NHS England Update

Lord Kamall Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, no one can really disagree with the intention to reduce unnecessary duplication between the NHS and the Department of Health and Social Care, so these Benches welcome these proposals where they ensure value for money for taxpayers and free up money from bureaucracy to spend on front-line services. One of the many things that many medical staff have complained about is the amount of paperwork. We hope that these reforms and better investment in technology will reduce the time spent on administration. Although administration can be tedious, it provides much-needed data to monitor the level of services and, we hope, to improve patient care. But these changes need to be judged on more than just money; they must make sure that the patient remains at the centre of the conversation when we talk about our system of health and care.

We have had many reforms over the years, and whether these reforms are the right ones can be judged only on what comes next. My noble friend Lord Lansley, who has been much maligned recently, has written that the lesson he learned from the 2012 reforms is that his Government, and subsequent Governments, delivered only one part of the intended reforms—creating NHS England—but did not always intervene when NHS England sought to block other reforms, such as clinically led local commissioning, competition and choice, choice of large-scale commissioning support organisations, tariff reform, “any qualified provider”, and an annual mandate from the Government and Parliament to the NHS, with accountability through the NHS outcomes framework. This, he believes, is what led to the centralised, bureaucratic system that the Government are trying to reform.

Whether noble Lords agree with my noble friend or not, surely the lesson is to have an overall plan for reform and to intervene when a bureaucracy is a barrier to further reform. For this reason, noble Lords look forward to the publication of the 10-year plan. I wonder, at this stage, whether I can tempt the Minister to say whether she is any closer to giving us a date for that 10-year plan. I suspect that these reforms have to be seen in conjunction with the 10-year plan, and cannot be seen in isolation.

Given these lessons, where clinical leaders are calling for greater autonomy from centralised control in order to offer better care for patients at a local level, how do the Government intend to balance centralisation to the DHSC with empowering clinicians and giving them autonomy at a local level? They are better equipped to know what services are needed locally.

I know from my experience of organisational change that it is often not enough to change structures if the organisational culture does not also change. I will give your Lordships an example. I had an operation in Brussels a few years ago, and when I came back to the UK I wanted to have my annual check-up. I contacted a GP and eventually got a double appointment: an ECG at a local health centre, and a consultant phone call a week later. I thought that this was really good and modern. The ECG went smoothly and, a week later, I got a phone call from a junior doctor in the consultant’s office. It was clear that he had not seen the ECG, so I asked him, “Have you seen the ECG?” He said, “No”. I asked, “Can I tell you exactly what time, what day, and where it was, then you can call me back and we can discuss it?” He refused, and said, “I’ll just make a new appointment, including a new ECG”. I wonder what it is in the system that incentivises this sort of behaviour, rather than making that phone call and saving taxpayers an awful lot of money.

Although these changes will save money, which is welcome, can the Minister provide clarity to the House on how these reforms will drive efficiency and cultural change within the health service, and ensure that we improve care, with patients at the centre?

One of the key challenges your Lordships will be aware of when dealing with the NHS is the lack of willingness to own mistakes and accept responsibility. The NHS needs to be better at taking responsibility when targets are missed and things go wrong. Can the Minister assure your Lordships that the new structure the Government propose will have clear lines of responsibility, redress and transparency? Will it allow noble Lords, other politicians and people throughout the country to understand how the NHS is governed, who is responsible for what and how it operates? I look forward to hearing from the Minister, and I hope that we can work constructively, on a cross-party basis, to improve patient outcomes and our system of health and care.

[Lord Scriven (LD)]

My Lords, the Government, with their sovereign right, propose the abolition of NHS England. Although the method of delivery is a matter for the Secretary of State to propose, governance changes in themselves will not achieve better outcomes. These Benches will continue to point out that chronic operational issues in the NHS cannot and will not be dealt with effectively until the Government show the same speed and determination to deal with the social care crisis. The Minister must know that you cannot have 13,000 hospital beds full of people medically fit for discharge and pretend that a change of who sits in what chairs in the governance of the NHS will solve that issue. When will the Government commit to a timetable to restart the cross-party talks to deal with this important issue?

The paramount—indeed, the sole—objective of any organisational change to the NHS must be demonstrable improvement of patient experience and outcomes. The Government assert that this change will improve efficiency and streamline services. However, assertions alone are insufficient. We require rigorous evidence, not mere conjecture.

Therefore, I am going to ask the Minister five questions. First, and most importantly, what detailed analysis has been conducted on the projected impact of this abolition on patient outcomes? We require more than abstract pronouncements. For instance, how will it improve cancer treatment? What will these changes do to improve access to GP services? How will they improve local integration, particularly when 50% of funding for ICBs will be reduced across the board?

