NHS: Pre-pandemic Facility Levels

Lord Kamall Excerpts

Tuesday 29th March 2022 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government when they expect the full range of NHS facilities, such as hospital visiting and booking GP appointments, to return to pre-pandemic levels.

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

My Lords, NHS services are open to patients and numbers of general practice appointments have returned, or are returning, to pre-pandemic levels. As before the pandemic, hospital visiting is currently at the discretion of NHS trusts. Hospitals are expected to accommodate at least one hour of visiting per day, and preferably more. The department is working closely with the NHS to tackle the Covid-19 backlog and restore pre-pandemic activity and performance as soon as possible.

[Lord Balfe (Con)]

I thank the Minister for that Answer, but in our local hospital there are very big signs saying that visiting is still not permitted, while it seems to be quite in order for staff who are unvaccinated to go in and out of the hospital at will. What steps are being taken to test unvaccinated staff to ensure that they are not carrying Covid, and can the Minister remind me whether we have repealed the bit of legislation that restricted the number of people who can be in a GP’s surgery?

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer as many of them as I can. We are aware that this idea of returning to normal is patchy in different parts of the country. Some people have told me that visiting their GP or a hospital is fine, while others have had real trouble. Therefore, when these issues come up, I hope that noble Lords and others make us aware, so that we can ask the NHS what is happening. It is clearly an issue of capacity, but also, some people are trying to get face-to-face appointments with their GPs, while some practices are trying to move towards a technology-based service offering. I am aware of that. GP appointments are up to 60% of what they were pre-pandemic, but we understand that there is progress to be made in other areas.

[Lord Laming (CB)]

My Lords, I wonder whether the Minister realises that he could make himself hugely popular in the country if he could persuade GP practice reception facilities to be more user-friendly and welcoming to the clients.

[Lord Kamall (Con)]

The noble Lord makes an important point, and I can see a lot of agreement, judging by noble Lords’ body language. However, we must always be careful about this issue because patients have had different experiences. I have been speaking to noble Lords about this. Some have told me that it is really good and has gone back to normal; others are having real trouble getting access to a GP or even getting someone to answer a phone in the first place. We must be careful, because if I say, “GPs should be doing more,” I will be criticised for being tough on GPs, but if I say that we must understand that GP practices are under a lot of pressure, I will then be criticised for not pushing hard enough to solve the problem. The pandemic accelerated pre-existing trends. We were already moving more towards the use of technology. Some people were quite happy to contact their GP by phone or online, and we will see some of that. We will never go back to 100% face-to-face, but certainly, patients should be able to have face-to-face appointments unless there are good clinical reasons why they cannot.

[Lord Watts (Lab)]

My Lords, is it not about time that the Government reformed GP services? Should we not have GP and diagnostic centres replacing traditional GP services? At the moment, many GPs are making thousands of pounds out of buildings that have been paid for by the NHS. When will the Government be getting value for money for taxpayers?

[Lord Kamall (Con)]

One of the advances we have seen with technology is the community diagnostic centre; these will no longer necessarily be at health centres or GP surgeries. We are looking at rolling them out in the community, in shopping centres and sports stadiums. About 80% of the people on the waiting lists are waiting for diagnostics, so we hope that will be a great way of tackling the waiting list.

[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, surveys of parent carers during the pandemic by the Disabled Children’s Partnership reveal that more than 70% of disabled children were unable to access their pre-pandemic levels of therapies and health services, and many of their conditions regressed during the pandemic. How do the Government plan to use wider NHS recovery funding to meet the acute health needs of disabled children and young people?

[Lord Kamall (Con)]

I thank the noble Baroness for making me aware of this issue. We are aware of a number of front-line services where there is a backlog as a result of the pandemic and not being able to have face-to-face appointments. However, I will have to write to her on the specific case that she raised.

[Lord Geddes (Con)]

My Lords, on the other side of the question from the noble Lord, Lord Laming, I have it on very good second-hand authority that receptionists are getting an extraordinary amount of abuse from the public. That is one of the problems.

[Lord Kamall (Con)]

My noble friend raises an important point. No matter how frustrating we might find trying to get an appointment with a GP, there is no room for abuse of our NHS staff—whether GPs, doctors, nurses or other health and care workers. I completely support the point he made.

[Lord Austin of Dudley (Non-Afl)]

My Lords, for many patients, the service before the pandemic was not nearly good enough, so our ambition ought to be much higher in the future. Why can we not reform the system by empowering patients with choice and competition? With modern IT services, why can GPs not be paid by appointment and why can patients who choose to not be able to ring round to find a GP who can treat them when and where they want, instead of being restricted to one practice?

[Lord Kamall (Con)]

The noble Lord makes some really good suggestions. On technology, one of the things we are looking at is why, in this day and age, when you can book appointments online for most other meetings, you cannot for GP practices. We want to make sure that people can book online, by telephone, and in advance—rather than having to phone at 8 am —and also let them choose between different places. We have to look at all these options, but, at the same time, technology is not enough: we also have to change the work processes to match the changes in technology.

[Viscount Hailsham (Con)]

My Lords, a problem that I have encountered in Lincolnshire is that when one tries to get a telephone appointment with the GP, one is offered a point in a spectrum of a number of hours. One simply cannot sit at one’s desk waiting for a call back within a spectrum of a number of hours.

[Lord Kamall (Con)]

That is exactly why, as technology has improved, you should be able to book a specific time. In fact, in some practices, it has gone backwards since the 1970s. When I was a child, my mother was able to phone up and ask, “Can my son have an appointment on Tuesday next week?” These days, you have to phone at 8 am hoping to get in the queue to book an appointment. Technology should improve that, and we hope that once we are able to recover, we will be able to use technology to book in advance.

[Baroness Wheeler (Lab)]

My Lords, the BMA’s Rebuild General Practice campaign has warned that GPs’ lack of time with patients, workforce shortages, heavy workloads and administrative burdens mean that patients’ safety is being put at risk when they attend a surgery. Data shows that GPs are conducting nearly 50% more appointments, but staff vacancies continue to soar and GP numbers to decline. In the light of this, can the Minister explain to the House how the Government expect to achieve their target of an extra 6,000 GPs by 2024—just two years away?

[Lord Kamall (Con)]

I thank the noble Baroness for reminding us of the target. We have been quite clear that it is important that we have as many healthcare professionals as possible and fill the vacancies as soon as possible. We made £520 million available to improve access to GPs and expand general capacity during the pandemic. That is in addition to the £1.5 billion announced in 2020 to create an extra 50 million general practice appointments by 2024, by increasing and diversifying the workforce.

[Lord Bethell (Con)]

My noble friend is entirely right that the technology offers benefits, but the health infrastructure plan, promised some time ago, has not yet been published. That will outline the framework for investment in the technology he mentions. When will the update be published?

[Lord Kamall (Con)]

My noble friend will be aware from when he was a Minister that there were other priorities in tackling Covid, trying to get a vaccine and procuring much-needed equipment. This was therefore all delayed, but we are now working with stakeholders to ensure that the updated capital strategy sets a clear direction for the system, taking into account significant events since the first publication. The multiyear settlement confirmed for 2021 allows us to take the next step forward. We expect the paper to be published at some time in 2022.

