Lords will recognise that the Government have listened to both this House and the other place. We have proposed some changes to the drafting of Amendment 105 in the name of the noble Lord, Lord Bradley, which I am aware that the noble Lord has seen. We hope that he recognises that our amendment in lieu meets the original intent of his amendment.

On Amendment 11, we hope that Amendment 11A in lieu, proposed in the other place, meets the expectations of your Lordships’ House. To avoid a number of unintended consequences or implications, we proposed an amendment in lieu that will ensure that those who pose a threat to the independence of the health service are excluded from the ICB and its committees. We have applied the same test to committees as we have to the main board, and the conflict of interest provisions and safeguards in the Bill also apply. We are grateful for the discussions on this question that we have had with noble Lords, including with the Front Bench opposite, and we hope that this amendment will be satisfactory.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I shall make a few brief comments about Motions A, E, G1, L1 and Q. On Motion A, we very much welcome the Government’s amendments in lieu, to make it clear that no commissioning organisation within the ICS can have a member appointed to it who could reasonably be regarded as undermining the independence of the health service because of their involvement in the private sector. The Government have listened to the concern expressed by the noble Lord, Lord Hunt of Kings Heath, whom I congratulate for spotting the loophole, and that is very good and welcome.

On the matter of carers and safe discharge in Motion E, we on these Benches were concerned that unpaid carers would not be sufficiently consulted and their own health and well-being might not be sufficiently taken into account. I am grateful to the Minister for spelling out, at my request, how the impact on carers will be assessed before a patient is discharged into her or his care. However, at the moment, when there is an outbreak of Covid-19 in a hospital ward, the carers are not allowed to visit the patient. Therefore, those conversations are not taking place. I should be very interested to know what the Minister will suggest about how those conversations can take place in that situation.

It is very important that appropriate action is taken to address the carer’s needs as well as those of the patient. Indeed, if those needs were not addressed, it would affect the ability of the carer to look after the patient, so both would suffer. I know this is a big responsibility for local authorities, which are strapped for cash, but it is vital that these needs are catered for, especially in light of the fact that those many thousands of unpaid carers save the public purse a massive amount of money, as well as looking after their loved ones with the loving care and attention that it would be very difficult for professionals, however dedicated, to give.

On Motions L and L1, I have listened carefully to the concerns of the noble Baroness, Lady Finlay, and she is quite justified. Governments have a habit of promising action but then moving on to something else, so we on these Benches, like the noble Baroness, will be looking out very carefully for the results of the review and the actions which we hope will follow.

We very much welcome Motion Q and congratulate the noble Lord, Lord Bradley, on achieving what he has. We particularly welcome the mention in the amendment in lieu of the word “prevention” of mental ill-health, as well as diagnosis and treatment.

Finally, as my noble friend Lady Brinton said, we support Motion G1 from the noble Baroness, Lady Wheeler. I want to add just two comments to those of my noble friend. We should support the amendment because the government savings will be paid by the poorest and most vulnerable, and 80% of those with dementia who have very long-term caring needs will be worse off under the Government’s proposals, and that is not right.

[Lord Kamall (Con)]

I thank all noble Lords who took part in this wide-ranging and interesting debate. Perhaps I can deal quickly with some of the issues. On mental health membership of the ICBs, I thank the noble Lord, Lord Bradley, for his persistence, but also for accepting the amendment that we produced in lieu.

On conflicts of interest, I thank all noble Lords for acknowledging the work that the Government have done, and I shall try to answer a couple of points. The noble Lord, Lord Hunt, asked about the chairs of the ICBs. They are appointed by NHS England, with the Secretary of State’s approval, which is the route by which the Department of Health and Social Care can ensure that the chair does not undermine the independence of the NHS. NHS England and the Secretary of State will want to appoint people who meet the highest standards and will not undermine the interests of the NHS. On the second question, ICBs will have to make arrangements to manage conflicts of interest to ensure that they do not affect, or appear to affect, the integrity of ICBs’ decision-making. This would implicitly include data sharing and access to information. I hope that that meets with the noble Lord’s approval and addresses his concerns.

