Debates between Lord Kamall and Baroness Thornton during the 2019 Parliament

Tue 18th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 1
Thu 13th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2
Tue 11th Jan 2022
Health and Care Bill
Lords Chamber

Committee stage & Lords Hansard - Part 1
Tue 14th Dec 2021
Thu 18th Nov 2021
Wed 20th Oct 2021

Health and Care Bill

Debate between Lord Kamall and Baroness Thornton
Thursday 20th January 2022

(4 days, 6 hours ago)

Lords Chamber
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Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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My Lords, this has been a fascinating debate, covering issues around prevention, as the noble Baroness, Lady Walmsley, said, and talking about what we mean by integration and how we make sure that it is more than just a word. I remind noble Lords that we have a forthcoming paper on integration as part of the overall package of the Bill, and a social care paper as well.

The noble Baroness, Lady Thornton, mentioned culture and attitude. I think it is very important to recognise that you can change structures and have legislation but you have to make sure that the culture and attitude are right across the system. I say to noble Lords that we fully sympathise with the intentions and I hope I can offer some reassurance.

In my departmental job as Minister for Technology, Innovation and Life Sciences, I feel very strongly that one way to drive integration is through better use of data across the system. Even before we look at integrating with social care, the NHS as it is at the moment is not sharing data well across the system. There are still a number of inefficiencies. I really believe in the digital transformation agenda and will give a quick example of that.

Just before Christmas, at a time when the NHS was under extreme pressure, I had my annual check-up in two parts. One part was an ECG at a local community centre; the second was supposed to be a telephone conversation with a consultant a week later. When the phone call came from the consultant, he started talking and I had to stop him. I said, “Have you seen my ECG results?” and he said, “No. What ECG? When was that?” I said, “This is all part of the same appointment. Can I now give you the date and time when I had it so you can look at the results?” “Don’t worry about that,” he said, “we’ll just have to make a new appointment”.

This was at a time when the NHS was under extreme pressure, as it is every winter. That shows the challenge. Even though we have been talking about the integration of health services since 1948, we still have these problems. That is why I believe so strongly in the digitisation and data-sharing challenge. It is not just because I am a geek and love technology; it really can make a difference, save money and lives and mean a more effective service all around.

I start by addressing Amendment 50 on fracture liaison services. Fracture liaison services and fragility fracture prevention are recognised by NHS England as critical to both healthy ageing and elective recovery. Within its high-impact restoration strategy, NHS England recommends that all systems optimise the secondary prevention of fragility fractures. NHS England is working closely with stakeholders to support the implementation of secondary fracture prevention services where they do not exist already and to support sustainability and quality improvement where services exist. Once again, this will rely on good data being shared across the system.

There are already duties in the Bill to require ICBs to commission such services. As fracture liaison services aim to identify people at risk and therefore prevent future fractures, their provision would already be covered in Clause 16 under new Section 3(1)(h), which places a duty on ICBs to commission such services or facilities for prevention, care and aftercare as the ICB considers appropriate. As I hope noble Lords will agree, it would be inappropriate to be overly specific in setting out the services to be commissioned as part of the new Section 3 that would be inserted by Clause 16, given the wide range of services the NHS needs to commission. However, I hope I can give assurances to noble Lords that NHS England will continue to monitor this and ensure that ICBs are commissioning effective fracture services. I hope we continue to drive this data being shared appropriately.

I turn to Amendment 51A. It makes sense that people should be able to receive emergency treatment wherever they are, as the noble Baroness, Lady Thornton, alluded to. We believe that is already the case. Once again, data would make a huge difference. If I am in Newcastle and fall off my bike and am taken to hospital, and if I have an existing condition, would it not be great if the clinicians when they triage me could know about it? I have asked my local GP practice to share my data on the app and it still has not done it. The mechanisms are there but the culture and attitudes are a huge challenge for whichever Government are in power.

The Bill confers a power on NHS England to publish rules that determine the people for whom each ICB is responsible. Those rules must make sure that everyone registered in the area, or everyone who may have need of services, is looked after. The Secretary of State may make regulations expanding that responsibility or creating exceptions where necessary. This was the case with existing CCGs and will continue under the ICBs. I hope I can reassure your Lordships that these regulations will be replaced to ensure continuity in this between CCGs and ICBs,

I now turn to the noble Lord, Lord Farmer, and his amendment. I also thank him for sharing his wisdom and his experience of family hubs. It is incredibly important. We agree with the spirit behind Amendment 57. We fully agree that, generally speaking, as the noble Baroness, Lady Walmsley, said, prevention is better than cure. One of the things that I have been reassured by in my early conversations in my role as a Minister for Health is the number of people in meetings who have said that they want to move towards a focus on prevention. That is not avoiding cure. We have to tackle cure, of course, but we can avoid a lot of that and save resources and time and promote better health and healthy living if we focus on prevention.

There are also duties in relation to the improvement of services for the prevention of illnesses as well as a duty to obtain appropriate advice, which expressly includes a requirement to seek advice from people with expertise in the prevention of illness. The NHS is already working hard to prevent ill health but, once again, we have to make sure that, in this prevention, people are all talking to each other, we are learning from best practice, and ICBs and trusts are learning from each other. As a number of noble Lords have made clear in their contributions in Committee, the issue is wider and social prescribing, for example, and other issues are really important.

Commissioners have also developed good practice, including funding alcohol care teams and tobacco treatment teams in hospitals, and expanding the diabetes prevention programme. This was re-emphasised in the NHS Long Term Plan, which contained commitments for the NHS to focus on major causes of ill health such as smoking, poor diet, high blood pressure, obesity and alcohol and drug use.

I remind noble Lords that prevention is not simply also a matter for ICBs. It involves local authorities and sometimes law enforcement authorities. It is a multiagency approach, led by local authorities but with ICBs, the NHS and other agencies playing their role.

I acknowledge the point that my noble friend made about cannabis and young people and I will write in more detail about that rather than take up time now. But we also have to look at such issues in the round. For example, in the United States Michael Cannon of the Cato Institute wrote that a lot of drug enforcement or anti-drug policy disproportionately affects young black men who then get thrown into the criminal justice system. How do we tackle that? One of the interesting conversations I have had with the noble Lord, Lord Paddick, was about his experience as borough commander in south London, an area that my noble friend mentioned. He gave the example that young black men in possession of drugs were far more likely to be picked up than a white middle-class male or female.

We have to make sure that we look at this as a whole. When we look at the tackling inequalities strand that we all feel so strongly about, we have to make sure we get the right balance. It is, of course, very difficult on a case-by-case basis but we have to be aware of unintended consequences.

On the integration duty, we are sympathetic to the intent behind the amendment from the noble Baroness, Lady Hollins, and support greater integration between health and social care. We hope that we can make sure that stakeholders work together and that, with all the papers, we are able to push through this integration.

Baroness Thornton Portrait Baroness Thornton (Lab)
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I hesitate to take the words of the noble Baroness, Lady Hollins, away from her, but she is talking about putting a duty for this integration in the Bill. That is the way forward. Assurance is not the point here. I think we have gone past the point of needing assurance. We have been assured about this for years. This is about the duty.

Lord Kamall Portrait Lord Kamall (Con)
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I was just about to come to duty, so I thank the noble Baroness for hurrying me along.

Health and Care Bill

Debate between Lord Kamall and Baroness Thornton
Lords Hansard - Part 1
Tuesday 18th January 2022

(6 days, 6 hours ago)

Lords Chamber
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Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, I will speak to the amendments to Clause 14, which is a very important clause. There is absolutely no doubt about that, and the Minister can be in no doubt that that is exactly how we see it. It was touch and go whether we would have a clause stand part debate on this, and I am not sure that we were right not to do so, because this debate, particularly my noble friend Lord Hunt’s comments, has highlighted some serious problems.

My noble friend Lady Pitkeathley is quite right that the arrangements that we are seeking to put into statute, which have grown up over the last few years to allow areas to collaborate, were the right thing to do. In my area of the world, I have no doubt that it was important that the boroughs collaborated together, particularly in their relationship with and commissioning of services from the very big providers.

The question in Clause 14 is: what is going on with the arrangements that the Government are putting into statute? I am very pleased to follow the noble Baroness, Lady Walmsley, and to speak to Amendments 23 and 44 in my name. Amendment 23 addresses the vexed issue of boundaries for an ICB. In this Bill we are dealing with geography, whereas the 2012 Act dealt with GP lists. The area of an ICB is defined in terms of tier 1 local authorities.

Concerns have been expressed, because the NHS is often a bit clueless and sometimes very defensive about local government, its boundaries and its powers. Maybe the Minister will tell me I am wrong, but I suspect that one of the reasons why elected members have been precluded from the boards is that the NHS does not feel comfortable with the direct democratic accountability at that level. That is a great shame. I think it is wrong; accountability is extremely important.

How can we have an integrated service when social care is provided by local government, which is democratically accountable, and we want to integrate that with the NHS at a local level in an area to provide the best service that we can for that population and those patients? The almost offensive way of constructing a board that does not allow elected representatives is not acceptable.

My quite modest amendment seeks to change that situation for the future. There were exchanges in the Commons about this, and there have been meetings with disgruntled authorities that seem to have ended without agreement. We may need to take a step back and learn some of the lessons, perhaps from Scotland and Wales where more logical boundaries have been applied for their health boards.

We may learn a bit more about plans for integrated commissioning at this level when we get the promised but overdue White Paper on integration. It is possible that it will set up a third set of geographies, and who knows how that will line up? This seems to be the wrong way around. Our amendments at least elevate the need to consult with local authorities over boundaries to start off with. That is perhaps a pious hope, but we can agree that any future changes can be made only if the local authorities agree.

Amendment 159 arises out of lengthy discussions elsewhere. In the twin-striker model for ICS, we have the ICBs and the ICPs. We know almost nothing about ICPs; all that is said is that it is part of the “flexibility” and so should be valued. Referring back to my previous remarks, I just hope that local authorities will be genuinely involved in the ongoing discussions about ICPs, how they are set up and their governance. What we do know is that the ICPs will own the analysis of needs and the strategy that follows from that. What, therefore, is the role of local health and well-being boards?

