NHS: End-of-life Care

Debate between Lord Kamall and Baroness Brinton

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

The noble and learned Baroness makes an incredibly important point about getting this right and getting the right balance. We know how difficult and sensitive these cases are when they have come to court. One issue that has been discussed by a number of parties is mediation: can we avoid it going to court in the first place, but also at what stage should mediation take place? It should not just be offered right at the end when everything has ended. We must make sure we really hear the voices of professionals as well as those affected, and families, to get the right balance. So far, we have relied heavily on the courts for some of these cases, sadly, but we just want to make sure we get this right.

[Baroness Brinton (LD)]

My Lords, over the last six years, the provision of palliative care for children and young people has become very patchy. CCGs across England have been closing down palliative care for children. Are the Government taking action to hold integrated care boards to account publicly on implementing their duty to commission palliative care for children and young people?

[Lord Kamall (Con)]

The noble Baroness will be aware that earlier in the week, when we had the debate on integrated care boards and their responsibilities, we added—thanks to the work, once again, of the noble Baroness, Lady Finlay—palliative care services to the list of services that integrated care boards must commission. Integrated care boards will be accountable to NHS England, but also the CQC will be doing a lot of evaluation and they will be measured against the list of services that they have to commission. Clearly, there will have to be accountability on palliative care services.

NHS: Access to Treatments

Debate between Lord Kamall and Baroness Brinton

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raised a number of different points, which I will try to respond to. One issue is that, although we are recruiting more doctors, at the same time clearly there are doctors who are looking to leave. There is a demographic of people reaching a certain age, and one of the issues is pensions and whether they hit the limit. Those discussions are going on. There are also lots of discussions going on about how we can improve retention of those staff who feel overworked and have had enough.

In addition, at certain levels, for example primary care, it does not always have to be a doctor that the patient sees. It could be a practice nurse or a physiotherapist. There is also more emphasis on the Pharmacy First programme, whereby people can get advice from pharmacies, unless they actually need to see a doctor.

[Baroness Brinton (LD)]

My Lords, for elective surgery, it does need to be a doctor that the patient sees. On Monday, a patient waiting for a long-delayed hip operation was told by his doctor about the delay. He thought he heard “18 months’ delay”: the doctor corrected him. It is 80 months’ delay in that particular area. This is the workforce problem that other Peers have already raised. What are the Government going to do? Setting up emergency elective places does not solve the problem when there are not enough doctors to go around at the moment.

[Lord Kamall (Con)]

If we look at elective care, we have seen a record number of referrals. We are also seeing more people receiving treatment. Of those on the waiting list, 16% are waiting for in-patient surgery. A lot of those on the waiting list are waiting for diagnostics. We have the surgical hubs and community diagnostic centres. On top of that, the two-year waiting list has been virtually eliminated, except difficult cases and those who need complex treatment. The next target is to eliminate the 18-month waiting list by 2023. It is a concerted effort right across the system, looking at a number of innovative solutions.

Integrated Care Boards

Debate between Lord Kamall and Baroness Brinton

Monday 5th September 2022 Lords Chamber

[Lord Kamall (Con)]

During the debate on the Health and Care Bill, which became the Health and Care Act, one of the things on which we agreed across the House was that each integrated care board should have the appropriate mix of skills. I think that was thanks to an amendment by the Liberal Democrats. This particular issue shows that we need to ensure that we are considering all the important aspects of health. One of the things that will be very important is the parity of mental health with physical health. All these issues will be considered at the local partnership level.

[Baroness Brinton (LD)]

My Lords, one of the key elements of ensuring there is a good transition is the procurement process. Last month, three CCGs were fined for using considerable organisational bias to ensure that their contracts went to a preferred company. The fine must be paid by the ICB, and the staff from the CCG are now in the ICB. What are the Government going to do to ensure that this sort of practice is monitored and ruled out by the new bodies as they get under way?

[Lord Kamall (Con)]

I hope the noble Baroness will remember that, during the debate on the Health and Care Bill, there were concerns about private sector bias, as it were, in giving contracts. We agreed to an amendment suggesting that there should be no conflict of interest. I am afraid I am not aware of the specific cases that the noble Baroness raises, but I will look into them and write to her.

General Practitioners: Shortage

Debate between Lord Kamall and Baroness Brinton

Tuesday 12th July 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Baroness, Lady Brinton, to make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, the Royal College of GPs reports that since 2019, GP clinical administration tasks have risen by a shocking 28%. GPs say that it would make a significant difference if hospital consultants could refer patients directly to other consultants, rather than patients having to come back to GPs and then be redirected. The back-office functions for repeat prescriptions take an ever-increasing amount of their time, and GPs are not in control of either of these processes. As a matter of urgency, will the Minister investigate how to reduce some of this bureaucracy so that GPs have more time to see their patients?

[Lord Kamall (Con)]

As part of the joint NHS England and NHS Improvement and DHSC bureaucracy review—there is such a thing—we have been working across government to reduce unnecessary bureaucratic burdens. There have been a number of key work streams, including a new appraisal process and digitisation of the signing of some notes, along with work to reform who can provide medical evidence and certificates and who can provide notes—nurses, occupational therapists, pharmacists and others. We are continuing to look through the process to engage with GPs to see how we can remove more such administrative burdens.

Thyroid Patients: Liothyronine

Debate between Lord Kamall and Baroness Brinton

Wednesday 6th July 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, will make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, what assessment has been made of the T3 Prescribing Survey Report, which was published on 13 May, and of the reported failure by clinical commissioning groups to follow NHS England’s national guidance, Prescribing of Liothyronine, published in 2019, which shows that 58% of CCGs are still not complying with the national guidelines? Can the Minister intervene? This seems to be a ridiculous situation.

[Lord Kamall (Con)]

I have had prior notice from other noble Lords about this issue and have organised meetings with my officials in the past on this—I am always happy to do so. Given the concerns about the lack of commissioning for people who have tried the first-line treatment and now want the second-line treatment, NHS England intends to revise its guidelines. It is sorry about the process, but it must consult before it can change those guidelines.

Paramedic Services

Debate between Lord Kamall and Baroness Brinton

Monday 4th July 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, when Sandra Francis of Oswestry had a cardiac arrest a few months ago, her son had to do 35 minutes of CPR waiting for an ambulance delayed in handovers at A&E. Sadly, she died. Her son said:

“An ambulance should be a way of getting someone to hospital. It shouldn’t be a waiting room sat at the hospital.”


He is right. Ambulance delays are the very visible part of the A&E crisis and the wider shortage of hospital beds, doctors and other healthcare professionals. Again, I ask the Minister: what are the Government doing to remedy this much wider emergency that is causing preventable deaths right now?

[Lord Kamall (Con)]

The noble Baroness will be aware that there are a number of things going on with the 10-point plan. Maybe I will go through some of the points now. We are supporting 999 and 111 services, making sure that the appropriate person answers the call; supporting primary care and community health services to manage those services; making more use of urgent treatment centres; and providing more support for children and young people. Sometimes people ring 999 but do not need emergency treatment and they can be redirected to another clinician, who can speak to them and that takes pressure off. We are recruiting more staff and looking at more prevention and looking at different rules which prevent the appropriate workflow through the system.

Mental Health: Advertising and Body Image

Debate between Lord Kamall and Baroness Brinton

Thursday 30th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

We have a remote contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Children’s Society’s Good Childhood Report 2021 shows that one in seven girls and one in eight boys is particularly unhappy about their appearance. Young people who are not happy with their lives at 14 are more likely than others to have symptoms of mental health issues by 17, including instances of self-harm and suicide attempts. Despite the Government’s promises of future funding for mental health support for schools and CAMHS, it is clear that young people are not getting that initial front-line support that they need now. How soon will there be mental health counsellors in every secondary school?

[Lord Kamall (Con)]

When we look at mental health in children and body image, we see that it varies not only among age groups but within age groups. We have identified concerns about poor body image as a risk factor that leads to mental health conditions, but it is not necessarily a mental health condition in itself. We have to look at how much of this was already present in the playground before the age of social media, with people being called nicknames for their appearance. However, that has been amplified by social media. We are working with social media companies and others to find the most effective solution.

Diabetic Prevention Programme

Debate between Lord Kamall and Baroness Brinton

Thursday 23rd June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, the observational study by academics of the 2018-19 wave of the NHS diabetes prevention programme, published by BMC Health Services Research, observed disengagement within sessions when patients reported that information was difficult to understand, and when there were very large group sizes and problems with session scheduling. This is all before Covid. Problems with the course will inevitably make patients more likely to drop out but 50% is shocking. Now that this diabetes prevention programme has been rolled out across England, have these specific problems been addressed?

[Lord Kamall (Con)]

The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.

Social Care: Adults

Debate between Lord Kamall and Baroness Brinton

Wednesday 22nd June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, is participating remotely.

[Baroness Brinton (LD) [V]]

My Lords, I go back to the previous question: this ADASS survey shows that almost 170,000 hours of homecare a week could not be delivered for the first three months of this year, because of a shortage of care workers. This is a sevenfold increase on the previous year. The changes proposed to the social care system will not increase the rates of pay for social care workers, at the moment, to make it attractive to others, who can work in hospitality. But there is a dire need for people now. What will the Government do right now to help solve this crisis?

[Lord Kamall (Con)]

As the noble Baroness will acknowledge, some of the problems have been in evidence for a long time. Sometimes, we are tackling the legacy of this neglect of the social care system. At the same time, we have to remember that many social care providers are not run by the state; they are private providers. Following the People at the Heart of Care White Paper, we want to make sure that, first, we encourage better conditions for workers. We also want to make sure that local authorities determine a fair rate of pay based on local market conditions. We have seen an increase in the national living wage, which means care workers will get an increase. But we are looking at all this as part of the overview of the social care landscape.

Vaccinations

Debate between Lord Kamall and Baroness Brinton

Wednesday 15th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, the shingles vaccine is available in the UK only to those aged between 70 and 79, whereas in the USA it is automatically available to everyone over 50. NICE data says that shingles is much more prevalent in those with a weakened immune system, yet they are not offered it until they are 70, resulting in severe cases of shingles, possible sight loss and other serious consequences which could have been mitigated by an early vaccine. Can the Minister say when Shingrix, the shingles vaccine suitable for the immunocompromised will be automatically offered to this group of patients?

[Lord Kamall (Con)]

I thank the noble Baroness for that question. I am afraid I will have to write to her with the details.

Defibrillators

Debate between Lord Kamall and Baroness Brinton

Wednesday 15th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, I call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, 12-year-old Oliver King died suddenly of sudden arrhythmic death syndrome, a condition that kills 12 young people under 35 every week. The Oliver King Foundation has been campaigning for a defibrillator in every school. Last September, the Secretary of State for Education said this should happen. The DfE has been working with the NHS to make this possible, but the NHS Supply Chain website says that, in December last year, only 3,200 were advantageously procured for schools to then purchase. Can I ask the Minister: is the NHS expanding its procurement to enable all 22,000 schools to be able to purchase defibrillators now and not just when the school is rebuilt?

[Lord Kamall (Con)]

The noble Baroness raises an important point: while we require defibrillators to be purchased when a school is refurbished or built, one of the things we are looking at is how we can retrofit this policy. We are talking to different charity partners about the most appropriate way to do this. What we have to recognise is that it is not just the state that can do this; there are many civil society organisations and local charities that are willing to step up and be partners with us, and we are talking to all of them.

Health and Social Care Leadership Review

Debate between Lord Kamall and Baroness Brinton

Thursday 9th June 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

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

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

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

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

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

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

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

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

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

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

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

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

“Blockbuster healthcare system in the age of Netflix”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

GP Access

Debate between Lord Kamall and Baroness Brinton

Tuesday 7th June 2022 Lords Chamber

[Lord Kamall (Con)]

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

[Baroness Brinton (LD)]

My Lords—

--- Later in debate ---

[Baroness Brinton (LD)]

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

[Lord Kamall (Con)]

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

Children: Cancer

Debate between Lord Kamall and Baroness Brinton

Thursday 26th May 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

Long Covid

Debate between Lord Kamall and Baroness Brinton

Monday 23rd May 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

International Healthcare Outcomes

Debate between Lord Kamall and Baroness Brinton

Thursday 19th May 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

St George’s Hospital: Patient Deaths

Debate between Lord Kamall and Baroness Brinton

Wednesday 18th May 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

NHS Mental Health Patients in Private Hospitals

Debate between Lord Kamall and Baroness Brinton

Thursday 28th April 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

Folic Acid Fortification

Debate between Lord Kamall and Baroness Brinton

Wednesday 6th April 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Kamall (Con)]

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

Down Syndrome Bill

Debate between Lord Kamall and Baroness Brinton

3rd reading
Friday 1st April 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I too want to join in congratulating the noble Baroness, Lady Hollins, on the Bill reaching the end of its legislative passage today. Her expertise and commitment to people with Down syndrome and other learning disabilities is well known and much respected—and not just in your Lordships’ House.

I rise to speak on behalf of some of the Peers who raised concerns about this Bill at Second Reading, particularly the noble Baroness, Lady Neville-Jones, and the noble Lord, Lord Farmer, who cannot be in their place today. I will start by saying what is good about this Bill. It has raised the profile of Down syndrome, which, speaking as someone with a nephew with Down syndrome, I say is a good thing and long overdue.

Your Lordships’ House will remember that eight of the 12 cross-party speakers noted that, if the Bill had the powers which its promoters suggest, there risks being a hierarchy of learning disability. This has already caused a split between families with learning disability, all of whom still need to fight for the limited resources to which the law says they are entitled. I am pleased to hear the noble Baroness, Lady Hollins, expressing her desire that the objectives of this Bill are extended to other people with genetic conditions and learning disabilities. I am sure that she and I—and others —will be looking to future government Bills to make a real difference to the lives of all people with learning disabilities.

I will not go through the details of the concerns we had before, because now is not the time. One of my great concerns is that the hopes of many families of people with Down syndrome have been raised beyond the powers in this Bill. I hope that the Minister will ensure that those aspirations are met, not just for people with Down syndrome but for the wider learning-disabled community. I wish this Bill well.

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

My Lords, I begin by extending my congratulations to the noble Baroness, Lady Hollins. I am grateful to the noble Baroness for steering the Bill to this point. I also extend a warm welcome to those who were in favour of this Bill, some of whom are in the Public Gallery. I offer my thanks to the right honourable Member for North Somerset, Dr Liam Fox, who introduced this Bill in the other place. I also want to thank everyone else who has been involved in developing this important piece of legislation.

I know that a number of concerns have been raised, and I welcomed the scrutiny of the Bill two weeks ago at Second Reading. The Government recognised some of the points that were made. Noble Lords raised important matters about the risk of discrimination and widening inequalities, as well as how the proposed guidance could be developed, scrutinised and implemented in a fair and inclusive way. We have listened closely to these concerns, and I hope to reassure noble Lords on a few points so they can be confident in their support of the Bill and the impact it will have at this stage.

The guidance is about making clearer what steps could be taken by relevant authorities to meet the unique needs of people with Down syndrome. The Bill does not remove the duties under the Equality Act 2010 for relevant authorities to assess all the needs of people to whom they provide support. Our assessment is that, to prioritise funding and resources for people with Down syndrome above other groups without proper assessment of people’s needs would be considered unlawful.