On palliative care, I once again thank the noble Baroness, Lady Finlay, for all her work and for teaching me so much about the subject. Indeed, the officials in my department are very grateful for what they have learned about the whole palliative care process: the noble Baroness has definitely put it right on the agenda for consideration.

It is clear that the views of parents are very important, and it is essential that their voices are heard. That is why we expect the review to include evidence from both parents and clinicians who have been involved in disagreements in the care of critically ill children.

I also thank my noble friend Lord Balfe for the points that he made and I hope that we will have further conversations. I would be happy to put my noble friend in touch with officials in my department, so that they can benefit from his wisdom and many years’ experience of mediation.

There are already robust duties to involve parent carers in hospital discharge planning. Parent carers of a disabled child are covered by the right, under the Children and Families Act 2014, to request a carers assessment at any time. We will continue working closely with the Department for Education to ensure that, in guidance, we signpost to existing rights and protections for these individuals. The existing guidance stresses that discharge teams should ascertain whether the carer is willing and able to provide care and support post discharge, before an assessment of longer-term needs. No assumptions should be made about their willingness or ability—that includes all forms of ability—to care. This will be set out in the new statutory guidance. As the noble Baroness rightly knows, we will be working with Carers UK on the guidance.

I will finish on the adult social care cap. I understand the concerns that many noble Lords have expressed. In the current system, individuals with more than £23,500 face unlimited costs. The cap is not a target to work towards; it is a backstop to make sure that people are not liable for unlimited costs of care. There are a number of different issues and views on this, but we believe that our proposal is better than the current system. Although I understand the concerns of this House, I once again urge noble Lords to consider that the other place has considered this and rejected noble Lords’ amendments. The Government Benches will be opposing Motions G1 and G2.

I am also grateful to my noble friend Lord Lansley for the points he raised. We will look at all aspects of the trailblazer schemes; it would not be wise to limit what we look at. We want to get the best from that discovery and learning process, and perhaps spot with the trailblazing and piloting any unintended consequences. So we will look in a holistic way at how the trailblazer schemes are working before we roll them out nationally. We believe that that is wise and prudent.

I think that completes my points.

Motion A agreed.

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 29, to which the Commons have disagreed for their Reason 29A.

29A: Because there is already a clause in the Bill about reporting in relation to workforce and it is not necessary to impose further or different reporting duties on that topic.

[Lord Kamall (Con)]

My Lords, I have the notes just in time. I just hope I have impressed noble Lords with our lean operation—although sometimes the leaner the operation, the more brittle it is.

The amendments in this group all relate to questions of accountability. Amendment 29 addresses the question of workforce projections. I draw noble Lords’ attention to the sustained disagreement of the other place to this amendment. The Government are committed to improving workforce planning and we recognise the importance of having a properly trained workforce. Indeed, during my short time as Minister, noble Lords have asked a number of parliamentary Questions on workforce issues.

We are taking a number of steps to ensure that we have record numbers of staff working in the NHS and we are committed to continue to grow and invest in the workforce. This year, we have seen record numbers of staff in NHS trusts and CCGs, including doctors and nurses. The monthly workforce statistics for December show that there are more than 1.2 million full-time equivalents.

These workforce numbers come on the back of our record investment in the NHS, which is delivering on our manifesto commitment of 50,000 more nurses. We are on target with that, with nursing numbers a little over 27,000 higher in December 2021 than they were in September 2019. The spending review settlement will also underpin funding the training of some of the biggest undergraduate intakes of medical students and nurses ever. We recognise that doctors are liable to stay in the places they are trained, which is why we have opened up a number of new medical schools. That will take time to come through, but it is making sure that we are looking at the workforce in terms of longer timeframes.

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[Baroness Merron (Lab)]

My Lords, I sense a deepening of support in your Lordships’ House for the issues contained within this group. I start by thanking the noble Baroness, Lady Cumberlege, for introducing Motion B1. I also put on record my thanks to the 100 organisations which have indicated their support and got involved to make this an even better Motion for us to consider.

Yesterday’s Health and Social Care Committee report said:

“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce”


through a workforce plan. The lack of staff, both currently and projected, is not restricted to the cancer workforce but extends to the total staff shortage of some 110,000 across the NHS as well as 105,000 vacancies in social care, while some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest number on record.

