Debates between Lord Kamall and Baroness Merron during the 2019 Parliament

Thu 23rd Jun 2022
Wed 15th Jun 2022
Wed 15th Jun 2022
Thu 26th May 2022
Mon 23rd May 2022
Tue 5th Apr 2022
Health and Care Bill
Lords Chamber

Consideration of Commons amendments
Wed 16th Mar 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2
Thu 3rd Mar 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 1
Tue 1st Mar 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 1
Wed 9th Feb 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 1
Mon 31st Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2
Wed 26th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 1
Mon 24th Jan 2022
Mon 24th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 1
Mon 24th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2
Tue 18th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 3 & Lords Hansard - Part 3
Mon 17th Jan 2022
Tue 11th Jan 2022
Health and Care Bill
Lords Chamber

Committee stage & Lords Hansard - Part 1 & Committee stage & Lords Hansard - Part 1
Tue 2nd Nov 2021
Mon 18th Oct 2021
Tue 12th Oct 2021

Cannabis: Medicinal Use

Debate between Lord Kamall and Baroness Merron
Tuesday 12th July 2022

(1 month ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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In simple terms, I completely agree. There should be a way around this and I will take this back to the department. In fact, I was quite provocative when I was getting advice on this, but I have also been warned that I am conflicted on this issue, so I will try to push it as long as I am not seen as being in conflict. It is very difficult, but I want to do the right thing.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, we look forward to the Minister returning on this point, but to build on the points made by other noble Lords, despite the change in the law, many families are experiencing great anguish in getting treatment for young epilepsy sufferers and are left with little option but to pay thousands of pounds each month. What is the Government’s view on implementing all the recommendations of the recent NHS review of the barriers to accessing prescription cannabis products for medicinal use? If they are not planning to implement all the recommendations, which ones are the Government looking at?

General Practitioners: Shortage

Debate between Lord Kamall and Baroness Merron
Tuesday 12th July 2022

(1 month ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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There are a number of reasons why some GPs and other health professionals prefer to work part-time as opposed to full-time. Many people, especially given the stresses of the pandemic, want a better work/life balance. Some people have suggested in the past that we should focus on full-time equivalents. We should make sure that current staff who want to go from full-time to part-time can do so within the system, so that we can retain them, while tackling all the barriers to retention as well as recruiting more GPs.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the appointments system is not working well for GPs or patients. Healthwatch England reports that complaints about GP services are rising, the main problems being difficulties getting an appointment, exorbitant waits on the phone, about which we all know, and an end to online facilities to book slots. What assessment has been made of the detrimental impact on people struggling to access GP services, particularly those who are more vulnerable, and what is the plan to put this right?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness is absolutely right. We know that, for many people, their first entry into the system—their portal, if you like—is trying to get an appointment with their GP. As the noble Lord, Lord Patel, mentioned earlier, we have to look at how we can modernise this service. In the short term, we have made money available to help improve triage for people who phone up for services; this includes how to manage incoming and outgoing calls. In future, we are looking at more digitisation and extending the functionality of the NHS app so that people can book appointments for all sorts of services; if they are waiting for an appointment or secondary care, they will also be able to see how long they will have to wait and where they are in the queue.

Coronavirus: New Cases

Debate between Lord Kamall and Baroness Merron
Monday 11th July 2022

(1 month ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron
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To ask Her Majesty’s Government what assessment they have made of the recent rise in Covid cases across the UK to 2.7 million infections over the last week.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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We continue to see Covid-19 case rates and hospitalisations rise in all age groups, with the largest increases in hospitalisations and ICU admissions in those aged 75 and older. A large proportion of those hospitalised are admitted for reasons other than Covid. However, Covid is identified due to the increase in case rates in the community and the high rates of testing in hospital, including among those with no respiratory symptoms. Current data does not point to cases becoming more severe.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, with a stark rise in infections, many people—particularly the clinically vulnerable, carers and older people—are feeling anxious, yet the Government have been noticeably silent, perhaps being somewhat distracted. We might be through the worst of Covid but evidently it has not gone away; individuals, organisation and businesses still want guidance. I have two questions for the Minister. Are the Government planning any campaigns, perhaps involving scientists and others, to highlight current risks and to encourage the take up of booster jabs? Are there plans to reintroduce mandatory mask wearing in hospitals, which the chair of the JCVI considers sensible?

Lord Kamall Portrait Lord Kamall (Con)
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I have to strongly disagree with the noble Baroness when she says that the Government are doing nothing. We are reliant on the UKHSA, which monitors rates and gives us advice, along with the JCVI. In my briefing from the UKHSA, it said it is continuing to monitor cases. As many noble Lords will remember, when we announced the living with Covid strategy we said that we are always ready to stand up measures should case rates rise so much that our health system was under pressure. We managed to break the link between infections and hospitalisations and hospitalisations and death; if that gets out of control then of course we will stand up the measures that we had previously.

Health Improvement and Food Production

Debate between Lord Kamall and Baroness Merron
Thursday 7th July 2022

(1 month, 1 week ago)

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

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

Once again, we have to be open—

Baroness Merron Portrait Baroness Merron (Lab)
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I thank the Minister for referring to the delay, which I accept is a delay, to the restrictions on advertising. Can he explain what that has to do with the cost of living crisis, because I have heard that before?

Bread and Flour Regulations: Folic Acid

Debate between Lord Kamall and Baroness Merron
Wednesday 6th July 2022

(1 month, 1 week ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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Perhaps I have not made it clear enough that we are proceeding with this; there is no stopping the process or review. We are clear that the scientific debate should not hold up progress, so we want to launch the consultation in August/early September. The closing date will be 12 weeks after that, and we should have a government response on the final position in Q1 2023. We would then notify the WTO and European Commission, and once that is all cleared, it should result in legislation being ready to be laid in Q4 2023, and the transition period for the industry would be discussed after that. When I spoke to the noble Lord, Lord Rooker—I hope he would acknowledge this—he believed that I was one of the few Ministers who is very intent on progressing this.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, as the noble Lord, Lord Patel, has said, the scientific evidence is readily available and evidenced across the world. Can the Minister tell us what, on this new timeline, he thinks the new consultation and process might reveal that we have not seen so far?