The Government will consult with a broad set of stakeholders in developing the guidance, including those with other conditions. I want to be clear that people with lived experience will be at the heart of this at each phase of its development. We will strongly encourage and support people with other genetic conditions, disabilities and protected characteristics, and their advocates, to engage with this process. It is right that we support legislation that will improve life outcomes, reduce inequalities and build a fairer society.

NHS: Pre-pandemic Facility Levels

Debate between Lord Kamall and Baroness Brinton

Tuesday 29th March 2022 Lords Chamber

[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.

NHS: Gambling Treatment Services

Debate between Lord Kamall and Baroness Brinton

Monday 28th March 2022 Lords Chamber

[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.

Covid-19: Restrictions

Debate between Lord Kamall and Baroness Brinton

Monday 14th March 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

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

[Baroness Brinton (LD) [V]]

My Lords, at the publicly streamed evidence session of the All-Party Coronavirus Group on 1 March, we asked some members of SAGE to outline SAGE modelling for the lifting of restrictions in the living with Covid plan. They replied to us that they had not been asked to model any such plans by Ministers. Given that cases, as the noble Baroness, Lady McIntosh, said, are now 221,000 a day, with active cases of more than 2 million and hospital admissions rising across England, exactly what modelling advice did the Prime Minister and Secretary of State for Health and Social Care take?

[Lord Kamall (Con)]

We constantly have meetings with the UKHSA and a number of different scientists join us for the calls when we have them, but we have always balanced things up. I shall give an example of a conversation I was having just before Christmas with some of the modellers. I asked them “What is your advice?”, and they said “Minister, before we give you the advice, you have to bear in mind that we are only considering the variant at the moment. It is for you to consider the wider medical balancing issues, and also the economic and social costs as well, and we recognise that you have to balance all those up.”

Care Homes: Evicted Residents

Debate between Lord Kamall and Baroness Brinton

Thursday 10th March 2022 Lords Chamber

[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, the provision of high-quality, personalised care in residential care settings is likely to reduce the chance of complaints being raised in the first place. The Skills for Care workforce review showed that only 44% of care staff have any training on dementia. Will the Government commit to all social care staff receiving tier 2 training in the dementia training standards framework?

[Lord Kamall (Con)]

The noble Baroness raises a very important point. When we look at the current landscape in the social care sector, it is clear that people do not really understand the overall sector. One thing that we are looking at in regard to the voluntary register is encouraging care staff to come forward to register. Registration includes their standard of education and the qualifications they have received. We will look at how we can improve and have a more consistent qualification system, so that being a care worker is a more rewarding vocation in the future.

Health and Care Bill

Debate between Lord Kamall and Baroness Brinton

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

[Baroness Brinton (LD) [V]]

My Lords, it is a pleasure to follow the introduction from the noble Baroness, Lady Thornton, of her Amendment 9, which I signed. It is the first of a group on the structure and membership of integrated care boards—including the Commons amendments to which she referred. We agree with the noble Baroness and have concerns about the possible loophole of sub-committees. Before I go into that, I will add my thanks and congratulations to my noble friend Lady Walmsley on her excellent proposals for a skills audit and thank Ministers for agreeing to them. I hope that the Minister will reflect on some of the other amendments in this group that seek to ensure core representation from certain key groups within the NHS.

In Committee we had a lengthy debate on the roles and responsibilities of those who may have current or past connections with private sector providers. A key element of that debate revolved around the duties of board members and sub-committee members of the ICB to have its duties at the heart of all they do as they commission using public money. In his response to that debate, the Minister said that

“each ICB must make arrangements on managing the conflicts of interest and potential conflicts of interest, such that they do not and do not appear to affect the integrity of the board’s decision-making processes. Furthermore, each appointee to the ICB is expected to act in the interests of the ICB.”—[Official Report, 13/1/22; col. 1308.]

Amendment 9 seeks to clarify exactly what is meant by “each ICB” by looking at the structures for those that make decisions—which includes sub-committees. The noble Baroness, Lady Thornton, described the difficulties in the example of Virgin Care that demonstrate the loophole she spoke of.

I want to go back a step to the principles behind conflicts of interest. In 1995, the then Conservative Government adopted the seven Nolan principles of public life, which are applied to all who hold public office. Members will know very well that these key principles of personal and corporate behaviour are a golden thread running through the public service that any officeholder delivers, and health bodies are specifically included in the rubric of Nolan. All seven principles are absolutely intrinsic to how an ICB and its members will operate, whether at board or sub-committee level. To pick just two, they must have integrity, including not to

“act or take decisions in order to gain financial or other material benefits”,

and they must

“act and take decisions in an open and transparent manner”.

Amendment 9 expresses exactly the type of arrangement that a public-facing body, even a sub-committee that commissions public services, should have in place. I ask the Minister: would any Government not want conflicts of interest in respect of sub-committees of ICBs to be clear, unambiguous and strong? Is he really arguing that each board should not have that wall of protection in ensuring the integrity of its decision-making processes, as set out in proposed new subsection (4)(a)? Does he think that it is appropriate not to have an appointment process that avoids the appointment of anyone who would be perceived to have a conflict of interest, as in proposed new subsection (4)(b)? Does he also not agree that anyone who has a conflict of interest or potential conflict of interest should not have information that

“might be perceived to favour the interest or the potential interest”,

as set out in proposed new subsection (4)(c)? If the Minister cannot answer those questions, I fear that some noble Lords might be concerned that the Government have abandoned the Nolan principles for some people on sub-committees who will make decisions on commissioning many millions of pounds of public funds. I look forward to his response.

[Lord Kamall (Con)]

My Lords, with the leave of the House, I hope that noble Lords will find it helpful for me to speak early in this debate, since we believe that government Amendment 31 addresses some of the concerns raised by noble Lords. I shall, of course, listen carefully to the rest of the debate and respond in full at the end.

In speaking to Amendment 31, I thank noble Lords from across the House for the wide-ranging discussions in the Chamber on membership of ICBs. We are grateful for the discussions. Many noble Lords have offered their gratitude to the noble Baroness, Lady Walmsley, for the suggestion on the skills mix. We accept the spirit of these amendments and agree that it is important that ICBs are populated by members with the appropriate range of skills and expertise. I know that noble Lords have heard this many times, but it is also important that we do not over-prescribe, as ICBs should have the flexibility to design their boards to meet their needs, while also ensuring they have the skills and experience necessary to properly discharge their functions.

We have listened, and I hope that the amendments we have brought forward, which require ICBs to consider these skills, knowledge and experience, address those concerns while also ensuring balanced, workable boards. When the amendments refer to the necessary skills, knowledge and experience, that is in relation to the discharge of all the ICBs’ functions, including those related to mental health, children’s health, public health, public and patient involvement, engagement with the voluntary, charity and social enterprise sector, and digital innovation and integration. Therefore, these amendments would help to ensure confidence that ICBs have the necessary skills and expertise to discharge these functions, while allowing them to retain discretion in how they deliver this. This approach has been welcomed by stakeholders, including the Allied Health Professionals Federation, which represents 12 professional bodies representing allied health professionals.

The second, connected amendment would ensure that an ICB reports on how it has discharged this new duty in its publicly available annual report. This will allow public scrutiny of ICBs and create confidence that they are drawing on an appropriate range of skills, expertise and knowledge. This is in addition to governance of ICBs being clearly set out in their constitutions, which will also be published and signed off by NHS England. As I have said, I shall listen carefully to the rest of the debate, but at this stage, for these reasons, I commend these amendments to the House.

Integration White Paper

Debate between Lord Kamall and Baroness Brinton

Thursday 10th February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice president of the Local Government Association. Both the Statement and the White Paper set out a laudable ambition to integrate health and social care and communities, but I am afraid that we echo the disappointment of the noble Baroness, Lady Thornton, especially at the glaring omission of children, young people and disabled people who need care.

While reading the White Paper, I had a sense of déjà vu, and I dug out my copy of the White Paper Integration and Innovation: Working Together to Improve Health and Social Care for All, which was published on 11 February last year—almost exactly one year ago. The tone and the ambition were remarkably similar. All noble Lords know that the Health and Care Bill we are debating at the moment sets out in part how the Government believe that the White Paper from last year is going to be turned into legislation and changes in practice. The Minister knows the real concerns across the House about that practical implementation, and I do not believe that this new White Paper takes matters further forward.

From these Benches we also ask: where are carers? There is zero mention of carers in the Statement but 13 in the White Paper, two in the index and two as part of headings. The remaining nine in the text relate only to the people carers care for. There is no formal recognition of the role and no mention of support directly for them as carers. It says:

“People will move seamlessly between health and care settings because people and those supporting their health and care, including … unpaid carers, will be able to see and contribute to their care record and care plans.”


Is that the best on offer for carers—that they will actually be able to see the care plans? They can usually see them now, although most, I must confess, are still in paper format.

That was one example; I want to go on now to a couple of other issues. Much of the paper talks about how data will transform care in the future. On page 14 it says:

“A core level of digital capability everywhere will be critical to delivering integrated health and care and enabling transformed models of care.”


Can the Minister say—because the White Paper is absolutely silent on this—whether there will be funding for fast broadband across the country, especially in rural areas, to deliver that capacity to every single home? Without it, this entire system will fail before it even starts.

The White Paper also says that

“the data and information required to support them should be available in one place, enabling safe and proactive decision-making … We will aim to have shared care records for all citizens by 2024 that provide a single, functional health and care record which citizens, caregivers and care teams can all safely access.”

Can the Minister say how citizens’ data will be protected so that only those who need access to it will see it? As the Minister knows, this is another area where there is real concern over the Bill.

The paper talks extensively about leaders but in a generic way. There are muddles over NHS leaders, social care leaders and leaders of ICBs. Is it referring to council leaders or just leaders? I have to say that the organogram on page 37 makes the classic assumption of councils being single-tier metropolitan authorities, ignoring the plethora of two-tier council arrangements as well as other key stakeholders such as housing associations. It talks about

“3-5 local authorities within an Integrated Care System”.

Even at upper-tier authorities, that number is way too small with the shadow boards at the moment, and dwarfed when you add in district councils, which have key roles in delivering support for care. Unless this is hiding a proposal from the Secretary of State for Levelling Up, Housing and Communities, this is another massive reorganisation for local government.

Housing is vital to the aims of the Bill. The paper says:

“People’s homes should allow effective care and support to be delivered regardless of their age, condition or health status.”


But housing is not mentioned in the “Next Steps” section. I ask the Minister whether there will be specific funding to ensure that housing can be improved at a local level for people who will need it for the next stages of their lives.

The Statement and White Paper recognise the importance of the workforce—in theory. The section in the White Paper talks about continuous development and joint roles, some of which is very laudable, but what is actually happening in the Health and Care Bill at the moment, where the Government will not commit to proper planning for the workforce, makes this unattainable too.

Above all, from our Benches, we want to know where the resources are that will enable this transformation to take place. Even before this week’s announcement about the patient backlog, the levy for health and social care was already prioritised for the NHS. Every time we have asked the Minister when the social care sector will get the resources it so desperately needs—and what they will be—we are told that it will happen at some point in the future.

We need to know when social care and councils will get the support they need, particularly councils with extra responsibilities in this White Paper and the Bill. The LGA has said, correctly:

“Adult social care is in a fragile position, with councils struggling to balance their budgets … A long-term funding solution is urgently needed.”


Can the Minister tell the House what, where and when resources from both departments will be announced and made available to at least give this White Paper half a chance to get going?

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

I begin by thanking both noble Baronesses for their questions. I will try to answer them within the time and, if I do not, will write to the noble Baronesses or others. I will go through some of the issues, first on place-based models.

As we discussed on the Health and Care Bill, ICBs operate at a system level. They will be working with place-based organisations, including health and well-being boards. We expect several models of place-based alignment and governance to emerge and we are not going to be prescriptive about a single model. We are clear that, whatever model is adopted, in the coming years all places must be characterised by clarity of leadership and accountability; a strong shared mission across the sectors, informed by local citizens; a commitment to integration manifested in removing unnecessary boundaries between services and strengthening connections to agencies able to influence the wider determinants of health and well-being; a strong culture of improvement; and a linked sense of urgency about the need to deliver more integrated care to improve outcomes, particularly care quality.

By that we mean that we do not start thinking in siloed ways—of hospitals or primary care, with social care over there. All these White Papers are building-blocks to help explain some of the intentions behind the Health and Care Bill. The Bill itself creates a flexible framework based on the real experience of making effective change happen locally. This flexibility is designed for a purpose: the stronger integration of health and care services. The White Paper picks up that ambition by making clear the strong commitment of the Government to this agenda and our ambition to make progress. The White Paper will ensure that we go further and faster on health and care integration with local authorities and the NHS to make the most of the forthcoming legislation. It does not contradict the Health and Care Bill.

I will pick up on accountability. Three things are different. There is a wider recognition of the demographic challenges we now face, which will increase. We cannot manage it as just health any more or, even within health, primary, then secondary and care over there. The pandemic showed us that some of the cultural and governance barriers to change that seemed impossible to shift have moved. We have seen this work in lots of places up and down the country. There are some model ICSs, which many noble Lords have drawn my attention to, and case studies; we want to learn best practice without being overprescriptive. The noble Lord, Lord Mawson, has talked effectively about place-based organisations many times and getting the right mix of skills and people for a particular place. What works in east London will not necessarily work in South Yorkshire. Some of it will, but some of it will not. We will learn from best practice.

We can be confident that the approach to accountability set out in the paper will work, because it draws on real examples that are already in place. If you ask local leaders what accountability means to them, they will be able to tell you who can ultimately hire and fire them. That is one version of accountability. They will also give you a list of the people and bodies to which they are accountable—partner organisations, local democratic institutions, staff, patients and service users, as well as regulators. We want to make sure that all that comes together to address accountability.

We hope to have shared care records for all citizens by 2024 but, as noble Lords will remember from the debate about data last night or early this morning, we have to get that balance right to make sure that people trust that data will not be shared unnecessarily or inappropriately. One of the key challenges for any integration is that it needs data across primary, secondary, social care and other agencies but, at the same time, we have to allow people to opt out. When people opt out, they might have to re-register a number of times. We want to avoid people, particularly vulnerable people, being asked the same question time and again. We hope that integration and people speaking to each other will help across the health and social care sector.

On carers, I was in fact having conversations yesterday on that subject, and I am going to be doing a round table with a number of noble Lords. One of the issues is making sure that we professionalise and give real respect to the caring workforce. One of the reasons why we set up the voluntary register was to understand the landscape of care, the different qualifications and levels, so that we can get a clearer understanding of what qualifications carers need and how we can make sure that works across both health and social care, so that staff can move between health and social care without feeling that one is better than the other.

We want to build on existing reforms. We want to talk to a number of partners—the noble Baroness, Lady Brinton, mentioned housing, for example—and in the adult social care White Paper we looked at ideas about people being treated at home, some of the things that will have to be done at home, whether that is done at system level and how to make sure that partners are working together.

One thing I will say is that the vast majority of care workers are employed by the private sector. The increase the national living wage means that they will benefit from a pay rise, but we have also put in money. Some private providers feel that they are using private profits to subsidise others. We are making sure there is more money to make sure that we get a better quality of service right across. What we really want to do is say, “Tell us where it doesn’t work and where it breaks down” and to make sure that at the place-based level they are able to work together. We will speak to as many stakeholders as possible and we will continue to ask them to inform us.