[Lord Reid of Cardowan (Lab)]

My Lords, did not the noble Lord, Lord Austin, hit the nail on the head when he said, regarding GPs, to give the patients choice? Back in the days when we reduced the waiting list from 1.1 million to just under 400,000, we reduced waiting times in hospitals from over three years down to 18 weeks. We did that primarily by giving the patients the choice to go to another hospital if they were not getting the service they needed and making the money follow the patient’s choice. Is that not the way to solve the GP problem?

[Lord Kamall (Con)]

Yes.

NHS: Gambling Treatment Services

Lord Kamall Excerpts

Monday 28th March 2022 Lords Chamber

[The Lord Bishop of St Albans]

To ask Her Majesty’s Government, further to the announcements that the NHS (1) will no longer accept money from GambleAware, and (2) is establishing two additional NHS gambling clinics to meet demand, what plans they have to agree a long-term independent funding settlement for NHS gambling treatment services.

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

In 2019, the NHS committed to establishing 15 specialist gambling clinics by 2023-24. Five clinics are now operational across England, with a further two to open by May. This rollout carries a budget of £15 million, including £6 million allocated for 2023-24. After this, NHS England will provide recurrent annual funding of £6 million. The Department of Health and Social Care and NHS England and NHS Improvement are currently undertaking a review to ensure there is a coherent pathway of advice and treatment for those experiencing gambling-related harm.

[The Lord Bishop of St Albans]

I thank the Minister for his reply, but it is quite extraordinary that, at a time when the NHS is in such dire straits, with such financial pressures, we are picking up the costs incurred by an industry. This announcement has shown that far more resources are needed to deal with the outcome of problem gambling, and that the current voluntary levy is simply inadequate to provide the level of independent research, education and treatment that we need. Will the Government commit to introducing a compulsory levy of, say, 1% of gross gambling yield on the polluter pays principle, so that taxpayers are not picking up the huge bills being created by this problem that exists right across society?

[Lord Kamall (Con)]

I thank the right reverend Prelate for his follow-up question and for raising the issue in the first place. He is absolutely right that we must think about this across government; DCMS leads the policy, but the Department of Health and Social Care is co-operating with it to look at the health issues. Gambling used to be considered a syndrome, but it is now recognised as an addiction. We are committing resources to it through our long-term plan, and will open 15 NHS specialist gambling clinics by 2023-24, with £15 million of funding over the period.

[Lord Watts (Lab)]

My Lords, do we not need a mandatory levy now? The Government should be setting up a body made up of independent experts, charities and the NHS to decide what services are required and where they should be provided.

--- Later in debate ---

[Lord Kamall (Con)]

The former Public Health England, now the Office for Health Improvement and Disparities, works closely with us, particularly on this issue. We understand the call for a compulsory levy. Indeed, as I am sure many noble Lords will be aware, DCMS recently conducted a review of the Gambling Act 2005. The DHSC was part of that, looking at the impact of gambling on health. Gambling is now recognised as an addiction, as opposed to any other issue. We are looking at this and considering all options. The Government received 16,000 responses to the consultation; we are looking at that and will publish the White Paper soon.

[Lord Butler of Brockwell (CB)]

My Lords, with respect, the Minister did not really answer the question about the financing of these services. Does he accept, or understand, that those who treat and research gambling conditions are reluctant to accept funds that are voluntarily provided by the gambling industry?

[Lord Kamall (Con)]

I completely recognise the noble Lord’s point, which is why we welcome the fact that GambleAware will no longer fund the two clinics in London and Leeds. NHS England has stepped forward on that, but we are reviewing this overall, in a holistic way. When we have an issue that is considered across government, we must make sure that it is all joined up. The Department for Digital, Culture, Media and Sport has been leading the review into the Gambling Act 2005, and has asked the Office for Health Improvement and Disparities and the Department of Health and Social Care to feed into it, along with all the other stakeholders.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, will make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, Public Health England says that around 246,000 people are likely to have some form of gambling addiction, but last year, only 668 people—with the most severe addiction issues—were referred to the gambling clinics because of a lack of resources. Even with the extra clinics over the next three years, will this number of clinics be able to treat the top 10% of patients, which is 24,000 people? If not, when will the service expand to help them too?

[Lord Kamall (Con)]

The noble Baroness makes an important point and there is recognition that we must do far more on this. That is why we held a review of the Gambling Act in the first place. As noble Lords will be aware, when the work is cross-government, the Department of Health cannot lead in this area; it can contribute when it comes to the health and addiction impacts of gambling but we are doing this in a joined-up way. The White Paper will be published soon and we are continuing to have conversations with the Department for Digital, Culture, Media and Sport on this issue.

[Baroness Manzoor (Con)]

My Lords, I echo the point made by the right reverend Prelate. The polluter pays principle is really important, particularly when we think that the gambling industry continues to offer customers VIP packages and streams live sport, which are equally damaging. This badly affect the lives of families and has an impact on individuals’ struggles. I welcome the NHS clinics but we always seem to tackle issues once the horse has bolted. I want my noble friend the Minister to address the issues of prevention and working much more closely with the gambling industry and others in government.

[A noble Baroness]

My Lords—

[Lord Kamall (Con)]

I am very happy to take two questions at once; I will even take three, if noble Lords want, and try to answer them.

The important point that a number of noble Lords are making is that many want to see a polluter pays principle. In economics, this goes back to negative externalities, where you attack things that are considered bad. Some people call them bad; others call them negative externalities. However, when you say that the polluter should pay, who is that? People sometimes say that it should be users but, if you do that, users will end up paying more. Others say that it should be the industry, but will the industry then pass on those costs to users and put those people into even more distress? This is why we want to look at this issue in a joined-up way. Yes, it is about the gambling industry, and this may well be the option we land on, but we want to make sure that we tackle the issue in a completely holistic way.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I welcome the Government saying that there needs to be a range of treatment and not just the hard-end clinics. I declare my interest, as in the register, having recently become a trustee of GambleAware; I did that because I want those people who are scared of going for treatment and frightened of the stigma to be able to access early intervention, which means much more work for the voluntary sector. Can the Minister commit to the Department of Health ensuring that the pathway is very clear and will involve early intervention, particularly for women, so that they do not have to end up in heavy-end treatment?

[Lord Kamall (Con)]

The noble Baroness makes a very important point: people must be treated as individuals—they will have come to addiction from different pathways. We have been engaging with the Department for Digital, Culture, Media and Sport on a number of issues. Additionally, the Office for Health Improvement and Disparities regularly engages with NHS England working-level counterparts, including recently on the establishment of a joint task and finish group on integrating the gambling treatment pathway. Referring directly to the question asked by the noble Baroness, there is no one simple pathway into gambling, and there is a stigma. By putting it at the forefront of some NHS services, we are showing that we are taking it seriously, and that it is not just an affliction but an addiction. We recognise that we must do more to tackle that.

[Lord Foster of Bath (LD)]

My Lords, I declare my interest as chair of Peers for Gambling Reform. The Minister has talked a lot about treatment, but does he accept that by adopting a public health approach, we would reduce harm in the first instance? Can he give us an absolute assurance that his department is co-operating on all aspects of the gambling review that is currently taking place and that it will be involved in the writing of the White Paper that will, I hope, come before us very soon?

[Lord Kamall (Con)]

We take the public health aspect very seriously. Public Health England did some work with the DCMS on looking at gambling from a public health perspective, and the Office for Health Improvement and Disparities continues to do that work. While the Department for Digital, Culture, Media and Sport is looking at the gambling industry, we are also looking at this as a public health issue via the Office for Health Improvement and Disparities. I see that the seconds are running out, so I will give the Labour Front Bench time to ask a question.