Secondly, what specific legislative changes are required to abolish NHS England and redistribute its functions? I note that the Secretary of State pointed out that the Government could predominantly go ahead with these changes but that legislation is required, so will the Minister explain to the House exactly what legislation will be required to bring about this change? Will she give a commitment that no redundancies will take place until legislation has been passed and these changes have been given the go-ahead by this House and the other House?

Talking of redundancies, my third question is: what are the estimated costs of redundancies associated with the abolition of NHS England, including not only financial implications but the potential loss of expertise and institutional knowledge? Furthermore, will the Minister indicate whether any departing executive has been offered a severance package exceeding statutory redundancy limits and, if so, how many? What justifications are there if such arrangements have been made?

Fourthly, how will the Government ensure continuity of service during the transition period? Any disruption to patient care is unacceptable, so when will there be a robust plan that outlines how essential services will be maintained, how staff will be supported and how the public will be kept informed?

Finally, in line with what the noble Lord, Lord Kamall, said, what mechanisms will be put in place to ensure ongoing accountability and transparency in the newly restructured healthcare system? How will the Government measure success—not just of the times in which people are seen but that these changes have contributed to improvements in patient care? The Government are the custodians of this vital public service and have a duty to ensure that any changes to NHS structures are driven by evidence, guided by principle and focused relentlessly on improving the lives of the people it serves. They must proceed not blindly but with clarity, so I look forward to the Minister’s answers.

NHS Dentistry

Lord Kamall Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

There is a cavity that needs filling. I defer to the usual channels, the senior leadership, the leaders of all parties, the Convenor of the Cross Benches, and all the other bodies that decide who should be in this House.

[Lord Kamall (Con)]

My Lords, I say to the noble Baroness that when it comes to comedy, she is doing an excellent job as a Minister.

[Noble Lords]

Oh!

[Lord Kamall (Con)]

I am sorry—I hope she takes that in the way it was intended. She is a wonderful comedian and a wonderful Minister. How about that? Hopefully, I have redeemed myself in the eyes of the Minister.

One of the frustrations of the past on this issue has been the battle between the Treasury and the department over the unit of dental activity—the UDA—as the noble Lord, Lord Rennard, said. That is how much dentists are paid for each patient they see. Can the Minister tell your Lordships about the conversations that her department is having with the Treasury? For example, how willing is it to raise the UDA in dental deserts to encourage local dentists who exist in those areas but do not see NHS patients? What conversations is the department having also with dental charities in the shorter term to help fill some of these gaps?

Safe Housing and Hospital Discharge

Lord Kamall Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend has given me an invitation to agree with him. As he knows, it would be quite inappropriate to suggest that integrated care boards are not integrated or about care—that is their focus—but I appreciate his view on the matter. I do agree with him that much good work is done on the health and well-being boards. This all says to me that local decision-making, and local provision for local populations with their particular dimensions and demands, is the best way forward. My final point on this question is that local systems have to agree plans to achieve more timely and effective discharge from hospital, and to work with local authorities to develop those plans.

[Lord Kamall (Con)]

My Lords, NHS data from last month revealed that there are about 13,800 people who are medically fit for discharge, which is up from 12,000 patients awaiting discharge on 1 December. As other noble Lords have said, we know that that causes a bottleneck in hospitals that is not good for patients while they wait to go home. As has been said, one way to reduce that bottleneck is the greater use of virtual wards, allowing people to stay in their home for longer, to be monitored in their home and to receive care. The Minister has answered this question to a certain extent, but can she tell us more about the Government’s overall plan for virtual wards, not just in this case but for physical and mental health care, in order to ensure that we can get more patients out of hospital beds and into their homes, where they can receive the care they deserve and be constantly monitored?

[Baroness Merron (Lab)]

I am glad that the noble Lord shares my enthusiasm for virtual wards. I shall expand on what they are: they allow people to be not in hospital but in their own home, whether it is their personal home or whether their home happens to be in a care home or some other setting, by the use of technology that allows them to be monitored. I recently saw an excellent example of that, and the liberation that it provides for individuals who would much rather not be in hospital is key. The noble Lord will know that, in the 10-year plan, the move from hospital to community is a key pillar, and we will soon be reporting on that. I certainly share his enthusiasm.