There are echoes of 2012 here, as, during the consideration of the 2012 Bill, amendments were advanced on the same issue. In the 2012 version, it was the health and well-being boards that did the strategy and the CCGs that did the commissioning, at least of health. Nobody ever properly addressed how social care would be commissioned in any integrated way in a wider strategy. It was proposed in 2012 that the health and well-being boards had to approve the plans of the CCGs, and that was the glue that would hold the whole thing together. We know that that has not worked. It has sometimes worked on paper, but it is not the thing that has driven the work of the CCGs.

The answer so far for 2022 is that everyone will play nicely and it will all be resolved. I do not think that can possibly be the case when there is such a serious imbalance. Our Amendment 159 acknowledges that there just might be a dispute over whether some decision or plan of an ICB was genuinely aligned to the strategy that it was supposed to be following, so a process for resolution is needed.

I am not sure whether Amendment 44 sits easily in this group, but it is a matter on which assurance is needed. When foundation trusts came into being, they were rather bravely given the power to set their own terms and conditions for staff. One of them might have tried it, and it was not a great success. In general, despite whatever powers exist, almost every part of the NHS follows the Agenda for Change, the collective agreement that took 10 years to agree but which has stood the tests of time.

Now, as with CCGs, we have the power of ICBs to set their own terms and conditions. They are probably unlikely to do so, as it takes an enormous amount of work and the risks that it brings are probably not worth the effort. Without doubt, some staff are worried that they just might be the ones picked on for special treatment. The Minister will no doubt say that the ICBs need the flexibility, but surely, given the pandemic and everything else that faces the NHS, it would be much better to give staff certainty and confidence they will be treated properly.

We agree with the sentiments of Amendments 22 and 24, which try to ensure that agreement on ICB constitutions will be done promptly. We agree with the sentiments of Amendment 53, which echoes a previous amendment about the need to drive improvement. In my noble friend’s Amendment 45, he asks a legitimate question, which I think the Minister will need to answer.

Lord Kamall Portrait Lord Kamall (Con)
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Once again, I thank all noble Lords for bringing this debate before the Committee today. There have been a wide range of views on the establishment of the ICSs and on what is currently going on in the NHS.

I will start with Amendments 22 and 24 from the noble Baroness, Lady Walmsley, which were supported very strongly by the noble Lord, Lord Hunt of King’s Heath, and on the ICBs’ establishment. I am grateful to the noble Baroness, Lady Walmsley, for bringing the amendments, and I understand her concerns about ensuring that ICBs are established in a timely way. We agree. We have had an interesting debate here. A number of people have said that it is really important, given that ICSs have already been established, that you put it on a statutory footing, but we are also being asked how they dare to go ahead and do this, because the legislation is not there yet.

In recognition of the fact that ICSs have been set up in some areas and are being established, we are trying to get the right balance. That is why work is under way to prepare existing organisations, including CCGs, for the transition once the Bill comes into force.

The noble Lord, Lord Hunt of Kings Heath, rightly asked whether NHS England is pre-empting Parliament. He raises an important point but I assure him that the powers necessary for establishing each ICB and publishing any statutory guidance cannot be made until the Bill has been enacted and the relevant provisions commenced. However, to ensure that ICBs are ready to begin work, NHS England is producing a range of draft guidance, including a model constitution, so that system partners can start work on preparations—but this does not have the power of statutory guidance. The guidance and the model constitution are based on the proposed requirements—

Ambulance Queues: Health Outcomes

Debate between Lord Kamall and Baroness Thornton
Thursday 13th January 2022

(1 week, 4 days ago)

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Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, NHS workers on the front line have been warning for months and months that the service is under strain due to a combination of waning workforce, Covid, respiratory infections, a backlog of patients and a build-up of health problems over lockdowns. The Royal College of Emergency Medicine has been calling for months for a response from Ministers to provide short-term and long-term solutions. We called on the Health Secretary last summer for urgent additional support to be put in place. Why are we still waiting for that leadership and necessary support to materialise?

Lord Kamall Portrait Lord Kamall (Con)
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I am sure the noble Baroness will acknowledge that a number of people have been calling for ways to address this. The Government announced the Urgent and Emergency Care Recovery 10 Point Action Plan last year, which includes supporting 999 and 111 services, looking at primary care and community health services, greater use of urgent treatment centres, increased support for children and young people, better communications and call handling, improving inflow and hospital discharge, looking at mental health needs and a number of other issues. In each of those 10 points we have drilled down on working with trusts and the ambulance service to make sure we can address the issues that are currently being raised.

Health and Care Bill

Debate between Lord Kamall and Baroness Thornton
Lords Hansard - Part 2
Thursday 13th January 2022

(1 week, 4 days ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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My Lords, this has been an excellent and wide-ranging debate, and I really am grateful to all noble Lords who tabled amendments today.

With your Lordships’ leave, I turn first to Amendment 18 in the name of the noble Baroness, Lady Thornton. This amendment would mean that the relevant ICB and ICP would need to be consulted before NHS England is able to provide support and assistance to bodies other than NHS bodies. The NHS has, under successive Governments of all political colours—indeed, since its foundation in 1948—commissioned care from various sectors to help it be more responsive to patients’ needs, and particularly to help deliver the commitments set out in the NHS constitution.

The vast majority of NHS care has been—and will rightly continue to be—provided by taxpayer-funded public sector organisations. But experience before and during the pandemic has demonstrated how important it is for NHS England to have the power, as the Trust Development Authority currently does, to provide support and assistance to any providers of services on behalf of the NHS. This will ensure that independent providers can, if necessary, be commissioned to provide important additional capacity where needed.

Baroness Thornton Portrait Baroness Thornton (Lab)
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I really rather hoped the Minister would not go into whether or not I was suggesting that we should or should not be using private services. This is about who commissions services; this is not about who provides services. In my opening remarks, I said that a variety of providers is exactly what we have and will continue to have.

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for that clarification.

The amendment seeks to exclude individuals whose GP practices hold an alternative provider of medical services, or APMS, contract from being a member of an integrated care board. While APMS contracts may not be appropriate for all GPs, they offer the ICBs, as commissioners, greater flexibility than other general practice contract types. As the noble Baroness, Lady Walmsley, acknowledged, the APMS framework allows commissioners to contract specific primary medical care services to meet local needs. APMS contractors include some private and third sector social enterprises and GP partnerships, which provide outreach health services for homeless people, asylum seekers and others. It is quite clear that none of this diminishes the commitment to ensure that care is provided free at the point of use, paid for by taxpayers.

All contract holders providing NHS core primary medical services are subject to the same requirements, regulations and standards, regardless of the type of contract. The Care Quality Commission, as the independent regulator, ensures that all contracts meet these standards.

Some GP partnerships concurrently hold a general medical services contract for core medical provision, as well as an APMS contract. Some individual GPs provide services for a range of practices. The concern is that this amendment would exclude GPs working for one or multiple practices which operate under APMS contracts from being members of the ICB.

NHS England’s draft guidance states that nominated members of an ICB will be full members of the unitary board, bringing knowledge and a perspective from their sectors, but not acting as delegates of those sectors.

This amendment would prevent some individuals being on integrated care boards, based on what type of NHS GP contract their practice holds. This could limit the ability of primary medical service providers to appoint an ICB member who understands the health requirements of the local population. This could reduce the diversity of GPs who could be appointed, based on their contract type. If we think of the unintended consequences, this may inadvertently exclude representatives with much-needed expertise in serving specific local populations and addressing their health needs.

Earlier, we talked about tackling inequalities. I feel very strongly that there are sometimes unintended consequences, where people think that they know better what is best for their communities. It would be unfortunate to exclude APMS contracts, or anyone who had an APMS contract and who had the expertise needed for those communities that are not receiving an adequate service, or for poor, immigrant communities. This could go against the goal that we all want to see of tackling inequalities.

I now turn to Amendments 29 and 30. I am grateful to the noble Baroness, Lady Merron, and the noble Lord, Lord Davies, for bringing this issue before the Committee. I understand the interest in the role of independent providers in the integrated care boards. I also understand the concern across the Committee to ensure that independent providers, including companies seeking to produce health and care products, should not be appointed to the board of ICBs. We agree. Integrated care boards will be NHS bodies whose board membership consists of a minimum of individuals nominated by NHS providers, GP services and local authorities whose areas coincide with that of the ICB.

Although, as has been acknowledged, service provision by the independent and voluntary sectors has been an important and valuable feature of the system under successive Governments, it has never been the intention for independent providers as corporate entities to sit on integrated care boards, nor for an individual appointed to be there as a representative of an individual provider, in any capacity. People must therefore be assured that the work of ICBs will be driven by health outcomes, not profit. However, we recognise that this is a matter of concern to many noble Lords, as well as to the other place. We have been keen to put this beyond doubt, which is why we brought forward the amendment on this very point at Report stage in the other place. This amendment makes clear that no one may be appointed to an ICB who would undermine the independence of the NHS as a result of their interests in the private healthcare sector, social enterprise or elsewhere, including the public sector.

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Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for that suggestion and for trying to narrow the gap that there clearly is. If an amendment were put forward, we would look at it very carefully and consider the unintended consequences from the way it is drafted. We will consider it but, as I am sure the noble Baroness appreciates, I can make no promises at this stage.

I turn to the point made by my noble friend Lord Hunt of Wirral about how provider input in the work of an ICB will be reconciled with assessing both the suitability and performance of providers. As my noble friend correctly noted, each ICB must make arrangements on managing the conflict 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. They are not delegates of their organisations, but are there to contribute their experience and expertise for the effective running of the ICB—a point made most eloquently by the noble Lord, Lord Mawson, my noble friend Lady Harding and the right reverend Prelate the Bishop of London. It is important that this is about expertise, not the trust or organisation that they are taken from, or their skills and knowledge, as the noble Lord, Lord Mawson, said.