[Baroness Wheeler (Lab)]

I thank the Minister for that.

GambleAware recently announced a new major public health campaign to raise awareness of the gambling harms that women experience and to highlight the warning signs and the support that is available. It is particularly focusing on women between the ages of 25 and 55 who gamble online. Can the Minister reassure the House that such vital campaigns will continue to be supported through the long-term funding settlement for NHS gambling treatment and support services?

[Lord Kamall (Con)]

I am afraid that I cannot answer on the specific initiative that the noble Baroness refers to, but I know we take very seriously that this is a public health issue that we must tackle in a holistic way. We are looking at how we can allocate funding in the NHS long-term plan to tackle gambling addiction and to ensure that we focus more on prevention rather than simply dealing with people once they have a problem.

Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022

Lord Kamall Excerpts

Wednesday 23rd March 2022 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 7 February be approved. Considered in Grand Committee on 21 March.

Motion agreed.

Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022

Lord Kamall Excerpts

Wednesday 23rd March 2022 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 21 February be approved. Considered in Grand Committee on 21 March.

Motion agreed.

Health and Care Bill

Lord Kamall Excerpts

3rd reading
Wednesday 23rd March 2022 Lords Chamber

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

My Lords, the Government will not oppose the minor and technical amendments tabled by the noble Baronesses, Lady Wheeler and Lady Thornton. We respect the fact that both amendments are necessary to reflect, and are consequential on, the removal of the care-cap metering clause and the reconfigurations clause, respectively, even though the Government are disappointed that noble Lords chose to remove these clauses from the Bill.

Amendment 1 agreed.

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[Baroness Penn (Con)]

I think that noble Lords may want to make a few remarks before we reach the Question.

[Lord Kamall (Con)]

Is that me?

[Baroness Penn (Con)]

Yes.

--- Later in debate ---

Moved by

[Lord Kamall]

That the Bill do now pass.

[Lord Kamall (Con)]

As noble Lords know, I am still learning. I will take a moment to mark the end of the Bill’s passage through your Lordships’ House. Its size reflects the Government’s ambitious agenda for change and the NHS’s requests to help to deliver this change. The Bill intends to strip out needless bureaucracy, improve accountability and enhance integration, and it will form the bedrock for the NHS to build on in years to come.

I will express some words of gratitude. In many ways, the many meetings, the debates and even the late nights during the passage of the Bill have, I believe, shown this House at its best—informed, collaborative and considered. I am grateful to all noble Lords for their intense scrutiny over the nine days of Committee and four days of Report.

I pay tribute to the willingness of noble Lords, right across the House, on all Benches, to engage with me and my officials to find ways to improve the Bill. As well as being grateful to the Labour and Liberal Democrat Front Benches for at times challenging us and at other times agreeing and co-operating, I thank a number of Cross-Bench Peers, including the noble Baronesses, Lady Finlay of Llandaff, Lady Watkins of Tavistock and Lady Hollins, and the noble Lords, Lord Stevens of Birmingham and Lord Patel—who sends his apologies—for their always constructive contributions. I should perhaps also thank noble Lords on the Benches behind me and reflect that the challenge was sometimes from them.

As a relatively new Minister, thrown in at the deep end—your Lordships can see how new I still am from my asking, “Am I on yet?”—I also thank my colleagues on the Government Benches, who have assisted, advised and, I have to admit, consoled me at times throughout the passage of the Bill. I pay tribute to the kind support and advice of my noble friends Lord Howe, Lady Penn and Lady Chisholm of Owlpen.

I also put on record my thanks to the wide range of stakeholders which have engaged with me and many noble Lords, including the NHS Confederation, NHS Providers, the King’s Fund, the Nuffield Trust, the Health Foundation, the Academy of Medical Royal Colleges and the Local Government Association, for their sustained and constructive engagement over several years. I am sure that noble Lords will agree that the Bill is better for all their work.

It would be remiss of me not to pay tribute to the work of colleagues across the NHS, government and the devolved Administrations, who have worked so hard behind the scenes. In particular, I thank my fantastic Bill team and the departmental policy teams supporting them, all of whom have been assiduous, helpful and uncomplaining at all times, despite very long hours. Perhaps I should give a special shout-out to 10 month-old Teddy Povey, son of the Bill team manager. You say that you are getting old when the policemen look younger, but I must say that I felt very old on seeing that the policy officials are getting younger. I pay a special tribute there, on his early introduction to politics.

I thank officials across government, including the Department for Culture, Media and Sport, the Department for Education, the Department for Levelling Up, Housing and Communities, the Ministry of Justice, the Cabinet Office and the Foreign, Commonwealth and Development Office. That shows the sort of cross-government dimension to this Bill.

There is no doubt that your Lordships have improved the Bill. I hope that noble Lords across the Chamber will recognise that the Government have listened, considered and responded positively to suggestions where we were able to. However, I also recognise that there are some areas still to be resolved and where, to use my oft-used phrase one more time, we were unable to close the gap between our positions, including on social care, workforce planning and reconfigurations, on which the House of Commons will want to make its voice heard—and to which we may return in debate. But the areas of disagreement should not overshadow the improvement that all noble Lords have made to the Bill. Together, as a House, we have banned hymenoplasty; introduced a power to create a licensing regime for non-surgical cosmetic procedures; extended the gamete and embryo storage limits; made important commitments to safeguarding children; and strengthened the NHS’s commitment to net zero. On a subject close to my heart and that of my right honourable friend the Secretary of State, we have included specific references to tackling inequalities.

We send to the other place a Health and Care Bill that is improved with its three underpinning principles reinforced: embedding integration, cutting bureaucracy and boosting accountability. I beg to move.

[Baroness Thornton (Lab)]

My Lords, I was rather hoping that we would do one of these. I agree with the Minister that we have improved the Bill; it is a much-improved Bill that we are sending back to the Commons, and I hope that they have the good sense to accept all the wise amendments that this House has made.

I also say to the noble Lord, Lord Kamall, that this is his first Bill, and it has been a baptism of fire for him. It is a very large Bill to cut your teeth on. I think that he has had a bit of a masterclass on legislation and legislative processes, but I compliment him on how he has risen to the occasion and thank the whole ministerial team, including the noble Earl and the noble Baroness, Lady Penn; I was about to call her Baroness Jo-Jo, sorry. I also observe that this is a three-baby Bill. The leader of the Bill team and the noble Baroness, Lady Penn, have had babies, and our adviser who started out on the Bill, Rhian, has also had a baby. That is probably quite unusual in your Lordships’ House.

I say thank you, of course, to my wonderful colleagues, my noble friends Lady Wheeler and Lady Merron, and also to the Labour team behind me, particularly my noble friend Lord Hunt, who has been especially active on the Bill—and very welcome that has been, too. We have worked very well across the House, and we have been very pleased to work with the noble Baroness, Lady Walmsley, as well as the noble Baroness, Lady Brinton, at a distance, and with many colleagues on the Cross Benches. If I start listing them, I know that I shall forget someone, but I need to mention the noble Lord, Lord Patel. He has not been with us for as much of the Bill as he would have liked, but of course his wisdom has been with us all the way through the Bill.

We are sending the Bill back to the other place, and I suspect that we are all going to be busy when it starts pinging and ponging back.

Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022

Lord Kamall Excerpts

Monday 21st March 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022.