I will try not to run over time, but I shall talk about the single accountable person. This will be agreed by the local authority and the integrated care board. An increase in long-term conditions and an increase in the number of people being treated for them means that, increasingly, the co-ordination between the range of services looking after them can fall apart; we know that too many people fall between the cracks. That is why we want to have the single accountable person—so that we can make sure that people are no longer falling through the cracks.

I know I have gone on a bit long, so I will allow other questions to come in, but I hope that addresses some of the concerns.

Covid-19: Lockdowns

Debate between Lord Kamall and Baroness Brinton

Wednesday 9th February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, this paper’s economist authors admit that it reflects their opinions. Extraordinarily, they chose to exclude the most recognised epidemiological research on excess deaths. It is not even peer-reviewed. The conclusions are contradictory to the established annual excess death protocols, published for years by the ONS and other national statistical agencies around the world. Which data should scientists advising the Government and Ministers rely on when making decisions about lockdown?

[Lord Kamall (Con)]

The noble Baroness makes some important points about the meta-analysis in the paper. Undue attention has been given to one paper out of 34 studies. While I am answering the noble Baroness, I will refer to an earlier question. In academia there is a huge debate about meta-analysis in all sorts of fields. The question is what other research should be analysed with meta-analysis. This continues to be an issue of debate among academics in many disciplines.

Vaccination: Condition of Deployment

Debate between Lord Kamall and Baroness Brinton

Thursday 3rd February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from our Benches, I thank all the staff and volunteers in the entire health and social care sector, as well as the scientists and other experts, who are still working to keep us all safe as this pandemic continues, because it is clear, especially with omicron BA.2, that it is not over yet.

We are warned that there may yet be more surprises down the line, which is why it is somewhat bemusing that the Statement begins with this phrase:

“Last Thursday, we woke up to a new phase of this pandemic as we returned to plan A.”


That is extraordinary, because the Prime Minister made his Statement with neither the Chief Medical Officer nor the Chief Scientific Adviser by his side. His press conference and this Statement feel like the Government trying to create good news against the constant bad news battle, not least over partygate.

Last summer, and again before Christmas, we warned that the insistence on compulsory vaccination for front-line staff in the social care sector and the NHS would cause severe problems, specifically in terms of staff shortages as staff either left or were sacked. That problem is already evident in social care; a number of care homes have already been taken to court by staff they have had to let go.

The Statement on Monday also talked about cases falling but, frankly, the opposite is happening at the moment, with cases plateauing in some areas and rising in others. Tim Spector of the ZOE Covid study is warning that the numbers are consistently increasing despite many people no longer recording their results. The high level of cases in schools and in the younger adult age groups shows that Covid is still prevalent. Even if omicron BA.1 and BA.2 are less severe than delta—which is, by the way, good news—the number of cases has two consequences. First, there is increased pressure on primary care, especially GPs and hospitals, even if there is less pressure on ICUs. Secondly—the Minister will not be surprised to hear me say this—there are the problems faced by the clinically extremely vulnerable. I will return to this point later.

Yesterday afternoon, the director-general for adult social care wrote to providers of CQC-regulated adult social care activities about the removal of vaccination as a condition of deployment, or VCOD. Extraordinarily, this letter was written as late as on the eve of the date when notices would have to be served to staff in the NHS. Further, the letter refers to a Written Statement being laid before Parliament today but, as at 3.30 pm, it still has not been laid.

The first and second paragraphs of the letter refer to the regulations on VCOD, which relate to care homes and the wider social care sector, but the heading of the letter reads:

“Vaccination as a condition of deployment … in wider social care (social care settings other than care homes)”.

For anyone reading this letter at face value, it clearly excludes care homes from the U-turn on compulsory vaccination. There is no mention of a separate letter for them and the sector is extremely concerned. I know that the department has been dealing with calls on this matter today, but those I have talked to say that they cannot get a straight answer from the department. Can I try to distil this to get a clear answer from the Minister, who I wrote to about this earlier today?

Is the reason that the letter to the social care sector specifically excludes care homes from the compulsory vaccination rule changes because they are covered by regulations that are being revoked and it is not necessary and, if so, why were they not told that in the letter? Or is it because of an error, and they will receive a separate letter that has not gone out yet, despite today being the day that any final employment notices must be served? Or is it because compulsory vaccination rules remain in care homes? Another matter that I have picked up today is that this letter was not sent to hospices. Why was that? I hope the Minister can give your Lordships’ House a precise answer, but there is a wider interest in this so, if he cannot give me that now, I would welcome a written response.

Secondly, can the Minister say whether UKHSA gave formal advice to the Department for Education, in advance of Nadhim Zahawi’s guidance to schools on 20 January, specifically the strong guidance on no face coverings in schools, other than temporarily and only on the advice of their director of public health? Further on in the guidance, on page 12, it says that

“Children and young people previously considered CEV should attend school and should follow the same … guidance as the rest of the population. In some circumstances, a child or young person may have received personal advice from their specialist or clinician on additional precautions to take and they should continue to follow that advice.”


What would the Minister say to the head who, earlier this week, asked all pupils—not just the CEV pupil—to wear masks until further notice, as one pupil has leukaemia and is severely immunocompromised? The family and the school want that pupil in school, if possible. Why have the Government, the Department for Education or the Department of Health—I do not mind which—not given advice to these pupils, their families and their schools?

Finally, the briefing to journalists earlier this week that the Secretary of State for Health wants to stop publishing Covid data in mid-April has rung alarm bells across the medical and scientific community, as well as for those who are CEV and are still following the guidance in place for them. Scientists say it will reduce their ability to look at data to understand the progress locally, regionally and nationally, and doctors need that information too. I hope the Minister can confirm that any such decision is in the hands of the Chief Medical Officer and the Chief Scientific Adviser, as these are scientific, not political, decisions.

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

I start by thanking both the noble Baronesses for their questions and the Benches opposite for their support during this difficult time. There was not really much political difference between us. We all recognised that vaccination remained the best defence against the virus and the variants. I also thank them for their support on VCOD.

One of the things we have constantly been doing—for example, over the Christmas break, I was on almost daily calls with other Ministers, the UKHSA and others—is to look at the evidence and the data, as it came in. We were always led by data when it came to making decisions. At the time, we felt that it was right to bring VCOD in for care homes and then to extend it across wider health and social care. You only have to look back to the beginning of Covid when we saw the disproportionate number of deaths in care homes.

Given that Delta has now been replaced, it is not only right but responsible to revisit the balance of risks and opportunities that guided our decision last year. In weighing them up, this was the balance we struck. First, our population as a whole is now better protected against hospitalisation from Covid-19. Secondly, the dominant variant, Omicron, is intrinsically less severe. Taken together, the evidence shows that the risk of presentation to emergency care or hospital with Omicron is approximately half that with Delta. Given these changes, and in conjunction with scientific advice, we have reviewed the policy and decided it is no longer proportionate to require VCOD.

We continue to encourage staff to take up vaccines. It is really important. I know most noble Lords have supported this. The NHS has focused on a targeted approach, particularly among hesitant groups within the health service, but in some ways, those hesitant groups reflect hesitant groups in the wider population. When speaking to my colleague, the Minister Maggie Throup, I have been very impressed by the number of different targeted interventions and consultations there has been, sometimes targeted right at the level of local communities. When I chaired a round table for black and ethnic minority organisations this week, one of the things we looked at was how to roll out antivirals. The question there was do we need to do still more work to convince those who are hesitant in certain communities, sometimes based on ethnicity, sometimes based on geography, sometimes based on income levels. How do we make sure they are vaccinated?

The NHS has continued and will continue with its one-to-one conversations with all unvaccinated staff. This has been associated with an early increase in vaccine uptake by 10%. Even though VCOD, we hope, will be dropped subject to the consultation, we will continue, and I know the NHS will continue, to consult all staff.

On the written advice to those who are about to issue letters today—I have to take responsibility for this—it was waiting for sign-off from me because I was doing lots of meetings for the Bill. I am very sorry; I was juggling two things at once. However, literally just before I came into this Chamber, I gave my sign-off for that letter to go out to give advice that those letters of dismissal should no longer go out.

We know it does not happen immediately, but we want to finish the consultation quickly. We hope to finish the consultation by April, and then we can drop VCOD.

As I said, we are continuing with the wider vaccination programme, and our intention is to be able to revoke it well ahead of 1 April, which is our target date. We want to move as quickly as possible, but as noble Lords will acknowledge, we also have to do a consultation process.

In the care home sector, employees have already been dismissed since 11 November. We know it has been difficult. Care homes were following the laws at the time. There have been conversations about whether some care homes will have those conversations with staff who have left. Will those staff want to go back, or have they got new jobs? This is part of our wider recruitment process to make social care a more attractive vocation and a more attractive career. Some care homes have told us individually that they will probably keep VCOD because it gives more assurance to the relatives of patients in those care homes. So, it is very much not one size fits all.

Some have asked why we are doing this now and whether it is still too dangerous. Others have asked why we have not done this sooner. We have always followed the evidence. We have always balanced the risks, and we now recognise, clearly, that given the rates of transmission, the lower severity of Omicron and the higher percentage of staff that are vaccinated in both the health and social care systems, this was the right time.

I thank the noble Baroness, Lady Brinton, for giving me advanced notice of some of her questions. Unfortunately, I do not have good enough answers at this stage, so I am going to go back to my department and ask for clearer answers, and I will write to her.

Social Care Sector: Private Equity

Debate between Lord Kamall and Baroness Brinton

Thursday 27th January 2022 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually, and I think that this is a convenient point to call her.

[Baroness Brinton (LD) [V]]

My Lords, typically, private equity-backed providers spend about 16% of the bed fee on complex buy-out debt obligations. The accounts of Care UK show that it paid £4.1 million in rent in 2019 to Silver Sea Holdings—a company registered in low-tax Luxembourg—which is also owned by Care UK’s parent company, Bridgepoint. Given that the ONS says that 63% of care home residents are paid for from the public purse, does the Minister not think that private equity providers should be subject to a financial code of conduct?

[Lord Kamall (Con)]

What is important is to make sure that we have continuous and high-quality care for patients. Therefore, where there are concerns about the financial stability of any company, whether it is funded by private equity or otherwise privately owned, it is important that we have a system to make sure that we manage that. If a company goes under, there is the ability to transfer patients to high-quality care. The important thing for us is the quality of care for patients—it is important that we put patients first.

Covid-19: Vaccinations for School Pupils

Debate between Lord Kamall and Baroness Brinton

Monday 17th January 2022 Lords Chamber

[Earl Howe (Con)]

My Lords, the noble Baroness, Lady Brinton, has indicated her wish to speak virtually, and I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, many parents are still saying that they have not heard when their clinically extremely vulnerable five to 11 year-olds will get their vaccinations, despite the JCVI saying that they should. Last week’s update to the GP green book now includes severely CEV children as eligible for the third primary dose, which is progress. However, there is no news for CEV young children not classed as severe, so can the Minister please say what he will do to ensure that GPs will call all these children for their vaccinations as soon as possible?

[Lord Kamall (Con)]

As the noble Baroness says, the JCVI advised on 22 December that children aged five to 11 in a clinical risk group, or who are a household contact of someone who is immunosuppressed, should be vaccinated. GPs and hospital consultants are now urgently identifying the children eligible, and we expect rollout to have started by the end of this month, with children and parents starting to be called up for appointments by the NHS locally. The message here is that there is no need for parents to contact the NHS; the NHS will make contact with the parents or carers of those eligible. Just to further reassure parents, we will be using a paediatric Pfizer vaccine authorised by the MHRA for use in this age group.

Ambulance Queues: Health Outcomes

Debate between Lord Kamall and Baroness Brinton

Thursday 13th January 2022 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, yesterday NHS England data showed that trolley waits of more than 12 hours in A&E rose in December to just under 11,000, which is three times higher than in December 2020. One hospital reported that it had a dozen patients waiting on a trolley for a bed for over 24 hours. The Minister has talked about extra money, but without staff and bed capacity in both hospitals and care homes, the crisis remains. Can he say what the Government are doing right now to help alleviate the current crisis?

[Lord Kamall (Con)]

I thank the noble Baroness for giving me the opportunity to say what the Government are doing right now. We are working closely with ambulance services, NHS England and the Association of Ambulance Chief Executives to reduce the handover delays. The 10-point plan I referred to earlier goes into detail about how we handle this, both in handling calls at call centres—some calls are not emergencies, for example, and patients are directed elsewhere—and in making sure that the wider system is available to make sure that patients are unloaded within the 15-minute target and that ambulances are turned around as quickly as possible. Where we have spotted disproportionate pressures in the system, as in the 29 hospital trusts across 35 sites, we have focused more resources there.

Vaccination Strategy

Debate between Lord Kamall and Baroness Brinton

Thursday 13th January 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I too echo the gratitude that this House and this country shows to Jonathan Van-Tam. Four months on, there are still severely clinically extremely vulnerable people eligible for a third primary dose and then a booster who cannot book their booster because the data system still cannot record this. Many CEV young children with underlying conditions are still waiting for their vaccines, as well as for guidance on how they, their families and their schools can keep them safe from Covid. This is important because there are now more children in hospital with Covid in the last three weeks than in the nine months of the first wave. Please can the Minister say how these people, who the Government say need the vaccines right now to keep them safe, can get them?

[Lord Kamall (Con)]

I thank the noble Baroness for making me aware of the issues. She will recall that we had a meeting on how we can address the concerns of the clinically extremely vulnerable, and I had hoped that a number of action points had flowed from that. If those have not been acted upon, I hope she will write to me and I can chase up the department and the NHS. I had assumed that that meeting, where we gave them some action points, was effective. I am sure she remembers that we requested a letter with action points, but if those have not been followed up, I will endeavour to chase that up.

Respiratory Viruses

Debate between Lord Kamall and Baroness Brinton

Tuesday 11th January 2022 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. We have her on screen. This is a convenient point to call her.

[Baroness Brinton (LD) [V]]

My Lords, government data show that more children have been admitted to hospital with Covid in the last three weeks than in the whole of the nine months of the first wave. Many clinically extremely vulnerable children are still expected to go to school, even though they still await their vaccines and guidance on how to manage the risks they face, including RSV and influenza. Can the Minister say when these children and their families will get the vaccines and guidance they need? If he cannot, will he please write to me with the answer?

[Lord Kamall (Con)]

The Government have put in place a range of measures to protect children from RSV this winter, including expanding the passive immunisation programme for all at-risk infants, ensuring that the NHS has surge plans in place to respond to any increasing cases, raising awareness among parents and at schools of the symptoms of RSV and when to seek medical help, and increasing our out-of-season surveillance capacity.

Covid-19 Update

Debate between Lord Kamall and Baroness Brinton

Wednesday 8th December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for repeating the Statement. The chaos to even get it heard in the Commons and the very late notice on whether we were having this or Monday’s Statement sum up the chaos that the Government find themselves in.

As the noble Baroness, Lady Thornton, outlined, the Government have once again lost the trust of the public. My first question is: how on earth will Ministers persuade people to follow these new, very important restrictions, with the chaos going on at the moment?

We understand that restrictions are disappointing but, from these Benches, we have always said we want people to remain safe. As for these proposals, we have said before and say again that we think the Government are once again late to move to plan B.