We are also keen to allow ICBs to develop their own governance arrangements, which best take their local circumstances into account. We want to give them the flexibility to learn and develop as their best practice evolves, so that other ICBs could learn from that best practice where there are concerns.

To support ICBs, NHS England is working with them to issue guidance and to develop and make clear our expectations of ICB leaders—expectations that have been reflected in the discussions and fantastic contributions from many noble Lords. For these reasons, I regret that the Government cannot accept these amendments at this stage. However, I hope I have given noble Lords such reassurance that they feel able to withdraw their amendments.

Turning to the membership of integrated care boards, I will begin with Amendments 27, 37, 38, 39, 40 and 41. I am grateful to all noble Lords who have brought forward these amendments today. I understand the interest from all sides in this membership. Schedule 2 sets out the minimum membership of the integrated care board; it will need to include members nominated by NHS trusts and NHS foundation trusts, by persons who provide primary medical services and by local authorities of areas that coincide with or include the whole or any part of the ICB’s area.

I take the point of the noble Lord, Lord Bradley, about mental health. I am sure he recalls the debate on Tuesday, when noble Lords felt very strongly about this. I have offered to meet many noble Lords from across the Committee who indicated that they want to see this parity with mental health, which they do not believe is implicit at the moment, even if we believe that “health” refers to physical and mental health. Indeed, it refers to spiritual health in many ways. But we understand that we have to close that gap and I will make sure that the noble Lord, Lord Bradley, is invited to those meetings.

It is important for us that we are not overprescriptive, which is especially true of any membership requirement. Any extension beyond the proposed statutory minimum will risk undermining local flexibility to design a board, as my noble friends Lord Mawson and Lady Harding and others have said, in the most suitable way for each area’s unique needs, drawing on the best expertise, but not where they are from. It may also make the boards less nimble and less able to make important decisions rapidly if we overprescribe.

It is important to remind the Committee—I apologise if noble Lords do not appreciate the repetition—that we set a floor and not a ceiling. The ICB can appoint board members if it wishes. Local areas can, by agreement, go beyond the legislative minimum requirements. They will want to ensure they appoint individuals with the experience and expertise to address the needs and fulfil the functions. Areas are already doing this. For example, in south-east London the ICB is proposing to include three provider members—acute, community and mental health—and six place members, one for each borough. This approach is exactly how we want ICBs to use the flexibility available to them.

If, in time, some of the concerns expressed today by noble Lords become clear—such as issues being skated over, ignored or elbowed out by others with louder voices—we may need to add further requirements that relate to ICB membership, and there are regulation-making powers in place in Schedule 2 to allow the Secretary of State to do so. Furthermore, NHS England has the power to issue statutory guidance to ICBs. It could, for example, use this to recommend that each ICB should consider appointing a learning disability and autism senior responsible officer, as I know the noble Baroness, Lady Hollins, has asked for and has spoken about most eloquently many times, most recently in a debate a few weeks ago.

Taken together, our approach reflects our view and, I reiterate, the view of the NHS that we should not attempt to overlegislate for the composition of ICBs and instead let them evolve as effective local entities to reflect local need. Let us get the right balance between the top-down and bottom-up approach, and make sure that they are relevant to their local areas. I am afraid that these amendments are seen to take a different approach, by adding more people to the minimum requirements for the ICB, making them larger but not necessarily better. They also add additional complexity by introducing a significant number of members who are responsible for activity outside the NHS. We think these would be better represented on the integrated care partnerships, which have a broader remit. I come back to the point that it is about expertise, not which trust.

I will consider the comments made by noble Lords very carefully if some of the concerns have not been met, and will have future conversations, between this stage and the next, if they feel that we have not addressed their concerns completely. I regret that the Government cannot accept these amendments. I hope that I have given your Lordships some, if not complete, reassurance and that noble Lords will feel able at this stage to withdraw and not press their amendments.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, I thank the Minister for his detailed response. I was disappointed with the first remarks he made because he resorted to the mantra that the Government tend to go to when the question of private sector interests in delivering healthcare is raised by this side of the House. That is a shame, because the questions that we have raised are legitimate. In fact, his friends in the Commons accepted the conflicts of interest that could arise from private sector interests being represented on ICBs. We were seeking to make sure that that is watertight and there is no way of it changing. That is a legitimate question to ask.

I thank the noble Lord, Lord Patel, and the noble Baronesses, Lady Walmsley and Lady Meacher, for supporting Amendment 37, which is the key amendment in this group as to who may or may not be members of the board.

The noble Baroness, Lady Hollins, made a powerful case for the interests of people with learning disabilities and autism being represented. We know that where health systems make the health of people with learning disabilities a central priority, the whole health system benefits from it. That has happened in some places—for example, in Manchester—and it demonstrates how we improve the whole system. It is an important point.

My noble friend Lady Bakewell made the point about Centene and Operose, and that is partly why I put forward my amendment on APMS. The Minister may recall that we raised this matter in Questions a few weeks ago, when I asked him to write to me about what system had been used to give that contract to Centene, or Operose, in Camden, the area where I live. Having served on the CCG in Camden, I was aware of the importance of who runs primary care and of who the GPs in our surgeries are. Having right and proper people and organisations running our primary care was one of the criteria that you would use as a commissioner when you were looking at who was running, and who might wish to run, primary care and GP surgeries. I was involved in that process. As I learn about the history and background of this organisation now running primary care and GP surgeries in the UK, I do not think they are right and proper people to be doing that.

If this amendment does not serve the purpose of stopping that happening, I ask the Minister and the Bill team to reflect on what we might need to do to ensure that those from the private sector, social enterprises and charities whom we commission to run parts of our health service are right and proper people to do so. The remarks made in that regard by the noble Lord, Lord Hunt, were very interesting and useful, as they often are.

The noble Baroness, Lady Meacher, made the point about public health. That is the theme running through this Bill: the need for public health to be represented. She was also absolutely correct to bring us back to the idea that clinical leadership is very important. Of course it is. The right reverend Prelate the Bishop of London asked some pertinent questions.

My noble friend Lady Pitkeathley raised the issue of social enterprises, which is close to my heart. I am the honorary secretary of the All-Party Group for Social Enterprise, which I helped to found 20-odd years ago. The APPG has just completed an inquiry, chaired by the noble Earl, Lord Devon, about the impact of Covid on social enterprises, which absolutely illustrates the points made by my noble friend and which I will share with the Minister when it is available.

The noble Baroness, Lady Finlay, made relevant points about Allied Healthcare. I think that the noble Baroness, Lady Walmsley, and I agree that the problem with APMS is that there is a lack of clarity and it is a bit of a loophole, and we need to look at it again. This may not be the Bill to do it in, but it might be.

With those remarks, and hopeful that the issue of who the members of the ICBs will be will run through our discussions for the next few weeks, I beg leave to withdraw the amendment.

Respiratory Viruses

Debate between Lord Kamall and Baroness Thornton
Tuesday 11th January 2022

(1 week, 6 days ago)

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Lord Kamall Portrait Lord Kamall (Con)
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My noble friend makes a very important point that during the winter people quite often need some help and assistance with winter fuel and other issues. For RSV and influenza, this winter we have had the continued offer of vaccination for 50 to 64 year-olds for the first time, and to additional cohorts. By 19 December, 82% of people aged 65 years and over and 48% of people under 65 years in risk groups had received a flu vaccine.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, in July last year my right honourable friend Jonathan Ashworth anticipated the risk of co-infection with both viruses—popularly known as “flurona”—being likely to compound the impact of Covid. He asked then whether the Prime Minister would invest now in testing capacity so that, alongside a Covid test, it would be possible to test for flu and RSV. Is there a plan to take up multipathogen testing for the future—it is obviously too late for this winter—as we learn to live with Covid?

Lord Kamall Portrait Lord Kamall (Con)
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There are a number of innovations when it comes to vaccines and testing for vaccines. Indeed, some of the companies and organisations we spoke to recently about future testing requirements, for example, have looked at multiple tests or tests where you can identify multiple conditions. It is one of the things that the department and the NHS are continuing to have conversations on with suppliers.

Health and Care Bill

Debate between Lord Kamall and Baroness Thornton
Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022

(1 week, 6 days ago)

Lords Chamber
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Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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I start by thanking the noble Baroness, and indeed all noble Lords who have spoken thus far. I will make a general point in response to my noble friend Lord Cormack. I recognise that I am relatively new to this House and that I have much to learn. I hope to learn much, not only from noble Lords who have more experience of the procedures of this House and of holding the Government to account but from many noble Lords from across the House with medical expertise and management expertise in the health and social care sector.

I also thank the noble Baroness, Lady Thornton, for bringing this debate before the Committee. Amendment 1 would mean that we could not commence the change of legal name from the National Commissioning Board to NHS England until after an impact assessment for each of the clauses in Part 1 of the Bill is published, while Amendment 315 would mean that we could not commence Part 1 until after the publication of an impact assessment for each clause’s impact on the risks, costs and benefits to patients.

I hope I can reassure the noble Baroness that my department has published the impact assessments. She acknowledged this and I accept that they were not published in the most timely way. I will endeavour to do my best to make sure that we publish these assessments with as much notice as possible. They are available for noble Lords to review on GOV.UK. I am very happy for the noble Baroness to take credit for the first impact assessment. We will endeavour to do better. We will also commit to publishing further impact assessments for secondary legislation made under the powers contained in the Bill, where those regulations will have significant impact on the health and care system or private businesses, to provide transparency and clarity to the system.

The amendment would also delay the commencement of Part 1 until at least six months after commencement regulations were laid before your Lordships’ House. This would delay the implementation of the key provisions contained in Part 1.

The NHS put forward its recommendations for legislation in 2019. It is preparing, subject to parliamentary passage, to implement the ICB provisions of the Bill from July 2022. We know that ICBs in effect exist in many areas, in whatever form of development, and it is essential that we put these on a statutory footing as soon as possible. The development of ICBs builds on years of development work in local systems to improve partnership working. Delaying the implementation risks a loss of momentum in establishing statutory integrated care boards and the benefits that they are intended to deliver. For these reasons, I ask the noble Baroness to withdraw her amendment.

