Youth Sport Trust Report

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Tuesday 11th October 2022 Lords Chamber

[Lord Kamall (Con)]

We are working across government on this. With DfE, we are looking at opening up existing sports and leisure facilities, including schools. We have to work with schools to work out what works for them and how we share the cost, to make sure they do not have an unfair burden on them. We are now working on the third phase of the opening school facilities programme to meet those needs. This phase will look at consistency in the school system and how to connect schools to national and local sporting activities and providers, as well as making sure that children get access to extra-curricular activities, whether at school or local sports clubs.

[Baroness Bennett of Manor Castle (GP)]

The Minister referred to the importance of making use of existing systems and spaces. He may be aware that 80% of public space in London is made up of streets, a figure that is reflected in many other cities around the country. He may be aware of the play streets scheme, whereby neighbours get together and close streets to allow children to play out in them—and adults to get together and mix. There is also the school streets scheme. As part of Learn with the Lords, I recently visited Challney boys’ school in Luton. It is desperate to get a school street outside it so that pupils can walk and cycle to school more often. Should we not ensure that those streets are far more often spaces where children can take physical exercise and play informal sports?

[Lord Kamall (Con)]

The noble Baroness makes a very important point about the use of streets. A number of countries do this across the world. I remember going to Guyana as a young boy in 1976 and playing cricket in the street. That was the culture of sport in those days. There are also a number of existing playing fields and facilities that we want to take advantage of, but I would be far more interested in play streets. If the noble Baroness could write to me or meet me to give me more details, I would be very interested in learning more.

Urgent and Emergency Care

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Tuesday 6th September 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for his question. We have a debate this week tabled by the noble Lord, Lord Patel, on reform of the health system. One thing the noble Lord believes, as do a number of other practitioners and noble Lords who have worked in the health service, is that it is time to reform the old model of seeing your GP, getting five or 10 minutes if you are lucky, and then being referred to secondary care elsewhere. In this day and age, we need such reform. We need to take advantage of data and new technology but also to look at work processes. Some of the stuff that was being done in secondary care until recently can now be done at primary care level. Even in primary care, it does not always have to be the doctor who sees the patient; it can be a practice nurse, a physiotherapist or a local civil society group.

Clearly, there is a need to look at the model of the NHS and how services are provided; all parties recognise that there are areas for reform. It would be great if we could get consensus but, sadly, this issue is too much of a political football. When I speak with my friends from other parties, we say candidly that something has to change and that there has to be reform, but it is clearly too tempting to bash any Government. I know that, when we were in opposition, we would have bashed the Government of the day on health. It is, sadly, too tempting a political football.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I follow on from a point raised by the noble Baroness, Lady Merron. The Statement refers to the new contract with St John Ambulance—I join others in welcoming that—and to recruiting call handlers, paramedics and social carers. There is no reference to the acute crisis we have regarding doctors, nurses, midwives and associated health professionals.

To pick up on the question of whether we need a royal commission and systems change, the underlying situation is that the UK has 2.8 doctors per 1,000 people and 7.9 nurses, which is the second lowest in the OECD. Our number of hospital beds per head of population is on average lower than everywhere in the OECD but Denmark and Sweden. We simply have an acute lack of resources, which is independent of systems and is putting enormous pressure on services. We are now seeing huge pressure being put on medical professionals. Being a specialist in A&E is an acutely difficult and challenging task. The issues of ambulance response times and the queues of ambulances outside A&E are clearly putting huge pressure on people.

The Minister referred to the fact that, as we speak, we have a new Secretary of State. Surely it is time to acknowledge the contribution that those doctors, nurses and other medical professionals are making, through some kind of new, big gesture from the new Secretary of State to say, “We have to keep you. We really value you.” We are recruiting new people but others are walking out of the door as quickly or more so. This has to change. Surely a recognition of the care and service that has been given and continues to be given would help.