I note that the arrangements will remain until 5 January and that there is a sunset clause of 26 January. Please can we debate the regulations before they expire—preferably next week, before we rise for Christmas?

Today, there are 131 new cases of omicron, a rise of a third in one day, taking the UK to nearly 600 cases. This confirms that the doubling rate is between two and three days. Scientists are talking about an R rate of between 2 and 4 and it is also following the same rapid transmission trajectory seen in many other countries. Unfortunately, in the last 48 hours, we have seen that South Africa is now showing increasing hospital and critical care bed admissions, showing that, even if there is less likelihood of serious disease, there is still some serious disease.

Ministers are right to be concerned about superspreader events, which are being reported all over Europe. Assuming that doubling continues at this rate and with a million cases possibly by the end of the year, that is very worrying, as is the news of the lower immunity against omicron from the vaccine compared to delta.

Just this afternoon, Antonio Conte, head coach of Tottenham Hotspur, reported that eight of his first team members and five members of staff have tested positive ahead of a big European game. He said:

“The situation makes me very upset … It’s contagious and there is a big infection.”


He is right.

The Statement does not mention that there is a higher percentage of young children both contracting omicron and going into hospital in South Africa. What arrangements are being made to ensure that parents recognise that and understand the different symptoms that young children have?

From these Benches we have been urging the Government to move ahead with plan B since cases started rising steadily in September. Today, all cases—of whichever variant—still number over 51,000, with a further 161 deaths. It is vital that we make sure that those numbers do not go up.

Face masks are vital, especially with increased transmission. But do I understand the Minister to say that singing, which we already know is high risk for transmission, will be exempt? On what medical grounds is that sound? I understand that hospitality has exemptions too. Is this taking us back to when you could take your mask off if you were sitting at a table and eating, but had to wear one when you were moving around a pub, bar or restaurant?

Ventilation is vital. Can the Minister say how many schools have received the air filters they were promised a year ago?

I notice that we are moving now to lateral flow tests rather than isolation. Can the Minister say what the current percentage of false negatives is for lateral flow tests and how that is going to be managed?

It makes sense to follow both Scotland and Wales in asking people to work from home if they can. How is that likely to affect the working arrangements on the Parliamentary Estate, including your Lordships’ House? In particular, and as a minimum, should the House consider returning to remote voting to avoid noble Lords mixing together in large numbers? We know we have a large number of votes over the next few weeks.

There are also a large number of notable omissions from this Statement. The first is the difficult issue of social care and support for those in homes, or housebound, as well as the staff who look after them. I see that the Statement says that there will be information to follow.

The second is the lack of mention of the Covid app. Given that many people are saying that their third dose or booster dose information is still not being recorded properly, can the Minister say if these difficulties have been resolved? The consequences of having to have Covid certification will affect people from Friday.

Thirdly, there is not one word about the clinically extremely vulnerable: that is 3.7 million people, of whom 800,000 are severely clinically extremely vulnerable. Most of the larger group should have had their booster jabs by now, and should be reasonably protected, but can the Minister say yet if that is true of omicron, especially as no one will have had three doses of Pfizer?

I thank the Minister for arranging our meeting next week to discuss the problems that the severely clinically extremely vulnerable are facing. Doctors are already telling this group that they will have a less good and shorter-lived response—if any—to vaccines. Is there any data on vaccinations for this group and omicron?

Other problems remain, as the Minister will have seen from the responses to my tweet this morning. Many people are still finding that their GPs do not know they should have a third dose, because there is no register and their hospital consultants have not had time to write to every patient’s GP. The NHS app still is not recognising third doses. GPs are not sure if it should be eight weeks or 12 weeks between the third dose and the booster.

While the news about the antivirals and retrovirals is good, most CEV people do not want to catch Covid. So above all, following this Statement, where is the specific guidance to both groups who are alarmed by the high number of delta cases, the growing number of omicron cases, and the marked reluctance of people generally to follow mask guidance. This is not a “nice to have”. This is 5% of the population who risk severe disease or dying from Covid. Please can the Minister agree to advise this group in the same way that there will be advice for the social care sector?

[Lord Kamall (Con)]

I will try to answer as many of the noble Baronesses’ questions as I can. Regarding the more scientific data and evidence, I hope that Peers have received an invitation—if not, I will make sure that it is sent out—to a call with Dr Jenny Harries and me on Friday, during which we will be providing further details and data. It will be an all-Peers call, so noble Lords can discuss a lot of the scientific facts and evidence.

We are advising that you should work from home if you can. If you cannot, you should take lateral flow tests regularly when attending the workplace. We are requiring the wearing of face coverings in a wider range of settings. If noble Lords will forgive me, I will go into some detail here and, if appropriate, I will place these details in the Library.

Last week, we took the initial step of making face coverings mandatory again in England in shops, including contact services such as hairdressers, on public transport and on transport hubs. We are now going further, requiring the wearing of face coverings in a wider range of locations. Police and community support officers can take measures if members of the public do not comply with the law. Exemptions apply for children under the age of 11 and those unable to wear a mask covering due to health, age, equality or disability reasons.

From Friday, the settings requiring face coverings will be attractions and recreation venues—concert halls, exhibition halls et cetera—cinemas, theatres, museums and galleries. I have a longer list and I am happy to share that as appropriate with noble Lords. Other settings include bingo halls and casinos, snooker and pool halls, skating rinks, circuses, other business ventures such as public areas in hotels and hostels, play and soft play areas, sports stadia, other indoor public venues, places of worship, crematoria, chapels, community centres, public libraries and polling stations.

Places that already require face coverings, just to remind noble Lords, are shops and supermarkets, shopping centres, auction houses, post offices, banks and building societies et cetera, estate agents and letting agents, premises providing personal care, veterinary services, retail galleries, retail travel agents, takeaways without space for consumption, pharmacies, public transport and others.

So, face coverings have been reintroduced. We know that they are effective at reducing transmission indoors. I thank the noble Baroness for the support for these measures. We appreciate it on this side of the House.

It will not be a legal requirement to wear a face covering in hospitality settings, restaurants, cafés, canteens, bars, shisha bars and premises other than registered pharmacies providing medical or dental services, including services relating to mental health, and photography studios. The reasoning behind that, I am sure, will be covered in the call on Friday. I do not have all the details and the scientific evidence to hand, given the late notice of this, but I hope that Dr Jenny Harries can share much of that detail with noble Lords.

On the booster rollout, we have already seen nearly 21 million people take up their booster dose, with 1.9 million people coming forward last week. The NHS vaccine programme is to be extended today. People over 40, along with those in high-risk groups, can take their dose.

I was interested to hear from the noble Baroness, Lady Brinton, that people were still reporting that the booster was not on their app. I was not aware of that. In fact, a number of noble Lords had told me that it was on the app. I apologise for not recognising this—this is the first I had heard of it.

NHS: Elective and Cancer Care Backlog

Debate between Lord Kamall and Baroness Brinton

Tuesday 7th December 2021 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, this week the Royal College of Emergency Medicine reports that 40 hospitals have cancelled at least 13,000 operations over the last two months because of the surge in demand, as well as the high number of Covid patients in hospitals. The Government winter plan says that there will be extra beds and staff to help, but there are no beds or spare staff right now, so what are the Government proposing to do before many of these patients end up back in A&E because of their delayed surgery?

[Lord Kamall (Con)]

One thing that the Government are doing is looking at a number of different ways in which we can think outside the box and be multifaceted to make sure that, for example, instead of patients going directly to A&E they can be dealt with by 111 or other services. In addition, we are committed to delivering 50,000 more nurses, growing the workforce and making sure that we have a trained workforce not only in healthcare but in social care.

Health and Social Care

Debate between Lord Kamall and Baroness Brinton

Monday 6th December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

I, too, thank the Minister for the Statement and I start by thanking all our NHS and social care staff, at all levels—back room or front line—for all they are doing to keep the NHS and social care going while under the most extraordinary, sustained pressure.

Like others, I am struggling to see what is new in the Statement, which admits that the funding mentioned is not new. Although there is marginally more detail on how some of it will be spent, it is very light on by when the extremely urgent investment will deliver the help that our NHS and the public who use it desperately need.

Repeatedly, the Statement, and the accompanying so-called policy paper, The Health and Social Care Approach to Winter, refer to the urgent need to recruit more staff for both the NHS and the social care sector. However, it reports that currently, the NHS has an 8% vacancy rate at all job levels, and the social care sector, which has had more than 100,000 vacancies for some time, has had a further 3% reduction in staff since March this year.

Although there are proposals to increase staffing, can the Minister please explain where those staff will come from if they have not been able to be recruited over the past few months? How long will it take to recruit them? It is good that money is being put into the workforce, but I struggle with any suggestion that that will help to deal with the current winter crisis. When will the staff who are desperately needed in health and social care be available to join the teams out in the wards?

Both the Statement and the report talk about using locum services for doctors and agencies for nurses and social care staff, but health and social care employers tell the public daily that the extra qualified people are just not there. One of the problems in social care at the moment is that the NHS is poaching nurses from care homes. Please can the Minister explain who is going to fill those roles, given that training those skilled personnel takes a lot longer than a few months?

I echo the comments of the noble Baroness, Lady Thornton, about delayed discharges. We have all been asking the Minister and his predecessor about specific plans to help the social care sector overcome its problems in the workforce, not just for months but for years. The high level of staff vacancies continues to worsen. Can the Government help in the short term? For example, NHS Providers made the very helpful suggestion today that the Government help to fund a winter retention bonus for social care staff. NHS Providers understands that we must get the log-jam moving, and if the only way to do that is for the Government to help, please will they consider that proposal very seriously?

The Statement says that the NHS needs to be able to offer more appointments, operations and treatments, which is absolutely right, including with the NHS itself. However, the capacity to change to innovative ways of working, with a heavy load of staff vacancies and the current sustained 20 months of intense pressure, seems to be extraordinary. To illustrate this, in the second week of November, there were 966,406 more GP appointments in England compared with the same week last year—and we were not in lockdown at that point last year.

The Statement talks about the transformation funding for elective recovery, announced in September. The plan lists the hospitals that have been successful in getting their schemes approved. I know, from experience in my local area in Watford, that some of the modular ward proposals can move ahead very quickly. Can the Minister tell us the likely earliest delivery date for any one of these projects? Once the buildings are there, when will extra staff be available to make these new wards work? We certainly do not want to see a repeat of the Nightingale hospitals.

The plan says that NHS Test and Trace will be carrying out contact tracing, so will the Minister say whether local test and trace will continue? It is noticeable that this was not mentioned at all, yet only two months ago Ministers were saying that this was where the focus of contact tracing would be. May I repeat the questions that I have asked on at least two occasions to the Minister? What is happening to the funding for the local resilience teams for Covid tracing and other pandemic work from April, given that, at the moment, there is no money in the budget whatever for the next financial year?

Last week, the Minister wrote to my noble friend Lady Thomas of Winchester about the delivery of vaccines to the vulnerable housebound who cannot go out either to their GP’s surgery or to vaccination centres. He wrote to her after the Question, confirming that GPs have a duty to offer vaccines to the housebound. He went on to say:

“If there are no GP practices signed up to phase 3, the CCG will make these alternative arrangements instead.”


Today’s Daily Telegraph talks about more than 300,000 people—more than two-thirds of the housebound—having yet to receive their booster doses. This is not hesitancy in people coming forward; it is clear that there is a problem. With many GP surgeries having withdrawn from delivering booster jabs because of their increased workload, can the Minister tell me when CCGs will be setting up these new systems and, most importantly, contacting and reassuring this vulnerable group of people about when they will get a visit from the mobile vaccination team? Putting the booster programme on steroids for all adults is of no use if the most vulnerable are not even being contacted. I look forward to hearing from the Minister. If he does not have the answers at his fingertips, I ask him to write to me.

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

My Lords, I thank both noble Baronesses for their questions and for acknowledging that I may not have all the answers immediately; I will commit to write to them if I do not.

I will start with the questions on hospital beds and discharge. We are very aware that we have put in £478 million to get patients out of hospitals, freeing up beds. The NHS is also giving ambulance trusts an extra £55 million to boost numbers. It is our priority to ensure that people are discharged safely from hospital to the most appropriate place, and that they receive the care and support that they need. Our guidance sets out how the health and social care system is continuing to support the safe and timely discharge of people in hospital. People who are clinically ready are supported to return to their place of residence where possible, where an assessment of longer-term needs takes place using the discharge-to-assess Home First model.

New or extended health and care support is funded for up to four weeks, until the end of March 2022. During this period, a comprehensive care and health assessment for any ongoing care needs, including determining funding eligibility, should take place. Since March 2020, we have made nearly £3.3 billion available via the NHS to support enhanced discharge processes and implementation of the discharge-to-assess model. This approach means that people who are clinically ready and no longer need to be in hospital are supported to return to their place of residence. We are also reviewing the way that we look at this scheme and how it works. We are very much aware of the issues raised about how we make sure that people are discharged in the most appropriate manner.

On the issue of investment, a number of trusts were asked to bid for funding, very much on the basis of which of those schemes could be delivered immediately and which were longer-term. Trusts have now been informed that their bids have been approved, and they are beginning to work to deliver them. NHS England and NHS Improvement will be monitoring the programme closely. Schemes were selected that could deliver immediate solutions that will support elective recovery this winter, as well as over the next three and a half years and beyond. This is just one element of how we are looking to make sure that we are dealing with things in the short term.

As the noble Baroness, Lady Brinton, acknowledges, some of these modular systems can come up to speed quickly, and that was considered in the bids that were put forward. Funding was allocated on a regional basis, based on the number of people living in each area, to ensure that funding is equally spread across the country. NHS regional teams identified and prioritised individual schemes and DHSC evaluated and approved them to ensure that the schemes that had the highest potential to help us reduce waiting lists for elective care were selected.

We have looked at a number of areas and, looking at the regional breakdown, we have had about £112 million in the north-east and Yorkshire; £97 million in the north-west; £131 million in the Midlands; £78 million in the east of England; £105 million in the south-east; £69 million in the south-west; and £109 million in London. There are a number of different schemes at various hospitals, on which I would be very happy to go into more detail if asked.

Turning to waiting lists, we need to recognise that 75% of people waiting do not require surgical treatment; 80% of those requiring surgical treatment can be treated without an overnight stay; and 20% of patients are waiting for ophthalmology treatment for eyes, or orthopaedics for bones, muscles and joints. So we are looking at how, on a targeted basis, we can address that backlog. We hope that, with the new diagnostic centres rolling out, we should be able to tackle a lot of that backlog.

Adult Social Care

Debate between Lord Kamall and Baroness Brinton

Thursday 2nd December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for the Statement. It is no exaggeration to say that we on these Benches, along with many other noble Lords, have been repeatedly pushing Ministers to publish this White Paper for years. It is now two and a half years since the Prime Minister announced from the steps of 10 Downing Street:

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care. And so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … that is the work that begins immediately behind that black door.”


We were pushing because it was evident even then that adult social care was already in crisis. High levels of staffing vacancies, and cuts to local government meant that fewer people who had been entitled to state support would receive it, as the criteria for eligibility were repeatedly tightened. Even then, it was common knowledge that private patients were having to subsidise those funded by the state, as the amount given to local authorities did not match the actual costs of that care.