Baroness Thornton Portrait Baroness Thornton (Lab)
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I thank the Minister for that very gracious answer and start to our deliberations. I also thank in particular the noble Baroness, Lady Walmsley, and the noble Lord, Lord Cormack. I really was rather hoping that the noble Lord, Lord Cormack, would come in, as this is absolutely what he knows about. He is quite right. I hope that noble Lords who are experts in this will look carefully at the Bill and at the two reports I referred to, because they will need to guide us in our deliberations over the next few weeks.

Let us see what the impact assessment says—whether it works or not—and see whether we need to review certain parts of the Bill with a view to looking at the Constitution Committee’s report, for example, which also was published only yesterday. With that, and with the warning that this is the beginning and not the end of the discussion, I beg leave to withdraw the amendment.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Debate between Lord Kamall and Baroness Thornton
Wednesday 15th December 2021

(1 month, 1 week ago)

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Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, this has been a proper House of Lords debate and I thank the Minister for introducing the regulations with such clarity. I need to declare an interest as a non-executive director of an NHS hospital.

I would like to start my remarks by quoting my honourable friend Wes Streeting, the shadow Secretary of State for Health and Social Care, who said yesterday that

“it should not be for me, as shadow Secretary of State, to point out”

to some Conservative MPs, following remarks made in the media in recent days,

“that we are not living in the 1930s and that the Secretary of State and his team are not Nazis.”—[Official Report, Commons, 14/12/21; col 954.]

It is sad that my honourable friend felt that he needed to say that. Our history is peppered with examples of where we required citizens to act in a way that served both their own self-interest and the interests of others. That does not make us a totalitarian state. I believe that the public are less outraged by the fact that some obligations are being placed on them than by the antics of those who blatantly and arrogantly imagine that the obligations do not apply to them.

On these Benches we will be supporting the Government today, as we did yesterday, and we will vote with the Government if the noble Lord, Lord Robathan, chooses to test the opinion of the House on either of the fatal amendments before us. Actually, the noble Lord said that these Benches would go further than the Motions before us. That is not true—but what is certainly true is that we have tended to be two or three weeks ahead of the Government. We have said “We think you need to do this, that or the other”—and I can testify to this, having been here for nearly two years, saying this —and the Government have said “No, no, no”, and two or three weeks later that is exactly what happens.

We will act in the national interest, as we have done throughout the pandemic, putting public health before party politics, by supporting the Motions under consideration now. Our task today—as it has been throughout the pandemic—is to consider what is best for the health of our nation and how to discharge our responsibility to protect our NHS.

The noble Lord, Lord Fowler, absolutely nailed it when he said that we had to listen to the CMO, the CSO, the other scientists and the public health experts, and follow the course of action that they were recommending. This was echoed by the noble Baroness, Lady Hayman, who said that we should be listening to the advice we are given. My noble friend Lord Davies put these regulations into proportion in terms of what they are seeking to achieve. There is no doubt that sacrifices have impacted on lives, livelihoods and liberties; that is why noble Lords need to scrutinise and question how the Government are dealing with this issue, or indeed mishandling it. I say to the noble Lord, Lord Robathan, and other noble Lords that we would be having this debate today whether or not he had put down his amendments.

On Sunday the Prime Minister made a totally unnecessary broadcast which served to panic people and create worry and confusion. Presumably he was trying to re-establish leadership credibility for himself, which clearly did not work with his own Conservative Benches. The broadcast was irresponsible in its lack of preparedness and clarity. As well as displeasing Mr Speaker, as the Prime Minister tends to do, it held Parliament in contempt yet again.

The lack of clarity is clear, for example, as NHS England and the Prime Minister have made conflicting promises on the booster rollout, leaving plans to deal with the rapid spread of omicron mired in chaos and confusion. On Sunday evening, the Prime Minister said:

“Everyone eligible aged 18 and over in England will have the chance to get their booster before the New Year.”


However, the NHS has promised a different target, pledging to offer all adults the chance to book a booster rather than receive one. Pressed on the conflicting advice, NHS England said:

“The NHS vaccination programme will offer every adult the chance to book a COVID-19 booster vaccine by the end of the year”.


Perhaps the Minister could clarify for the House which it is. If the Prime Minister has promised 1 million vaccinations a day, how is that supposed to be achieved?

I think it was even worse for local government than for the NHS. A local council leader in London, with a London-wide strategic role, said that 72 hours’ notice would have been helpful. It is not the need to up the vax and testing capability but the lack of planning—hence no tests, no testing ability and vaccinations not available. There was not one mention of local government in the Statement we heard on Monday. Had the relevant Government departments talked to local government, and when did they do that? It begs the question: did the NHS even know about Sunday’s statement before it was made?

We cannot yet be sure about the severity of the omicron variant, but we can be certain, as many noble Lords have said, that it is spreading faster than any other variant. Even if a smaller proportion of omicron victims are hospitalised, the rapid advance of the virus through the population could see large numbers of people admitted to hospital during the months in which the NHS is already under the greatest pressure. The winter months present pressures on the NHS in any normal year, and we know that this is far from a normal year.

The NHS is contending with winter pressures, a serious backlog, the delta variant and now this variant. Many of the challenges are understandable, given the unprecedented challenge of the Covid-19 pandemic, but we have got to be honest and acknowledge that confronting them has been made much harder because the country went into the pandemic with waiting lists already at 4.5 million, 100,000 NHS staff vacancies and a shortage of 112,000 staff in social care. My noble friend Lord Rooker was quite correct on that. We support the NHS and care services in the task they have been set. Let me say from these Benches to every NHS worker, every GP, every pharmacist, every public health official in local government, every member of the Armed Forces and every volunteer stepping up to meet this enormous task that we are with them 100% and thank them again.

The measures put forward for consideration today are an attempt to slow the spread of the virus, while trying to protect Christmas so that people can enjoy the festive season. They are about limiting interactions in the workplace, wearing face coverings in settings where the virus finds it easiest to spread, testing before we attend large indoor gatherings, and getting behind the booster rollout to ensure that everyone who can be protected is protected.

The goal in the end must be to learn to live with the virus. That means effective vaccination, antiviral treatments and public health measures that have a minimal impact on our lives, jobs and businesses. No one enjoys wearing a mask, but it is nothing compared with the costs that more draconian restrictions have for our lives, livelihoods and liberties. Masks are simply a price worth paying for our freedom to go out and live our lives during this pandemic.

On the introduction of a Covid pass for large indoor gatherings, the Labour Party argued against vaccine passports without the option of showing a negative test. Further, we argued that such passes should not be required for access to essential services. On both counts, I am pleased to say that the Government listened and amended the proposals, so we will support this measure today. I regret that colleagues on the Liberal Democrat Benches do not feel able to do so, but let me be clear: we in the Labour Party support Covid passes because we support British businesses. We want to give people the confidence to go out and about—to go to venues and to the theatre—despite the presence of this virus.

With passes and lateral flow tests, venues can operate at 100% capacity. Look at Italy, France and Denmark—countries with strict Covid rules. All have seen their retail and recreation sectors fare far better than those in the UK. However, for the passes to work, people must be able to access tests readily and easily. We cannot continue in this situation where tests are out of stock, so I ask the Minister whether this has been resolved or when it will be.

For months, we have called for workers to be given the flexibility to work from home and we support the guidance to work from home where possible. However, how does the Minister explain the contradiction that many noble Lords have asked about, which is why, at the same time, the Government are allowing them to go to Christmas parties? By limiting the interactions people have at work and by lowering infections, we hope to preserve their ability to go ahead with social events anyway.

Noble Lords have talked about ventilation in schools. We know that young people have borne the brunt of this pandemic, and we owe it to them and their education to support them and staff to make sure our schools are properly ventilated. The Christmas holidays seem to us to be an ideal time to get young people vaccinated. When does the Minister expect to know about this matter and share it with the House?

I hope this is my last contribution on Covid this year. I therefore end by wishing all noble Lords a safe and happy Christmas.

Lord Kamall Portrait Lord Kamall (Con)
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I start by thanking noble Lords for their valuable contributions to this debate. They showed the very best of debate in this place, in the range of views covered—some political, some scientific and some challenging the Government on constitutional issues. This demonstrates the importance of these discussions and I welcome all contributions, whether or not I agree with them. That is the purpose of debate and discussion.

I remind some of my noble friends behind me and other noble Lords why we have acted now and gone to plan B. We want to slow the spread of the virus, after looking at the replication rate; we want to buy time for more people, especially the older and more vulnerable, to get their booster dose; and we want to give our experts crucial time to gather and understand the data about omicron.

Noble Lords, and indeed noble friends, look at the experience of South Africa. As the noble Lord, Lord Birt, and others have said, its experience is different. It has a younger population, with an average age of about 29, when our average age is in the mid to high 40s. Given our experience at the beginning of the Covid pandemic, when a disproportionate number of older people died, surely it is right that we collect data to make sure that the most vulnerable people are safe before we go forward.

I turn to some specific points raised by noble Lords. As I said, my noble friend Lord Robathan asked about the data from Africa, which we will continue to monitor. We will monitor whether it is different or milder here.

The noble Baroness, Lady Bennett, mentioned the risk of exponential growth and I thank her for making that point. We do not want to see waiting times and patient numbers starting to overwhelm hospitals. By the time we had waited for exact data, it might be too late. The noble Lord, Lord Davies, rightly spoke about the limited data available. I assure the House that we will continue to review the data as it comes in.