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

My Lords, the Government’s priority is, as always, to ensure that the high standard of food safety and consumer protection that we enjoy in this country continues to be maintained now that the UK has left the European Union. This instrument follows the 18 EU exit instruments in the field of food and feed safety made during 2019 and 2020. It addresses two deficiencies identified in retained EU law, and provides transitional arrangements for labelling changes introduced as a result of EU exit. Since the instrument is technical in nature, I hope noble Lords will allow me to briefly summarise the changes we are making.

The instrument serves three key functions. First, it will ensure that emergency powers can be applied equally to all food and feed entering Great Britain. Retained EU Regulation 178/2002, on the general principles of food law, provides Ministers with emergency powers to suspend or restrict the placing of food or feed on the market. This can be used where food or feed presents a threat to human health. Legal analysis of Article 53 of that regulation identified that, as worded, it is not possible for a Minister to exercise those emergency powers on third-country food and feed entering Great Britain via Northern Ireland. To correct this operability issue, this proposed regulation includes a technical amendment that will enable all Ministers to apply, equally, the same emergency controls to all food and feed destined for our market. The amendment does not extend the remit or gravity of the controls that may be introduced, but will ensure that emergency controls are exercisable equally across all parts of the UK.

Secondly, the statutory instrument ensures that authorising provisions for feed additives and for GM food and feed authorisations will be made by legislation. Legal analysis of fixed and retained EU law identified that retained law on feed additives and on GM food and feed contained certain omissions. The regulations did not sufficiently make it clear that Ministers’ authorisation decisions will be prescribed in legislation. While this does not prevent Ministers from taking decisions to authorise these products, provision for those decisions to be implemented through legislation makes certain their enforceability in law. It also ensures consistency with other retained EU law in this area.

Thirdly and finally, the amendment provides a period of adjustment for changes to labelling requirements made necessary by EU exit legislation. In preparation for EU exit, changes were made to the legislation on extraction solvents and quick-frozen foods to reflect the fact that the UK would no longer be part of the EU. As a result, relevant food placed on the market is required to be labelled with the name and UK address of the legal person responsible for it, rather than an EU contact and address. This statutory instrument provides a period of adjustment in those sectors, allowing for the continued use of existing labels until 30 September 2022.

I should be clear that this instrument does not introduce any changes that will impact the day-to-day operation of food businesses, nor any new regulatory burden. The essence of the legislation is unchanged. However, it provides benefit for certain businesses by enabling a period of grace in the introduction of labelling changes.

It is also important to note that we have engaged positively with the devolved Administrations throughout the development of the instrument. I take this opportunity to note that their ongoing engagement has been warmly welcomed.

I reassure noble Lords that the overarching aim of this regulation is to provide continuity for businesses and to ensure that high standards of safety and quality for food and feed regulation will continue across the UK. The changes do not affect the essence of existing legislation. Having effective and functional law in this area is key to ensuring the high standards of food safety and consumer protection that we enjoy in this country and to make sure that they are maintained in the immediate and long term. I hope that noble Lords will feel able to support the amendments proposed in this instrument to ensure the continuation of effective food and feed safety and public health controls.

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[Baroness Merron (Lab)]

My Lords, I am grateful to the Minister for setting out the rationale behind this eminently sensible statutory instrument, which deals with a number of significant technical issues relating to the Food Standards Agency, some of which have come about because of the Northern Ireland protocol. They need to be resolved, and from these Benches we are of course happy to support this statutory instrument.

I add that the Explanatory Memorandum is very helpful in outlining the approach that the FSA is taking. I will just pick up on a few points. First, paragraph 7.7 refers to

“An analysis of the emergency powers for”


food and feed control, which revealed that these powers could not be deployed as effectively as required. I am interested in exploring the context. It would be helpful if the Minister could advise on whether this analysis was through a hypothetical desk-based exercise, or whether the situations referred to actually occurred. For example, did goods identified as presenting a serious threat to human health enter Great Britain through Northern Ireland or did that not happen in reality?

I welcome the clarification that the GM and feed additive authorisations will be dealt with through an SI. It would be helpful if the Minister could confirm whether this will be through the negative or affirmative approach. Also, are there any implications for the Government’s longer-term strategy for GM products, given the recent statutory instrument that changed some of the rules on research and gene-edited crops?

On the issue of labelling, it would also be helpful if the Minister could comment a bit on whether he feels that the date in place is the right one. I say that because the food production sector finds itself under pressure, of course, and we want to ensure that this is a practical step.

Throughout the consultation, the National Farmers’ Union has sought clarification on the UK’s relationship with the European Food Safety Authority. The NFU has stressed the importance of the UK’s close collaboration with the EFSA on equal terms. Can the Minister comment on the Government’s intentions for their relationship with the EFSA in the context of this statutory instrument, given its importance to our food industry? I would be most grateful.

I have a final point to raise. With regard to the consultations, one observation by the sector was about the expectation that these changes to the regulations could be read through in under an hour, such that businesses, regulatory agencies and councils would be able to work out in that short period how to apply the changes to their organisations. I know that this was regarded as somewhat overoptimistic, but has any further thought been given to an assessment of just how easy it will be to work with these regulations? With those comments, I offer our support for these regulations and thank the Minister in advance for the reply that I know he will give.

[Lord Kamall (Con)]

My Lords, I thank both noble Baronesses for their contributions and for their general positive response. Once again, I can only apologise for the fact that that some provisions are late. That is an issue that I constantly raise internally and I understand the criticisms.

I will try to address as many of the questions asked by the noble Baronesses as I can before I conclude. On the Northern Ireland protocol, one thing we are looking at is the United Kingdom Internal Market Act and its purpose of promoting the functioning of the internal market, given that we have the Northern Ireland protocol. The Act specifically serves to strengthen and maintain Northern Ireland’s position in the UK internal market. In terms of the bigger picture and how the Northern Ireland protocol works in future, we are hoping that will be done via the UK internal market Act, taking account of that protocol.

The SI makes provision for a specific transitional period to allow the industry to use up existing labelling stocks. A period of 12 to 24 months is indicated as being sufficient time to use up labelling stocks; some quick-frozen produce can also have a shelf life of up to two years. However, if there are still concerns from industry, no doubt we will look at them. We are in constant conversation with industry and a whole range of sectors related to health and other issues.

I hope that covers some of the questions that the noble Baroness, Lady Brinton, asked. Once again, if I have not answered all the questions, we will check Hansard and make sure that we sweep up any answers to both noble Baronesses.

The noble Baroness, Lady Merron, asked how the issue was identified. It is hypothetical; nothing has happened, there was no breach of standards. The procedure will be a negative procedure for authorisations. We have had the first group of applications for authorisations, which have progressed through the risk analysis process, and advice has been prepared for Ministers. This amendment is required to empower Ministers to prescribe the authorisation by regulation.

The wider question of the future of GM and gene editing is not considered by this SI, and really it is a matter for the Secretary of State for Environment, Food and Rural Affairs. Of course, if the noble Baronesses want more information, I am very happy to contact that department. For now, the commercial cultivation of gene-edited plants and any food products derived from them will still need to be authorised in accordance with existing GMO rules.

The UK has developed an enhanced risk analysis process, through the FSA, and we will seek close co-ordination with the EFSA. It does not mean we will always align, but it is really important to make sure that we have a strong relationship. Quite often, clearly, the issue of food safety is something that is shared by a number of jurisdictions, not just the UK and the EU, but in fact globally. So we will be looking at that.