Even allowing for the inevitable delays caused by the pandemic, this Government have insisted on continuing with their structural reforms, rushing through the Health and Care Bill—which NHS leaders are now asking to be delayed because of the continuation of coronavirus and its pressure on all NHS services—as well as the health and social care levy, rushed through your Lordships’ House in one day, six weeks ago, which now requires amendment in the Health and Care Bill, which will mean that house owners outside the greater south-east will end up paying a higher percentage of their assets than those in the greater south-east. So much for protecting them from the fear of having to sell your home to pay for the costs of care—yet another broken promise from this Prime Minister.

In setting the scene, we and others have pushed for the publication of the White Paper prior to the Bill starting its journey in the Lords, because we cannot understand how any Government could restructure integrated care services between the NHS and the care sector without knowing what plans they have for the future of the adult social care sector. Yesterday’s paper was deeply disappointing—but I think the Government know that, which is why Ministers announced yet another White Paper next year on integration. But hang on: was that not why this White Paper was due to be published? If there is to be another White Paper, the timing is important. Can the Minister say when this new White Paper will be published? This one certainly is not the answer.

Allocating some money to developing the workforce in five years’ time will not even start to address the current crisis in social care: with well over 100,000 vacancies; with social care providers still having to pay for expensive PPE that is provided free to the NHS; and with providers handing back state-funded payments to their local authorities because they cannot provide a safe service for those patients. It does not address the current practice, caused by lack of funding, of domiciliary care workers not being paid as they travel between clients. It does nothing to change the experience of unpaid carers. There are lots of great ideas about following best practice and getting people to talk together, but there is no real offer of funding for regular respite care or other benefits and support.

Reading the full White Paper, the truth about the promises in the Statement begin to be revealed. The Minister knows that, from these Benches, we have repeatedly emphasised the importance of housing in relation to care and support for adults of all ages. It was, therefore, perhaps encouraging to read the recurring phrase

“Making every decision about care a decision about housing”,

but closer examination of the funding for disabled facilities grants increases shows that there will be £570 million a year in 2022–23, 2023-24 and 2024–25. The current budget for this year is already £537 million. Although continued funding is welcome news, this is only a £33 million—or 6%—increase, which, given rising costs of labour and materials, will barely keep up with inflation. It is not the transformative grant that the Statement trumpets. On the funding for

“a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe”,

for which most authorities are able to offer only £1,000 to £2,000 per person before they have to look at their assets, no cash amount is specified, but it is hoped that this will give a boost to handyperson services that are so highly valued by older people and provide such a great return on investment.

It is impossible to transform way our social care provision works, keeping people in their homes, unless this White Paper demonstrates the practical support that the Government can give to make that happen. The real difficulty we face is that staff in the sector, providers, the NHS and, above all, the users and their families are severely let down by the White Paper. The word “dignity” is used repeatedly in the Statement. The reality is the opposite: no vision, no real reform and, worst of all, no attempt to deal with the current crisis.

[Lord Kamall (Con)]

My Lords, I thank the noble Baronesses for the points they raise. But let us be clear that for many years—not just five, 10, 15 or 20 years; some noble Lords have said that we knew this issue was coming after the war, in the 1950s—the demographics of the country meant that we were going to have an ageing population, and successive Governments of all colours have not grasped the nettle. They have commissioned a report, it has gathered dust on the shelf and another report has come along. Many noble Lords, including my noble friend Lord Lilley and others, have written papers for various think tanks, but those also gathered dust and nothing has been done. When I have spoken to friends of all political colours, they have said that, frankly, it was too difficult and there were other priorities. So the Government should be given some credit for finally grasping the nettle.

We have set out a vision. Before you set out a strategy, you have to set out a vision, and we have done so. This is a 10-year vision, and we have committed to the first three years. Throughout the White Paper, we have said that we will continue to consult the sector—experts, carers, both paid and unpaid, local authorities and nursing or care home providers—to make sure that we get the right balance and understand the issues. As technology develops—medical technology, information technology and other technology that enables people to live in their own homes—we will see how the vision might adapt, rather than laying out everything from day one. We have laid out the vision and the spending for the first three years, but we will continue to consult to ensure that we are adapting to the changing technology and circumstances.

Compared to the current system, more people will be supported with their social care costs and have greater certainty over what they pay and receive higher-quality care. We think the plans announced represent the best value proposals. As many noble Lords will appreciate, that means balancing many issues: how many people are supported; how much they are supported; and the cost to taxpayers of offering that support. We believe that the plan sets out an appropriate level for the cap and balances that with people’s personal responsibility for planning for their later years. A number of experts have written recently asking why financial advisers advise people to build up ever-larger sums of money but they then leave it to their children at the end of their lives, rather than depleting their assets as they get older to look after themselves. We were clear that the £86,000 would be the amount individuals will need to pay towards the cost of their care, and the amendment to the Health and Social Care Bill reflects the changes. We believe the new system is necessary, fair and responsible.

We admit that the Care Act 2014 was landmark legislation informed by a range of partners, and we want to build on those strong foundations, rather than reinvent the wheel. Many of the provisions in that Bill act as a platform for better, even more joined-up health and social care in future. We are the first Government to announce that we are going to integrate health and social care, and that we will have a system of healthcare all the way through—not social care as a bolt-on afterwards—from your birth all the way through your life.

The Health and Social Care Bill contains several provisions built on the Care Act 2014. We have looked at assurance, with a new duty on the Care Quality Commission, and we have looked at data, to make sure we have the appropriate data on adult social care. People should pass from hospital to social care with no delay and as seamlessly as possible. We have looked at provider payments and the better care fund. The Bill also proposes to put integrated care systems on a statutory footing, which will make sure that, in each area, working with local authorities, account is taken of the needs of social care, joined up with the other parts of the healthcare system.

On 3 November, we published the adult social care winter plan, because we recognise that this is a long-term plan, but we have constantly been listening to stakeholders and have drawn up recommendations with a number of people, including Sir David Pearson, who reviewed last year’s adult social care plan, advisers from SAGE and UKHSA. So we have listened carefully to make sure that we meet some of the short-term issues that we are facing. We have looked at how we can increase spending, where relevant, to make sure that we tackle some of those issues.

Across the House, noble Lords will want to pay tribute to social care workers, both paid and unpaid. We have a track record of responding to workforce pressures—for example, the £162.5 million workforce recruitment and retention fund and the £388 infection control and testing fund. We will continue to keep this situation under control. We are also increasing the rate of the national living wage, which means that many of the lowest-paid care workers will benefit from pay rises. We are also investing at least £0.5 billion in the way we support the development and well-being of our social care workforce—an investment in knowledge, skills, health and well-being, and how we drive the retention of existing staff and boost recruitment. This will set the conditions for professionalisation over a longer period, giving carers recognition. When we look at the social care workforce and how much they are valued, one of the great issues has to be recognition of their skills and giving them a professional development pathway.

In the longer term, as set out in the White Paper, we remain interested in working with commissioners and providers to make that sure care workers have the best terms and conditions possible, including being paid for all the hours possible. This is already set out in our existing market-shaping and commissioning guidance. We will also explore how we can champion best practice and support local authorities, including through the new CQC assurance framework. We acknowledge the prevalence of zero-hours contracts in the social care sector and we are interested in working with commissioners, providers and care workers to understand how those contracts impact this sector.

Chapter 6 of the White Paper sets out three key aims for the workforce strategy over the next three years, backed up by £500 million of investment. We want to create a workforce that is well-trained and well-developed, healthy and supported, sustainable and recognised. We want to make sure that social care is seen as a rewarding career—that it is not only heart- warming but has professional recognition. I should stop there and take some more questions at this point.

Ambulance Response Times

Debate between Lord Kamall and Baroness Brinton

Wednesday 1st December 2021 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what assessment they have made of current ambulance response times; and what steps they are taking to reduce them.

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

We recognise the unprecedented pressures that the ambulance service is facing, and strong support is in place. A £55 million investment by NHS England and NHS Improvement will provide 700 additional staff in control rooms and on the front line to improve response times. This is alongside £4.4 million to keep an additional 154 ambulances on the road this winter. NHS 111 is recruiting an additional 1,100 staff, alongside a £250 million winter GP capacity fund to avoid unnecessary ambulance calls and visits to A&E.

[Baroness Brinton (LD) [V]]

Last week, the BBC reported that Shropshire had run out of ambulances, as every ambulance was queueing outside hospitals. Yesterday, the Shropshire Star reported that the West Midlands Ambulance Service had apologised that ambulance-hospital handover times were now four hours. This is happening all over the country, and people are dying waiting for paramedics. This is before the expected winter surge starts, so what is the Government’s emergency plan right now?

[Lord Kamall (Con)]

The Government understand that the reason for a number of these waits is related to the Covid pandemic and increased callouts, and we have stats for that. Ministers are in regular contact with NHS England and NHS Improvement about the performance of the emergency service care system, including the ambulance service. One Minister of State has meetings that track the improvement effort at all times, including in ambulance trusts. In addition, there is investment of £55 million to boost ambulance staff by more than 700 and £4.4 million to keep an additional 154 ambulances on the road. Also, we are looking at ways to stop people calling out an ambulance when they do not need to—when their calls could be handled without the need to call out an ambulance.

Covid-19 Update

Debate between Lord Kamall and Baroness Brinton

Monday 29th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for repeating today’s Statement. The World Health Organization and many globally respected scientists and doctors have been warning us that variants of Covid-19 might pose a serious risk, especially when a Government think that we are winning the war against the virus and that we can all afford to relax. Omicron reminds us that the battle is not won until it is won across the world. From these Benches, we also thank the South African scientists for their genome sequencing that has alerted the world, and I hope that the UK and the other G7 countries will offer them not just gratitude but countries in southern Africa more practical support.

I echo the comments of the noble Baroness, Lady Thornton, about arrangements for international travel and test and trace. I also support her request for a briefing for Peers. For some bizarre reason, the Liberal Democrat MPs were not included in the MPs’ briefing. Please could the Minister make sure that we are included in any such meeting in the Lords.

In April, before the Minister was appointed, we warned Ministers that the Government were responding far too late to the reports of the delta variant in India. So we warn again. While the face mask mandate in shops and on public transport is welcome and well overdue, we are absolutely bemused that it excludes hospitality and that the advice to schools excludes classrooms. Professor Chris Whitty said in Saturday’s No. 10 press conference that when there is a risk we should go in hard, so can the Minister explain how the virus will be kept at bay in those indoor settings where masks are not required? Why is there no encouragement for people to work from home where possible? Trains and buses are crowded and unventilated. Risks will remain there too, even if lessened with masks.

I have said before that I am in the clinically extremely vulnerable group. I have had my third dose of the vaccine and now look forward to my fourth, or booster, dose. But many of those who should be getting the third dose still face a series of problems in the NHS about who should get it, as opposed to a booster, and how it is recorded. Indeed, today, in response to a Written Question to my honourable friend Daisy Cooper about the recording of a third dose, the Minister, Maggie Throup MP, replied:

“Work to assess the need to include boosters in the NHS COVID Pass is ongoing and we will provide a further update in due course”,


so even the records cannot distinguish. Can the Minister say when “in due course” is? I am afraid this is symptomatic of the way the clinically extremely vulnerable have been ignored and left to fend for themselves.

I will ask a question that I have asked the Minister’s predecessor repeatedly since June of this year. In May 2021, Jenny Harries left Public Health England to set up the UKHSA. For the preceding 12 months she had specific responsibility for co-ordinating all the different elements of Covid issues for the CEV and for shielding. When she left, no one was given that responsibility, and it was noticeable that all communications with CEV people and the different parts of the NHS on Covid just stopped when shielding stopped. Can the Minister tell us which senior person in the NHS has that managerial responsibility? It has been five months since I first asked and there are 3.7 million worried people still waiting for answers. It would be good to know which Minister has the responsibility to co-ordinate all Covid matters for the CEV or former shielders. This is important, because the last letter from the Secretary of State tells the CEV not to go into any environment where people have not been double-jabbed. There is no mention of boosters, and obviously no mention yet of omicron.

Is there a confirmed register that distinguishes between the CEV and the severely CEV? Unlike in Scotland, hospital consultants in England do not have access to individual patient records that GPs use or even to the Covid app data. Can the Minister say how NHS England will be able to communicate directly with eligible people if they do not have a register? Is there a specific communications plan to ensure that primary care, secondary care and the 119 vaccine helpline are fully aware of plans and processes for this group? Reports are coming back of blood cancer patients being told at vaccine centres that they do only boosters—there is no knowledge or understanding of the third dose.

I recognise that I am asking the Minister a large number of questions on the immunocompromised. I really do not expect answers to them today—written answers are always very welcome—but please will he agree to meet with me, Blood Cancer UK and the Anthony Nolan Trust to discuss these key questions, not least because we are now in a different situation, with the 3.7 million, which is 5% of the country, left in limbo?

As the noble Baroness, Lady Thornton, said, it is too early to say whether omicron is more dangerous than delta or beta, or whether treatments such as Ronapreve and the current vaccines might not be as effective. The Government are right to be cautious. I echo her comments about Clive Dix, the former head of the Government’s Vaccine Taskforce. What plans are in place for vaccine development for an escape variant?

At a time when manufacturing is one of the key issues slowing down the delivery of vaccines worldwide, why is the Vaccine Manufacturing and Innovation Centre at Harwell, which has received in excess of £200 million of public funding via UK research and development, now up for sale, long before the pandemic is over? We still need its expertise. Selling off a publicly funded, not-for-profit organisation during the pandemic, if at all, seems, frankly, bizarre.

Finally, the Statement has a passing reference to test and trace domestically. It says:

“We have a much greater capacity for testing, enhanced ability for sequencing”.


Genome sequencing in the UK has been a real strength of UK science and has undoubtedly helped us considerably in this pandemic. But, in recent weeks, with the Government’s determination to open up and return to normality, test and trace has been scaled back, with reduced centres and reduced hours for those that remain open. Can the Minister say what plans there are to increase these back as needed? Are directors of public health and their local resilience forums receiving funding for the current omicron problem? It also appears that there is no Covid funding for them next year at the moment. If omicron is a viable variant, we must plan to fund them to keep these safety nets of test and trace in place, because without an effective test, trace and isolate system, including proper payments to those who need to isolate, we will not manage, let alone control, this virus. Defences are not defences when there are large holes in them.

[Lord Kamall (Con)]

I thank both noble Baronesses for their questions. I will try to answer as many as I can.

On the first issue of face coverings and why not all places, we are taking temporary, targeted and proportionate action as a precaution while we learn more about this new variant. Face coverings have been introduced as part of the temporary measures being put in place to slow the spread of the omicron variant. We know that face coverings are effective at reducing transmission indoors when people are likely to come together—for example, on public transport or in shops—while having a low impact on our daily lives. We continue to encourage everyone to wear face coverings in settings that are crowded or where they meet or come into contact with people they do not normally meet, but we are also guided by the advice of our scientific and medical experts. We are constantly keeping these under review.

One of the reasons why our advice is not the same for hospitality venues is that the advice has been that it is not seen as practical for people to wear a face covering when eating or drinking. It is not recommended that face coverings are worn when undertaking strenuous activity, including exercising and dancing. That is the advice we have had to date on that one.

Questions were asked about NHS capacity. The NHS can respond to local surges in demand in several ways, including through expanding surge capacity in existing NHS hospitals, mutual aid between hospitals, and making use of independent sector capacity and accelerated discharge schemes. The NHS is the Government’s key spending priority. That is why we committed to the historic settlement of the cash increase of £33.9 billion a year by 2023-24, and other investments we have made to make sure we have that capacity.