[Lord Kamall (Con)]

The noble Baroness makes a very important point which noble Lords across the House will agree. We should pay tribute to the hard work of medical staff in our system of care; there is no doubt about that. I take the point that this is about not just the ambulance service but other parts of the health service. In fact, had my right honourable friend the former Secretary of State stayed in post, he would have issued subsequent Statements on what we are doing about the GP workforce and some of the other issues that noble Lords have raised.

It is clear that one of the issues is retention. The NHS has its people plan, published in July 2020. We understand that people are leaving and, yes, there are newspaper headlines, but what are the issues behind those headlines? There is a very difficult issue around pensions and, particularly for some of the wealthier GPs, whether it is worth their while, having built up a massive pension over the years. There has been a bit of discussion and to and fro with the Treasury over that. However, it is quite clear at trust and workplace level that we have to make sure there are well-being courses and that we are looking after staff. We also have to look at the individual decisions as to why people may want to leave.

No doubt many staff are exhausted after the last couple of years. An amazing amount of pressure has been put on them and, as the noble Baroness says, it is right that we find ways to send a strong message that we value them and want to keep them as well as recruit new staff. We also have to look at this against the wider picture. We have more doctors and nurses than ever before. The question is: why, despite that, do we have this pressure? It is because the demand is outstripping supply.

We are now aware of far more health conditions than we were, say, five, 10 or 20 years ago. When preparing for a debate on neurological conditions the other day, I asked my officials to list them all. They said, “We can’t do that, Minister—there are 600.” Let us think about that. We were not even aware before of all those conditions. How many staff does that require? Or let us think about mental health: 30 or 40 years ago, it was not taken seriously; it was all about a stiff upper lip and pulling yourself together. Now we take it all seriously, and have mental health parity in the health Bill, which will need more staff. We will have more staff—more doctors and nurses—but the demand will outstrip supply. That is why a proper debate is needed across parties.

--- Later in debate ---

[Lord Kamall (Con)]

I thank the noble Lord for sharing that personal story—the good and bad side of it. I was on a visit to a hospital a few months ago where they showed us a nice, new scanner, which they were very proud of. The question was: how much is that used? Does it sit empty at weekends? With more networks and being more connected, we can find out where there is capacity in the system. If there is equipment, why are there not staff available? It could be for staff absence reasons. If it is not there, where can people go? With more community diagnostic centres, you will find lots more diagnosis facilities and scanners, so if the acute place does not have it, there should be availability in the community.

On the wider question about being “radical”, the noble Lord will know that, while we may have candid conversations as friends from different parties, sadly, health is too tempting to use as a political football. There are some issues that people feel very strongly about. Some of the points about charging that the noble Lord mentioned would be seen as too radical by some, or as undermining the very ethos of the NHS. I think we have to be prepared to be radical and think the unthinkable, but, sadly, this is the formal, political debate that we have got, and we have to work within the remit of that debate. Why should it be, for example, that millionaires could not pay a little bit more to help—not through taxation, but maybe direct?

Some local trusts have tackled this issue. For example, my local trust has set up a private arm, but the money paid for private diagnosis or surgery is reinvested into the hospital to help NHS patients. I know that more than one trust has done that. That might be an interesting way of raising more money and making sure that people value the service and care they get.

On the specific issues, one of the reasons we are having this discussion is because the former Secretary of State was looking at all the issues that need to be tackled now, both in the short term and the long term.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the noble Baroness, Lady Brinton, referred to overseas recruitment of doctors and nurses. The Statement refers to the “international recruitment task force” for social care. I am not sure if the Minister is aware of the report prepared by the Rights Lab at the University of Nottingham, The Vulnerability of Paid Migrant Live-in Care Workers in London to Modern Slavery. If not, I ask him to assure me that the department will be looking at this. The report highlights real issues about the treatment of migrant care workers, particularly in live-in situations. It is a cross-departmental issue, looking also at immigration issues like being tied to one employer where migration status is a real problem. It also looks at the need for a registration system for recruitment agencies. Can the Minister assure me that the department will look at that?

[Lord Kamall (Con)]

I thank the noble Baroness for the question. I am not aware of that report. If the noble Baroness would be happy to send a copy to my parliamentary email, I will happily forward it to officials in my department and see if we can get an answer to that.