Lord Kamall Portrait Lord Kamall (Con)
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The reason we have a consultation is so that we are aware of unforeseen circumstances and that, hopefully, we deal with unintended consequences before they occur. It is all very well saying that the science is settled; we have reached a level of consensus where both sides can agree, and that is what we are progressing from. Once it is implemented, we can start reviewing whether it should be a higher level and whether there are unintended consequences. The history of contestation in science goes back a long way; think of the heliocentrism versus geocentrism debate. People thought that the universe revolved around the earth, but Aristarchus of Samos, al-Battani, Islamic philosophers and others challenged that, and Copernicus proved that heliocentrism was right.

Paramedic Services

Debate between Lord Kamall and Baroness Merron
Monday 4th July 2022

(1 month, 1 week ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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The right reverend Prelate raises an important issue for those of faith who want to share their last moments of life with someone. I am afraid that I do not have a detailed answer, but I will go back to the department and write to the right reverend Prelate.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, as other noble Lords have said, ambulance delays are a symptom of pressures elsewhere in the health and care system. At the end of April, 62% of over 20,000 patients in England who were medically fit to be discharged remained in hospital, largely due to a lack of appropriate social care provision. Can the Minister say how and when there will be a fully costed workforce plan to ensure that the relevant staff are in place to urgently tackle this bottleneck?

Mental Health: Advertising and Body Image

Debate between Lord Kamall and Baroness Merron
Thursday 30th June 2022

(1 month, 2 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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If I have been accurately briefed, I will begin by wishing my noble friend a very happy birthday.

This is a really important issue concerning ethnic minorities and people of different colours. First, young people want to see people who look like them on TV and in the media as role models, to show that they are part of everyday society. Also—I am sure my noble friend will be aware of this—sadly, there is the issue of colourism, whereby sometimes there is a preference for people of a lighter colour within certain ethnic minority groups. People who are darker are quite often discriminated against; they are not necessarily abused, but there is this preference for lighter colours. This is all being looked at. What my noble friend says shows what an incredibly complicated area this is. It is really important that we look at all these issues: is it size, is it appearance, is it colour?

Baroness Merron Portrait Baroness Merron (Lab)
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Advanced early intervention is crucial. Treatment for mental health conditions such as eating disorders has consistently unacceptable waiting times. At the end of last year, a record 2,100 children and young people were waiting for treatment, with demand continuing to rise. Can the Minister tell your Lordships’ House when the waiting times will mean timely intervention? What are the Government doing to recruit, retain and train the necessary levels of staff to provide the treatment that is so desperately needed?

Lord Kamall Portrait Lord Kamall (Con)
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I hope the noble Baroness will recognise that before the pandemic, we were meeting the waiting times targets for many younger people. Clearly, as with many things in our health and social care service, the pandemic has had a huge impact—not only delaying the treatment of people who should have been treated before the pandemic, but increasing the number seeking help with mental health issues. As I am sure noble Lords will recognise, for young people those two years were a massive proportion of their lives compared to us. Those are lost years for them, and it has led to many mental health issues. As the noble Baroness will know, we have announced the draft mental health Bill. The NHS long-term plan will have an additional £2.3 billion a year for mental health services by 2023-24, and an extra 2 million people will be able to access support. This will all take time, and we will have to work through that.

Diabetic Prevention Programme

Debate between Lord Kamall and Baroness Merron
Thursday 23rd June 2022

(1 month, 3 weeks ago)

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

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the national paediatric diabetes audit shows that the impact of type 2 diabetes and the cost-of-living crisis is disproportionately felt by children living in the most deprived areas. What preventive measures specifically geared towards children are in place so that they may avoid type 2 diabetes? What are the Government doing for the almost 4 million children, and their households, who are struggling to access and afford enough fruit, vegetables and other healthy foods to meet official and basic nutrition guidelines?

Lord Kamall Portrait Lord Kamall (Con)
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One of the NHS programmes that will be repeated by integrated care boards when we have them is the eight annual diabetes checks for people of all ages. Certain factors—HbA1c, which is your average blood glucose level, or your glycated haemoglobin; blood pressure; cholesterol; serum creatinine; urine albumin; foot surveillance; BMI; and smoking—are checked for patients of all ages to identify early onset of diabetes.

Polio

Debate between Lord Kamall and Baroness Merron
Thursday 23rd June 2022

(1 month, 3 weeks ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron
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To ask Her Majesty’s Government what action they have taken in response to the national incident declared due to the polio virus being found in London sewerage systems.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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The established UKHSA public health response mechanism has been stood up in line with national polio guidelines. This national incident means that a national team has been set up to manage and co-ordinate these actions across areas, which is standard procedure for many of the health threats that the UKHSA foresees and manages. Although samples have been detected in London, the UKHSA is working to ensure that other areas are aware and are taking actions necessary to protect populations, including encouraging people to take the vaccine.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, while the risk to the public is considered low, the declaration of a national incident will of course give cause for concern, so the Government need to communicate swiftly and clearly about the situation and to ensure that children in particular are vaccinated against polio, especially as there is lower vaccine coverage in London among younger children. What is being done to address this situation and how will the Government roll out their messaging, working with local authorities, schools, the NHS and GPs, who already have added pressure from being contacted in greater numbers by the public who are concerned about vaccinations? Can the Minister reassure your Lordships’ House that he is working closely with the Treasury to ensure a properly funded communications and vaccination campaign?

Lord Kamall Portrait Lord Kamall (Con)
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We should start by being clear about what has been found. As part of routine surveillance, the MHRA analyses sewage from a number of treatment works and looks at what may be identified—it is world-leading in this. We should pay tribute to the UKHSA for its world-leading work and for being ahead of the game in spotting potential health risks early. It is normal for one to three vaccine-like polio viruses to be detected each year in UK sewage samples, but those are usually one-off findings. In this case, a vaccine has been detected; it is probably related to someone having had the polio vaccine and having shed it as part of their faeces. A couple of things will now happen. First, the MHRA will go further down the system to see whether it can isolate where that came from. Secondly, the messaging is quite clear: you must get your vaccine. Most people get their vaccines as part of a routine. They get it twice in preschool and then at school at 14 as their final booster. However, there are some areas of low vaccination, and we are making sure that we are rolling out that message along all the channels mentioned by the noble Baroness.