The booster vaccine will be offered in order of descending age groups, with priority given to older adults. This will probably be the most complex phase of the NHS vaccination programme so far, but the NHS is working through updated guidance and will set out how this will be operationalised shortly. It will contact you when you need to act and book in for your life-saving vaccination.

On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We will have donated more than 30 million vaccines by the end of 2021 and we have announced plans for 70 million doses in total so far. We will continue to work to ensure that any vaccine that the UK does not need is reallocated to other nations that require it, wherever possible.

On future preparedness for variants and future pandemics, as noble Lords will know, the UK Health Security Agency, which focuses on health protection, became fully operational on 1 October 2021. It will operate as an integral part of our health system and utilise state-of-the-art technologies and ground-breaking capabilities in data analytics, including genomic surveillance, as acknowledged by the noble Baronesses. The UKHSA will play a critical role in the route to developing vaccines that are effective against new and emerging variants. In the longer term, to make sure we learn the lessons, we will build on the infrastructure developed for Covid-19 to tackle and prevent other infectious diseases and external health threats. This work will include a strong focus on the life sciences, strengthening relationships with academia, research organisations and industries that have developed and grown through the pandemic, in which there are now several centres of expertise.

We are delighted to see students back at schools and higher education settings, but to reduce transmission we are keeping some sensible measures in place across education and care settings. These include access to twice-weekly testing in secondary schools and the provision of CO₂ monitors to all schools. We have said that education settings must continue to comply with health and safety law, and we are working between the Department of Health and the Department for Education to make sure we have the right and appropriate response in our education settings.

The noble Baroness, Lady Brinton, asked about severely immunosuppressed individuals—I thank her for the acknowledgement that I will not be able to answer all the questions in detail and that it probably would be better if I write to her in more detail. So far, however, the individuals who have completed their primary course of three doses should be offered a fourth booster dose with a minimum of three months between the third primary and fourth booster dose. If they have not yet received their third dose, they should have that now to avoid further delay.

The other point I will make is that it is not too late for anyone who has not yet had their first or second dose. Please do not think that, because we are advertising for boosters, it means that you have missed the boat. In fact, we are working very hard—and I have received a lot of advice from noble Lords across the House—on how to address the low take-up of vaccines among certain communities and demographics. I am grateful to noble Lords for that. I also reiterate the point that it is not over. I humbly disagree with the statement that we have given the impression that it is over. We have been quite clear that it is not and that we must continue to be vigilant.

In terms of briefings, I will commit to giving a briefing to all Peers. I thank the noble Baroness for that suggestion. I have apologised for not being more proactive on that—maybe I should have done so on Sunday afternoon or evening after the Secretary of State. To the noble Baroness, Lady Brinton, I can only apologise for not having an answer sooner to the questions she has asked in the past. The best way to resolve this is for me to commit to the meeting that she has requested so that we can try to answer the questions that she has outstanding. I apologise to her for those questions not being answered previously.

NHS: Primary Care Surgeries

Debate between Lord Kamall and Baroness Brinton

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

[Baroness Brinton (LD) [V]]

My Lords, one of the concerns is the transparency of agreements between clinical commissioning groups and these private companies. Are CCGs required to make absolutely transparent any arrangements they have made with these private companies?

[Lord Kamall (Con)]

The noble Baroness will understand that it is not for the Government to intervene in the decisions of CCGs. All who believe in devolution and decisions being made as close to the people as possible believe that we should not be interfering. These decisions are made by CCGs and it is not for the Government to interfere.

New Hospitals

Debate between Lord Kamall and Baroness Brinton

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

I completely agree with the sentiments expressed by my noble friend. Surely what we should focus on is output; surely what we need is the best healthcare system across the country. We need up-to-date healthcare with the best information from patients to make sure that we can diagnose and give them appropriate treatment, working with the very latest technology such as artificial intelligence to spot patterns, to make sure that we can also build in prevention when we look at tackling health issues in the future. I welcome my noble friend saying that we have to focus on output—modern digital infrastructure and modern digital hospitals fit for the future.

[Baroness Brinton (LD) [V]]

My Lords, my local hospital, Watford General, is on the list of 40 so-called new hospitals, although the plans have been in place and supported cross-party for close to two decades, and its infrastructure is failing. Despite a clear promise of funds by the Prime Minister during a visit to the hospital in October 2019, the trust is yet to be allocated funding from the Treasury and it remains a pathfinder. I want a clear outcome. When will funding be confirmed and granted?

[Lord Kamall (Con)]

On the point about the noble Baroness’s local hospital, I am afraid that I am not aware of where she is situated geographically, but I can tell her that six of the 48 hospitals are already under construction and one is now completed. I hope that the noble Baroness will write to me on the hospital that she referred to so that I can give her an answer.

Covid-19 Update

Debate between Lord Kamall and Baroness Brinton

Wednesday 10th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I also thank the Minister for repeating this Statement. Covid-19 Statements are now taking on the role of London buses—large gaps for a while and then suddenly two in one week on vaccines. It feels as though arguments were going on behind the scenes for such a quick second vaccine Statement to be repeated in less than two or three working days.

Like the noble Baroness, Lady Thornton, my honourable friend Daisy Cooper MP asked yesterday about the publication of the long-awaited impact statement —Making Vaccination a Condition of Deployment in Health and the Wider Social Care Sector—that this Statement refers to. It would have been helpful for MPs to have had sight of it at the same time as the Statement. As the noble Baroness, Lady Thornton, said, frankly we needed to see it a long time ago, given that the social care deadline starts tomorrow. It was finally published overnight, and I have some questions on it for the Minister.

The Statement announces that all NHS and social care staff will have to have to be fully vaccinated by 1 April 2022. The deadline for care home staff remains tomorrow. The predicted numbers on page 4 of the impact statement are pretty staggering—up to 126,000 staff, of whom 73,000 are expected to be NHS staff. Page 6 of the impact statement also says that the modelling cost of replacing unvaccinated workers is between £162 million and £379 million. That is also staggering, given the financial pressures and backlog of cases across a health and social care sector that at the moment is still struggling with the pandemic.

From these Benches we really want to see staff vaccinated but would prefer that it is voluntary and remain concerned about the consequences of tomorrow’s care homes deadline. Page 6 of the impact statement published overnight talks about the disruption to health and care services. But for social care that disruption has already started. Many care home staff have already left or this week are being fired, with a good number moving to the NHS and to retail and hospitality roles.

Large homes are reporting closing down wings of beds due to lack of staff and some smaller homes are handing back state-funded patients to local authorities. Both the Statement and the impact statement are silent on how patients will be looked after before we even get to the consequences of social care homes without beds.

So can I ask the Minister what emergency plans there are to help areas? By the way, answers that say “It’s down to local authorities” are not helpful. This is a crisis created, at least in part, by mandatory vaccines, and there are no staff or beds that can just magically appear. Or is what Sajid Javid said at the Conservative Party conference the reality: namely, that families will be expected to step up to the plate to look after their loved ones in the absence of care home beds? If so, it would be good to see Ministers’ planning for that and the consequent problems for the workforce.

The Statement says that other parts of the social care system—for example, domiciliary care—that were excluded from the original care decision will now be included, but neither the Statement nor the impact statement is clear about the deadline for those in the social care system now being drawn into mandatory vaccination. Can the Minister say what the deadline is for these new groupings? It surely cannot be that the deadline for domiciliary workers is this week. Is this just for full-time staff employed by the care sector, or will others offering regular services such as activities in care homes or subcontractors working in hospitals now be included? There are staff working as sub- contractors for the NHS who have front-line access to patients; for example, delivering meals. Are they included or excluded?

The table on page 4 of the impact statement lists the total number of staff in each sector exempt from vaccination. I cannot find anywhere the criteria for exemption. Can the Minister please tell the House what those criteria are?

I have now asked the Minister at least twice in the past fortnight about the online vaccination form which sits behind the GP records and the app. How many of those who were vaccinated overseas and those who took part in clinical trials are now on the records system? Has it increased from the 53 people that he talked about last week, and are the arrangements for logging third doses for the severely clinically extremely vulnerable, as distinct from the booster doses for everyone over 50 and health staff, now sorted out? I am still getting reports that they are not.

Finally, there has been considerable concern that the Prime Minister was not wearing a face mask at Hexham hospital yesterday, against all NHS advice. This morning, Dr David Nabarro, the World Health Organization’s special envoy for Covid-19, said on Sky News:

“I’m not sitting on the fence on this one … Where you’ve got large amounts of virus being transmitted, everybody should do everything to avoid … getting the virus or inadvertently passing it on. We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own. So … please, would every leader be wearing face masks, particularly when in indoor settings? … This virus is unforgiving, and we need to do everything possible to prevent it getting in between us and infecting us.”


Can the Minister explain why the Prime Minister was not wearing a face mask, in breach of Hexham hospital’s rules, and will he pass on those words from Dr Nabarro to No. 10 Downing Street?

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

I thank both noble Baronesses for their questions and the important points they made. It is important that we are clear about many of the issues that they have brought up.

Let us be clear that the best mitigation against this is to encourage those who are vaccine hesitant to take up the offer of vaccination. In both health and social care, we have worked extensively with key stakeholders and arm’s-length bodies to encourage vaccine take-up. This has involved a number of different measures: bespoke communications materials, paid advertising, stakeholder toolkits, positive messaging using influencers and leaders, content in different languages, briefings with different faith groups, webinars with clinical experts, vaccine champions and practical support including vaccination at places of work, flexible access to vaccine hubs, digital booking support and monitoring and support from NHS England. We will continue to encourage uptake in the run-up to the requirements coming into force.

The NHS has also focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking specific, targeted campaigns directed towards, for example, midwifery staff, ethnic minority groups in certain areas that have been hesitant and students, as well as using the booster campaign as an opportunity to re-engage staff. I thank noble Lords across the House for the advice that they have given me on how we can address hesitancy in some communities and for their very useful suggestions. I have discussed this with a number of other people, and we are looking at potential pilot projects, one working, for example, with faith communities in inner-city areas and mapping the data from Public Health England and the relevant offices.

It is interesting to see how many absences are due now to the unvaccinated. The seven-day average to 6 October 2021 shows an average of 74,863—nearly 75,000—absences in NHS trusts per day, of which more than 15,500 were for Covid-19-related reasons, including the need to isolate. This benefit would be reduced if we relied only on testing, although that remains part of our armoury.

I was asked a number of questions about scope and who this extends to. It applies to all providers, both public and private, of a CQC-regulated activity. This obviously covers a wide range of services, including hospitals, GP and dental practices, and social care providers. Further support on implementation for the sector will be provided through continuous guidance. The policy does not apply to those services and activities which are not regulated by the CQC. Children’s and social care services which are CQC regulated will be in scope of the requirement, but it will not apply to services that are provided as part of shared-living arrangements. Many of these reasons are of course as a result of the extensive consultation that has been undertaken.

I was asked for the number of uptakes. The vaccination uptake figures for NHS staff show that nearly 93% have had at least one dose. Uptakes still vary, from 84% to 97% for the first dose, among NHS trusts. Among primary care workers, this ranges from 94% in the south-west to 76% in the east of England—so we would welcome the advice of any noble Lords who have experience of the east of England. In adult social care, nearly 84% of domiciliary care staff have received one dose of the vaccine, and nearly 75% have had a full course of a Covid-19 vaccine, as of 14 October, which we believe represents the best proxy for the workforce in scope of the policy in other settings, too. So, despite our best efforts, there is still much more that we can do. I personally feel very uncomfortable about compulsion, but I also understand the arguments on both sides when I meet many patient groups and others who tell me that, if they were in hospital or a care home or had relatives there, they would feel much better if the staff were vaccinated and were protected.

What more can we do? The Covid-19 vaccines have been approved by the MHRA as safe and effective, and we continue to send that message out. Analysis suggests that the Covid-19 vaccination programme prevented more than 100,000 deaths in England as of 20 August. We continue to have targeted engagement. The NHS plan also includes one-to-one conversations for all unvaccinated NHS staff with their line manager, with clear guidance on how to do this. We have found that such one-to-one conversations are working in some cases. We want to make sure that we listen as well, hearing concerns that are seen to be legitimate as well as concerns that are not medical reasons but other reasons that staff may have for being so hesitant. It is really important that we understand, and that was all part of the extensive consultation.

We are trying to increase the number and diversity of opportunities. We are using the booster campaign, walk-ins and pop-ups for not only the public but staff as well.

A question was asked about pregnant women. Short-term exemptions from requirements are available to those with short-term medical conditions, but also including pregnancy. For pregnant women, the exemption expires 16 weeks after childbirth. This will allow them to become fully vaccinated after the birth. We will set out these arrangements, as has been called for by noble Lords, in the guidance on exemptions.

As noble Lords acknowledged, we set out yesterday an assessment of the impacts alongside the laying of the regulations. We also published a full impact assessment yesterday for the original care home regulations, and I thank the noble Baroness for acknowledging that. As committed to by my right honourable friend the Secretary of State in the other House yesterday, we will publish a full impact assessment for the regulations as soon as possible, and before Members vote on the proposed legislation. I recognise that Peers will be keen to understand the impacts of the policy as soon as possible and as part of consideration of the regulations. However, I hope that noble Lords will appreciate the necessity of trying to move as quickly as possible to ensure that patients are protected and that workers are given as much notice as possible. We will set out the statement of impact, which noble Lords will be able to consider, and it will be published before Members cast a vote.

We have done a number of things on vaccine hesitancy, and I have laid them out already. We want to encourage as many people as possible to take up the vaccine ahead of the regulations, which is one reason why we have the grace period until 1 April next year. The individual worker maintains a choice as to whether they decide to have the vaccine. Even if they choose not to have the vaccine, the registered person may redeploy them to a non-patient-facing role. When that is not possible, the worker cannot be employed or otherwise engaged by the registered person. This is incredibly important when it comes to patient-facing staff, especially for the families of those patients who are deeply concerned that their loved ones may be infected by unvaccinated staff.

I was asked how the measure will be enforced. On the approach to vaccination requirements, it is the CQC’s role to monitor and take enforcement action. At the time of registration and when inspected, health and care providers would need to demonstrate that they have effective systems in place. There are a number of measures in place to support care home workers. The majority of care home staff are now fully vaccinated, but there are a number of different programmes. Given the time, I shall not go into them but, if noble Baronesses would like more details on those encouragement programmes, I should be happy to write.

David Fuller Case

Debate between Lord Kamall and Baroness Brinton

Tuesday 9th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

[Inaudible]—but that such a prolonged period of abuse was able to take place without it being noticed. We echo the sincere condolences to the families and friends of Wendy Knell and Caroline Pierce, as well as the many families and friends of those whose bodies David Fuller so foully desecrated.

The Statement says that the families and friends will have access to mental health support and counselling. That is good, but can the Minister confirm that it will be available for as long as they need it and will not be time limited? Will the staff at the mortuaries and hospitals, as well as the police and the over 150 family liaison officers involved in this case, also have access to counselling? They too have had to deal with this very distressing series of events.

We must obviously be very careful in our discussions today pending the sentencing of David Fuller, but we welcome the Secretary of State’s announcement for the upgrading of the trust’s independent review to an independent inquiry, to be chaired by Sir Jonathan Michael.