As we have heard, just last week your Lordships’ House debated the Ockenden review, which I believe has provided great focus on the issue of workforce planning. The review shockingly laid bare the reasons why hundreds of babies’ lives were avoidably cut short or damaged and mothers died; to their great credit, the Government have accepted every one of the recommendations. The clear finding here is that we must safely staff our maternity wards, yet midwives are leaving the NHS in greater numbers than it is possible to recruit them. If the Ockenden review does not illustrate why we need a workforce plan then I do not know what does.

It is worth reflecting on what Motion B1 is not about, in case that offers some late reassurance to the Minister. Despite needing all of these things, it does not commit the Government to hiring thousands more doctors and nurses, nor does it commit to new funding for the NHS. It does not even commit the Government to finally publishing the workforce strategy that the NHS is crying out for—even though the NHS has not had a comprehensive workforce strategy since the Government’s plan was published in 2003.

What Motion B1 talks about is an independent review of how many doctors, nurses and other staff are needed in health, social care and public health, both now and for the future, and that the report, which must be brought before Parliament, must be informed by integrated care boards, employers, trade unions and others—people with expertise and a great contribution to make. This is not just a question of recruitment, important though that is, but one of retention. There is absolutely no way out of planning and preparation; without them, it is just not possible to magic up the necessary staff. Motion B1 is about facing up to the scale of the workforce challenge so that we can see safe and efficient health and care. These Benches will certainly be supporting Motion B1 if the will of the House is tested.

I turn now to Motion C1 in the name of my noble friend Lady Thornton. The inclusion of a clause about changes to reconfiguration shows that not all of the Bill was what the NHS was asking for. The powers in this clause are unnecessary and introduce a very considerable new layer of bureaucracy. Just about every commentator and representative group has said that this approach of an interventionist Secretary of State is quite wrong. As many have pointed out, the power that any proposal can be taken over by the Secretary of State takes us down a road of politicisation and will deter some from even trying to pursue necessary but controversial changes. It matters not that we are told that this power will be used only sparingly; if it is there, that will influence behaviour.

Given where we are in the parliamentary process, outright rejection of this provision would, of course, be problematic. Our alternative in this Motion is to say that, if the power is only rarely to be used—in exceptional circumstances, when intervention is justified—then the way to deal with this is to make that case to Parliament, to put it up for proper scrutiny and to show the evidence. If we are potentially to deprive people of their right to be consulted, then at least let Parliament do a proper job of examining this.

I now turn very briefly to Motions D1 and K. I thank the noble Lord, Lord Blencathra, for presenting Motion D1 today. It seeks to ensure that health service procurement of all goods and services avoids modern slavery; in other words, it takes us further than Motion D. I thank the Minister for the move forward contained within that Motion; however, if the noble Lord, Lord Blencathra, wishes to test the will of the House, we on these Benches will certainly be in support.

I congratulate my noble friend Lord Hunt and other noble Lords for their persistence in ensuring that Motion K is before us today. Again, I thank the Minister for being so responsive on this point. I hope that, in the votes that follow, your Lordships’ House will swiftly take the opportunity to ask that we might further improve this Bill.

[Lord Kamall (Con)]

I thank all noble Lords for their contributions and their constructive debate and engagement, not only this evening but throughout the process of the Bill. I thank noble Lords also for their agreement to the measures we have drawn up on organ tourism. I thank the noble Lord, Lord Hunt, for the way he pushed the Government, making sure that we were able to find a constructive way of closing that gap.

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Moved by

[Baroness Penn]

That this House do not insist on its Amendments 30 and 108, to which the Commons have disagreed for their Reasons 30A and 108A.

30A: Because it is appropriate for the Secretary of State to have greater powers to scrutinise and intervene in NHS reconfigurations given the Secretary of State’s accountability to Parliament in relation to these matters.

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Motion D

[Lord Kamall]

Moved by

That this House do not insist on its Amendment 48 and do agree with the Commons in their Amendment 48A in lieu.