National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022

Debate between Lord Kamall and Baroness Merron
Monday 20th June 2022

(1 month, 3 weeks ago)

Grand Committee
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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I start by thanking the Minister for his extremely helpful introduction to these regulations. It is a pleasure to follow the noble Lord, Lord Scriven; I want to pick up some of the points he made. Let me say at the outset that we on these Benches support the regulations, which we accept are consequential and will not change services for people.

The words that have been used are that this is a “tidying-up exercise”. I want to dwell for a moment on the general point that there has been considerable time for this. The Health and Care Bill was introduced in July 2021 and we all know how long it spent in Committee, both in this House and in the other place. We also know how extensive the consideration of it was so it seems strange for us to find ourselves back discussing what are described as “consequentials”. This may be a simple tidying-up exercise—I accept that is what these regulations are—but calling it that ignores how we could have avoided the need to tidy up and, therefore, the amount of bureaucracy, time and effort that has been spent, not least in the department, in having to make these changes. Perhaps the Minister could address the general point that has been made in the course of this debate about why we find ourselves in this situation.

In the debate in the other place, the Minister talked about five more consequential statutory instruments that we should expect as part of this so-called tidying-up exercise. Perhaps the Minister can advise us on those. It is important that everybody, including system managers, knows what is coming down the track. I say that particularly given the record waiting lists and waiting times that the NHS is seeking to manage, yet we are talking about regulations that must be in place for 1 July so that everyone has certainty about what needs to be put in place and to be done. I accept the Minister’s assurance that this does not affect services to patients in a practical sense, but whenever we discuss regulations there is always an air of uncertainty around. Patients need to be assured that they will have a seamless service wherever they live or wherever they are. Therefore, knowing that we will be considering similar consequentials raises questions about certainty.

We hope that the regulations go through and that the Minister will respond to the points of concern that have been raised today. I hope that the regulations will ensure that the NHS can get on with the job that it is here to do.

Lord Kamall Portrait Lord Kamall (Con)
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My Lords, I thank both noble Lords who have spoken in this debate. The noble Lord, Lord Scriven, said this statutory instrument is not controversial, as reflected in the attendance at the debate, but when I saw that the noble Lord, Lord Scriven, was present I thought, “What’s controversial? I’d better look into it.” The noble Lord did not disappoint in that way. He quite rightly holds the Government to account.

Before I conclude I shall try to address some of the points that were made. The department has laid eight instruments so far to support the ICBs for 1 July. They ensure the continuation of the existing policy and provide the supporting legislative framework. The Health and Care Act 2022 (Commencement No. 1) Regulations 2022 were made on 6 May to commence a small number of preparatory sections from 9 May to enable preparatory steps to take place for the establishment of ICBs on 1 July. There are six negative resolution statutory instruments and one affirmative instrument—this regulation. The Health and Care Act 2022 (Commencement No. 2) Regulations 2022 are planned to be made by 30 June. This SI will commence major elements of the Health and Care Act on 1 July, including, but not limited to, ICBs, ICPs—integrated care partnerships—and the merger of NHS England Improvement, TDA and Monitor. We will be laying a further consequential statutory instrument which will amend redundant references to previously existing bodies and update legislation to support the implementation of ICBs.

On the point that the noble Lord, Lord Scriven, made about the federated data platform, I assure him that I have been in conversation with NHS England, particularly the transformation directorate, and it has been quite clear with me that it is an open tender. There is no preferred bidder. It has seen all the speculation in recent press articles and I have asked it directly about it. I will be quite clear: this is a very difficult for me to walk because as a Minister I do not want to interfere too much in those technical solutions and favour one or the other, but at the same time I have to warn about the politics around this. When I was speaking to the officials, they were very clear about that. We have to be clear about this. Whatever you chose, there will be some story out in the press, so we must make sure it is as open as possible.

Vaccinations

Debate between Lord Kamall and Baroness Merron
Wednesday 15th June 2022

(2 months ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I am afraid I am not aware of the details to which my noble friend refers, but I would be happy if he wrote to me. I will then take that back to my department.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, more than one in 10 children are not fully protected against measles by the time they start school, and research shows that many parents are unaware that it can lead to serious complications, such as pneumonia and brain inflammation —or, indeed, that it can be fatal. With the major focus on Covid vaccinations over recent years, what assessment has been made of the effect on the uptake of routine vaccinations, including MMR? What steps are being taken to restore any affected vaccination levels?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness raises a very important point. We have to recognise that the UK has one of the most comprehensive childhood and adolescent immunisation programmes in the world. We have seven national childhood immunisation programmes, three adolescent programmes and two elderly programmes. Vaccine uptake in the UK remains high overall, but there has been some decline in routine childhood vaccines—so we have been looking at school-based immunisation programmes, some of which were clearly interrupted due to Covid. At the same time, from October to December 2021, the coverage of childhood vaccination programmes actually increased.

Defibrillators

Debate between Lord Kamall and Baroness Merron
Wednesday 15th June 2022

(2 months ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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All I can say is that I hope so. I will try to find out and commit to write to my noble friend.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, with Travelodge, Tesco and Royal Mail all announcing that they will participate in the British Heart Foundation use training pilot, will the Minister undertake to look at the potential impact of this training on saving lives and work with his ministerial colleagues across government to encourage such training on defibrillator use by other companies, the public sector and other organisations?

Lord Kamall Portrait Lord Kamall (Con)
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If noble Lords will excuse the pun, one of the heartening things in answering this is that, when I received briefing on this, it is really important and interesting how we are working across government. It is not only in the Department of Health; we are working with the Department for Transport on transport locations, DCMS on sports grounds, the Department for Education on education settings and other departments. This is really a cross-government initiative.