Soft Drinks Industry Levy

Lord Kamall Excerpts

Tuesday 18th March 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, although sugar taxes and levies are examples of top-down state solutions to tackle obesity, I will ask the Minister about grass-roots, bottom-up solutions. She will know of non-state local civil society projects that work in communities to encourage healthier lifestyles, such as BRITE Box in south London, which offers recipes, ingredients and budgeting advice to help low-income families cook and eat more healthily. Can she tell your Lordships how the department works with such local projects to tackle obesity and how that best practice has spread to other communities? Could she also write to me with a list of some of the projects that her department is aware of, so that all noble Lords could learn a bit more?

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Lord on this matter. I pay tribute to all of those community third sector organisations that work in line with government direction to reduce obesity. There are many aspects to this: it is not just about what community organisations can do but, for example, about implementing TV and online advertising restrictions for less healthy food. In all these ways, we will be able to make progress to reduce obesity.

Primary Healthcare Facilities

Lord Kamall Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Merron (Lab)]

We will be providing further details in the national implementation programme, but I can say that neighbourhood health guidelines have already been published to help ICBs, local authorities and health and care providers to continue to progress neighbourhood health. We will trial neighbourhood health centres to bring together a range of services, and others that the noble Baroness refers to, to ensure that healthcare is closer to home and that patients receive the care they deserve when and how they need it.

[Lord Kamall (Con)]

My Lords, we know that the Government are keen to encourage more investment into our national infrastructure—which these Benches welcome. Given that, what conversations are the Department of Health and Social Care and the Treasury having with pension funds and other funds on investing in neighbourhood primary health and care facilities, and indeed in other parts of our system of health and social care?

[Baroness Merron (Lab)]

Although I cannot give a specific answer to the noble Lord on that point, I will be happy to look into it. As I mentioned earlier, in our discussions with the Ministry of Housing, Communities and Local Government we are, for example, looking at how we can lever greater contributions from developers who are working on new developments, where they will be providing much-needed health services and infrastructure. So we are taking a creative approach because we recognise the need to do more.

Apricity Fertility Closure

Lord Kamall Excerpts

Wednesday 12th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. The legislation goes back to 1990. We are in 2025, and there has been an advent of many new technologies, techniques and business models—for example, the noble Baroness, Lady Owen, referred to Apricity—that were never imagined just a few years ago, let alone in 1990.

The majority of clinics are privately owned. Many are part of large groups with external finance. Elements of fertility care and associated treatments are increasingly offered online or outside HFEA regulation. There is a huge challenge here. That is why we are in discussion with the HFEA, and we will be in discussion tomorrow.

[Lord Kamall (Con)]

My Lords, the Minister will recall that in 2022 the previous Government published the 10-year Women’s Health Strategy for England. During the consultation process, it came out that access to fertility services differs greatly across the country—possibly one of the reasons that many women went to Apricity in the first place. Part of the solution that was proposed to tackle these disparities was a target to establish women’s health hubs. I understand that the current Government have decided not to go ahead with these women’s health hubs. My question is not why, but how the Government envisage tackling these disparities without women’s health hubs. What is the strategy for doing that?

[Baroness Merron (Lab)]

Women’s health hubs—which are a huge success and we continue to support and promote them, without any shadow of a doubt—do not deal with fertility treatment in the way this Question is discussing. I gently point out to the noble Lord that, as he rightly said, commitments were made to improve access to fertility services, which is very variable across the country. They were made under the last Government’s women’s health strategy but, regrettably, were not delivered. It now falls to us to look at how we can improve both availability and quality, and to equalise what is available, which is a huge challenge. This continues to concern me.

Autism and Learning Disabilities: Hospital Detention

Lord Kamall Excerpts

Tuesday 11th March 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise the fact that at the end of January 2025 there were some 2,065 people with a learning disability, autism, or both, in mental health in-patient settings. The population I referred to is not a static one; there are new admissions every month. We know, for example, that in January 2024, some 10,000 discharges to the community had been undertaken since 2015. So it is not necessarily the same group of people. She will know that funding decisions are made at the appropriate point. Again, this is a matter of great importance to the Mental Health Bill, and we will continue to take that through the House to get it into the best place possible.

[Lord Kamall (Con)]

My Lords, during the 45 years that this poor autistic lady with learning disabilities was detained and the 25 years she was in segregation, we have had Governments of all political colours, so this is clearly not a political issue. Indeed, I remember the Minister challenging me on such detentions when I was in her place. Given that, are the Government any closer to understanding the barriers that prevent such patients from being released into the community? Rather than assuming that the state always has a solution, have the Government and the NHS had conversations with local community civil society organisations so that they can support these patients once they are released into the community?

[Baroness Merron (Lab)]

This matter is one of concern on all sides and yes, indeed, we continually have those discussions, because this is not just something for the NHS and social care—the third sector is absolutely key. I have already outlined the measures we are currently taking and the way in which we continue to monitor.