Breast Screening

Debate between Lord Kamall and Baroness Thornton
Tuesday 14th December 2021

(1 month, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for giving me advance notice of the question, and so giving me the chance to get some information. Data on cancer stages is currently published only annually, and NHS Digital is publishing the data from 2019 on Thursday 16 December. The latest data from 2018 shows that nearly 86% of breast cancers were diagnosed at stages 1 and 2, meaning that about 15% were diagnosed at stages 3 and 4, but this was pre-pandemic. I will make sure that I get the updated data as soon as possible.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, in October, when we last had a Question on this issue, the Minister was asked about the need to ensure that innovative new treatments such as Trodelvy reach patients as quickly as possible. I gather that this issue is still not resolved. As yet, there is no agreement between the drug company Gilead and the NHS, which means that access to this transformational treatment is extremely ad hoc and unfair. Will the Minister please help to expedite this issue with NICE, the MHRA and the manufacturer?

Lord Kamall Portrait Lord Kamall (Con)
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As the noble Baroness will acknowledge, the MHRA and NICE are independent, but I can, of course, raise the issue with them.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Debate between Lord Kamall and Baroness Thornton
Tuesday 14th December 2021

(1 month, 1 week ago)

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Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, I declare an interest as a non-executive director of an NHS hospital. I thank the Minister for explaining this statutory instrument, although I have to confess that I had a moment of panic during his opening statement. I thank him also for explaining his understanding of how the Government arrived at this point. I note that the department has at last produced at least something called an impact assessment, as well as other documentation. This was the subject of my Motion to Regret, now withdrawn. That does not mean that I no longer regret the lackadaisical manner in which this Government approach their accountability to Parliament and the legislative process.

As most noble Lords, including the noble Lord, Lord Cormack, have said to the Minister in clear language, we still wish to know how the legislation will operate. We hope that the Minister will be more forthcoming about, for example, the “significant workforce capacity risk” which the Secondary Legislation Scrutiny Committee mentioned in its very critical report. We note that the committee was damning in its criticism, and I thank my noble friend Lord Cunningham for speaking about the fact that these things are not an option but a requirement.

I say to the noble Baroness, Lady Noakes, that we agree with her criticism of the Government’s handling of these issues. We absolutely agree about the procedure, the drafting and the lack of justification that supports the legislation. I have been commenting on this from this Dispatch Box since March last year. However, the noble Baroness did not say that this was necessarily the wrong way to go. I withdrew my regret Motion because, today, given the new clear threat of omicron, we need to focus on the way forward. I do not believe that that is a political reason for withdrawing the Motion. Had the noble Baroness tested the opinion of the House on her fatal Motion, we on these Benches would have supported the Government, just as we are doing right now in the Commons. The Labour Party has acted, and will always act, in the best interests of our NHS, our public health and our nation.

Of course, we want everyone working in the NHS to take up the vaccine. It is safe and effective, and the Government should be focused on driving up vaccination rates through persuasion, education and support for the vaccine-hesitant, as many noble Lords, particularly those on the Liberal Democrat Benches, have said. We know that omicron is now a clear threat. It is important that the elderly and the vulnerable, and those being cared for in healthcare settings, are protected. Vaccination also protects staff from severe disease, so we will not oppose the Government on this.

Compulsory vaccination for NHS staff is a difficult question—of course it is—as the right reverend Prelate the Bishop of St Albans and my noble friend Lord Hunt explained to the House. We would all much prefer that all front-line NHS staff voluntarily agree to have the vaccine. The latest SAGE advice, however, suggests that omicron may increase the risk of hospital-acquired infections. Vaccination will not eliminate all transmission, but it will reduce the risks and protect both patients and staff in the NHS from severe disease. It may also reduce staff absences caused by Covid.

Of course, there is a precedent for certain NHS staff having to be vaccinated, for example against hepatitis, and given the evidence that being vaccinated reduces the risk of transmission, it is reasonable to ask whether those who are looking after our loved ones should themselves have taken every step possible to reduce the risk that they may pass the virus on to those whom they are caring for, many of whom may be elderly and vulnerable.

However, ahead of any rollout, the Government must ensure that this change does not make the staffing crisis in the NHS any worse and must work with the royal colleges, NHS Providers and the trade unions to agree a framework for how this change is rolled out. The trade unions and royal colleges have been critical of the proposals for compulsory vaccination, ahead of what will be, and is becoming, a very difficult and challenging winter for the NHS because of the implications this could have for staffing. So we welcome the fact that the Government have pushed the date back to April 2022, but we continue to be concerned about the implications that mandatory vaccination for NHS workers will have on staff shortages. We have asked the Government to set out a plan for this.

For the record, on the separate issue of mandatory vaccination for the public, the Prime Minister probably puzzled the whole nation—he certainly puzzled me—when he floated this idea. We are opposed to this—as is the Minister’s boss, I expect. We are opposed to the use of Covid status certification for access to essential services. Forcing the general population to have the vaccine would not only be wrong but impractical. The Government have not brought forward any measures to introduce this, and we would not support any future attempt to do so.

Finally, all of us want to enjoy Christmas safely this year. We all want to protect our NHS, which has been suffering from staff shortages and record waiting lists and has been performing miracles for the last 18 months. Our best defence against all variants of the virus, including omicron, is that we all get vaccinated.

Lord Kamall Portrait Lord Kamall (Con)
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My Lords, I thank all noble Lords for taking part in this debate. I apologise to noble Lords for getting the terminology wrong at the beginning. I will make sure that that is corrected in future.

I thank my noble friend Lady Noakes for raising this important issue, and for challenging us and rightly holding the Government to account on many procedural issues. I accept that your Lordships perform an essential role in scrutinising the measures that we have put forward today. That is one of the things that makes me very proud to be a Member of this House. I recognise the strength of feeling of your Lordships for and against what we are proposing and about the procedures thus far. I know that these feelings are sincere and heartfelt.

I now turn to some of the point raised by noble Lords. My noble friends Lady Noakes and Lord Cormack and the noble Baroness, Lady Brinton, raised questions about the red-rated impact assessment from the Regulatory Policy Committee. I hear the concerns of this House, and I acknowledge that, due to the necessity to move as quickly as possible and minimise the risk to those who are vulnerable, we were unable to publish the full impact assessment alongside the regulations being laid. We set out a statement of impacts, and the full impact assessment has now been published on GOV.UK, but I accept the argument made by noble Lords that this is rather late. We have also now published additional consideration of the points raised by the RPC in relation to private businesses.

My noble friend Lady Noakes also asked what the Government have done in response to the criticisms of regulations from the Secondary Legislation Scrutiny Committee. I reassure noble Lords that we have published the updated Explanatory Memorandum to provide additional information on the specific concerns raised. I also accept the criticisms that this could have been more timely. This includes more information on the scientific and clinical rationale for the policy, the exemptions that have been provided for, those not included, and the steps that we have taken to further encourage uptake of vaccinations and to mitigate work- force risks.

The SLSC also raised concerns about the impact assessment on process. We have worked hard and as quickly as possible to finalise the impact assessment that we feel best captures the likely impact of this novel policy in the uncertain circumstances that we are still living through and the need sometimes to react quickly. As my noble friend Lady Noakes rightly said, this impact assessment was laid before the House in advance of this debate.

My noble friend Lady Noakes also raised the question of whether a cost of £270 million is value for money, considering the impact assessment. While it is not possible to model the non-monetised benefits that this policy would have due to the limited data available, the health benefits through reduced infections and deaths among health and care users—as well as the wider community—from the workforce being vaccinated are likely to be large and should be considered when focusing on costs.

A key benefit is the impact of reassurance to patients and care users that they are being looked after by staff who are vaccinated. This avoids the very dangerous situation of people feeling wary of going to the NHS and other health and care providers, which can have dangerous long-term implications regarding health outcomes for our society. This is non-monetised, yet it remains a highly significant factor.

My noble friend Lady Noakes also asked about the workforce impact of this legislative instrument. As of 5 December, 521,000 staff in all care homes, or nearly 96%, have been vaccinated with the first dose, and 511,000 staff, or 94%, are reported to have received a second dose based on responses from 99% of providers. Although NHS workforce figures are dynamic as people join and leave, since the Government consulted on the policy in September, the latest published figures show an overall net increase of NHS staff vaccinated with a first dose of over 55,000.

My noble friend Lady McIntosh also raised valid questions about the impact on the social care workforce. We are not aware of any care homes where VCOD is the primary reason for closure, but we continue to work with our regional assurance team, which works closely with regions across the country to understand the local and regional pressures, and offer support and advice as appropriate.

In social care, we have already put in place a range of measures to help local authorities and providers to address workforce capacity pressures; indeed, I have announced some of those in this House. As in healthcare, there will be a 12-week grace period for workers in the wider social care sector before requirements come into force, which will give all unvaccinated staff time to get their jab. We are focusing every effort on promoting and encouraging vaccine take-up across social care, and £300 million was announced for the workforce on Friday 10 December to support the care sector over winter.

My noble friend Lord Cormack, the noble Lords, Lord Cunningham and Lord Hunt, and several other noble Lords have eloquently raised points about the use of retrospective legislation and emphasised the importance of parliamentary processes. I sympathise with noble Lords who are concerned about some of the procedural aspects of the passage of this legislation.

As my noble friend Lord Cormack rightly said, in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable. Vaccination is our best defence against Covid. It reduces the likelihood of infection and therefore helps to break chains of transmission, as the noble Baroness, Lady Thornton, rightly acknowledged. It is safe and effective. The legislation will protect those receiving care in all health and social care settings as well as our valuable health and social care workforce themselves.

I agree with my noble friend on the point about reviewing the use of such legislation. I assure noble Lords that Regulation 5 sets out the requirement for the Secretary of State to carry out an annual review of these regulations, taking into account clinical advice and accessibility and availability of authorised vaccines, and to publish a report setting out the conclusions of this review.

On my noble friend Lord Cormack’s suggestion of an ongoing Joint Committee, I apologise if the response I suggested was inaccurate. I suggest that I discuss it with him so that I can learn from his experience of parliamentary procedures.