Personal Protective Equipment: Waste

Debate between Lord Kamall and Baroness Merron
Tuesday 14th June 2022

(2 months ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron
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To ask Her Majesty’s Government what assessment they have made of the expenditure on unusable and excess Personal Protective Equipment (PPE), and the reasons for the waste.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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We have delivered over 19.8 billion items of PPE to keep front-line staff safe. Facing a dangerous virus, and against the background of no vaccine, as well as rising demand, market disruption and panic buying, we procured as much PPE as possible rather than too little. Only around 3% of PPE that the department purchased is unusable, and we are working with waste providers to dispose of unusable stock in the most environmentally friendly and energy-effective way.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, £9 billion was wasted on PPE due to obscenely inflated prices, irregular payments to intermediaries and faulty kit which is now poised to go up in smoke, along with nearly one in four of the contracts in dispute around products which are not fit for purpose or where allegations of slavery have been made. We know that the Government were responding to an unfolding crisis, but how was this shameful episode allowed to go unchecked and why has the department been allowed to establish a track record for not following public spending rules?

Lord Kamall Portrait Lord Kamall (Con)
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We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.

Children: Cancer

Debate between Lord Kamall and Baroness Merron
Thursday 26th May 2022

(2 months, 3 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I completely apologise to all noble Lords. It is important that we look at this issue; I am afraid I will have to write to the noble and gallant Lord with more detail.

Baroness Merron Portrait Baroness Merron (Lab)
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Following on from the question of the noble and gallant Lord about the matter of significant improvements being made in the lives of children with cancer by detecting cancer early and avoiding delays in care, there are of course three components to early diagnosis, with the first being awareness of symptoms by families and primary caregivers. Can the Minister tell your Lordships’ House what assessment has been made of the level of awareness and what is being done to promote that awareness among families and primary caregivers?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness raises an important point about how we raise awareness, and that goes right across not only the population but patients themselves. NHS England and NHS Improvement are developing plans for future phases of their Help Us Help You campaign to raise awareness of key cancer symptoms. To date, the campaign has contributed to the record high levels of urgent cancer referrals that the NHS has seen since March 2021.

Perhaps I may take the opportunity to address the question from the noble and gallant Lord. Covid clearly affected the backlog. One of the things about the waiting list is that now 80% of people on it are waiting for diagnosis. One of the issues we are looking at is how you push out more community diagnosis centres around the country, not only in hospitals but in shopping centres and sports arenas, so that effectively we go to the patient and detect as early as possible. We hope that all that, in conjunction with things such as blood testing and genomic sequencing, will lead to earlier diagnosis.

Sugar Reduction Programme: Bread

Debate between Lord Kamall and Baroness Merron
Wednesday 25th May 2022

(2 months, 3 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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Right. I begin by thanking my noble friend for that very comprehensive question. As I said earlier, some sugar is needed in the process, but he makes an important point about how we reduce the unneeded additional sugar that is added. I have already given the reasons why there is some sugar, and no doubt the chemical processes will be improved over time: as mankind’s innovation and ingenuity increase, we will see more substitutes for sugar. I was also interested in the point made by the noble Lord about chapatis; next time I go to a restaurant I will ask about their sugar content.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, with the UK attending the 75th World Health Assembly in Geneva as we speak, it is concerning that the Government have delayed their planned measures to encourage a move away from foods that are high in fat, sugar and salt. To compensate for this, particularly for those who are experiencing higher levels of deprivation, can the Minister tell your Lordships’ House in what specific ways the Government intend to show the leadership that is so urgently needed?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising that point. Part of my role is in international health diplomacy, where other countries come to the UK wanting to learn from us. It is very interesting that a number of other countries are asking to learn from our sugar and salt reduction programmes, our alcohol and anti-tobacco programmes and our campaigns for healthy eating—not just telling people they should not do things but encouraging them to have a healthier lifestyle

NHS Dental Services

Debate between Lord Kamall and Baroness Merron
Tuesday 24th May 2022

(2 months, 3 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?

Lord Kamall Portrait Lord Kamall (Con)
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I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.

Long Covid

Debate between Lord Kamall and Baroness Merron
Monday 23rd May 2022

(2 months, 3 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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The NICE guidelines start with the definitions as I have laid out previously, and the NICE definitions are aligned with the World Health Organization. On the noble Lord’s specific question, I will have to write to him.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the Equality and Human Rights Commission made an announcement on Twitter that it recommended that long Covid should not be treated as a disability. That would mean that those suffering from the condition would have to take their employer to a tribunal if they felt that they were being discriminated against. Can the Minister tell your Lordships’ House what his view is on how reasonable or not this is? What steps are being taken to promote understanding by employers of this debilitating condition and to encourage and guide them to be open to making changes in the workplace to support sufferers in continuing to work?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness makes a very important point. We are learning more about the different types of long Covid, how to treat them and what interventions they need. People will not always need to go to a primary or secondary care centre for their treatment; in fact, there is an app to help people who can be supported at home. In terms of general advice about disability or to employers, we are working across government as we learn more about this in order to give appropriate advice to employers.

North East Ambulance Service

Debate between Lord Kamall and Baroness Merron
Monday 23rd May 2022

(2 months, 3 weeks ago)

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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, human tragedy permeates this scandal, which has seen up to 90 unnecessary deaths, gross negligence, cover-ups and public money buying the silence of staff. Quinn Beadle, who was just 17 when she tragically committed suicide, died because an ambulance worker failed to perform proper resuscitation. In the report that was then made to the coroner, North East Ambulance Service managers removed this detail. The Secretary of State said today that this and dozens more injustices will be investigated more fully. Will the Minister confirm that this will take the form of a formal inquiry, as it surely must? Will questions be asked of the Care Quality Commission, which, despite being tipped off two years ago, failed to flag or even spot this outrage?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising those concerns. I completely agree with the sentiments she expressed; this is completely uncalled for. As I said previously, my honourable friend Maria Caulfield pledged that there would be an investigation into this. As to whether it will be a formal inquiry, it is too early for me to give a direct answer, but I will go back to the department and as soon as I have more information I will write to the noble Baroness. I understand that these are historic incidents and that the CQC has said that its service is improving, but as more information is still coming out—even today when I had the briefing, not all the information was there—I will of course commit to write to the noble Baroness.

Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Debate between Lord Kamall and Baroness Merron
Monday 23rd May 2022

(2 months, 3 weeks ago)

Grand Committee
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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I welcome the Minister’s helpful introduction and his acknowledgment of the delay in bringing this statutory instrument before us. These Benches welcomed the initial preparation and dispensing errors instrument when it came before Parliament in 2017. That welcome was in line with that of a number of organisations, including the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. Today, we are very happy again to give that welcome to this statutory instrument, not least because it is entirely focused on patient safety and on improving safety for patients. It also brings parity across the pharmacy profession, something that has been much called for.

There were some 1 billion prescriptions dispensed last year. At this volume, it is, of course, impossible to avoid all errors, and it is certainly a credit to the pharmacy profession that they are statistically very few and far between. Most professional groups in the health service do not face criminal conviction and potential imprisonment for an inadvertent dispensing error, and therefore it would be quite wrong for pharmacists to be the only ones who do. It is therefore very welcome that this SI extends legal protections to pharmacists working in a range of locations, such as prisons, hospitals and care homes.

Those working in these settings are often under increased stress, and this has been exacerbated by the challenges of the pandemic. The Pharmaceutical Journal has found an approximate doubling of pharmacists reporting that they feel extremely stressed compared with recent years. In often very pressured circumstances, it is right that we, in the way we are discussing today, protect pharmacists—who are often people’s first point of contact with the healthcare system and too often victims of abuse—from unintended mistakes. Ensuring the right to legal defence against prosecution in cases relating to inadvertent error will undoubtedly remove some of the fear these clinicians feel when it comes to admitting errors. It will help to prevent and reduce patient harm through taking the wrong medication or dosage.

It will also assist in promoting a culture of transparency, as has been referred to already. That will help to inform future learning and improve protocols for the dispensing and preparation of medicines. I agree that this is very much a helpful step towards cultural change and towards a more positive and candid workforce, which, as we have already referred to, can only serve to make patients safer.

Of course, again, it is right that this SI extends only to inadvertent errors. Where they are wilfully negligent or intent on causing deliberate harm, those who are responsible will continue to face criminal prosecution. This is critically important and we certainly support that.

I move on to my outstanding questions on the SI. I am concerned that, of the 523,000 dispensing errors that occur each year, only 5% are reported. Does this not suggest that the 2017 legislation increasing protection for inadvertent errors has been largely unsuccessful in encouraging honesty? What more are the Government doing to increase that number? How will the Government further encourage individual pharmacists to feel safe to come forward if they have dispensed the wrong medication? I should like to understand further how the professionals affected by this legislation, especially those who are more isolated than those who have the benefit of a network of pharmacists easily accessible to them, are informed about these changes.

There is always so much more to do when it comes to patient safety, but this is a very welcome step forward. I look forward to the Minister bringing forward further improvements in due course.

Lord Kamall Portrait Lord Kamall (Con)
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I begin by thanking noble Lords for their questions. I shall try to answer as many as I can and, in the usual way, if I have missed any of them, I will go through Hansard and make sure I respond in more detail. The noble Baroness, Lady Walmsley, asked about deterrence. I have some statistics here. In 2021, a survey of community pharmacists found that 95% of pharmacists said that they report errors to improve practice and 80% to learn from mistakes. In response to her specific question about fear of prosecution as a reason not to report an error, it dropped from 40% in 2016 to 18% in 2021, largely attributed to the 2018 change in law. Therefore, we expect a similar drop in the fear of being prosecuted for the pharmacists covered by this order.

The noble Baroness also asked about the chief pharmacist. This is a statutory role that mirrors the statutory role of the superintendent pharmacist in registered retail pharmacies. This aims to strengthen the governance of pharmacy services by incentivising the creation of this role, if a hospital, prison or care home does not already have one, in order to benefit from these defences. However, to reflect the diverse arrangements in different health settings, organisations do not necessarily need a specific chief pharmacist role, but should ensure that the statutory functions of a chief pharmacist are included in the relevant individual’s job responsibilities if they want to benefit from the defences.

There was a specific question about where there is no chief pharmacist officer. I understand that, at the moment, existing pharmacists can have that duty extended to them, but I shall have to write to the noble Baroness with more detail. What is really important, as she acknowledged, is the duty of candour. We want to encourage an environment where people do not feel afraid to come forward in order to learn. Of course, there is always the right balance between those who have acted maliciously compared to those who have made a mistake. As the noble Baroness, Lady Merron, rightly said, when you are dispensing this number of prescriptions, statistically and probability-wise, there is probably bound to be some error.

To go back to the point about the chief pharmacist officer, given the flexibility, people do not need to adopt the statutory term of chief pharmacist as a job title; they can have the role of chief pharmacist assigned them. I just wanted to clarify that; if I have not been clear, I shall write to the noble Baroness.

I just want quickly to give a bit of a flavour of the errors to show how something might not necessarily be malicious but could be an error. A medicine intended for another patient could be dispensed to the wrong patient. The wrong medicine could be dispensed. An ingredient could have inadvertently been omitted or added when making up a medicine. A medicine could be dispensed at the wrong strength or in the wrong dosage form. These things happen, not intentionally but unintentionally, which is why we want to make sure that we learn from such mistakes.

Given that we have already introduced these offences for the majority of pharmacy professionals in the retail sector, it is right that we extend them to colleagues working in hospitals. By introducing this order, we are not only removing the fear factor for pharmacy professionals but helping to protect the patient under their care. We know from patients that it is important for them to know that, when an error is made, responsibility is taken and the service learns lessons. This legislation supports and incentivises that principle.