Health Improvement and Food Production

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Thursday 7th July 2022 Lords Chamber

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

My Lords, I also congratulate the noble Baroness, Lady Walmsley, on securing this debate. I am also grateful to all noble Lords for their considered and thoughtful contributions. It is a self-evident truth that we all need food to survive. However, as with many things in life, it is not enough simply to restate this. As noble Lords have rightly said, there are many factors to be considered. How is the food produced? Is it done sustainably? How affordable is it, and what is its impact on our health?

We know that access to good-quality, healthy food is essential to achieving our ambition to halve childhood obesity by 2030, to reduce the gap in healthy life expectancy and to reduce the number of people living with diet and weight-related illnesses. The Government are committed to supporting the production and availability of good food to help improve the nation’s health.

As noble Lords have referred to, our recently published food strategy puts food security at the heart of our vision for the food sector. Our aim is to maintain broadly the current level of food that we produce domestically and to boost production in sectors where there are the largest opportunities. It sets out our ambitions to create a sustainable and accessible food system, with quality products that support healthier and homegrown diets for all. Our farming reforms are designed to support farmers to produce food sustainably and productively and in a more environmentally friendly way, from which we will all benefit. I am sure we all want to see a sustainable and healthy food system, from farm to fork and catch to plate, seizing the opportunities before us and levelling up every part of the country so that everyone, wherever they live and whatever their background, has access to nutritious and healthier food.

We all know that the food we consume plays a role in our overall health. Covid-19 highlights the risks of poor diet and obesity, driving home the importance of better diets and maintaining a healthy weight. As noble Lords have referred to, the Eatwell Guide outlines the Government’s advice on a healthy, balanced diet. It shows the proportions in which different types of food are needed to have a well-balanced and healthy diet, to help meet nutrient requirements and reduce the risk of chronic disease. We know that too many of us are eating too many calories, too much salt and saturated fat and too many large portions, and are snacking too frequently.

While some parts of the food and drink industry are leading the way, by reformulating products or reducing portion sizes, and I think we should pay credit to those parts of the industry that have done so and sometimes met targets in advance of target dates, the challenge to go further remains.

We know that obesity does not develop overnight. When you look at the behavioural contributions, it builds over time through frequent excessive calorie consumption and insufficient physical activity. It is not the stereotype of Billy Bunter stuffing his face with 75 cream cakes. Even eating small amounts of excess calories over time can add up for both adults and children. It catches up with many people over time.

As noble Lords have rightly said, obesity is associated with reduced healthy life expectancy. It is a leading cause of serious non-communicable diseases, such as type 2 diabetes and heart disease, and it is often associated with poorer mental health. We also know now that it increases the risk of serious illness and death from Covid-19.

Helping people to achieve and maintain a healthy weight and a heathier diet is one of the most important things we can do to improve our nation’s health. We all have a role to play in meeting this challenge: government, industry, the health service and many other partners across the country. As a government, we can play our role in enabling healthier food choices by making a greater range of healthier food more accessible; by empowering people with more information to make informed decisions about the foods that they eat; and by incentivising healthier behaviours.

As noble Lords have acknowledged, the food industry supplies most of the food and drink that we consume. Therefore, it plays a critical role in supporting the aims that we want to see, such as selling healthier food and drink. Through our reduction and reformulation programmes, we are working with the food industry to encourage it to make everyday food and drink lower in sugar, salt and calories. The programme applies across all sectors of the food industry: retailers, manufacturers, restaurants, cafés, pubs, takeaways and delivered food. We have seen some progress since the publication of chapter one of the childhood obesity plan in 2016, with the average sugar content of breakfast cereals and yoghurts decreasing by 13%, and drinks subject to the soft drinks levy decreasing by 44% between 2015 and 2019. These statistics are very welcome, but we know there is more to be done.