The noble Baroness, Lady Tyler, referenced the importance of encouraging the hesitant. I completely agree. We both come from the same part of London; indeed, she informed me that we went to the same school. We come from an incredibly diverse area, and we understand the different concerns and pressures in many of these communities; as noble Lords will recognise, I myself come from one of these communities. But as she will know, the NHS has focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking campaigns not only based on function, such as at midwifery staff, but directed at different communities, such as ethnic-minority groups and students, as well as using the booster campaign as an opportunity to re-engage staff. I repeat my gratitude to noble Lords across the House who have suggested to me ways that we can address many of these communities, including working with interfaith communities and networks which really understand these communities and have the trust of many individuals.

Covid-19: PCR and Lateral Flow Test Providers

Debate between Lord Kamall and Baroness Thornton
Monday 13th December 2021

(1 month, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend for bringing that to my attention. I was in a meeting with my right honourable friend the Secretary of State for Health and Social Care as well as other Ministers today. We were told categorically that we have ordered many more tests to enable people to test more often.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, there are hundreds of private test companies to choose from when you are heading abroad, and that is part of the problem. Which? carried out some mystery shopping in the autumn and revealed a list of companies that give the most reliable and best-value tests—I share that information with the House—and also the ones to avoid as being rip-offs and unreliable. Is the Minister aware of this consumer research? What notice will the Government be taking of the ones that Which? recommends not to use? Have they yet been removed from the Government’s list?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for making noble Lords aware of that particular comparison website—let me put it that way. We try carefully not to recommend particular private providers or comparison websites, but this market is developing, and there are lots of comparison websites out there looking at this market. As we start to have more testing and do more diagnoses at home, this market will develop.

Ambulance Response Times

Debate between Lord Kamall and Baroness Thornton
Wednesday 1st December 2021

(1 month, 3 weeks ago)

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Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, it seems clear that the problem is a symptom of system pressures and will require a whole-system approach to resolve it once and for all—Covid, social care packages to help with discharges and local factors, and the fragility of the NHS infrastructure going in to the pandemic. The Minister has explained some of the short-term emergency plans literally to save lives, but in the absence of an NHS workforce strategy, how will the Government produce a system-wide resolution of this matter?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness makes a very important point: we should be looking at this in a systemic way. In fact, I did my PhD in a department of system science, where you look at problems in a holistic way—rather than analysing individual problems, you look at the whole system. We found odd unintended consequences. For example, a friend forgot his inhaler, could not get one from the chemist, could not get one from the A&E and, in the end, had to call out an ambulance. There are a number of times when ambulances are called out needlessly, and that is on top of the pressures we are already facing due to Covid. We are tackling the backlog, which, hopefully, will also reduce ambulance waiting times.

Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021

Debate between Lord Kamall and Baroness Thornton
Wednesday 1st December 2021

(1 month, 3 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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Sorry, was that offensive? I apologise for any offence caused to my noble friend. I just assumed that because I like teacakes, my noble friend also does.

I will start with some of the questions. On the question of how many people have been helped by some of these financial services, as of 17 November 2021, local authorities have reported 362,573 successful claims since the start of the scheme, totalling £181 million in test and trace support systems.

Despite the easing of the restrictions at step 4 of the road map, the Government have continued to recommend that face coverings are worn in crowded and enclosed spaces. We accept that there is wide support for reintroducing mandatory face coverings, but we have always tried to balance these issues. As I said in previous debates, we look at a number of factors, not only medical but economic and social. Also, within health itself, many mental health experts are very concerned that we might go for more lockdowns and about some of the measures that a number of noble Lords have mentioned.

As we saw in the debate, there are noble Lords who believe that we have gone too far and noble Lords who feel that we have not gone far enough unless we effectively enter a second lockdown. That shows the range of views here and the difficulty, as my noble friend, Lady Altmann, said, that the Government are damned if they do, damned if they do not, but we accept that.

So, do face masks actually work? This is where there is still a debate. I thank my noble friend Lady Noakes for pointing out the article by Professor Simon Wood, who is professor of statistics at the University of Edinburgh, in which he analysed the BMJ paper. It is in effect a meta-analysis. A number of newspapers have taken a line saying that wearing a mask cuts Covid by 53%. I encourage noble Lords to read the article, in which he takes apart the statistics as a statistician and looks at, as those who have done statistics will understand, whether we have a significant number of samples to make it statistically sound. In addition, Professor Naismith of Oxford University has been quoted as saying that

“the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to delta.”

Once again we see that there is a whole range of views, but we have listened to those views. Because we do not yet know enough about this variant, we will continue to review the data. For example, some say that it is very mild in South Africa so we should not be overly concerned about it, but we also have to remember that South Africa has a different demographic in terms of younger people. We know that when the virus first struck it disproportionately affected older people—as my noble friend Lord Robathan said, people aged over 85. On the balance of the data at the moment, we believe that wearing face masks works but we have always been very careful to make sure that it is proportionate where we do it.

On the expiry of some of these measures, as the Prime Minister said on Saturday, all the provisions that have been voted on will be reviewed in three weeks. They are necessary and proportionate while we learn more. I refer to the economics Nobel laureate Friedrich Hayek, who talked about humans having limited knowledge. He talked about the conceit of knowledge. The way to understand a lot of complex problems is to allow the discovery process to take hold and to look at what we can learn from that process. We should be very careful not to imagine that we have total knowledge. What we have to do is assess it proportionately.

It is our hope that these regulations will no longer be necessary in three weeks’ time and that we can return to the system that we lived under last week, but in the event that we need more time to understand the effect of the variant, or that the data shows that we need to take a different approach that requires new regulations, the House will return to Parliament ahead of the Christmas Recess for a debate and vote on the regulations ahead of their coming into force.

On regulations expiring, the international travel regulations will expire at the end of 16 May 2022. The face covering regulations will expire, unless extended, at the end of 20 December 2021. The self-isolation regulations at the moment expire at the end of 24 March 2022, but we will continue to review the data. Almost daily the data is being reviewed and conversations are going on. We will also continue to review the data on the new variant and we hope to update Parliament on the review in the week commencing 13 December.

A number of noble Lords asked about facilities. We are told that setting up dedicated testing facilities at border entry points such as airports is logistically difficult at the moment, and risks delays to passenger journeys and operations. Given the turnaround for a PCR test, passengers would still have to travel to their home or the place they are staying and isolate there before receiving a result. The Government are taking a measured and proportionate response. We want to try to protect the UK from omicron while allowing continued safe travel.

A number of references were made to points made by Dr Jenny Harries. As the Prime Minster said, the guidance remains the same as the measures that were in place to fight delta. We have now brought in tougher measures, but we continue to take advice from a number of experts. Individual experts are free to give their viewpoint but we look at the balance—some of it medical, some of it clinical, but also economic and social factors—and getting that proportionate.

Baroness Thornton Portrait Baroness Thornton (Lab)
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I need to ask the Minister about the fact that our most senior adviser on these matters gave advice that was then completely denied by No. 10 and the Government. That will at least cause confusion. It is not a question of balancing this and that; Jenny Harries was very clear in her advice about what she thought should happen. It was quite the opposite to what the Prime Minister said should happen. The Minister needs to acknowledge that that will cause confusion.

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising the point, but it depends on how it is reported. The real issue here is that a number of different experts are advising. Of course, you can pick and choose which expert you decide to listen to. A few weeks ago, noble Lords were picking up on comments made by the NHS Confederation. That is not a scientific body, but noble Lords claimed that it showed that we need to lock down. It is very easy to pick and choose your experts, but we continue to listen to a wide range of experts.

One of the great things about science that we should remember is that there is no such thing as “the science says”. Science should remain contestable. Can you imagine if science was not contestable? We would still be saying, “You can’t challenge the notion that the solar system revolves around the earth.” Scientists challenged that, and that is how we advance knowledge. It is really important that we continue to contest. Scepticism is one of the most important factors in science to make sure we make progress. We will listen to a range of experts.

I ask those noble Lords who really want to lock down more, and who say that we not only have not done enough but should do more and lock people down, to look at the impact that has on people’s mental health and on our economy. I ask them to think about the wider impact and to remember that we are not in the same place we were a year ago. We have been absolutely clear that vaccines work and that the best thing we can do to get through this is to get vaccinated. It is not too late to get your first or second vaccine. I am grateful to noble Lords who have asked questions—

Baroness Thornton Portrait Baroness Thornton (Lab)
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The Minister is now saying that there is absolutely no doubt about the science behind vaccinations. That is not a matter of opinion; there is no doubt about the need for vaccinations. He is straying into dangerous territory when he says that there is science on this side and science on that, because the Government have rightly said that vaccination is the way forward.

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for agreeing with the Government’s line that vaccination is the most important way forward.

Baroness Thornton Portrait Baroness Thornton (Lab)
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The Minister is being patronising. We have always—always—supported the Government on vaccination; I am sorry that the Minister feels he needs to be sarcastic about that.

Lord Kamall Portrait Lord Kamall (Con)
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I apologise to the noble Baroness if I came across as sarcastic.

In terms of hospitality settings, quite rightly, as a number of noble Lords have said, even though we have mandated it in certain settings, it is being left to settings to decide. This is in line with property rights, but also something that people have been asking for—a number of noble Lords have asked “Why not just let the establishments themselves decide, so people can make a decision whether they go to somewhere where masks are mandated or somewhere where they are not mandated?” We are looking really hard at this and we want to make sure that we are proportionate. It could be that we find out that omicron is not that dangerous, but we have to make sure that we have the data and that we sequence it all. It could be that it affects us more in the UK that it would in South Africa because of the change in demographics. That is a really important point.

In terms of who is responsible for enforcement, the police and Transport for London officers have powers to issue fixed penalty notices for non-compliance with the regulations. They are using the four E’s in a proportionate way: engaging, explaining and encouraging before enforcement, just to remind people, if they can, to make sure that they wear a face mask.

The Health Secretary has also asked the JCVI to consider giving boosters to as wide a range of people as possible. If you are boosted, your response is likely to be stronger, so it is more vital than ever that we get our jabs.