On the question about obstacles, it is about having the right community provision in place and also about having the right pathway and treating people as individuals. Increasingly, that is the case, and a revised Mental Health Act will be a tremendous support in this area.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Lord Kamall Excerpts

Monday 10th March 2025 Grand Committee

The requirement, now to be removed, for secondary legislation was introduced as a result of transposing EU regulations into a UK context at the time of EU exit—so much for reducing red tape as a so-called benefit of Brexit; it has clearly resulted in more red tape rather than less. However, as we have seen today, and as another Member of the Committee mentioned, secondary legislation can be helpful to Parliament as it gives parliamentarians an opportunity to keep themselves informed by scrutinising the issue in detail, hearing from the SLSC and asking Ministers questions, as we are doing today. In future, the onus will be on Parliament to keep itself informed, which will be challenging given the number of issues that cross people’s desks every day. Will the Minister consider whether there is any way in which the FSA could be asked to assist Parliament, such as by laying regular parliamentary Statements about any changes to authorisations every few months? That would help us enormously and avoid us having to do all this.

[Lord Kamall (Con)]

My Lords, I welcome the noble Lord, Lord Moraes, to his place. We served together in the European Parliament, of which he was a well-respected member. I thank the Government for sending out so many big guns—I think I count six on the Front Bench in this Room. I will not flatter myself that they are here for me, but I am impressed by how seriously the Government are taking this statutory instrument.

I thank the Government for addressing the concerns of the Secondary Legislation Scrutiny Committee. The noble Baroness, Lady Walmsley, rightly said that questions were not answered, but it is good that the Government were able to address those concerns, and we are grateful for that. Like my noble friends Lady Coffey and Lady McIntosh of Pickering, I think that these Benches generally welcome measures to streamline processes, but I understand potential concerns over the safety and oversight of regulated products. As the saying goes, one person’s safety standards may be another’s red tape. That was something that the noble Baroness, Lady Bennett, alluded to.

We welcome that there was a consultation between April and June 2024. I understand that, while there was broad agreement in principle, there were some concerns and disagreements, which I would like to ask the Minister about today. Before I do that, I shall pick up on the issue of GMOs. Let me clear—I have nothing in principle against GMOs, but for consumers it is important that there is labelling, so that they can make that choice in an informed way. When we were in the European Parliament and negotiating the Transatlantic Trade and Investment Partnership with the US and made the point about labelling GMOs, what was interesting was that the US negotiators would say, “That’s a non-tariff barrier”. If the Government intend to label GMOs, is that an issue that will be brought up in future trade negotiations? The Minister may not be able to answer that immediately, but perhaps she can write to us about it, or ask her colleague who is taking through trade issues at the moment.

The Government claim that these changes will provide businesses with quicker approval times, increasing the return on investment and stimulating innovation. That is of course to be welcomed, but we should always be aware of two things. What happens in the case of negative unintended consequences, and what happens if new evidence comes to light that shows that a product authorised under these terms presents previously unforeseen risks to public health or the environment? That is something that other noble Lords referred to. In a situation where regular renewals are no longer required, can the Minister assure your Lordships if and how products covered by this regulation will be reassessed, if any new data emerges that suggests that they are not as safe as originally thought, especially if these products are already on the market?

I understand that the Food Standards Agency and Food Standards Scotland have the power to conduct evidence-based reviews if new information surfaces, but can the Minister assure us that a less regular review mechanism will not compromise safety? I think that she mentioned the phrase “where necessary”. Can she put more meat on the bone and explain a bit more what that means? What mechanisms are in place to ensure that products remain compliant with safety standards over time? We know that regulation is often outpaced by innovation, so how do the FSA and the FSS plan to stay ahead of new risks or scientific developments with less regular oversight than these renewals once provided?

The second potential concern is that the Government do not appear to have conducted a formal impact assessment of these proposals. Given that these regulations will affect a significant number of products and legislative instruments, could the Minister tell noble Lords whether it is correct that no formal impact assessment was conducted and, if not, why not? Was there an informal impact assessment of any kind, and why was it decided that no formal impact assessment would be needed? Can the Minister assure the public that the full range of potential risks and benefits has been properly assessed?

Finally, as noble Lords may know, I spent 14 years in the European Parliament—not as long as my friend, the noble Lord, Lord Moraes. I was often frustrated by EU regulations, because they were more often than not based on the precautionary principle, or the over-precautionary principle, rather than the innovation principle. It is important that we get the balance between innovation and precaution right—I welcome that. I am not necessarily against divergence between UK and EU regulations, especially when it allows innovation, but could the Minister tell your Lordships what conversations the Government have had with EU counterparts and colleagues in Northern Ireland about the potential impact of these regulations on the Windsor Framework?