However, we also need to be careful about the unintended consequences. As an example, when the sugar content of Irn-Bru was reduced, customers complained about the taste. How did the company respond? By claiming to rediscover an old recipe from 1901, which contained even more sugar. It was a huge hit with Irn-Bru drinkers. How do we address these unintended consequences?

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for giving way. He referred to “everyday food and drink” and the formulation thereof. Will he acknowledge that, if we are talking about everyday foods, we should not be talking about formulation? You do not talk in that way about fruit and vegetables, and unprocessed food.

[Lord Kamall (Con)]

The noble Baroness makes an important point, but we have to recognise the reality: not where we want to get to, but where we are at the moment. People do eat food that will need to be reformulated if we want to make it healthier. Of course, we know that fruit and vegetables are healthy, but not everyone, as we help them transition, will eat fruit and vegetables, or make stuff from the raw products. They will buy products in supermarkets, and therefore if they are buying them, we have to make sure that they are healthier and reformulated. We do not yet live in that ideal world where everyone buys fruit and vegetables, and cooks everything for themselves.

Given that, we also need new regulations on out-of-home calorie labelling. As we know, many people go to restaurants, buy takeaways or have their food delivered. It is important that we have calorie labelling for food sold in large businesses, including restaurants, cafés and takeaways, which came into force on 6 April 2022. As noble Lords are aware, there will be further legislation, on restricting the promotion and advertising of products high in fat, salt and sugar, which will come into effect in the next few years. I know that many noble Lords disagreed with the Government’s views on delaying some of those measures. We will continue to have the end-of-aisle promotion on the target date, but others, such as “buy one, get one free”, are delayed because of the trade-off with the cost of living crisis, but will come. It is delayed, but we have set target dates.

Once again, we have to be open—

Health and Care Bill

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

I wish my noble friend had stood up the moment I mentioned Amendment 10A. I can only apologise. I have received advice to agree with what my noble friend said. I shall very quickly move on and I thank him for his vast experience of this.

Let me move on to a couple of issues raised about mental health. We expect mental health trusts to play a critical role in ICBs and ICPs. The Bill sets out a minimum requirement. It does not specify what sort of care NHS trusts or NHS foundation trusts deliver. As we said earlier in the debate, we hope that ICBs by local agreement go beyond the minimum requirements. We clearly want to see parity of esteem between mental health and physical health.

Noble Lords mentioned public health. The department and NHS Improvement publications have stated an expectation of an official role for directors of public health in ICBs and ICPs. This recognises the vital advisory and leadership roles of directors of public health in the system-wide effort across all domains of public health, which is amplified by the shift to a more preventive, collaborative and integrated systems focus on improving population health. We are working very closely with stakeholders to shape this official role in relation to ICBs.

Can I just check that we talked about Amendments 14 and 32? Yes, we did. This is a more interactive session than many noble Lords would have expected. Perhaps it will do as a sort of novelty. I believe that Amendments 14 and 32 are aligned closely with the skills mix amendment, and I hope that will go some way to satisfying concerns.

On guidance, I am able to reassure your Lordship’s House that NHS England’s regional teams are having ongoing discussions with CCGs and will deal with ICB leaders about the potential membership of the ICB board on establishment. These discussions are focused on ensuring that the board will be effective in discharging the statutory duties of the ICB. Looking beyond this, NHS England is able to issue guidance to ICBs and will engage with them—to understand what issues are emerging during the initial period of operation —and their committees and how they are working with stakeholders. In some areas, NHS England is already developing draft guidance. For example, the proposal is that each ICB will be expected to have a named lead with responsibility for commissioning for learning disability and autism.

On regulations, we think the rules as currently set out in the Bill, and with the addition of the new skills mix amendment, are sufficient and will give ICBs the space they need to develop effective systems in their area. The Bill already includes a regulation-making power that covers any provision related to ICBs’ constitutions, including ICB membership. Therefore, if we deem it necessary in future to be more specific about ICBs’ membership requirements, we retain the ability to do so through regulations. I hope I have been able to provide some assurance—sufficient assurance—to noble Lords and that they will not move their amendments when they are reached.