On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We are also extremely grateful to the South African Government; we have been talking to a number of partners, including South Africa directly, to make sure that we do not disincentivise other countries for doing the right thing by reporting the outbreak in the first place. We are doing all that we can.

I am trying to make sure that I answer all the questions; I apologise if I am not able to. My noble friend Lady Neville-Rolfe asked about exemptions for children under the age of 11 and those unable to wear a face covering due to health, age, equality or disability reasons. In terms of the impact to the economy, we do not know the extent to which the variant escapes the vaccine, but as soon as we do, we will be able to make a better measure. We do not at the moment expect there to be significant economic disruption. We have said that we believe face coverings are effective at reducing transmission indoors. The recent UKHSA study suggests that all types of face coverings are, to some extent, effective, but we also welcome challenges to that data. The advice remains the same: we believe that, on balance, it is better to wear a face mask. Many noble Lords have agreed and disagreed with that, but we have to balance these things.

Proportionate measures remain in place in schools. Face coverings should now be worn in communal areas by older students and teachers. The Department for Education is looking at how we make sure that there are clear guidelines on that. We advise staff, visitors and pupils to wear face coverings in communal areas.

I turn to the point from the noble Baroness, Lady Tyler, and that very personal case; it highlights—this should sober us up—those very powerful words that this is not over. We have said that consistently. It is not over. If we believed it was over, we would have removed all restrictions. It is highly likely, but not definite, that we may have to continue to get boosters. Just as we have an annual flu vaccine, we may in the future end up with an annual Covid vaccine, including looking at other strains.

We have said who is responsible. In answer to a point made by my noble friend Lord Cormack, may I suggest that he takes his point about continuous committees up with the Lord Speaker? That is not really in my remit as Minister for Health. My initial reaction is that it seems a good idea, but let us see what the Lord Speaker says.

I again thank all noble Lords for their contributions and for continuing to challenge. That is really important. I can assure my noble friend Lord Cormack that today I asked my department for a list of potential or forthcoming regulations so that we can lay them as early as possible, as my noble friend and other noble Lords suggested. I am grateful for the acknowledgement that we laid these regulations as quickly as we could, and I pledge that we will try to improve that as much as we can, I too, believe very strongly in procedure and the Government and the Executive being held to account. It is really important.

NHS: Primary Care Surgeries

Debate between Lord Kamall and Baroness Thornton
Wednesday 24th November 2021

(2 months ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

Baroness Thornton Portrait Baroness Thornton (Lab)
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Notwithstanding the fact that the Minister says that the NHS is not up for sale, would he care to speculate what would motivate an American health insurance company to buy into a UK primary care GP market? Was this procurement carried out under the Covid relaxation that allowed contracts to be awarded without competition, or the usual procurement regime?

Lord Kamall Portrait Lord Kamall (Con)
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I wish I could read the minds of those who bid to run these services, but I am afraid I will have to admit that I cannot. The contracts are awarded at the local level by CCGs. It is their decision and it would be inappropriate for the Government to intervene.

New Hospitals

Debate between Lord Kamall and Baroness Thornton
Thursday 18th November 2021

(2 months, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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Each of the building projects will be a new hospital that will deliver brand-new, state-of-the-art facilities. One thing that we must be careful of is that if we say, “Well, you can’t call that a new hospital, even though it is a new facility, because it’s on an existing site”, we do not create perverse incentives, where the local NHS or the local ICS says, “We mustn’t build it there, because we will be accused of not having a new hospital”. Surely what we should be focusing on is outcomes, not inputs, and the fact that we are delivering modern, digital hospitals for the future.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, leaving aside the dubious and overinflated claims of 40 new hospitals, many of which are, in reality, upgrades—as welcome as they are—I and others in the House raised with the Minister’s predecessor but one in 2019 that there was an alarming repairs and infrastructure crisis, which was then in the region of £3 billion. Could the Minister explain to the House which part and how much of the new hospitals programme will address the immediate and urgent matter of crumbling wards, sewer leaks in wards and old and dodgy kit?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness will recognise that we need not only to build new hospitals but to upgrade existing infrastructure and this is all part of the capital programme. The decisions on individual hospitals and upgrades will be taken in local communities in consultation with clinicians and local ICSs.

Covid-19: UK Arrivals

Debate between Lord Kamall and Baroness Thornton
Tuesday 16th November 2021

(2 months, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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Last night I took part in a debate that involved the issue of the Covid pass, particularly with the boosters. I was frustrated because I thought I had a date I could announce. That was pulled at the last moment, but we are very close to a solution. The technical point on test and trace is that, at the moment, it is unable to validate the vaccination status of people whose vaccines are not registered on the database. We are looking at whether that can be done on trust, or whether that would open a loophole for getting around the system. I have been assured when pushing the NHS on this that it is looking at an answer.

Baroness Thornton Portrait Baroness Thornton (Lab)
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The Minister must accept that this a very confusing area for everybody. Perhaps he would like to clarify the Prime Minister’s comments yesterday on what impact tougher overseas travel rules and self-isolation for those without a jab might have. He mentioned those yesterday in the press conference. I think they are linked to the Question my noble friend asked. It is very important that the NHS app shows the booster as soon as possible, because it is going to cause a lot of trouble for Christmas travel.

Lord Kamall Portrait Lord Kamall (Con)
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I welcome questions from noble Lords, particularly on getting the booster on the app, because when I am talking to officials in the department and the NHS it shows how important it is that we do this as quickly as possible. One of the tasks is to be accountable and to push the NHS and others to make sure that we are doing this. Sadly, when I ask what the problem is on test and trace, I am told that it is unable to validate the vaccination status of people whose vaccines are not recorded on a national immunisation management system. I have asked about passenger locator forms and whether we could use a similar technology. At the moment that is done on trust, but you face a very high fine if you are misleading; maybe that could be a solution. I assure noble Lords that I really am pushing.

NHS England: Waiting Lists

Debate between Lord Kamall and Baroness Thornton
Tuesday 16th November 2021

(2 months, 1 week ago)

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Baroness Thornton Portrait Baroness Thornton
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To ask Her Majesty’s Government what steps they are taking to reduce NHS England waiting lists.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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I thank the noble Baroness for raising this. It is a top priority for the Government and for the NHS. This year we are providing a record amount of funding to the NHS, with an extra £34 billion. This includes £2 billion this year plus £8 billion over the next three years to step up activity to tackle long waiting lists for elective care and to transform elective services. This funding could deliver around 9 million more checks, scans and procedures.

Baroness Thornton Portrait Baroness Thornton (Lab)
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I thank the noble Lord for that Answer. I figured that that was what he would say. It is not about how much the Government intend to put in but how it is being spent. That is particularly important in the absence of any workforce strategy. If the billions were directed immediately at investing in social care and care workers, for example, both domiciliary and care homes, how many beds does the Minister believe could be freed up in the next eight weeks? What effect would that have on the throughput for elective surgery and accident and emergency departments?

Lord Kamall Portrait Lord Kamall (Con)
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When you look at the data on the waiting lists, what is interesting is that 75% of patients on the list do not require surgical treatment. Most actually require diagnostics. Some 80% of patients requiring surgical treatment could be treated without an overnight stay in hospital, and 20% of patients are waiting for either ophthalmology or orthopaedic services. That shows where you can target the spending to cut the waiting lists.

Gametes and Embryos: Storage Limit

Debate between Lord Kamall and Baroness Thornton
Tuesday 9th November 2021

(2 months, 2 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend for his work on the subject when he was the responsible Minister to help change the policy so that all people, regardless of medical need, may benefit from greater choice about when to start their family. The 10-year renewal periods will be put in place to give people the opportunity to decide whether they wish to continue with their storage of gametes or embryos. The department is currently working with the Human Fertilisation and Embryology Authority to set out the plans for detailed implementation, including on how the renewal periods should be handled by fertility clinics to ensure that they work.

Fertility clinics will be expected to contact people storing their gametes or embryos a year before a renewal period has ended, so there would be 12 months’ notice. In addition, people will have a six-month grace period following the expiry of any renewal period, in which they can get in touch with clinics to re-engage storage if they wish. I am sorry that I am going on longer than usual, but this is an important issue. It is our view that we would provide an appropriate amount of time for clinics to contact their patients, and for patients to decide what they wish to do with their gametes or embryos in storage.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, I return to the question of the noble Baroness, Lady Deech, because we need some clarity here. For some people, months count. They will be having their eggs destroyed now, in the next few months. Therefore, while I congratulate the Government on the regulations that added two years to the 10-year period in recognition of the need to provide an extension during the pandemic, the Minister needs to be absolutely clear because time is fast running out. Are the Government going to provide interim transitional arrangements before the legislation is before the House? From these Benches, we are very keen and across the House there is an enormous amount of support for this to happen. Frankly, if the Minister brings forward the regulations tomorrow, they will go through.

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for that very kind offer, but we have already stated that it is the Government’s intention that no one misses out on the opportunity to extend the storage of their eggs, sperm or embryos. As she will be aware, in 2020 in light of the Covid pandemic, we took steps to extend the storage. We are currently considering options to make sure that no one misses out on the benefits of the new policy. Given the detailed consultation we have just been through, we hope to announce details in due course. Of course, if an amendment is laid to the forthcoming Health and Care Bill, we will consider it.

Cancer Drugs: Licensing and Approval

Debate between Lord Kamall and Baroness Thornton
Monday 8th November 2021

(2 months, 2 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness. It is important that NICE, MHRA and others hear some of the concerns, and the fact that we are being held to account today shows how important this is. Unfortunately, some existing legislation restricts MHRA’s ability to share information with partners, including NICE, which would help them to plan their processes more efficiently. NICE, MHRA, NHS England and NHS Improvement are talking about the concerns raised by noble Lords and generally about delays in the process. They are talking about how they can improve access, including through initiatives such as the Innovative Licensing and Access Pathway launched in January 2021, and sharing as much information as they can upfront. Both MHRA and NICE are aware of the concerns and made that clear when I met them recently after their board-to-board meeting.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, I will follow up on questions that noble Lords have already asked. The ongoing NICE methods and processes review missed the opportunity to propose a new process to mirror accelerated regulatory processes. There are concerns that capacity constraints will limit NICE’s ability to publish decisions as close to marketing authorisation as possible, including for oncology drugs, through the new Project Orbis route, as has been the case with the secondary breast cancer drug, Trodelvy. Have the Government assessed whether the system is fit for purpose in achieving the objective which the noble Lord has articulated: to deliver quick patient access to new, clinically effective treatments? What concrete steps have been taken so far to address any concerns?