In closing, I am grateful for the noble Baronesses’ contributions today. As I have said, if I have not answered questions, I hope, after a quick read of Hansard, I will try to sweep them up. I grateful to the noble Baronesses for their support. We want to make sure that there is a smooth transition for certain businesses in adjusting to the new labelling requirements. I take on board the comments made and I beg to move.

Motion agreed.

Mental Health Services for Rough Sleepers

Lord Kamall Excerpts

Monday 21st March 2022 Lords Chamber

[Baroness Morgan of Drefelin]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of the £30 million programme to provide specialist mental health services for people sleeping rough, as detailed in the NHS Long Term Plan; and what plans they have to publish an evaluation of the outcomes of that programme.

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

This Government are committed to ending rough sleeping by the end of this Parliament. The long-term plan set a target of 20 high-need areas to receive new specialist mental health provision for people sleeping rough by 2023-24. In fact, the NHS has exceeded that target, with 23 sites. There are plans to share learning from these sites to identify the key successes and effective approaches, and NHS England plans to undertake a formal evaluation before the end of the programme.

[Baroness Morgan of Drefelin (CB)]

I thank the Minister for that Answer and look forward very much to the publication of that work. We know that common mental health conditions are twice as high among people who have experienced homelessness, and psychosis is 15 times as high. Obviously, I commend the Government’s commitment to end rough sleeping. Does the Minister know what figure has been settled on for the number of people sleeping rough with specialist mental health services needs? If one has been settled on, is that the criterion that will be used to review progress with the NHS long-term plan when that is refreshed?

[Lord Kamall (Con)]

I thank the noble Baroness for her Question and for her continued conversations with me on a number of different health-related issues; I am learning quite a lot from those. I understand that the data will be collected at some point, and I hope that that will be done regularly. If the noble Baroness will allow me, I write to her with more details, but I know that the top-level answer to that question is that we are about to get the data.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, about two-thirds of people who are homeless cite alcohol misuse as one of the reasons that first made them homeless, and for about one in 10 people who die homeless, alcohol is the main cause of death. Can the Minister assure us that all this work will include a proper alcohol treatment programme, so that the underlying problems are dealt with in addition to the other mental health problems?

[Lord Kamall (Con)]

The noble Baroness makes the very important point that a number of people who are homeless suffer from alcoholism and alcohol abuse—and indeed drug abuse. For some of these people, the issues they are suffering from are often interrelated. Therefore, in the joined-up thinking we are looking at, charities, civil society organisations and the NHS are making sure that we treat the various symptoms in an integrated way.

[Lord Young of Cookham (Con)]

My Lords, given the success of the Everyone In campaign, through which 15,000 rough sleepers were given accommodation to protect them from Covid, does my noble friend agree that that progress must be maintained? Given that many rough sleepers have mental health issues, can my noble friend say whether the specialist funding for mental health services for rough sleepers will be extended beyond the next two years?

[Lord Kamall (Con)]

I thank my noble friend for raising that important point. The new rough sleeping strategy from the Department for Levelling Up, Housing and Communities will set out how departments will work together to end rough sleeping. This will build on the recent success to which my noble friend refers to ensure that rough sleeping is prevented in the first instance and responded to when it occurs. We are going to work closely with the Department for Levelling Up, Housing and Communities and other departments, as well the voluntary and social enterprise sector and others, to make sure that we are all joined up.

[Baroness Tyler of Enfield (LD)]

My Lords, the most common health problems among homeless people are substance abuse, as the Minister just mentioned, and mental health problems; often it is a combination of the two. Given this correlation, can the Minister say what the Government are doing to reconnect addiction services with health services in order to treat homeless people with multiple health problems? Does the Minister agree that specialist addiction services should be jointly commissioned by the NHS and local authorities to ensure full integration?

[Lord Kamall (Con)]

Like many other noble Lords, the noble Baroness has raised a very important aspect of this issue. She is absolutely right that people with drug addiction often have physical and mental health needs as well. Mental health problems and trauma are often central to an individual’s dependence on drugs, alcohol or other forms of abuse. As set out in the drugs strategy, we are working with NHS England to ensure that there is joined-up service provision between specialist mental health services and substance misuse services for people with co-occurring issues, including those who are experiencing rough sleeping. We are also going to make sure that the next phase of integrated care system development includes leadership on drugs and alcohol to integrate both physical and mental healthcare and substance misuse services.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we now have a guaranteed virtual contribution from the noble Lord, Lord Howarth of Newport.

[Lord Howarth of Newport (Lab) [V]]

My Lords, I commend to the Minister’s attention, if he is not already aware of it, the work of Art and Homelessness International and its 500 or so member organisations. In working with the NHS and local authorities on ways to support people sleeping rough, will Ministers take into account the impressive evidence that enabling them to engage with creative and cultural programmes— I think of The Choir With No Name, Streetwise Opera, Museum of Homelessness and the work of the Booth Centre—leads to improved well-being, resilience, agency and skills and thus to improved prospects for sustaining tenancies and employment?

[Lord Kamall (Con)]

I am sure we are all grateful that the noble Lord was able to ask his question on this issue. I pay particular tribute to the noble Lord for all his work and for raising awareness of the creative sector across a whole range of health and social care issues. I am not aware of the projects to which he refers, so I will be happy if he writes to me about them. In a previous political career as a Member of the European Parliament for London, I would meet lots of civil society organisations right across London, including homeless projects, and I was amazed by the diversity of provision. It was not a simple matter: they were tackling a number of different issues because often, the needs of homeless people are complex and there is not just one simple solution to the issue.

[Baroness Manzoor (Con)]

My Lords, my noble friend will know that the people who are still sleeping rough after a year are generally those who started off with mental health problems. What action are the Government taking to prevent people hitting the streets in the first place? Is there a co-ordinated approach with the housing sector?

[Lord Kamall (Con)]

My noble friend raises the very important issue of prevention. When we look at the causes of homelessness, they are often complex, and we might consider that all of us—including noble Lords, perhaps—are only one or two steps away from homelessness. Someone loses their job, their relationship breaks up and they then lose their home—or it is the other way around: their relationship breaks up and they lose their job, and after a while of relying on a friend’s good will, they stop sleeping on their sofa and they end up homeless. So, it is really important that we understand all the different steps by which people become homeless and make sure not just that they get accommodation but that we tackle the underlying problems that led to them being homeless.

[Baroness Merron (Lab)]

My Lords, with a health audit by Homeless Link showing that some four out of five people experiencing homelessness need support with their mental health, how will the Government ensure that they get the help they need in areas that do not have the necessary specialist mental health services that are being funded through the long-term plan? Further to this, will the Minister commit to a continued expansion of specialist homeless healthcare services throughout the NHS as part of a renewed rough sleeping strategy?

[Lord Kamall (Con)]

I thank the noble Baroness for those questions on what are very important issues. Our plans to transform NHS mental health services as part of the long-term plan include investing an additional £2.3 billion a year by 2023-24, which we think will enable an extra 2 million people in England to access NHS-funded mental health support by 2023-24. On targeting much further down, we are hoping that some of the work we do through community mental health frameworks will give 370,000 adults with serious mental illness greater control over their care and support. We have to look at this in a multifaceted way, and we are looking at psychological therapies, improved physical healthcare, access to employment support, trauma-informed care and support for those with self-harm and substance misuse problems. We announced £30 million to establish these specialist mental health provisions, and we want to learn from those to see what the best way is of rolling out more in the future.