[Baroness Bennett of Manor Castle (GP)]

I do not believe that the Minister has directly addressed Amendments 10 and 13. I am aware of the time, so perhaps he will agree to write to me about them.

[Lord Kamall (Con)]

That is a very wise suggestion by the noble Baroness, and I will acquiesce to it.

Medical Abortion Pills

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

As I said, we are looking at the consultation carefully and considering all views. If we made it permanent, there would be lots of criticism, which we have to be aware of and make sure that we have the answers for. If we continue to expect it to be temporary, there will be plenty of criticism. Whatever we do, we will be damned, but we are going to try our best.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the noble Lord, Lord Patel, talked about convenience of telemedicine for women. The fact is that women from the most disadvantaged backgrounds are three times as likely to need an abortion as those from the wealthiest backgrounds. It is not just an issue of convenience. It is a question of whether childcare is available and affordable; whether someone has a zero-hours contract job and cannot afford to take time off; or whether someone does not have access to public transport. This is very much an equalities issue—that abortion is available to every woman who needs it.

[Lord Kamall (Con)]

I agree with that statement but it is not what the Question is about. The Question is about a temporary measure that was put in place and whether it should be made permanent. It involves the consideration of difficult issues, including ethical issues, and we want to make sure that when we come to a decision, it is justified.

Health and Care Bill

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Lord Patel (CB)]

Can the Minister confirm what he just said: that it is the intention to bring regulations? How strong is that intention? The “may” creates a problem.

[Baroness Bennett of Manor Castle (GP)]

My Lords, can I add a question about timeframes to that? When can we expect the regulations?

[Lord Kamall (Con)]

I have two points to make to the noble Lord. First, I have been advised that this is standard wording. Secondly, I have made the assurance at the Dispatch Box. It is here; it is on public record that the Government intend to bring forward regulations. On the timeframe, I will either write to noble Lords or arrange a follow-up meeting. I will make sure that there is some communication to bridge that gap.

Elective Care Recovery

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Monday 7th February 2022 Lords Chamber

[Lord Kamall (Con)]

We hope that the funding will deliver around 9 million more checks, scans and procedures, and we hope to support our aim for the NHS to deliver around 30% more elective activity by 2024-25, compared to pre-pandemic levels. As part of that, we have allocated £2.3 billion to increase the volume of diagnostic activity, and we are rolling out at least 100 further community diagnostic centres by 2024-25 to help with the backlogs of people waiting for clinical tests such as MRIs, ultrasounds and CT scans. These increases will allow the NHS to carry out 4.5 million additional scans by 2024-25, increasing capacity and enabling earlier diagnosis.

[Baroness Bennett of Manor Castle (GP)]

My Lords, today I received a message from a member of the public who said that a relative had been told by their NHS doctor that they could not even give them a timeframe for when treatment would be available, but that they could ring a private hospital where treatment would be available in a couple of weeks. Does the Minister acknowledge that there is a real conflict in resources between private and public? What will the Government do to deal with people left in that really difficult situation?

[Lord Kamall (Con)]

The Government clearly recognise that there is a backlog, which is why we have announced the additional funding. We hope to announce the elective recovery plan very soon. The other measure that we have taken is launching My Planned Care, which allows NHS providers to upload supportive information to the platform to help patients to manage their conditions while they wait for treatment. There will also be personalised support, including advice on prevention services et cetera. We also hope that, eventually, it will have more data on expected waiting times, for example, so there will be more information for the patient. At the same time, we hope that the additional investment that we have announced will help to tackle the backlog in elective recovery.

Social Care Sector: Private Equity

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Thursday 27th January 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises an important point about the pay of staff. One of the things that we are looking to do with social care staff is to make sure that it is an attractive career and to persuade all providers to try to pay their staff a more sustainable wage. That is why we invested money into social care. We also must make sure that we get away from the situation where some private providers effectively subsidise state-funded providers, and make sure that they receive a suitable return.