48A: Page 49, line 3, at end insert the following new Clause—


“Review into NHS supply chains


(1) The Secretary of State must carry out a review into the risk of slavery and human trafficking taking place in relation to people involved in NHS supply chains.


(2) The Secretary of State may determine which NHS supply chains to consider as part of the review or otherwise limit the scope of the review.


(3) But the review must at least consider a significant proportion of NHS supply chains for cotton-based products in relation to which companies formed under section 223 of the National Health Service Act 2006 (taken as a whole) exercise functions.


(4) The Secretary of State must publish and lay before Parliament a report on the outcome of the review before the end of the period of 18 months beginning with the day on which this section comes into force.


(5) The report must describe—


(a) the scope of the review, and


(b) the methodology used in carrying out the review.


(6) The report must include any views of the Secretary of State as to steps that should be taken to mitigate the risk mentioned in subsection (1).


(7) NHS England must assist in the carrying out of the review or the preparation of the report under this section, if requested to do so by the Secretary of State.


(8) In this section—


“health service in England” means the health service continued under section 1(1) of the National Health Service Act 2006;


“NHS supply chain” means the supply chain for providing goods or services for the purposes of the health service in England;


“slavery and human trafficking” has the meaning given by section 54(12) of the Modern Slavery Act 2015.”


Motion D1 (as an amendment to Motion D)

[Lord Blencathra]

Moved by

At end insert “and do propose Amendment 48B in lieu—

48B: After Clause 40, insert the following new Clause—


“Health service procurement and supply chains: modern slavery


The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England avoids modern slavery.””

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 51 and do agree with the Commons in their Amendment 51A in lieu.

51A: Page 70, line 20, leave out “omit section 74 and” and insert—
“(a) for section 74 substitute—
“74 Discharge of hospital patients with care and support needs
(1) Where a relevant trust is responsible for an adult hospital patient and considers that the patient is likely to require care and support following discharge from hospital, the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve—
(a) the patient, and
(b) any carer of the patient.
(2) In performing the duty under subsection (1), a relevant trust must have regard to any guidance issued by NHS England.
(3) For the purposes of this section, a relevant trust is responsible for a hospital patient if the relevant trust manages the hospital.
(4) In this section—
“adult” means a person aged 18 or over;
“carer” means an individual who provides or intends to provide care for an adult, otherwise than by virtue of a contract or as voluntary work;
“relevant trust” means—
(a) an NHS trust established under section 25 of the National Health Service Act 2006, or
(b) an NHS foundation trust.”;
(b) omit”.

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 57, to which the Commons have disagreed for their Reason 57A.

57A: Because the Amendment would limit the power to transfer functions under the Bill.

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 80 and do agree with the Commons in their Amendments 80A to 80N in lieu.

80A: Page 116, line 41, leave out from beginning to end of line 9 on page 117 and insert—
“(a) in relation to eligible needs met by a local authority, to any amount the local authority charged the adult under section 14(1)(a) or 48(5) for meeting those needs;
(b) in relation to eligible needs met by a person other than a local authority, to what the cost of meeting those eligible needs would have been to the local authority that was the responsible local authority when the needs were met.”

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Moved by

[Lord Kamall]

That this House do not insist on its Amendments 85 to 88, to which the Commons have disagreed for their Reasons 85A to 88A.

85A: Because it is unnecessary to impose a legal duty to carry out a consultation in relation to the subject-matter of this Amendment.

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88A: Because it is consequential on Lords Amendment 86, and the Commons do not offer any further Reason, trusting that this Reason may be deemed sufficient.

[Lord Kamall (Con)]

My Lords, I beg to move Motion J and, with the leave of the House, I will speak to Motions M, N and P. This group of amendments relates to questions of patient safety, patient engagement, public health and building a learning culture in the NHS.

Last week in the other place we tabled amendments to ensure the full operability of Lords Amendment 91, in the name of the noble Baroness, Lady Hollins, on mandatory training on learning disabilities and autism. We have discussed and agreed these changes with the noble Baroness, and together these amendments will require all health and social care providers who carry out regulated activities to ensure their staff receive specific training on learning disabilities and autism.