[Lord Watts (Lab)]

My Lords, have the Government carried out an analysis of why there has been a massive increase in the number of people rough sleeping on our streets? What does the analysis say, and what are the Government going to do about it?

[Lord Kamall (Con)]

Indeed, in some measures, the number of rough sleepers in every region of England have actually decreased. There were 2,440 people expected to have been sleeping rough on a single night in autumn 2021, which was an eight-year low. We have also seen some of the problems associated with experiencing homelessness, such as suicide, fall, but that is not a sign to get complacent. That is why we want to roll out this programme. We have exceeded the target of 20, and we will continue rolling it out.

Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022

Lord Kamall Excerpts

Monday 21st March 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022.

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

My Lords, patient safety remains a top priority for the Government, and we continue to place enormous emphasis on making our NHS safer and as safe as possible for patients. This builds on earlier measures including, for example, the first ever patient safety strategy launched by NHS England in 2019. This aims to improve the way the NHS learns from avoidable harm and to create a safety and learning culture across the NHS. However, we know that more work needs to be done.

The First Do No Harm report by my noble friend Lady Cumberlege highlighted and effectively exposed a healthcare system that failed to listen to and disregarded the experiences of women. In my noble friend’s absence, I pay tribute to her for the work and to the review team for their diligence and dedication in conducting the review. I should put on record that my noble friend Lady Cumberlege cannot be with us today but did send her apologies.

The Government published their formal response to the Independent Medicines and Medical Devices Safety Review’s recommendations in July last year, setting out an ambitious programme of change. This included accepting the recommendation to appoint a patient safety commissioner with a remit covering medicines and medical devices. We are making progress towards fulfilling this important commitment. We included provisions in the Medicines and Medical Devices Act 2021 to establish the commissioner and set out their core duties. We also held a public consultation between June and August last year on the detail of the commissioner’s appointment and operation. In January, we started the process to recruit the very first patient safety commissioner. The job advert closed on 1 February and we hope to make an appointment this spring.

As well as establishing the patient safety commissioner, the Medicines and Medical Devices Act allows the Government to make legislative provisions about the appointment and operation of the role. Our public consultation set out nine proposals, covering details such as term of office, reappointment arrangements and remuneration. We are grateful to all those who took the time to engage with our proposals and share their views.

I can inform noble Lords that each proposal was supported by more than half of those who responded, ranging from 59% to 91% of respondents being in agreement. Having considered all the responses carefully, we have laid before the House this statutory instrument that will implement the proposals put forward in our consultation. This instrument will enable the patient safety commissioner to function effectively by providing a clear legislative framework within which they can operate. It allows for the commissioner to serve an initial term of three years. This received strong support during our public consultation, and we believe it provides sufficient time for the postholder to become established and develop the role.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, the first thing I did when preparing for this debate was to ask the noble Baroness, Lady Cumberlege, if she was content—of course I did. Since her shocking and moving report First Do No Harm, mentioned by the Minister and the noble Baroness, Lady Brinton, and during the passage of the Medicines and Medical Devices Act, there has been active cross-party support for the recommendations in that report and a determination in this House to bring about change. This SI is another step along that path.

As one would expect, the noble Baroness, Lady Cumberlege, is involved in the appointment—and will, I suspect, be involved in the work—of the new commissioner. I join the noble Baroness, Lady Brinton, in asking why we are discussing this SI when action has already been taken. The reason this SI and the commissioner’s job are important is that when people, often at their most vulnerable, put their trust in the hands of healthcare professionals they do so in the expectation, quite rightly, that their safety will be of paramount concern. Sadly, that is sometimes not the case. Even worse, sometimes the patient is not heard. Where those incidents have taken place, patients have been made to jump through hoop after hoop in their fight for recognition and voice. The independent patient safety commissioner will take steps to ensure that patient safety is a top priority and will act as a voice for patients.

There is no question that the noble Baroness’s report was a landmark in the fight to improve patient safety, so I praise her but also honourable and noble Members of both Houses for their work, whether on sodium valproate, Primodos or surgical mesh, who have stood up for the thousands who have suffered because patient safety was not taken seriously enough. My honourable friend Sharon Hodgson MP, for example, was at the forefront of championing these women.

Despite this, there remain several outstanding ways in which this Government could further improve patient safety. I welcome that, in this instance, the Government have taken on board the recommendation to provide an independent patient safety commissioner, but I would like to know from the Minister what progress has been made on the remaining recommendations in the review. I think all are agreed that that full package of reforms is essential.

I would also like the Minister to explain why the tenure is only three rather than five years. I realise that it is allowed to roll over for another term but, when you are setting up a new office with a new role and getting an organisation up and running, three years is too short a time. The Children’s Commissioner has five years. I would be grateful if the Minister could outline how and why that decision was taken.

We welcome the obligation on the commissioner to lay an annual report before each House of Parliament. There is an additional obligation for the commissioner to publish a business plan at the start of each year, which is not mentioned in the SI. What is the point of the commissioner providing a business plan if they are not held accountable for its contents?

Finally, I draw the attention of the Committee to the advisory panel that

“must consist of persons who (taken together) represent a broad range of interests which are relevant to the Commissioner’s functions.”

Will that include the patient voice? Will patients have representation on this board?

Of course, this SI has our support and we welcome it, but the Government should see it as a beginning, not an end.

[Lord Kamall (Con)]

I am grateful to the noble Baronesses who spoke today. Once again, I would like to echo their gratitude to my noble friend Lady Cumberlege, but I also agree with the noble Baroness, Lady Thornton, that a number of politicians in both places across parties raised a number of these issues. We have read some horrifying stories about some of the victims of the three issues that were raised. They are really heartbreaking in many ways.

My Lords, we are determined to deliver meaningful change in our response to the Independent Medicines and Medical Devices Safety Review. We see the safety commissioner playing a key role in that change. I know there are concerns about the three-year and three-year-plus extension. When I was asking questions, right at the beginning of my awareness of this when I first became a Minister, I was told that three years is standard for a number of offices. So I was interested to hear the noble Baroness, Lady Thornton, talk about the term of the Children’s Commissioner being five years. The initial advice I was given was that three years is standard. There were also some concerns from other quarters about what happens if we appoint an ineffective commissioner; do we then have to wait five years to get rid of them? We think three years is the right balance, but it continues to be a subject of debate and I completely understand that.

I also take on board the point made by the noble Baroness, Lady Brinton, that it is not only about women who have had mesh complications or valproate or the other issue; there will be other issues we come across, but this was set up as a result of the Independent Medicines and Medical Devices Safety Review. We completely agree that patient safety must remain a top priority and we hope that this will not be the only way to improve safety. There is a statutory duty of candour, regulated by the CQC, which requires a trust to tell patients if their safety has been compromised and to apologise. There are protections for whistleblowers and “freedom to speak up” guardians; provisions in the Bill to establish, as the noble Baroness will be aware, the Health Services Safety Investigations Body; the implementation of the first-ever NHS patient safety strategy in 2019 with substantial programmes under way to create safety and learning; the implementation of medical examiners across the NHS as a critical reform, so that all deaths not involving a coroner are scrutinised by an independent medical practitioner; and of course legislation for the patient safety commissioner.