I am not clear whether I have answered every question, but I will check and write to the noble Baronesses as appropriate. I thank noble Lords for their interest and the positive debate today. I commend this draft order to the Committee.

International Healthcare Outcomes

Debate between Lord Kamall and Baroness Merron
Thursday 19th May 2022

(2 months, 4 weeks ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron (Lab)
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I shall start again. I beg to leave to ask the Question standing in my name on the Order Paper.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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I assure the noble Baroness that I am only too happy to answer the Question standing in her name.

The Government value the use of robust international comparisons to help improve and reform health services, and work closely with the OECD in compiling such statistics. The Civitas report is based on data already known to the Department of Health and Social Care, which highlights both where the NHS is world-beating as well as where it needs to improve.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the recent Civitas report on international health outcomes does not make pretty reading, showing the UK to be the worst for stroke and heart attack survival. With the NHS and patients facing record waiting times and soaring turnover and vacancy rates in the workforce, and no corresponding social care proposals in the Queen’s Speech to alleviate pressure, will the Government finally commit to a proper workforce plan with projections of future need and a proper plan to meet those requirements?

Lord Kamall Portrait Lord Kamall (Con)
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I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.

I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.

St George’s Hospital: Patient Deaths

Debate between Lord Kamall and Baroness Merron
Wednesday 18th May 2022

(2 months, 4 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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The noble and right reverend Lord raises a number of important points about consistency and the number of investigations. Their remits are often different, which can confuse the picture, and sometimes some of the investigating bodies are seen to extend beyond their remit, causing further confusion. In this case it is important to recognise the difference between the coroner’s inquest and the work of the independent mortality review. Coroners’ inquests are different, and an independent mortality review was not undertaken to determine the cause of death in individual cases or to attribute blame. It was all about processes, procedures and culture.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, it is hard to imagine the trauma and pain that bereaved families have suffered, and the terrible impact on surgeons, the staff team and patients. It is concerning to read reports that junior doctors have been prevented from returning to work at the unit to keep them out of a toxic culture of inappropriate behaviour. Can the Minister tell your Lordships’ House what is being done to stamp out toxicity, not just in these tragic circumstances but in NHS workplaces more generally, and what assessment has been made of the problem?

Lord Kamall Portrait Lord Kamall (Con)
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Let me begin by agreeing with the noble Baroness on how important it is to recognise the impact that this has had on the bereaved families, and the uncertainty they have experienced. They thought it was going in one direction; clearly that was addressed by the coroner and now the coroner may apologise. When I was looking at this in more detail, I was sadly told not to discuss the culture because of ongoing investigations, but I commit to write to the noble Baroness, to make sure that I am not breaking any legal principles and that I give her a proper response rather than an inappropriate one now.

Folic Acid Fortification

Debate between Lord Kamall and Baroness Merron
Wednesday 6th April 2022

(4 months, 1 week ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I understand the frustration that noble Lords have expressed. The same frustration is shared by officials in the department. When I asked officials, “What are the issues that you really need to get to the bottom of?”, one was the appropriate level of fortification. It is interesting that noble Lords seem to disagree with the department’s advice. Therefore, I will facilitate a conversation. Another issue is how that appears compared to other additions and fortifications put into flour. We want to get the right balance. The Government are committed to doing this and we will start as soon as the Northern Ireland elections are over.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, all the research on adding folic acid to flour, including that by the Government’s independent Scientific Advisory Committee on Nutrition, shows that it is a completely safe measure with no unintended health consequences. In preparation for going down this route to protect newborn babies—which I really would urge the Minister to progress as soon as possible—what plans do the Government have to communicate the benefits of these measures and to reassure those who may have concerns, including parents, and parents-to-be?

Lord Kamall Portrait Lord Kamall (Con)
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This will all be part of the consultation, but once the policy has been decided on and fortification starts, clearly, we will be communicating to parents, families and others. If there is a risk—which noble Lords in their expertise seem to disagree with—we will have to identify that. The history of good intentions is littered with unintended consequences. We must be aware of those in our pursuit of increased folic acid in flour.

NHS: Abuse of Nurses

Debate between Lord Kamall and Baroness Merron
Tuesday 5th April 2022

(4 months, 1 week ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend for his question. When the NHS started investigating and digging deeper into this issue, the assumption was that it was often just members of the public. It is finding that it is individuals who have had a mental health crisis or are suffering from dementia or another neurological condition, rather than the classic perception of members of staff being abused by the public.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, yesterday’s Health and Social Care Committee report emphasised that earlier diagnosis and prompt cancer treatment will not be possible without a plan to address gaps in the cancer workforce, including the need for nearly 3,500 additional specialist cancer nurses by 2030. Does the Minister accept that a workforce plan is essential to improving cancer diagnosis, research and treatment, and how will the Government attract new staff and improve staff retention by improving day-to-day working conditions, which must include preventing abuse and giving support where it does occur?

Lord Kamall Portrait Lord Kamall (Con)
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I hope the noble Baroness will appreciate that I have laid out some of the initiatives that are taking place, and which are not only trying to prevent abuses against members of staff and nursing staff but supporting staff to de-escalate them. On well-being and getting more nurses, the Government are committed to continuing to grow the NHS workforce. We are still committed to the figure of 50,000 more nurses and to putting the NHS on a trajectory towards a sustainable long-term supply in the future. We are working on a number of well-being schemes to ensure that nurses are supported and feel safer and more willing to stay in service.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I sense a deepening of support in your Lordships’ House for the issues contained within this group. I start by thanking the noble Baroness, Lady Cumberlege, for introducing Motion B1. I also put on record my thanks to the 100 organisations which have indicated their support and got involved to make this an even better Motion for us to consider.

Yesterday’s Health and Social Care Committee report said:

“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce”


through a workforce plan. The lack of staff, both currently and projected, is not restricted to the cancer workforce but extends to the total staff shortage of some 110,000 across the NHS as well as 105,000 vacancies in social care, while some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest number on record.