At Report stage of this Bill the Government committed to accept in principle the amendment by the noble Lord, Lord Sharkey, on reciprocal healthcare and to change the process for regulations that give effect to international healthcare agreements so that they are subject to the affirmative resolution procedure. To ensure this Bill achieves the intended effect, the Government tabled Amendment 95A in lieu, which achieves the same objective but amends the international healthcare agreements clause, rather than the regulations clause. This will ensure that all regulations made under the soon to be named healthcare (international arrangements) Act 2019 are subject to the affirmative procedure, including any regulations made by the devolved Governments. I urge noble Lords to accept all these amendments.

I now turn to the issue of abortion at home pills. This group contains Lords Amendment 92 and related amendments. Both this House and the other place voted to make provision to permanently allow both pills for early medical abortions to be taken at home. These were, rightly, free votes of both Houses, but the Government brought forward this amendment in lieu to ensure that the legislation operates in the way that this House intended it to. I therefore ask noble Lords who agree with the intention of my noble friend Lady Sugg to instead support the Commons amendment in lieu.

I am also grateful to my noble friend Lady Eaton for bringing the important topic of safeguarding before the House. I reassure her that the well-being and safety of women and girls accessing abortion services has been, and will continue to be, our first and foremost priority. Safeguarding is an essential aspect of abortion care, and it has been long-established that a doctor or health professional is legally able to provide contraception, sexual and reproductive health advice, and treatment, including abortion, without parental knowledge or consent to a person aged under 16 years, provided that the doctor or healthcare professional is satisfied that certain conditions, including ability to consent, are met.

As a matter of best practice, every effort should be made to encourage those under age 16 to involve their parents, and if they cannot be persuaded to do so, they should be assisted to find another adult, such as another family member or specialist youth worker, to provide support. All abortion providers are already required to have effective arrangements in place to safeguard vulnerable children and to assure themselves, regulators and their commissioners that those are working. Having effective safeguarding arrangements in place will be essential for clinicians to make a robust assessment of whether a home abortion is suitable for anyone under age 16 and those under age 18.

I noted the statement from the Royal College of Paediatrics and Child Health, which stated that all young women aged under 18 and care leavers aged under 25 should be actively encouraged to attend an abortion service in person. With that in mind, we will work with the royal colleges, including the Royal College of Paediatrics and Child Health, and NHS safeguarding leads, to ensure that children and young people are actively encouraged to take up a face-to-face appointment and that anyone at risk of harm is identified and supported appropriately, including through referrals to other agencies.

The Government will continue to work closely with relevant professional bodies to ensure that the principles and duties of safeguarding children, young people and adults at risk are consistently and rigorously applied and that we continue to monitor all impacts of home use of both abortion pills. I hope that my noble friend will be reassured to hear that we will work with NHS England, the Care Quality Commission and abortion providers to ensure that they can safely offer telemedicine abortion services on a permanent basis and that all women are genuinely offered the choice of a face-to-face appointment.

On other issues, the Government cannot accept Amendment 88B, which has been put forward by the noble Lord, Lord Crisp, as an amendment in lieu of Lords Amendments 85 to 88, which were rejected by the other place. It would bind the Government in statute to consult, to a particular timeframe, on all recommendations within the Khan independent review which in the opinion of the Secretary of State require a consultation to implement. The review itself is not yet complete and is not scheduled for publication until May, when we will of course consider our next steps.

As the review is currently in the process of being drafted, the Government should not pre-empt what it will include. Importantly, the Government should not be put under a duty to consult on a range of proposals that they have not yet seen and may not support. Some proposals may require further development and agreement across government and across the UK before a consultation. We risk wasting government resource and time to consult, and stakeholders’ time to respond, by consulting on proposals that we may not intend to pursue.

The Government are firmly committed to Smokefree 2030 and we look forward to the outcome of the independent review. The review will inform both the health disparities White Paper and the Government’s new tobacco control plan, which will be published later this year. If any changes to tobacco legislation are proposed by the Government in that plan, I can commit that they will be consulted on. The need for additional spending to deliver our Smokefree 2030 ambition—and possible funding mechanisms—will be considered as part of the tobacco control plan and agreed with Her Majesty’s Treasury in the usual way.