[Baroness Bennett of Manor Castle (GP)]

My Lords, on a number of occasions, the Minister has referred to the fact that, if these complex financial arrangements go wrong, we have the ability to transfer patients. Would he acknowledge that, when patients are forced to be transferred, the shock is too much for some of them and they die or suffer significant health damage?

Sugar

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Monday 24th January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that catchy slogan; I wonder whether we could use it in some of our campaigns. As he rightly says, it is not just sugar. There are concerns about ultra-processed foods, for example, but also the size of portions. Many noble Lords will be aware that, for some simple products, the portion sizes have increased over the years, and if you want to get a small portion you have to either buy something and share it with someone or throw away half of it. We are looking at all these measures to make sure that our diets are healthier, that we have the right balance with smaller portions and that people are doing exercise. It is one thing is to consume those calories but another to burn them off.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Government buy 5% of the calories eaten every day; that is a figure from Henry Dimbleby. Does the Minister agree that the Government must do a lot more in a co-ordinated way to use government procurement in schools, hospitals, prisons and other institutions to ensure that the food available to people has far less sugar in it and, ideally, includes fresh fruit and vegetables rather than ultra-processed food?

[Lord Kamall (Con)]

I thank the noble Baroness for her recommendations for the sort of healthy diet we should have. She is absolutely right that, when government expects people to reduce their consumption of unhealthy food, it should set the way and lead by example. We are therefore looking at how we change diets in schools and across the public sector.

Health and Care Bill

Debate between Lord Kamall and Baroness Bennett of Manor Castle

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

[Baroness Bennett of Manor Castle (GP)]

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

[Lord Kamall (Con)]

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

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

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

--- Later in debate ---

[Lord Kamall (Con)]

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

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

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

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

[Baroness Bennett of Manor Castle (GP)]

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

[Lord Kamall (Con)]

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

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

Public Health: Night-time Working

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Thursday 6th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle]

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

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

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

[Baroness Bennett of Manor Castle (GP)]

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

[Lord Kamall (Con)]

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

Health and Social Care

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Monday 6th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for the points she makes. We are doing what we can to support the dedicated NHS staff in healthcare services. This year alone, we have invested over £15 billion on top of the existing NHS annual budget, and that includes funding to help get patients out of hospital, freeing up beds and supporting hospitals to manage Covid-19. In addition, we are looking at how we can tackle capacity issues on NHS 111 and A&E. We are giving NHS 111 £98 million to boost capacity, help people avoid unnecessary ambulance trips to A&E and take pressure off hospitals. We realise that NHS 111 is often the first port of call to provide urgent medical advice quickly and book time slots for people at their local A&E or appointments at alternative services. We are also delivering the largest ever seasonal flu vaccination programme, so we hope to tackle it on that basis. A number of CCGs and others are having conversations about how we can tackle the pressures on A&E.

The noble Baroness makes the point about staff who, during Covid, went way beyond the call of duty, and we managed temporarily to address those concerns. We are very grateful to staff who had retired and returned, and we are looking at whether that can be a long-term solution. We need to make sure that no one who is willing to come back is disincentivised. I do not have the details at the moment but I commit to write to her.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the first paragraph of this Statement says that it outlines

“the preparations we are making so that health and social care services remain resilient … and available to patients”.

How does that square with the fate of the residents of Berkeley House in Kent, which was home to adults with severe learning difficulties and autism, who were told at 7.30 in the morning that they would have to leave by 5 that evening? Among them was one resident who had to be sedated to ensure he could safely be moved. Berkeley House is owned by Achieve Together, one of a chain of companies registered through the tax haven of Jersey that ultimately appears to be owned by AMP Capital, a global investment firm based in Australia. How does providing a “resilient … and available” social care system line up with homes such as this being run for profit, not for the public or the residents’ good?

[Lord Kamall (Con)]

We have to recognise that if we look at the social care system, there are an awful lot of private providers. Quite often, when we look at private providers, it is private patients who subsidise their ability to provide places for state-funded patients. In our health system overall, there will always be a mixed economy, including state provision. Lots of our GPs, for example, are partnerships—they are not state-run, some of them are co-operatives, some are even for profit. When we look at the overall health system, there will be a general balance. I am not aware of the particular case, so I thank the noble Baroness for raising it, but one of the things we are committed to is making sure that we improve services, whether they are state-funded or private, as part of the overall system of healthcare that we have in this country. Clearly, where providers are not providing a service, there will be CQC and other assessments to see whether they are fit.