As we have heard, just last week your Lordships’ House debated the Ockenden review, which I believe has provided great focus on the issue of workforce planning. The review shockingly laid bare the reasons why hundreds of babies’ lives were avoidably cut short or damaged and mothers died; to their great credit, the Government have accepted every one of the recommendations. The clear finding here is that we must safely staff our maternity wards, yet midwives are leaving the NHS in greater numbers than it is possible to recruit them. If the Ockenden review does not illustrate why we need a workforce plan then I do not know what does.

It is worth reflecting on what Motion B1 is not about, in case that offers some late reassurance to the Minister. Despite needing all of these things, it does not commit the Government to hiring thousands more doctors and nurses, nor does it commit to new funding for the NHS. It does not even commit the Government to finally publishing the workforce strategy that the NHS is crying out for—even though the NHS has not had a comprehensive workforce strategy since the Government’s plan was published in 2003.

What Motion B1 talks about is an independent review of how many doctors, nurses and other staff are needed in health, social care and public health, both now and for the future, and that the report, which must be brought before Parliament, must be informed by integrated care boards, employers, trade unions and others—people with expertise and a great contribution to make. This is not just a question of recruitment, important though that is, but one of retention. There is absolutely no way out of planning and preparation; without them, it is just not possible to magic up the necessary staff. Motion B1 is about facing up to the scale of the workforce challenge so that we can see safe and efficient health and care. These Benches will certainly be supporting Motion B1 if the will of the House is tested.

I turn now to Motion C1 in the name of my noble friend Lady Thornton. The inclusion of a clause about changes to reconfiguration shows that not all of the Bill was what the NHS was asking for. The powers in this clause are unnecessary and introduce a very considerable new layer of bureaucracy. Just about every commentator and representative group has said that this approach of an interventionist Secretary of State is quite wrong. As many have pointed out, the power that any proposal can be taken over by the Secretary of State takes us down a road of politicisation and will deter some from even trying to pursue necessary but controversial changes. It matters not that we are told that this power will be used only sparingly; if it is there, that will influence behaviour.

Given where we are in the parliamentary process, outright rejection of this provision would, of course, be problematic. Our alternative in this Motion is to say that, if the power is only rarely to be used—in exceptional circumstances, when intervention is justified—then the way to deal with this is to make that case to Parliament, to put it up for proper scrutiny and to show the evidence. If we are potentially to deprive people of their right to be consulted, then at least let Parliament do a proper job of examining this.

I now turn very briefly to Motions D1 and K. I thank the noble Lord, Lord Blencathra, for presenting Motion D1 today. It seeks to ensure that health service procurement of all goods and services avoids modern slavery; in other words, it takes us further than Motion D. I thank the Minister for the move forward contained within that Motion; however, if the noble Lord, Lord Blencathra, wishes to test the will of the House, we on these Benches will certainly be in support.

I congratulate my noble friend Lord Hunt and other noble Lords for their persistence in ensuring that Motion K is before us today. Again, I thank the Minister for being so responsive on this point. I hope that, in the votes that follow, your Lordships’ House will swiftly take the opportunity to ask that we might further improve this Bill.

Lord Kamall Portrait Lord Kamall (Con)
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I thank all noble Lords for their contributions and their constructive debate and engagement, not only this evening but throughout the process of the Bill. I thank noble Lords also for their agreement to the measures we have drawn up on organ tourism. I thank the noble Lord, Lord Hunt, for the way he pushed the Government, making sure that we were able to find a constructive way of closing that gap.

Mental Health Services for Rough Sleepers

Debate between Lord Kamall and Baroness Merron
Monday 21st March 2022

(4 months, 3 weeks ago)

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

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

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

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

Debate between Lord Kamall and Baroness Merron
Monday 21st March 2022

(4 months, 3 weeks ago)

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

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

“An analysis of the emergency powers for”


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

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

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

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

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

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

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

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

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

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

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

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

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

Cigarette Stick Health Warnings Bill [HL]

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

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

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

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

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

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

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

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

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

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

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I want to thank the noble Lord, Lord Moynihan—along with the noble Baronesses, Lady Morris and Lady Grey-Thompson, and the noble Lord, Lord Addington—for bringing forward this important amendment. It does strike me as strange that the UK does not already have a national plan in place to promote sport, health and well-being. If we are to tackle the acute obesity crisis in this country, a joined-up, forward-looking strategy at a national level is necessary. From these Benches, we support this amendment wholeheartedly. It offers huge potential to tackle obesity, poor mental health and a sedentary lifestyle in a joined-up way that sees people as whole people with different pressures and needs, but with the intention of focusing on prevention. So, I hope the Minister will be able to respond positively tonight.

Lord Kamall Portrait Lord Kamall (Con)
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I begin by thanking the noble Lords who initiated this debate tonight and my noble friend Lord Moynihan, the noble Baronesses, Lady Grey-Thompson and Lady Morris of Yardley, and the noble Lord, Lord Addington, for meeting with me yesterday, and with the Bill team and representatives from the Department for Education and DDCMS. What was really interesting was the experience that all four brought. The noble Baroness, Lady Morris, talked about her experience in government and how it was sometimes difficult to get departments to talk to each other, even though they all seemed to agree. We had two former Olympians, who spoke about their experience of elite sport. But how does that translate into grass-roots sport? How do we make sure we get people active?

What was also really interesting was when we spoke about the 2012 Olympics. Yes, we had them and there was some legacy of redevelopment in east London, but they did not really lead to a legacy when it came to physical activity. How do we make sure we avoid the so-called Wimbledon effect? We all know that effect: around the time of Wimbledon, you cannot get a place on a tennis court, but a few months later it is simple to do so. How do we make sure this is long term?

If you are going to tackle obesity, yes, we can reformulate food and look at other issues such as taxes and negative externalities to discourage the intake of calories. However, you also have to burn off calories at the same time through activity. It does not have to be elite sport. We are not all going to be Olympians—like the two noble Lords here who were—but that should not stop you. All too often, what happens at school level is that if you do not get into a top team, you give up because you are considered not good enough. It does not matter how good you are; it is the activity that counts.