In August 2018, the Health Service Journal reported that 58 mortuaries that had been inspected in 2017-18 revealed that more than 500 “shortfalls” were exposed during that period. Worryingly, that included eight critical failings. At that time, the Human Tissue Authority as regulator and the various other regulated bodies undertook to look at the large increase in failings that year and to review practice. What actions were taken following those 2017-18 reports and were measures on access by staff to mortuaries among them? I ask this because, looking at the Human Tissue Authority’s codes of practice online, almost the entire focus seems to be on those whose role is to be involved with bodies. In Code A: Guiding Principles and the Fundamental Principle of Consent, the only reference I can find that does not relate to those with direct responsibilities for bodies is in paragraph 14 on page 7, which begins:

“Quality should underpin the management of human tissue and bodies.”


It goes on to say that this means that:

“practitioners’ work should be subject to a system of governance that ensures the appropriate and safe storage and use of human tissue and which safeguards the dignity of the living or deceased”,

and that

“premises, facilities and equipment should be clean, secure and subject to regular maintenance”.

One of the concerning issues relating to this case is that Mr Fuller ceased to be an employee of the Tunbridge Wells health authority in 2011 when the maintenance contract was subcontracted out. Will the inquiry look at not just whether employees of subcontractors working in sensitive areas are subject to DBS checks but whether there is a duty on their employer to report any findings to the hospital, or in this case the mortuary? Mr Fuller had a previous criminal record, but it is reported that the hospital did not know this.

There is another issue which I have not heard referred to either here or in the Statement in another place yesterday, and that is our criminal justice system’s approach to the desecration of bodies. The respected criminologist Professor Jason Roach from Huddersfield University has analysed the policing of and law in Britain towards necrophilia. He found an almost complete absence of case studies, which is not true in the rest of the world. Indeed, it was not until the Sexual Offences Act 2003 that necrophilia became a criminal offence in its own right, but he says there is no evidence that anyone has ever been prosecuted. He reports that, as part of his research in 2016, he was told by one senior police officer that it was very unlikely that the police would ever urge the Crown Prosecution Service to charge an offender.

One hypothesis that Professor Roach explores in his 2016 work “No Necrophilia Please, We’re British” is that

“the attitude of the British criminal justice system towards necrophilia echoes that of the British public, i.e. one of embarrassment, whereby those caught are either not charged with a criminal offence or, perhaps for the sake of the deceased’s family, are charged with a less degrading offence such as grave robbing. Both routes will produce less attention-grabbing stories”.

Can the Minister say if the review will look at police and criminal justice system attitudes towards necrophilia or other forms of desecration of bodies? One of the deeply unsatisfactory legacies of Jimmy Savile’s extended abuse is the suspicion of his undertaking such activities. However, perhaps through embarrassment, there has been no real examination of that case and the cultures of the places where he was able to have access to the dead.

Can the Minister say if any lessons learned so far will be reported and implemented straightaway, before the full independent inquiry reports, to give the public confidence that hospital mortuaries are safe and secured? As ever, if the Minister does not have any of the answers to my questions to hand, please will he write to me with them?

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

My Lords, this is one of the most difficult issues that we have had to address and discuss in my short career at the Dispatch Box. It is one of those crimes that are beyond imagination. Who could think that an act of such depravity would occur? David Fuller has pleaded guilty to the murder of Wendy Knell and Caroline Pierce, and all our thoughts are with Wendy and Caroline’s families and friends.

In recent days the courts have heard about a series of David Fuller’s shocking and depraved offences. He is yet to be sentenced, so I am sure noble Lords will understand that it would not be appropriate for me to comment on the details of the case while the legal process is still in progress. However, I will try to address as many of the questions about the response as possible.

This is a profoundly upsetting case that has involved distressing offences within the health service. I apologise to the friends and families of all the victims for the crimes that were perpetrated in the care of the NHS, and for the hurt and suffering that they are feeling. It has taken months of painstaking work to uncover the extent of this man’s offending. The fact that these offences took place in a hospital, somewhere all of us would hope to feel safe and free from harm, makes it all the more harrowing. This has been an immensely distressing investigation, and I thank the police for the diligent and sensitive way in which they have approached it. I also thank Maidstone and Tunbridge Wells NHS Trust for co-operating so closely with the police.

I am sure that in the inquiry all matters will be considered and that it will be as full and comprehensive as possible, but it is critical that we investigate this case thoroughly to ensure that lessons are learned. My right honourable friend the Health and Social Care Secretary is replacing the trust investigation with an independent non-statutory inquiry, which will look into the circumstances surrounding the offences committed in the hospital as well as their national implications. That will help us to understand how these offences were allowed to take place without detection in the trust and then to consider the wider national issues, including for the National Health Service. My right honourable friend has also asked the Human Tissue Authority to advise on whether changes are required to the existing legislation.

What will the independent inquiry do? We thank the NHS trust and its leadership for its quick initial work in setting up the investigation, but we have a duty to look at what happened in detail and to make sure that it never happens again. The Secretary of State has appointed Sir Jonathan Michael to chair the inquiry. Sir Jonathan is an experienced NHS chief executive, a fellow of the Royal College of Physicians and a former chief executive of three NHS hospital trusts. He has been leading the trust investigation and will be able to build on some of the work that he has already done. The inquiry will be independent and will report to the Secretary of State.

The noble Baronesses asked about the timeframe. Sir Jonathan will split his time into two parts. The first report will be an interim one, which has been asked for early in the new year. The second and final report will look at the broader national picture and the wider lessons for the NHS and other settings. We will publish the terms of reference in due course. Sir Jonathan has been asked to discuss with families and others to ensure that their feelings are fully considered and that they input into the process. Sir Jonathan’s findings will be public and will be published.

We all know that this is a shocking case. None of us ever thought that we would have to take part in a discussion such as this. Specialist police officers have contacted the families of the victims directly and privately. We want to, and we must, respect the families’ privacy at this difficult time. There is a comprehensive package of support for the families affected. This includes dedicated caseworker support, a 24/7 telephone support line and specialist support, such as mental health support and counselling, as needed and as appropriate. The trust is also talking to family members who wish to be contacted.

Kent Police has set up a major incident public portal and contact centre to manage calls, collect any relevant additional information and direct people to other sources of support. If people are interested in looking at that, they can search online for the major incident public portal and select Kent Police and Operation Sandpiper. We know that this is distressing for many people, both the families and more widely.

Wider support can also be accessed through the Ministry of Justice Victim and Witness Information page, which provides links to local support according to postcode, the 24/7 Victim Support helpline and My Support Space, a platform providing many guides and tools and access to a 24/7 live chat function. The trust has worked closely with the police to put in place a comprehensive package, and we thank the NHS trust for the measures it has put in place. We also recognise that, as the noble Baroness said, all those working in the trust and wider health service are profoundly shaken by the nature of these offences. The trust has put support in place for affected staff.

The trust and NHS Resolution are considering the right approach to compensation, but that involves getting further legal advice. The trust will provide support to the families concerned. As we have said, it is also important that we understand what is happening.

The police have so far found evidence of 100 victims of the offences committed in the hospital mortuary and have been able to formally identify 81 victims. They are seeking to identify all the victims, as is appropriate. Specially trained family liaison officers have spoken to all the families of those identified to date.

It is important to make sure that this is investigated thoroughly, and I want to be careful not to pre-empt the inquiry’s findings. Under the current regulations, the Human Tissue Authority regulates licences and inspects organisations that run mortuaries where post-mortems are carried out. Mortuaries that do not carry out post-mortems may not need to have a licence from the Human Tissue Authority. It is the responsibility of the organisation running a mortuary licensed by the HTA to ensure that the HTA’s licensing standards are met, including those relating to security. It is also for the organisation running the mortuary to ensure that safety procedures are in place.

I was asked about the DBS regime. In July the Home Office announced an independent review of the disclosure and barring regime. The review will consider the adequacy of current arrangements for criminal record checks for jobs that entail contact with the deceased. Ministers are finalising arrangements for the review, and further details will be announced as soon as possible.

I apologise to noble Lords if I have not answered their questions. I hope I will be able to follow up with answers.

Cancer Drugs: Licensing and Approval

Debate between Lord Kamall and Baroness Brinton

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

I think noble Lords will agree with that frustration at the speed of approval and licensing, but in most cases it does happen speedily. One of the central issues is making sure that there is confidence in the ability to purchase. We are looking at a number of different ways to accelerate the process, including through ILAP—the accelerated partnership—while also making sure that MHRA and NICE can speak where they are allowed to, given some of the legal restrictions on their discussions. For example, I went a couple of weeks ago to a board-to-board meeting between MHRA and NICE at which they discussed issues of common concern.

[Baroness Brinton (LD) [V]]

My Lords, picking up on the point of the noble Lord, Lord Hunt, there is a particular problem in the United Kingdom with NICE and MHRA appearing not to talk together as much as they should to help streamline the process, where that is appropriate. An academic paper in March demonstrated that the CDC in America has a much stronger, streamlined system that works, with far fewer drugs being delayed. How can NICE and MHRA learn from what is happening abroad?

[Lord Kamall (Con)]

It is important that we learn the best lessons from abroad on incredibly important issues such as this. Where NICE and MHRA are allowed to talk to each other and co-operate—there are some restrictions, as I am sure many noble Lords are aware—both clearly recognise that there are great concerns and distress on the part of the many patients who want access to these drugs, and they are trying to work out how they can speed up the process as much as possible.

Covid-19 Vaccinations

Debate between Lord Kamall and Baroness Brinton

Monday 8th November 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Benches, we add our thanks to all those involved in the current delivery of vaccinations, whether they are GPs, nurses, healthcare assistants or volunteers at vaccination centres, and we thank more broadly our NHS and care-sector staff who are still working extremely hard to reduce the backlog of cases while coping with over 9,000 patients currently in hospital with Covid.

The Minister knows that the Delta variant and its subvariant, which is thought to be behind the growth of cases in the west country and Wales, remains highly transmissible. Doctors are reporting daily that double-jabbed patients are catching Covid and passing it on. Why have none of the mitigations in plan B been carried out? Many scientists, including some members of SAGE and Independent SAGE, believe that we should be operating them now to reduce the high numbers of cases and not be faced with a second Christmas being cancelled by the Prime Minister at short notice.

From these Benches, we have asked time and again for the wearing of facemasks inside and on public transport, as well as room ventilation in schools and other public venues, to be mandated, and for social distancing to remain. There are now, on average, 35,000 new cases daily, a shockingly high number. Professor Peter Openshaw, the chair of NERVTAG, said today that it was clear that immunity from the vaccines is waning. Yes, and vaccination is vital, but with cases at this level why are the Government not making mask mandates and social distancing formal?

Today, the Prime Minister once again reminded people to get their jab, whether first, second, third or booster, the ONS data showing that the risk of dying from Covid is 32 times greater in unvaccinated people. Can the Minister tell us why last week it was announced that vaccination centres are now closing at 6pm? Surely it should be easy for people to get vaccinated at a time that works for them, when they leave for work or get home from work?

The last time we spoke about Covid, I asked the Minister what the Government were doing to prevent some of the very unpleasant anti-vaxxer interventions at school gates and outside some vaccine centres. Has any action been taken on their disgraceful leaflets, which deliberately look like an NHS document but are full of direct lies and mistruths? It is important, because, by the Minister’s own numbers in this Statement, only 22% of 12 to 15-year olds have had their vaccination so far. I think Ministers now recognise that cases in this age group are driving cases in the older age groups, which is probably why hospital numbers are going up.

The noble Baroness, Lady Thornton, referred to the muddle between booster and third doses. The pandemic is far from over for immunocompromised and immunosuppressed people. I declare my interest as one of the clinically extremely vulnerable, as I have said before. I discovered by chance, reading something online, that I am now in the third-dose category. My GP did not know it and I certainly did not know it either. That is the problem. GPs and vaccination centres have not been told about the distinction. I have read the NHS guidance on the third dose, but many other clinically extremely vulnerable people are saying that their surgery or vaccination centre does not understand which category they fall into.

This is not helped by the problems with the online form which I asked the Minister about last week. Does the online form now specify the third dose, which is for around 800,000 people, according to current estimates, not for 400,000 people, as the noble Baroness, Lady Thornton, said, as distinct from the booster, which is for around 20 million? It is important, because the third-dose patients must have a booster in a further few months. If the system is not even recording the third dose, how will it know to call them back?

With the end of the shielding programme on 17 September, Sajid Javid wrote to all those on the patients’ list to inform them that it had finished, that the Government would no longer be offering specific advice and that we should go to our hospital clinicians. But many of us do not have an appointment in the diary, and there is not likely to be one because our clinicians are catching up with the backlog of cases, and those who are specialists in immune diseases are working on the Covid wards as well. So can the Minister say how on earth the clinically extremely vulnerable are meant to know what to do in the meantime?

Will the Minister ensure that the Government will work with patient organisations, clinicians and employer to produce clear and meaningful guidance that promotes safe working practices for this group and, in particular, let employers know that they have to help employees either to work from home or, if they have to go in, to make sure they do not have to go in by train or bus at peak hours? Please will the Government appoint a dedicated national lead to co-ordinate the support and guidance available to people in this group?

The news in the Statement of the approval of the Merck and Ridgeback antiviral Molnupiravir is also good news. I see that just under half a million courses of doses have been ordered. It was good to hear on Saturday of the success of the Pfizer clinical trials elsewhere, but I gather we are some way off from that being approved, because further trials of people who are clinically vulnerable are needed. Can the Minister tell the House the likely timescales of the actual delivery of both these different antivirals?

Finally, I am aware that I have asked some technical questions. If the Minister cannot answer them today, please will he write to me with the answers?

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

I thank the noble Baronesses for their questions and for raising some very important points, on which I and others have been in discussion not only with health professionals but with departments and other advisers. I will try to answer their questions in detail. The ones that I do not answer because of their technical nature—as the noble Baroness, Lady Brinton, acknowledges—I will try to answer later if I am unable to answer now.

First, I join the noble Baronesses, Lady Thornton and Lady Brinton, in praising our wonderful doctors, nurses and other healthcare staff. Also, we should not forget all the wonderful people who have supported them: the delivery staff who brought stuff to their homes and delivered food, and the local civil society projects. We saw a massive upsurge in voluntary work and volunteerism. Whatever our politics, whatever part of the spectrum we are on—whether we call it co-operative socialism, local libertarianism, community conservatism, or just humanity and people helping each other—I thought it was a wonderful expression of what we can do when we all pull together.

We also have to remember, as the noble Baronesses, Lady Thornton and Lady Brinton, reminded us, that this is not over. That is one of the reasons why the Secretary of State felt it was important to make this Statement and this point. There has been a level of complacency in encouraging people to come forward. We have not been strong enough, which is why we are pushing now and emphasising the fact that we want as many people as possible to come forward and get the booster. It was announced over the weekend that it is not necessary to wait for six months after the second dose; people can book from five months. In fact, today I tested the system and took advantage of it and was able to book my booster. I hope many others will be able to do so to.

I would ask noble Lords across the House that if anyone comes to them with experiences of not being able to use the service—we have had a couple of reports of a few technical hitches—please let me know so that I can pass them on to NHSX, so that we make sure that we are aware of problems as soon as possible. So far—I want to try to touch some wood somewhere—it seems to be working.