Overall, while these Benches welcome the regulations, I hope that the concerns expressed during the consultation, and today by other noble Lords, can be addressed by the Minister.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their valuable and considered contributions to the debate today. I re-emphasise the main point I made in my opening comments: removing automatic renewal processes and statutory instrument requirements will not lower food safety or standards. I am grateful for the support from the noble Baroness, Lady Coffey, and for her bringing to bear her experience across relevant departments, as well as from the noble Baroness, Lady McIntosh, and the noble Lord, Lord Kamall.

I have heard a number of concerns, including from the noble Baronesses, Lady Bennett and Lady Walmsley. I understand the points made, and I hope that I can reassure them further from my opening comments. I am very happy to follow up where I have not got the ability, time or wherewithal to answer the questions.

The noble Baroness, Lady Coffey, asked about ministerial decision-making and the assertion of the non-discrimination principle. These reforms do not change what is in place to maintain the functioning of the internal market Act. Differences in approach will continue to be managed through the relevant common frameworks. I reassure not only the noble Baroness but other noble Lords that the FSA and the FSS are strongly committed to achieving a four-nation consensus, in line with our commitment to the food and feed safety and hygiene common framework. Decisions by Ministers in England—which will be from the Department of Health and Social Care, to the point brought up by the noble Baroness—as well as Scotland and Wales, will still be required for authorisations in their respective nations.

The noble Baroness, Lady McIntosh, asked about processes that will be followed with the removal of the renewals process. This SI does not change current GMO labelling requirements, which I know was another matter of concern to other noble Lords. Products that contain or consist of GMOs must be clearly labelled as defined in current legislation. Nothing will change in that regard. Following the reforms, businesses will continue to be required to notify the FSA and the FSS, if they have any new information which might affect the suitability of a validated laboratory-based method for the identification, detection and qualification of GMOs, something that the noble Baroness, Lady Bennett, was also concerned with.

To the point about the SLSC, it is suggested that the House may wish to consider the steps proposed to maintain parliamentary oversight. However, proportionate processes are in place for sufficient scrutiny of authorisation decisions, such as public consultation and the publication of safety assessments and authorisations. It is an important point that the authorisation process remains open and transparent. The SLSC recognised that this aligned with the processes used by other UK regulators.

Prostate Cancer: National Screening Programme

Lord Kamall Excerpts

Thursday 27th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I was glad to have the opportunity to discuss this with the noble Baroness. Having looked into it, we do not currently hold this data. However, where strontium therapy is appropriate and preferred to improve patient outcomes, it will be offered. This is, of course, a clinical decision.

[Lord Kamall (Con)]

My Lords, when I worked in Belgium, a urologist told me that men over 45 years old should seek a test every year for this. When I came back and asked my GP, he was dismissive of that, saying that I should seek a PSA test. When I asked a nurse at my next blood test for a PSA test, she said, “Are you sure? They’re not very reliable”. Given that the last Government introduced trials, and that one of the tests seems to be 96% accurate, can the Minister say any more about that trial and its evaluation, and whether we are any closer to a definitive test? If not, what guidance is available to medical practitioners for the PSA test?

Musculoskeletal Health: Chiropractors

Lord Kamall Excerpts

Wednesday 26th February 2025 Lords Chamber

[Baroness Merron (Lab)]

Working with community-based organisations, including faith communities, has come up a number of times in the 10-year plan consultation, as I am sure the right reverend Prelate will find. I would certainly associate myself with the comments about the importance of getting healthcare provided in the community.

[Lord Kamall (Con)]

I thank the Minister for giving me the time to ask a question. Following the tragic death of Joanna Kowalczyk in October 2021, the coroner has recently raised concerns over the fact that chiropractors are not required to request their patients’ medical records before they begin treatment. While I recognise that there is scepticism from many in the NHS, and in fact physiotherapists, towards osteopaths and chiropractors, will the Government take on board the recommendations of the coroner to look at changing guidance to ensure that all healthcare treatments require consideration of a patient’s medical history, especially as we move toward a digital single patient record that could be shared across our system of health and care?

[Baroness Merron (Lab)]

The noble Lord raises an important point about what is required before healthcare is provided. I can certainly assure the noble Lord that, as I know he is aware, where there is a coroner’s report, we look at all of the lessons to be learned to consider how we might make it a safer and more effective environment for people. Certainly in the case to which he refers, that will happen.