--- Later in debate ---

[Lord Kamall (Con)]

When you look at our health and social care sector, you see that one of the issues is a lack of joined-up thinking over the years. We have seen report after report about the future of adult social care gathering dust on the shelves—not forgetting that lots of people who are not older are also in the social care system. The White Paper we published last week was a first attempt to try to tackle the problem long term. We recognise that you have to look at the long-term issue—which, frankly, successive Governments have kicked down the road for years, and not really tackled—and we have made an attempt to do that with the 10-year vision we published last week. But we have also committed to the first three years of funding, to realise that vision. We now have a framework against which to judge future progress in adult social care, so that, overall, it is no longer seen as a poor relation of the rest of the health system and is properly joined up on a number of different levels—not only career paths but also the data that can be shared, so that you do not have the drop-off that happens when someone leaves hospital and enters a social care home and you have to find all that data again; the home is prepared to accommodate that patient with all their specific needs at the beginning.

In the longer term, with increases in technology, we hope that, instead of patients leaving hospital to go to a residential home, they will be able to return to their own home with the help of technology. All that will take time, but we have laid out that vision.

In the short term, we have laid out the winter plan, which includes looking at how we tackle some of these social care issues and how we recruit more social workers via the £162.5 million. The Made with Care plan will make sure that social care seems more attractive. For a long time, no one has really “sold” social care as a career. We want to ensure that it is seen to be just as valid a career as any other and offers a real career path. We also want to see a professionalisation of the industry, so that people feel valued.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in responding to my last question, the Minister referred to the mixed economy of ownership of healthcare provision. I am sure that he is aware that 84% of care home beds are provided by for-profit providers. Tonight, the “Panorama” programme is looking at HC-One, which is the biggest care home chain provider, with 321 care homes, formed in 2001 from the collapse of Southern Cross. I will not ask the Minister to watch the programme, since I know that he is a very busy person, but will he undertake to look at a summary of it, particularly the fact of the funding of HC-One, which appears to include a £540 million interest-only loan from a New York-listed property company? A great deal of this has been uncovered by the Centre for International Corporate Tax Accountability & Research.

[Lord Kamall (Con)]

I thank the noble Baroness for sharing all that data with me. The point remains that our system of healthcare will, through CCGs at the moment and integrated care services in the future, continue to commission some from the state and some privately; that is the way it is. What is really important is not who provides it but the care that the patient receives at the end of the day, and the fact that taxpayers are getting value for money. We should judge outcomes, not inputs.

HIV and AIDS

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

One of the best ways to help to vaccinate people across the world is through multilateral, bilateral and plurilateral partnerships. We will have donated 100 million coronavirus vaccine doses by next June. We are committed to working internationally. This issue comes up at the G7 where, once again, we are seen as leaders on the COVAX programme and other such programmes. It is important that we focus on what is effective and how we can get vaccines to those who really need them.

[Baroness Bennett of Manor Castle (GP)]

My Lords, following on from the noble Baroness’s question, the UK Government played a leading role in establishing the Medicines Patent Pool, which is a means of simplifying and accelerating the generic production of HIV medicines by sharing patents. Does the Minister agree that a global pooling mechanism for Covid-19 would support countries’ ability to access the vaccine and the drugs required to control Covid-19 infections? Will the Government give their full support to the Covid-19 Technology Access Pool and encourage UK pharmaceutical companies to license through it?

[Lord Kamall (Con)]

In tackling coronavirus and helping those who cannot access even a first dose of the vaccine while people in this country are now going for their third—even fourth—injection, it is really important that we act internationally. This issue comes up at international meetings. We are seen to be leaders in co-ordinating; we are doing much of that via the international COVAX programme and by talking to pharmaceutical companies about what more they can do.