I am also in conversations directly with my noble friend Lady Cumberlege who, quite rightly, keeps pressing the department on the issues of valproate, vaginal mesh and the other issue, where we need some form of redress. I have mentioned to my noble friend where the concerns are and that, if we continue those conversations, I hope to close that gap as much as I can. I make no promises, but I hope noble Lords recognise that I do try to close the gap whenever I can, and I am in constant conversation with my noble friend Lady Cumberlege on that.

On top of this, we hope the patient safety commissioner will play a key role in that change, championing the view of patients in relation to medicines and medical devices. It is not particularly party political; this is important across the House. When the NHS performs brilliantly, of course it should be praised, but when things go wrong, we should find out. That then clearly makes it a patient-centred NHS, but it also means we can learn to make sure we have a better health service in the future. These things should not be swept under the carpet.

We hope the regulations before us will help us support the success of this new role, providing a sensible and clear legal framework within which to operate. In case I have not answered any of the questions, I will read Hansard and try to sweep them up and write to the noble Baronesses. Before that, I commend these regulations to the Committee.

Motion agreed.

Down Syndrome Bill

Lord Kamall Excerpts

2nd reading
Friday 18th March 2022 Lords Chamber

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

My Lords, I thank my friend, the right honourable Member for North Somerset, Liam Fox, who was here earlier; I thank the noble Baroness, Lady Hollins, for introducing the Bill in this place; and I thank all noble Lords for their contributions today.

Many who have spoken today have talked about their experiences of their own contact with people with Down’s syndrome. When I was a child growing up in Edmonton in north London, there were a couple of children in our neighbourhood who I sometimes used to play with who had Down’s syndrome. It is interesting to note that the words we used to describe them in those days would today be considered offensive. It is absolutely right that, as language evolves, we learn how to describe people with different conditions.

On that note, I take this opportunity to thank Rachel Ross from the National Down Syndrome Policy Group for sending me and other noble Lords the appropriate language and terminology. It is important that we get this right, and I know that there is cross-party consensus on that. If noble Lords have not received that, I have a copy in my pack and I will be happy to forward it on to them.

I want to be clear at the beginning that if there are no amendments, the Government will be able to give time to the Bill to support it. I should be clear about that from the start.

We agree on the need to improve life outcomes for people with Down’s syndrome; that case is compelling. It is very common for people with Down’s syndrome to experience compounded health risks compared to the general population. Some noble Lords have made the point that people may have more than one condition. We should be aware of the statistics: nearly half of children born with Down’s syndrome have a heart condition. People with Down’s syndrome face an increased risk of early onset dementia, and the NHS recommend regular check-ups to look for these signs from the age of 30. People with Down’s syndrome are also far more likely to experience recurring infections and become seriously unwell. This can be life threatening. Sadly, although life expectancy has increased, the risk of death for adults with Down’s syndrome can be around five times higher than for the general population. Despite this, people with Down’s syndrome are living longer. In 1983, the average person with Down’s syndrome lived to 25 years old. Life expectancy is now typically around 60 and has increased substantially in recent years.

There are existing legal frameworks in place which require health, care, education and housing authorities to consider a person’s individual needs regardless of their condition. However, there is evidence to suggest they have not always worked as intended for people with Down’s syndrome. That can be due to the lack of understanding or appreciation by commissioners and providers of services of the unique needs of people with Down’s syndrome, reducing the quality of care they receive and their overall life outcomes. For example, children with Down’s syndrome may remember and learn information in different ways from other children. This Bill is a significant opportunity to drive forward important changes, raising understanding and awareness of the needs of people with Down’s syndrome.

For the first time, legislation will require the Secretary of State to produce guidance to health, care, education and housing authorities about how to meet the needs of people with Down’s syndrome. Those authorities must consider the guidance; the relevant authorities will not be able to ignore it, and they must provide strong reasons for not following it. The practical impact of this guidance should not be understated. It will raise awareness and understanding of the needs of people with Down’s syndrome, and it will support authorities to recognise how to adapt services to meet those needs, ensuring that people with Down’s syndrome, their families and carers can get the support they need. That is why the Government support the Bill.

I recognise that there are concerns that a condition-specific Bill may be divisive. I hope that I can gently disagree, but also reassure noble Lords. This Bill is not about enhanced rights for people with Down’s syndrome; it is about making sure these identifiable and unique needs are not overlooked when planning, designing and delivering services. The Government have committed to develop the guidance through inclusive consultation with all interested parties, including some of the organisations named by noble Lords and, of course, people with Down’s syndrome and their families, those operating services and the organisations and individuals that represent people with Down’s syndrome. In the other place, as noble Lords have acknowledged, the Minister of State for Care and Mental Health made a clear commitment that in developing this guidance we will consider the links and similarities that Down’s syndrome has with other conditions. This consultation will make sure that all the available evidence and experiences can be considered to identify what support and interventions will best meet people’s needs.

We anticipate that the guidance will be published within a year of the Bill receiving Royal Assent, should it do so. At that time, Members in the other place and your Lordships will have the opportunity to scrutinise the guidance when it is laid before Parliament. Of course, people with Down’s syndrome and their families need to feel confident that this guidance will not be ignored—that it will result in action, and there will be avenues available to them if they do not believe they are receiving the appropriate care and support. There will be accountability at local level to make sure that this guidance is implemented. The Government made the commitment in the other place that statutory guidance relating to the Health and Care Bill will require ICBs to have a named person overseeing how the guidance is implemented and taken into account in practice.

I reassure your Lordships that this does not restrict the oversight to health and care authorities. ICBs are required to work with local authorities to establish integrated care partnerships, which bring together organisations to decide how to best address public health needs, including housing and education provision. The guidance will be subject to regular review to make sure that it remains current.

If noble Lords will allow me, I shall try to address some of the specific questions that were asked. It is important that I try to answer them. In response to the noble Baroness, Lady Jolly, officials are talking to stakeholders about this Bill, including the Down’s Syndrome Association and the National Down Syndrome Policy Group, to understand how it fits in and alongside wider policy on learning disability. We will keep the guidance under review and expect to update it periodically as policy and practice changes. I hope that this will be living, learning guidance, rather than just something that sits on dusty shelves for years. If we think about how our language and understanding has evolved, of course it is only right that we update that guidance as research increases and we learn more about this condition and other genetic conditions.

I am afraid that the reality is that it is difficult to say when an in-the-round look at services for people with Down’s syndrome was last done. In some ways, the fact that we cannot directly answer the question of the noble Baroness, Lady Jolly, highlights the need for this Bill and to shine a light on this issue. It is through wide consultation that we will determine the appropriate and best practice of this service for people with Down’s syndrome. I hope that noble Lords will contact me, as the Minister responsible, if they are contacted by any organisations which say that they have not been included in the consultation. I know that sometimes, noble Lords kindly apologise for writing to me, but that is my job as the Minister, and I accept that I should be held to account in this place. I hope that noble Lords, if they feel that any organisations are being ignored, will write to me.

The noble Baroness, Lady Bennett, rightly raised concerns, which we have received, regarding how this relates to abortion. For the avoidance of doubt, the Bill is limited to the needs of a person with Down’s syndrome after they are born. This means that it does not address abortion. This Bill gives authority to the Secretary of State to produce statutory guidance which will clarify existing frameworks and practices. Statutory guidance cannot be used to amend primary legislation such as the Abortion Act. By setting out in statutory guidance the steps that would be appropriate for health authorities to take when providing services and support to people with Down’s syndrome and their families, we believe there will be a wider positive impact for expectant parents who are told their unborn baby may have Down’s syndrome. However, the Bill is still about the child after they are born.