I beg to move the Motion standing in my name and commend many of these amendments to the House.

Motion J1 (as an amendment to Motion J)

Moved by

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[Baroness Thornton (Lab)]

I shall be very brief, because it is time we draw this ping-pong session to an end. First, I congratulate the Minister on his introduction to the tele-abortion amendment, and on the reassurance that he gave to the House and the noble Baroness, Lady Eaton. The issue has been expressed very eloquently by the noble Baronesses, Lady Sugg and Lady Barker, and I have no intention of going into detail.

The only other matter before us right now on which we need to take a decision is that of the amendment put by the noble Lord, Lord Crisp. From these Benches, I need to say that we absolutely support the noble Lord in his amendment, and we will vote with him, if he divides the House.

[Lord Kamall (Con)]

I thank all noble Lords who have taken part in this debate and the debates throughout the day. We managed to stick to the point and tried to be as brief as possible. I am afraid I will not be as brief as the noble Baroness, Lady Thornton, but I will try to be briefer than I usually am.

I should just make some acknowledgements, looking at the whole group. First, on learning disabilities and autism, I thank the noble Baroness, Lady Hollins, in her absence, for her constructive engagement with the Government.

On tobacco, I once again urge noble Lords to reject Amendments 85 to 88 and 88B. The independent review is not scheduled for publication until May, when we will of course consider our next steps. I understand that the noble Lord told us to get on with it, but we do not want to pre-empt the independent review. As it is in the process of being drafted, we really want to make sure that we have proper consultation and agreement, both across government and across the UK with the devolved Administrations.

I hope the noble Lord is in no doubt that we are also committed to the tobacco plan and the reduction of smoking. We just do not feel that this is the right amendment, but the noble Lord may feel otherwise. Any changes to tobacco legislation proposed by the Khan review, a plan supported by the Government, will be consulted on. We firmly want to make sure we reach our smoke-free 2030 ambition or get as close to it as feasibly possible.

There is a debate about the polluter pays principle. I am sure the noble Lord, Lord Crisp, will recognise the debate about Pigouvian taxes, taxing negative externalities and who is responsible. Who is the polluter? In the car industry we tax the driver, as they put more petrol in. Should it be the smoker or the industry? There is a debate about this, but I hope these issues will be considered by the Khan review.

I also thank the noble Lord, Lord Sharkey, for his constructive engagement on reciprocal healthcare. I am pleased that we were able to narrow the gap and get to the same place.

I turn now to the telemedicine abortion issue. The Government felt that we should have gone back to pre-pandemic measures, but it was right that there was a free vote. We saw the results of the votes in your Lordships’ House and the other place, and we accept them. The democratic will of both Houses is quite clear. At the same time, we also accept that there were some concerns, as my noble friend Lady Eaton rightly said, about underage women being forced to have abortions and safeguarding. My noble friend Lady Verma also made a point about issues in certain communities; we know that these things go on in certain communities and that there are close relationships.

After the reassurances I gave at the beginning, my noble friend Lady Eaton said she was reassured enough not to push her amendment to a vote. I hope that remains the case and that my noble friend has not been persuaded otherwise. It is important that we consult, treat this sensitively and get the appropriate guidance, but the decision has been made by both Houses and we have to make sure that it works and that we address some of the legitimate concerns that noble Lords have raised in this debate.

Given that, I ask this House to accept the Motions in my name.

[Lord Crisp (CB)]

My Lords, let me first say how much I respect the Ministers and appreciate the time they have given to me and other noble Lords to discuss the “polluter pays” amendment. I really appreciate it and found it very useful. I think it was the noble Baroness—I cannot remember the name.

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 89 and do agree with the Commons in their Amendment 89A in lieu.