Lord Kamall Portrait Lord Kamall (Con)
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Both NICE and MHRA are aware of the concerns, particularly regarding the delay between approval and licensing. That is why they are having conversations with NHS England and NHS Improvement to make sure, as far as possible, that they can discuss co-operation to ensure the speedy approval of drugs.

Covid-19: Vaccinations Administered Abroad

Debate between Lord Kamall and Baroness Thornton
Wednesday 27th October 2021

(2 months, 4 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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One of the difficult issues we face is pushing international partners to agree that the participants of well-regulated vaccine clinical trials should be treated as fully vaccinated. Only a couple of weeks ago I was on a call with G7 health and transport Ministers, trying to push them to ensure that they recognise those very brave people who came forward for vaccine trials. So far, sadly, we have not had much success. We continue to push them, but, in the meantime, we have found the solution of giving people another vaccine in order for them to be recognised. However, we would prefer international recognition.

Baroness Thornton Portrait Baroness Thornton (Lab)
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I think the Minister needs to simplify this for the House—it is a very simple issue. If it is possible to register in France that you have been double vaccinated through its systems, why is it not possible to do that in the UK? While the JCVI may be working to fix the issue for UK residents who have been double jabbed abroad, British entry regulations have left foreign visitors in limbo. So, although two doses of Covid vaccine administered by a UK-approved regulator is enough to enter Britain without having to self-isolate, it does not seem to be enough to avoid being pinged by what has now been exposed as our expensive and not very effective test and trace system. Does the Minister agree that this does not make sense, and can he confirm that the JCVI review will also aim to resolve this?

Lord Kamall Portrait Lord Kamall (Con)
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As I said, we are looking to resolve as many of these issues as possible. There is no logical reason for this not to happen—it is just that we have to push international acceptance but also make sure that we have gone through the processes, especially for those vaccines not recognised by the MHRA.

NHS England Funding: Announcement to Media

Debate between Lord Kamall and Baroness Thornton
Tuesday 26th October 2021

(3 months ago)

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Baroness Thornton Portrait Baroness Thornton (Lab)
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The Minister must by now be aware of the chronic staff shortages in the NHS. He will also be aware of the desperate state of some of our buildings in the NHS, and indeed the inadequate facilities for some of our mental health wards. This announcement mentions diagnostic staff, of which already one in 10 are missing. There is a 55% shortage of consultant oncologists, a shortage of radiologists, a shortage of specialist cancer nurses and, so far, no comprehensive NHS staff plan. Could the Minister tell the House who will run the proposed diagnostic centres? Will it be the NHS? Where will the staff for the diagnostic centres, surgical theatres and to operate the new equipment come from?

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

Men’s Health Strategy

Debate between Lord Kamall and Baroness Thornton
Monday 25th October 2021

(3 months ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising this important topic. I have to admit that I was not aware of this before it was raised. In looking into it further, I know that the noble Baroness was in contact with the previous Parliamentary Under-Secretary of State for Innovation on the issue. As the matter rests with the Department for Levelling Up, Housing and Communities, my predecessor, my noble friend Lord Bethell, had followed up with a letter in May this year, outlining the steps that the department is taking regarding toilet facilities, including looking at certain building regulations. The Department for Levelling Up, Housing and Communities has also launched a call for evidence on the provision of male and female toilets. As soon as we have more information, I will write and update the noble Baroness.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, suicide is the biggest killer of men under 50 in the UK. This figure, and the high rate among young men in particular, has not changed for decades. Research by the Samaritans shows that affluent middle-aged men seem particularly vulnerable—stigma and unwillingness to ask for support obviously play a part. What specific measures and investment are the Government building into their mental health strategy to address this serious matter?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising this very important issue. We know that men are not a homogenous group, as the noble Lord, Lord Scriven, previously said, but some men are less likely than women to seek help or to talk about suicidal feelings. Others can be reluctant to engage with health and other support services. One of the things we have to do is tackle the stigma associated with this; that has been a key priority for years. That is why we funded the Time to Change campaign to 2020-21; it has played a key role. In addition, we have looked at resources on Every Mind Matters, the mental health hub on the NHS website. We have also issued guidance to local authorities and looked at how we can target the high-risk groups such as men.

Covid-19: Plan B

Debate between Lord Kamall and Baroness Thornton
Wednesday 20th October 2021

(3 months ago)

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Lord Kamall Portrait Lord Kamall (Con)
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In order to judge what the next action should be, the Government have laid out plan A. Plan A is focused, for winter 2021-22, on building defences through vaccines, antivirals and disease-modified therapeutics, identifying and isolating cases of transmission through test and trace, and supporting the NHS and social care, but also advising people on how to protect themselves and offering clear guidance and communications.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, it is quite clear that those things are not working. When I saw the Secretary of State for BEIS doing the media rounds this morning denying that plan B was coming down the track, I thought we might open a book on how soon the Government will actually launch plan B. I would like to ask the Minister whether plan B becomes necessary because the Government have made such a mess of plan A, with very late vaccinations for 12 to 15 year-olds and a worryingly low uptake of booster jabs. Is it too late to prevent an NHS winter crisis, with the knock-on effects that will have for our backlog?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for her question and, while I have the opportunity, for all her advice, as a new boy in the role. We will continue to look at a number of different factors, including both economic and health indicators, before we judge whether it is necessary to move to plan B. Plan B does not actually involve complete lockdown. It involves introducing mandatory vaccine-only Covid status certification in certain riskier settings; legally mandating face coverings in certain settings, such as public transport; and communicating clearly and urgently to the public if the risk level increases.

GPs: In-person Appointments

Debate between Lord Kamall and Baroness Thornton
Tuesday 19th October 2021

(3 months, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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The relationship between the patient and the GP is important, so we have made sure that choice is at its centre. As they develop the relationship, they can decide on the most appropriate way to be consulted and to give advice.

Baroness Thornton Portrait Baroness Thornton (Lab)
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The Government have consistently promised and failed to increase the number of GPs. Instead of the 5,000 additional ones promised in 2015, this year we have 1,300 fewer GPs. When the Health Secretary announced the £250 million winter access fund to enable GP practices to improve the availability of services to patients, where did he think those GPs would come from? Where is the magic locum tree? It is a seven-year pipeline to produce a GP. Does the Minister agree that rubbishing and attacking GPs is not going to attract medics to take up this profession?

Lord Kamall Portrait Lord Kamall (Con)
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I think we all agree that we should appreciate the work that GPs did during Covid; they were often the front line. It is important that we continue to make sure that we recruit more GPs. Some 3,793 doctors—the highest ever number—accepted a place on GP training in 2020, so I do not recognise the criticism.

Health: Chronic Fatigue Syndrome

Debate between Lord Kamall and Baroness Thornton
Tuesday 12th October 2021

(3 months, 2 weeks ago)

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Baroness Thornton Portrait Baroness Thornton
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To ask Her Majesty’s Government, further to the decision to delay the planned new guidelines on the diagnosis and management of ME/CFS, what assessment they have made of the ability of the National Institute for Health and Care Excellence to carry out its functions; and when they expect such guidance to be published.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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NICE is seen as a world leader in the translation of research into authoritative, evidence-based clinical guidelines, and the Government have confidence in NICE’s ability to carry out its functions effectively. We all know that ME/CFS is a complex condition and, as we understand, a range of views about its management have been expressed during the development of the updated guidelines. To address as wide a range of views as possible, NICE is holding a round table with stakeholders next Monday to discuss these issues and will then take a decision on the next steps.

Baroness Thornton Portrait Baroness Thornton (Lab)
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First, of course, I welcome the Minister to his place and his job. There is nothing like hitting the ground running, since he has got to do three Questions in a row—that does not often happen. My Question was prompted by two important issues. First, public confidence in NICE’s methodology, and indeed NICE’s own confidence in its methodology, are vital. If the Minister says that the Government have confidence in NICE, it begs the question why the Government are not demanding that the ME/CFS guidance, three years in the writing and with patient support, is not being published immediately.

Secondly, I will quote from one of the many emails that I have had about this issue: “Thank you in advance for speaking up for ME patients. No treatment is better than harmful treatment. My daughter is now bedbound with severe ME due to GET”. GET is the current medical treatment regime for ME/CFS sufferers, which these guidelines say should be reformed. Did NICE come under pressure to pull these guidelines because of medical vested interests in the delivery of GET, particularly since they believe that this is the treatment for long Covid?

Lord Kamall Portrait Lord Kamall (Con)
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First, I thank the noble Baroness for her warm welcome. I look forward to many exchanges with her and to learning from Ministers across the House and those who have been in the Department of Health and Social Care before. I know that the noble Baroness is recognised as a champion of the 250,000 people who are living with ME/CFS. As the noble Baroness knows, there are a number of complex symptoms, and experts disagree over the multifaceted way to address this.

As the noble Baroness knows, the NICE guidelines were delayed twice. They were first delayed because it wanted to make sure that it had taken on board all the various submissions that had been made; they were delayed a second time because, just as they were about to be announced, concerns were raised by clinicians and other stakeholders. If you are going to have guidelines, it is important that they are accepted and recognised by as wide a range of stakeholders as possible; otherwise, they might lose their authority.

We want to make sure that, whenever we have this situation and there are people with a range of views, we get them around a table and have a conversation, as common sense tells us, to see if we can agree on a way forward. I very much hope that, once we have had this round table, we will be able to agree a way forward.