I thank my noble friend Lord Farmer for engaging with me on this issue. The Government rightly recognise that people with other conditions may experience similar problems. This is why I reiterate the commitment made by the Minister in the other place that we will consider the overlaps and linkages, as my noble friend Lady Neville-Jones said. We recognise the concern about services prioritising different groups of people in a way which is not focused on assessing people’s needs. I point out that any preference of which noble Lords may be fearful would be unlawful under the Equality Act 2010. The guidance is about making clearer the steps that could be taken to meet the unique needs of people with Down’s syndrome. This is something the guidance could emphasise strongly. We will engage and consult upon this in detail when developing the guidance.

Turning to one of the issues raised by the noble Baroness, Lady Uddin, I hear the concerns expressed about consulting with people with Down’s syndrome and other conditions. We are committed to ensuring that this guidance works, and that it evolves as we learn more. We believe that the best way of addressing this is to do it once the Bill has passed. Issues were also raised about the completion of the SEND review. Unfortunately, it has been delayed due to the pandemic. Also, the pandemic has highlighted some very real issues, and exacerbated some of them. Therefore, even though it is irritating that it has been delayed, it is only right that we take advantage of the light which has been shone upon the exacerbation of those conditions to ensure that we have appropriate guidance.

The Department for Education plan to publish proposals arising from the review of a public consultation by the end of this month. It is important to hear from a wide range of people, including the noble Baroness, Lady Uddin, given her years of experience, as well as the many organisations with which she has worked over the years. I emphasise that this is not about giving preference to people with Down’s syndrome. It is clear that to do so would be illegal under the Equality Act 2010.

In conclusion, I know that there are noble Lords who have concerns about this, and I am grateful to the noble Baroness, Lady Thornton, for her commitment that she will support the Bill. I make a plea to all noble Lords. Given, as my noble friend Lady Neville-Jones said, the time frame and the amount of legislation we trying to get through, if this Bill is amended, it may well fall.

Some of your Lordships may have read the Robert Caro biography of Lyndon B Johnson. In that book, it talks about his amazing career and at the end, one of the things it covers is the 1957 Civil Rights Act. That was criticised by a lot of people for not doing enough. Johnson’s plea to them was, “Let’s take this, bank it and build on it”. That led the way to the 1964 Civil Rights Act. Now I am not saying that I want to equate those Acts in any way with the Bill, but they are about recognising issues that ought to have a spotlight shone upon them.

I therefore make this plea to noble Lords: let us together take this step. Please let us support the noble Baroness, Lady Hollins, for all the work she has done and for the way she has pushed the Government during the Health and Care Bill and highlighted many of these issues. One of the things I find as a Minister in this place is how much I am still learning daily, about not just my portfolio of technology, innovation, life sciences and international relations but the many conditions that people have, and what more we can all do to help them. I hope that noble Lords will feel able to support the noble Baroness, Lady Hollins, and not amend the Bill, otherwise we risk not taking that first step.

[Baroness Neville-Jones (Con)]

My Lords, on the basis of what my noble friend the Minister has just said, is he open to further discussion on the Bill between now and Committee? I did ask, but I do not think he said whether he was ready to talk further. I think there are perhaps others in the Chamber who might be interested.

[Lord Kamall (Con)]

I hope the noble Baroness will not take this personally and I am sorry I forgot to answer that specific question. I am sure noble Lords will recognise that a number of questions were directed at me. I hope they will also recognise that I always try to answer as many questions as I can, and we go through Hansard to make sure that we sweep up afterwards, as it were, and write to noble Lords. I will of course be happy to have further conversations. It may be me or the relevant Minister at other times, but I am very happy to make sure that there is a Minister who will consult with the noble Baroness, and with any other noble Lords who feel that their concerns are not being heard enough; we can make that commitment.

Cigarette Stick Health Warnings Bill [HL]

Lord Kamall Excerpts

3rd reading
Friday 18th March 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I pay tribute to the noble Lord, Lord Young of Cookham, for his tireless efforts and creativity—over many decades, as we have heard—in tackling the negative effects of smoking on the health of individuals and communities. This is a considered and sensible Bill, and we are happy to support it today.

Additional health warnings at the point where people are about to smoke, on cigarettes and cigarette papers, is not a measure for its own sake; it is a further step towards helping to drive down smoking rates and indeed discourage people—especially the young, as the noble Lord referred to—from starting to smoke in the first place. By our doing this, people will have the chance to live longer and have healthier lives, and health inequalities between the richest and the poorest stand a chance of being reduced. For every smoker who dies, there are another 30 who are suffering from serious smoking-related diseases.

Just this week, on Report on the Health and Care Bill, your Lordships’ House voted in favour of a consultation to explore whether the “polluter pays” principle might be effective in the case of tobacco. This Bill seems to chime well with the mood about the direction that smoking legislation in the UK needs to go in. I wish the Bill every success and once again congratulate the noble Lord, Lord Young of Cookham.

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

My Lords, I congratulate my noble friend Lord Young of Cookham on progressing his Private Member’s Bill to this stage and securing this important debate. I am sure the many numbers of people who wish to quit smoking will also be grateful to my noble friend for his long-standing commitment to this cause, as my noble friend himself said, since his time as a Health Minister in the 1980s.

I thank noble Lords for their contributions today and at Second Reading, as well as during the debate on the Health and Care Bill when tobacco controls came up. Your Lordships’ continued engagement highlights how important this issue is and how it will continue to be an important issue for this House.

As I have stated before to this House, the Government are committed to reducing the harms caused by tobacco and are proud of the long-term progress that successive Governments of different parties have made in reducing smoking rates, which are currently, at 13.5%, the lowest on record. However, we cannot be complacent. With nearly 6 million smokers in England, smoking is still one of the largest drivers of health disparities and causes a disproportionate burden on our most disadvantaged families and communities.

I am grateful to noble Lords who have acknowledged that, as part of our plans to make England smoke free by 2030, we have commissioned the independent review into tobacco control, led by Javed Khan OBE. The Khan review has been asked to set up focused policy and regulatory recommendations for the Government on an evidence-led basis, including on what the most impactful interventions could be to reduce the uptake of smoking, particularly among young people, but also about how we support smokers in quitting for good. As my noble friend rightly said, we are hoping that this will be ready by the end of spring this year.

I am grateful to all noble Lords who have met Mr Khan directly, sharing their ideas and allowing him to consider them and the proposal in the Bill among other reforms to encourage smokers to quit. The independent review will both inform the health disparities White Paper and support the development of a robust tobacco control plan. I have been assured—because I know noble Lords are not always keen on the phrase “in due course”—that the White Paper and the tobacco control plan will be published later this year.

Our plans will have a sharp focus on helping to level up society and support disadvantaged groups. As I hope many noble Lords will acknowledge, this Government are committed to tackling disparities. I am sure that noble Lords will probably get tired of the number of times that I have spoken about the Office for Health Improvement and Disparities. We have to tackle those disparities. Where we know that the rates of smoking are highest, we truly want to make smoking a thing of the past. We want to have a healthier population as we build back better from the pandemic.

Once again, I thank my noble friend for this important debate. I thank all noble Lords, and I hope we can all work together to help to make England smoke free by 2030.

Bill passed and sent to the Commons.