89A: Page 123, line 35, at end insert the following new Clause—
“Commercial dealings in organs for transplantation: extra-territorial offences
(1) After section 32 of the Human Tissue Act 2004 insert—
“32A Offences under section 32 committed outside UK
(1) If—
(a) a person who is habitually resident in England and Wales, or who is a UK national and not habitually resident in
Northern Ireland, does an act outside the United Kingdom,
(b) the act, if done in England and Wales, would constitute an offence under section 32(1), and
(c) the controlled material to which the act relates is controlled material consisting of or including a human organ,
the person is guilty in England and Wales of that offence.
(2) In this section “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.”
(2) After section 20 of the Human Tissue (Scotland) Act 2006 insert—
“20A Offences under section 20 committed outside UK
(1) If—
(a) a person who is habitually resident in Scotland, or who is a UK national and not habitually resident in Northern Ireland, does an act outside the United Kingdom, and
(b) the act, if done in Scotland, would constitute an offence under section 20(1), and
(c) the part of the human body to which the act relates consists of or includes a human organ,
the person is guilty in Scotland of that offence.
(2) In this section “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.
(3) Where a person outside the United Kingdom commits an offence under section 20(1) the person may be prosecuted, tried and punished for the offence—
(a) in a sheriff court district in which the person is apprehended or in custody, or
(b) in a sheriff court district determined by the Lord Advocate, as if the offence had been committed in that district.
(4) Where subsection (3) applies, the offence is, for all purposes incidental to or consequential on the trial and punishment, deemed to have been committed in that district.
(5) In this section “sheriff court district” is to be construed in accordance with section 307(1) of the Criminal Procedure (Scotland) Act 1995 (interpretation).”

[Lord Kamall (Con)]

I have already spoken to Motion K—more than once. I beg to move.

Motion K agreed.

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 90 and do agree with the Commons in their Amendment 90A in lieu.

90A: Page 127, line 39, at end insert the following new Clause—
“Review into disputes relating to treatment of critically ill children
(1) The Secretary of State must arrange for the carrying out of a review into the causes of disputes between (on the one hand) persons with parental responsibility for a critically ill child and (on the other) persons responsible for the provision of care or medical treatment for the child as part of the health service in England.
(2) The Secretary of State must publish and lay before Parliament a report on the outcome of the review, within one year beginning with the date on which this section comes into force.
(3) In this section—
“child” means a person aged under 18;
“health service in England” means the health service continued under section 1(1) of the National health Service Act 2006;
“parental responsibility” has the meaning given by section 3 of the Children Act 1989.”

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Moved by

[Lord Kamall]

That this House do agree with the Commons in their Amendment 91A as an amendment to Lords Amendment 91.

91A: Line 2, leave out subsections (1) to (6) and insert—
“(1) The Health and Social Care Act 2008 is amended in accordance with subsections (2) to (6).
(2) In section 20 (regulation of regulated activities), after subsection (5) insert—
“(5ZA) Regulations under this section must require service providers to ensure that each person working for the purpose of the regulated activities carried on by them receives training on learning disability and autism which is appropriate to the person’s role.”
(3) After subsection (5C) (as inserted by section 145) insert—
“(5D) In subsection (5ZA)—
“learning disability” has the meaning given by section 1(4) of the Mental Health Act 1983;
“service provider” means a person registered under this Chapter as a service provider in respect of a regulated activity.”
(4) After section 21 insert—
“21A Learning disability and autism training: code of practice
(1) The Secretary of State must issue a code of practice about compliance with requirements imposed by virtue of section 20(5ZA) (requirements relating to training on learning disability and autism).
(2) The code must make provision about—
(a) the content of training; (b) training appropriate to different roles;
(c) circumstances in which it is appropriate for training to be delivered in person;
(d) the involvement of people with learning disability, autistic people, or their carers, in the provision of training;
(e) accreditation of training;
(f) procurement of training;
(g) monitoring and evaluation of the impact of training;
(3) The code may make different provision for different cases or circumstances.
(4) The Secretary of State must, at least once every five years—
(a) review the code, and
(b) lay before Parliament a report setting out the findings of the review.”
(5) In section 22 (consultation in relation to code of practice under section 21)—
(a) for the heading substitute “Codes of practice: consultation and Parliamentary scrutiny”;
(b) in subsection (1), after “21” insert “or 21A”;
(c) in subsection (2), after “21” insert “or 21A”;
(d) in subsection (3), after “(2)” insert “in relation to a draft of a code or revised code under section 21”; (e) after subsection (5) insert—
“(5A) Where, following consultation under subsection (1) or (2) in relation to a draft of a code or revised code under section 21A, the Secretary of State decides to proceed with the draft (in its original form or with modifications), the Secretary of State must lay a copy of the draft before Parliament.
(5B) The Secretary of State may not issue the code or revised code if, within the 40-day period, either House of Parliament resolves not to approve it.
(5C) In this section “40-day period” means—
(a) the period of 40 days beginning with the day on which the draft is laid before Parliament, or
(b) if the draft is not laid before each House on the same day, the period of 40 days beginning with the later of the days on which it is laid before Parliament.
(5D) For the purposes of subsection (5C), no account is to be taken of any whole days that fall within a period during which—
(a) Parliament is dissolved or prorogued, or
(b) either House of Parliament is adjourned for more than four days.”
(6) In section 25 (effect of code under section 21 and guidance under section 23)—
(a) in the heading, after “s. 21” insert “or 21A”;
(b) in subsection (1), for “A code of practice under section 21” substitute “Codes of practice under sections 21 and 21A”;
(c) in subsection (2),
(i) for “A code of practice under section 21 or” substitute “Codes of practice under sections 21 and 21A and”;
(ii) for “is” substitute “are”;
(d) in subsection (3), after “21” insert “or 21A”.
(7) Until the first regulations made by virtue of section 20(5ZA) of the Health and Social Care Act 2008 (as inserted by subsection (2)) come into force—
(a) the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (S.I. 2014/2936) (“the 2014 regulations”), and
(b) the Health and Social Care Act 2008, are to be read as if regulation 18 of the 2014 regulations contained such requirements.”