Let me now turn to some of the detailed questions that I was asked by the noble Baronesses. The JCVI has advised that people with severe immunosuppression at or around the time of their first or second vaccination receive a third primary dose as a precautionary measure. Some individuals who are severely immunosuppressed due to underlying health conditions or medical treatment may not achieve the same full immune response to the initial two-dose Covid-19 vaccine course. The third dose aims to bring them up to nearer the level of immunity. As with the vaccination of other at-risk individuals, eligible individuals will be identified and invited by the hospital where they receive care under a consultant and/or GPs.

If either of the noble Baronesses or any noble Lord here today is aware of that not happening, please let me know so that I can make sure that we push on this. I am told that the NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or consultant if they have not done so already. Any patients who have not yet been contacted but think they may be eligible, for example because they have previously been advised to shield, can contact their consultant for an update. If noble Lords know of any problems or are aware of any issues, I hope that they will let me know as soon as possible so that I can chase on them.

On the booster, while there are many stories saying that we have not done that well, we have 12% booster vaccination. When we look at booster vaccination in other European countries, the highest is Israel with 45%, but Spain is at 2%, Italy is at 3%, France is at 4% and Germany is at 2%. This is why we are emphasising the importance of booster vaccinations. My right honourable friend the Secretary of State and others are keen to push people to make sure that they have their booster as soon as possible. It is the best defence against Covid and it is important, especially as protection wanes, that people are getting their boosters.

On plan B, I repeat what has been said previously: there is no set threshold. We consider a range of evidence and data, as we have done throughout the pandemic, to avoid the risk of placing unsustainable pressure on the NHS. For example, while the number of Covid-19 patients in hospitals is an important factor, the interaction with other indicators, such as the rate of increase of hospitalisations and the ratio of cases to hospitalisations, will also be vital.

The Government monitor and consider a wide range of Covid-19 health data. I shall go into some of them in a bit of detail. We look at cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infections, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. We also look at the risk to the NHS. One of the issues, as many noble Lords will know, is about making sure that the NHS is not overwhelmed. In assessing the risks to the NHS, the key metrics include hospital occupancy for Covid-19 and non-Covid-19 patients, intensive care unit capacity, admissions in vaccinated individuals and the rate of growth in admissions. The Government also track the economic and societal impact of the virus to ensure that any response takes into account those wider effects.

On some of the measures that are being proposed in the potential plan B, clearly a number of people with other health conditions, including mental health conditions, would be incredibly concerned were we to go to some of the more severe measures under plan B. We always have to balance them up. As noble Lords will be aware, questions have been asked about those awaiting elective surgery and the unintended consequences of focusing on Covid-19, for example whether it has led to a disproportionate number of deaths from other diseases or conditions.

Covid booster jabs have been delivered or booked in almost nine in 10 care homes as the NHS vaccination programme accelerates ahead of winter. Around 6,000 care homes have already been visited, while a further 3,700 homes have visits scheduled in the coming days and weeks. The new figures also show that residents in more than half of care homes have received their booster jab. When I asked about the discrepancies in the small proportion that have not yet been booked or vaccinated, I was told that there may well be cases of Covid in those care homes and they are waiting for the delay after the positive test to ensure that it is safe to go there.

I was asked about the breakdown of different types of care home. Based on the latest CQC annual report on care, we can say that the CQC inspects a number of these care homes.

To answer some of the other questions, as I said, the NHS is writing to all patients who may be eligible so that they can talk through their options. On the issue of whether to make NHS staff take their vaccinations, we have consulted on vaccination as a condition of employment in wider health and social care; I am told that my right honourable friend the Secretary of State will set out the position very shortly. The important thing to remember is that we want people to take the booster, and we want to make sure that we reach those communities and demographics who have not had even their first or second vaccine yet.

I have had a number of conversations with noble Lords from across the House—I thank them for their advice and suggestions—about how to reach out to some of these communities. For example, I was in conversation with one right reverend Prelate about how we could work in conjunction with interfaith communities in local communities, for example in certain parts of London where there is a low uptake. Sometimes people may not be of faith, but they respect faith leaders—vicars, imams, priests et cetera. We are looking at how we can work on this, and I very much hope that we will be able to roll that programme out further. If any noble Lords are interested in or have any suggestions on that area, I would welcome them.

I apologise if there are technical questions that I have not answered; I will make sure that I write to noble Lords.

Social Care

Debate between Lord Kamall and Baroness Brinton

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we have to see reforms in the social care sector. The spending of £5.4 billion includes £1.7 billion for wider system reforms, including at least £500 million to support the adult social care workforce in professionalisation and well-being. We are also working closely with providers of care, local government charities, the unions, professional bodies, and users of care and their representatives, and will respond to their views in the forthcoming adult social care system reform White Paper, later this year.

[Baroness Brinton (LD) [V]]

My Lords, so far the Minister has responded only on the issue of adult social care. Freedom of information requests from every local authority in England by the Disabled Children’s Partnership reveal that 40% of authorities cut the respite care for parent carers during the pandemic. This comes as eight in 10 parent carers are experiencing some form of anxiety—a rate much higher than among the general population. Can the Minister outline specifically how the health and social care levy will help restore short breaks and respite care for families with disabled children?

[Lord Kamall (Con)]

The noble Baroness makes an important point that we should address. In looking at the wider picture, we recognise that unpaid carers play a vital role in our care system and make a considerable contribution to society, alongside the paid social care workforce. The Care Act encourages local authorities to support unpaid carers and provide preventive care to stop people’s early care needs escalating. The announcement of the £5.4 billion funding marks the next step in our transformational plans for the sector.

Covid-19: Vaccinations Administered Abroad

Debate between Lord Kamall and Baroness Brinton

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important issue about the devolved Administrations. As the noble Baroness will know, health is a devolved matter; we are keeping the devolved Administrations informed of progress on the overseas vaccination solution and they are looking to set up similar processes within their own jurisdictions. A Northern Ireland service has just launched. Bidirectional data flows have also been set up by NHS Digital for those who have been vaccinated cross-border between England, Scotland, Wales and the Isle of Man. Bidirectional data flows between England and Northern Ireland will be live soon.

[Baroness Brinton (LD) [V]]

My Lords, in July, the Minister’s predecessor, the noble Lord, Lord Bethell, told your Lordships’ House that the problem with registering Covid vaccines—whether it was UK residents jabbed abroad or those who had taken part in clinical trials—would be resolved by August, in time for the holidays. A further problem is that the app still cannot tell the difference between a third dose and a booster dose. That is important because third-dose people need a further booster dose. To hear that only 53 people have now got their records on an app is appalling. What are the Government going to do about this mess?

[Lord Kamall (Con)]

One of the reasons for the delay has been the wide range of vaccinations that have been administered worldwide. MHRA is working to make sure that it is confident about recognising them in a Covid pass. There is also a range of issues relating to anti-fraud measures that have to be put in place to maintain the integrity of a Covid pass service. The multi-organisation approach that has been adopted has ensured a high-quality service. NHS England has engaged vaccination centres, provided training and enhanced the vaccine data resolution service capability. NHS Digital has updated the API to allow overseas vaccinations to flow from the vaccine database—the so-called national immunisation management system—to the Covid pass. Also, NHSX has built the certification rules to enable overseas vaccinations in the Covid pass.

Health Care and Adult Social Care

Debate between Lord Kamall and Baroness Brinton

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government recognise the valuable role that paid and unpaid carers play in social care. We are looking at how we can make sure that we recruit and retain staff. We understand the challenges that many care homes, quite often those in the private sector, face when trying to recruit and retain staff, given the competitive pressures around the jobs market. The Government certainly take seriously the role of unpaid and paid carers.

[Baroness Brinton (LD) [V]]

My Lords, in addition to the winter’s and next year’s workforce plan, the CQC reports that providers of residential care showed the vacancy rate rising month on month from 6% in April to 10.2% in September. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that already are at, or close to, capacity. In recent weeks, two homes in York have announced that they are closing. I appreciate the discussion about planning for the workforce but this is a current crisis. What is the Minister going to do as councils are overwhelmed trying to find beds for patients when there are none?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for the specific examples that she gave. The department is constantly monitoring the workforce capacity pressures. We are continuing to gather a range of qualitative and quantitative intelligence in order to have a strong and live picture of how the risk is developing and emerging. In more detail, this includes drawing on evidence gathered by a regional assurance team and regular engagement with key stakeholders, including the Association of Directors of Adult Social Services in England, local authorities and care provider representatives. We are also monitoring data from the capacity tracker, Skills for Care’s monthly workforce reporting and wider market data. To ensure that we are aware of any emerging workforce capacity pressures, we are strongly encouraging providers to continue sharing available capacity and completing the capacity tracker.

NHS England Funding: Announcement to Media

Debate between Lord Kamall and Baroness Brinton

Tuesday 26th October 2021 Lords Chamber

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

I thank the noble Baroness for her question. Since 2010, we have increased the clinical radiology workforce by 48%, from 3,239 to 4,797 full-time equivalent posts. Numbers of diagnostics radiographers are up by 33% since 2010 and therapeutic radiographers are up by 44%. We are offering those who want to join the radiographic workforce at least £5,000 as a non-repayable grant for each year of their training to be a radiographer. Since 2016, we have seen a 26% increase in those studying diagnostic radiography and a 10% increase in those studying therapeutic radiography.

[Baroness Brinton (LD) [V]]

My Lords, the £5.9 billion in the Chancellor’s early announcement is to pay for physical infrastructure and equipment, not for current services. The NHS Confederation says that next year’s NHS funding allocations are nowhere near enough either. Last week, the Royal Cornwall Hospital declared a critical incident in its A&E department when it had 100 patients in the 40-bed department and 25 ambulances queuing. Its ambulance service is also under intense pressure, reporting that 50 ambulances have queued at times—again, that is much larger than the actual department. This is echoed across the country. How will Ministers help A&E departments and ambulance services in crisis right now?

GPs: In-person Appointments

Debate between Lord Kamall and Baroness Brinton

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

What is important here is that we leave it to the relationship between the GP and the patient to decide the best form of consultation. Sometimes that will be face to face and, if the patient wants a face-to-face consultation but the GP is unable to provide one, they have to give a good medical reason why not. However, we can balance that with online and telephone appointments.

[Baroness Brinton (LD) [V]]

Many GPs are feeling as if they have been completely thrown to the wolves by Ministers, and even Jeremy Hunt has said that the proposed plan and the £250 million winter access fund to support GPs and reduce the pressures they face is little more than a sticking plaster and will not help, given that the real problem is the shortage of qualified GPs. There are not even locums in many places and no longer applicants for many GP jobs. Has the Minister talked to GPs about their current extensive workload, and will he reconsider the assistance needed to support our exhausted GPs?

[Lord Kamall (Con)]

It is important that we listen to GPs and understand their needs and how we can support them. We have committed to growing and diversifying the workforce and boosting GP recruitment. We have also committed to recruiting an additional 26,000 primary care staff to be embedded in multidisciplinary teams. The details of the training will be left to the trainers themselves.

Drugs: Black Review

Debate between Lord Kamall and Baroness Brinton

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

In September 2020, Kit Malthouse and Jo Churchill, the then Minister for Prevention, Public Health and Primary Care, co-chaired a UK ministerial meeting focusing on UK-wide approaches to drugs misuse. The second UK drugs ministerial took place at Hillsborough Castle in Belfast on 11 October. The Government maintain a commitment to consulting the devolved Administrations—or devolved Governments in many cases—as well as a number of expert speakers.

[Baroness Brinton (LD) [V]]

My Lords, the Government’s initial response welcoming Dame Carol Black’s recommendation to create a cross-departmental approach to tackling drugs misuse and related harm is welcome. However, they have not responded to many of the key recommendations, of which the most important is the introduction of multi-year ring-fenced funding for treatment services, distributed by local need, with at least £552 million invested in the treatment system annually by the end of year 5. When will the Government’s full response be published? Will Dame Carol’s recommendations be fully funded?

[Lord Kamall (Con)]

The Government have committed to giving a full response to Dame Carol Black’s review by the end of the year and have already taken action. Since part 1 of her review, the Government have announced £148 million of investment to tackle drugs misuse, supply and county-lines activity. That also includes £80 million for drug treatment and recovery services.

HIV Action Plan

Debate between Lord Kamall and Baroness Brinton

Monday 18th October 2021 Lords Chamber

[Lord Kamall (Con)]

I am afraid I do not have a detailed answer to the question from the noble Baroness, but I commit to write to her.

[Baroness Brinton (LD) [V]]

My Lords, the Minister was right to highlight the fact that sexual health funding comes from public health budgets through local authorities. The Terrence Higgins Trust and British Association for Sexual Health and HIV report from 2019 showed that five years of cuts to public health and sexual health funding have had a direct impact on access to sexual health services. So can I push the Minister to confirm that there will be a real-terms cash increase, to fully fund the HIV action plan, to local authorities’ public health budgets for the next three years?

[Lord Kamall (Con)]

I thank the noble Baroness for her question. The department is currently developing a new sexual and reproductive health strategy and an HIV action plan, as she referred to. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December. The action plan will set out clear actions to achieve the interim target of reaching an 80% reduction in HIV transmissions in England by 2025. Publication of the detailed sexual and reproductive health strategy will follow shortly afterwards.

Virginity Testing

Debate between Lord Kamall and Baroness Brinton

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

We completely agree with my noble friend’s sentiments. It is really important that we ban virginity testing and hymenoplasty as soon as possible. The issue on hymenoplasty in particular is that, unfortunately, because it is classified as a cosmetic procedure, introducing legislation in this space might take away the right for women to make decisions about procedures that they wish to have and be counter to current regulation on cosmetic surgery. It is important that we work out how we can ban this practice, but those objections have been raised—and if those legal objections have been raised, we have to be careful that we work properly to make sure that we ban these procedures.

I give the commitment that I shall push as much as possible to make sure that we ban both virginity testing and hymenoplasty as soon as possible. My noble friend mentioned the amendments in the other place. The Member who submitted those amendments has been in consultation with the Department for Health and Social Care, and we hope to be able to introduce those changes, particularly those bans, as soon as possible.

[Baroness Brinton (LD) [V]]

My Lords, I also welcome the noble Lord, Lord Kamall, to the Dispatch Box. I want to pick up on points that the noble Baroness, Lady Sugg, raised. Some private clinics advertise these procedures to women, which perpetuate myths around virginity, falling way below the standards of honesty and integrity that are rightly expected of doctors. Indeed, the GMC ethical guidance on communicating information explicitly outlines that, when advertising your services, you must make sure that the information that you publish is factual, can be checked, and does not exploit patients. We have waited far too long for this to be made illegal. Can the Minister please press to make this happen sooner rather than later?

[Lord Kamall (Con)]

I thank the noble Baroness for her question, but also for having a meeting with me to discuss some of the issues that we will debate in future weeks and months. All preparation and revision are welcome.

I give a pledge that I will push back at my department and push to have both these practices banned as quickly as possible. However, as I said, some concerns have been raised from a legal perspective, given that hymenoplasty is a cosmetic procedure. All of us would agree that this is an awful thing and that it should be banned, but I want to make sure that in doing it we are very careful. A few years ago, I was a research director for a think tank, and one issue that I always considered with any change of law was unintended consequences. We have to be clear that we do this in a proper way, and I hope that we can introduce these bans as soon as possible.