Covid-19 Update

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

As my noble friend will be aware, vaccination as a condition of deployment has been brought in for the social care sector. It will be brought in for the wider NHS, but there is a grace period in certain cases. Management are being encouraged to meet with staff to encourage them, particularly staff who are vaccine-hesitant. There is a grace period to see us through the winter period; it runs up to April next year. However, we are encouraging as many members of NHS staff as possible to get vaccinated and we have a high rate of vaccination so far.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister referred to a thriving diagnostic market in PCR tests. When these were previously commonly required, there were huge problems with misleading advertising about costs and people being misled about the services and timings on offer. Have the Government solved these problems and are they looking at how much money these companies are making out of this thriving market?

[Lord Kamall (Con)]

The important thing for us is to make sure that PCR tests are available and that there is sufficient supply and capacity to deliver them. Frankly, as much as we want to make sure there are enough PCR tests, we want to make sure that supplies come to the market. But, as the noble Baroness will be aware, my right honourable friend the Secretary of State has raised concerns about the cost of some of the PCR tests and has been quite public about that.

Covid-19

Debate between Lord Kamall and Baroness Bennett of Manor Castle

Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises a really important point on staff, doctors, nurses and other healthcare workers in our health system. The Government have a zero-tolerance approach to abuse and harassment; we are investing in better security at GP surgeries and are committed to working with the NHS to make sure our primary care workers feel properly supported. We are also constantly having conversations with trusts and the NHS generally about making sure that staff feel safe to work and how we can make sure that that happens. Anyone who has visited a hospital recently will have seen the signs about zero tolerance.

We are constantly talking to NHS England about workforce pressures. We are looking at specific campaigns—for example, we have announced social care recruitment—and other campaigns to attract more workers to the NHS.

[Baroness Bennett of Manor Castle (GP)]

My Lords, on the Minister’s comment about masks on public transport, my understanding is that that is only in London and is not the case in the rest of England. I draw to your Lordships’ attention my experience in Edinburgh Waverley station yesterday evening. Scotland of course does have a mask mandate, and it was very clearly announced at extremely regular intervals. Additionally, it came with a message that said, “That means that you are not allowed to eat anything in the station”, which I have never heard in England.

The Statement says that

“we must stay focused on the threat that is in front of us and seize every opportunity to bolster our vital defences”.

As most of the Front-Bench questions pointed out, this Statement entirely focuses on vaccines. We have been very aware of the issue of aerosol transmission for a very long time now. The last figures that I have been able to find—from a week ago—show that fewer than the promised 300,000 carbon dioxide monitors for schools have actually been delivered. They were promised by the end of the autumn term. Of course, all those CO monitors do is identify the problem—the lack of air circulation. They do not actually deal with it. Will that target be met, and will schools get their carbon dioxide monitors? More than that, are the Government providing adequate support for schools and indeed other organisations that identify a problem with ventilation?

I notice that the UK Health Security Agency is funding a trial of air purifiers of different sorts in 30 Bradford primary schools. This is two years after the pandemic started, and we have known for a long time about aerosol transmission and the problem of unventilated rooms. Not all school rooms or rooms in general—including in your Lordships’ House—can be ventilated. Are the Government really paying the attention that they should be to dealing with aerosol transmission, ventilation and air purification?

[Lord Kamall (Con)]

A lot of investment has gone into making sure that there is ventilation in schools. I will talk to my counterpart in the Department for Education to see what more can be done, but I know that the department is very aware of this issue and is looking more into it.

On the noble Baroness’s first question, we want to be clear and not confuse the message: vaccinations work and are our best line of defence. We do not want people to get a false hope that there are other ways to protect themselves. Not all people who do not take the vaccine are anti-vaxxers: some of them think that just wearing a mask may well protect them.

We want to focus on this message: get vaccinated; if you have been, get your booster; and if you have had your first vaccine, get your second one. There is nothing to fear from getting vaccinated. We are not only sending that message out but actively looking at different campaigns to reach those difficult-to-reach individuals in many communities.