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 92 and do agree with the Commons in their Amendment 92A in lieu.

92A: Page 127, line 39, at end insert the following new Clause—
“Early medical termination of pregnancy
(1) Section 1 of the Abortion Act 1967 is amended as follows.
(2) In subsection (3), for “subsection” substitute “subsections (3B) to”.
(3) In subsection (3A)—
(a) the words from “includes” to the end become paragraph (a);
(b) after that paragraph insert—
“(b) is not limited by subsections (3C) and (3D).”
(4) After subsection (3A) insert—
“(3B) Subsections (3C) and (3D) apply where—
(a) the treatment referred to in subsection (3) consists of the prescription and administration of medicine, and
(b) the registered medical practitioner terminating the pregnancy is of the opinion, formed in good faith, that, if the medicine is administered in accordance with their instructions, the pregnancy will not exceed ten weeks at the time when the medicine is administered (or in the case of a course of medicine, when the first medicine in the course is administered).
(3C) If the usual place of residence of the registered medical practitioner terminating the pregnancy is in England or Wales, the medicine may be prescribed from that place by the registered medical practitioner.
(3D) If the pregnant woman’s usual place of residence is in England or Wales and she has had a consultation (in person, by telephone or by electronic means) with a registered medical practitioner, registered nurse or registered midwife about the termination of the pregnancy, the medicine may be self-administered by the pregnant woman at that place.””

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 95 and do agree with the Commons in their Amendment 95A in lieu.

95A: Clause 150, page 112, line 27, leave out paragraphs (c) and (d) and insert—
“(c) for subsection (4) substitute—
“(4) A statutory instrument containing regulations under this Act may not be made by the Secretary of State unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”;
(d) omit subsection (5);
(e) after subsection (5) insert—
“(5A) Regulations made by the Scottish Ministers under section 2A are subject to the affirmative procedure (see Part 2 of the Interpretation and Legislative Reform (Scotland) Act 2010 (asp 10)).
(5B) A statutory instrument containing regulations under section 2A may not be made by the Welsh Ministers unless a draft of the instrument has been laid before and approved by a resolution of Senedd Cymru.
(5C) Regulations may not be made by a Northern Ireland department under section 2A unless a draft of the regulations has been laid before and approved by a resolution of the Northern Ireland Assembly.””

--- Later in debate ---

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 105 and do agree with the Commons in their Amendment 105A in lieu.

105A: Schedule 2, page 137, line 41 at end insert—
“(5A) The chair must exercise the approval function mentioned in subparagraph (1)(b) with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”