The Government’s recent response to the National Plan for Sport and Recreation Committee report addresses clearly, we believe, the recommendations made in this amendment. I hope that noble Lords will take some reassurance from what I am about to say and the fact that we take this seriously. The Government agree with the committee’s overarching recommendation on the need for an ambitious national plan for sport and physical activity. We are firmly committed to increasing sport participation and physical activity levels, and to ensuring that everyone has access to opportunities to get active. It should not just be about elite sport.

I can confirm that the Government will set out their forward-looking strategy for sport and physical activity later this year. It will look at tackling levels of inactivity as part of our plan for recovery from the pandemic. We hope that this strategy will provide a unified, cross-government approach to driving participation, integrating with Everybody Active, Every Day, the School Sport and Activity Action Plan, and Sport England’s new strategy Uniting the Movement. Of course, while setting out a cross-government strategy will be welcome, it is equally important to set out information on the implementation. I can confirm that the strategy will set out further detail on implementation, including how to harness such action across government and between departments.

The Government understand the concerns that noble Lords have raised and recognise that previous Governments of all parties have not always got it right. They tried—it was not for lack of trying—but it is about the implementation and strategies in this area. However, we believe that lessons have been learned and I hope that our approach will have the intended positive impact.

After the conversation yesterday with noble Lords, during the post-meeting debrief I spoke to the officials from other departments and asked, “How can we make sure that this is truly cross-government?” Let me assure noble Lords that other departments have also been looking at this issue. The Department for Levelling Up, Housing and Communities and the Department for Transport also have important roles in helping to create health-promoting and more active local environments. I reaffirm the Government’s commitment to working cohesively on such actions.

I also assure your Lordships that departments involved in the sport and physical activity strategy take their responsibility to co-ordinate extremely seriously. This is being led by DCMS while, more broadly, the Government understand the utmost importance of getting this right—and we must not lose that. That is why I am delighted by the leadership of the Prime Minister on the Health Promotion Taskforce, supported by the Cabinet Office. That will enable the Government to consider all options open to them. I will come to this in due course.

The Government recognise that it is important to provide updates to both Houses on the progress of the strategy and will publish arrangements for that reporting in the strategy. I also assure noble Lords that the Government invite and welcome the continued scrutiny of plans to address inactivity, to promote sport participation and to improve people’s health through physical activity. Undoubtedly, the relevant committees in the House of Lords and the House of Commons will have an interest in any future strategy and its progress. I am sure noble Lords will also want to continue to ask Questions of Ministers.

We recognise the deep experience of noble Lords in this area and I know that that interest extends to the other place. Only last night, my honourable friend Gillian Keegan, the Minister of State for Care and Mental Health, responded to an adjournment debate on physical activity and health. On that point, I reiterate and acknowledge the benefits and importance of promoting that. We know the gains made in activity levels in some key populations, including women and older adults, before the pandemic have now been reversed, and the Government share the concerns of noble Lords on this matter.

Elderly Social Care (Insurance) Bill [HL]

Debate between Lord Kamall and Baroness Merron
3rd reading
Friday 4th March 2022

(5 months, 2 weeks ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron (Lab)
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The Lord Speaker is most kind: I will be quicker in future.

I thank the noble Lord, Lord Lilley, who is not able to be in his place today, for his considerable consideration and work during this Bill’s passage. I am grateful to him for having given your Lordships’ House the opportunity to discuss such important issues, which are particularly timely considering the passage of the Health and Care Bill. As noble Lords will be aware, while discussion on the Bill was welcome, it has unfortunately not found favour across the House. I certainly look forward to the Bill being an encouragement to the Minister to come forward with ways to support the sector properly. I look forward to a real and sustainable plan for fixing the issue that faces us. So, I extend my thanks to all Members of your Lordships’ House for their contributions during the passage of the Bill, and to the noble Lord, Lord Lilley, and I look forward to hearing from the Minister.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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My Lords, I begin by thanking the noble Baroness, and the Lord Speaker for allowing us time for this debate. I congratulate my noble friend Lord Lilley on securing the time for Third Reading of the Bill, which proposes a state-backed insurance company for social care. I am sure noble Lords across the House will wish my noble friend a speedy recovery. I thank him for his thoughtful proposal to address the long-standing issue of unpredictable social care costs. As many noble Lords will recognise, there have been many reports over the last few decades and they have just sat there gathering dust on shelves: to date, we still do not have a proper system. The Government wholeheartedly agree with much of the analysis underpinning the Bill and I shall mention but a few of the ideas that stood out for us.

First, we are well aware of the challenges around the private market delivering insurance for social care costs, so we recognise the benefits of delivering insurance through a public not-for-profit company owned and guaranteed by government. I also particularly admired how the proposal addresses affordability by allowing people to pay for the insurance premium through equity on their home. Lastly—this is probably the Bill’s strongest selling point—it would be cost-neutral to the Exchequer. I recognise the opportunity this presents for the savings to be invested in financial support for those not able to access the insurance offer—for example, people who do not own a home.

I reassure my noble friend that his proposal has been carefully considered in the lead up to the announcement of our reform package from October 2023, but I point out that one of the key benefits of the cap and extended means test is that it is a universal offer—universal for everyone, irrespective of age or home ownership. We believe that a universal cap means people can plan ahead for their care from the outset. Knowing that the cap is there will benefit everyone, not just those who own a home. The home ownership landscape is changing over time, and within that context the Government have developed a package of reforms which is future-proof and gives support and certainty to the current generation, as well as future generations.

In addition to the cap, from October 2023, anyone with assets of less than £20,000 will not have to make any contribution for their care from their savings or the value of their home, ensuring that those with the least are protected. Anyone with assets below £100,000 will be eligible for some means-tested support, helping people without substantial assets and ensuring that many more people benefit from funded support earlier in their care journey. We believe that our reforms significantly improve the current system. In developing the reforms, we had to make tough choices, balancing the generosity of the reforms with how much extra we ask taxpayers to contribute and pay for them. My noble friend may disagree with our current formulation of the cap, but we believe the plan is credible, deliverable and affordable. Therefore, while the Government are not convinced that the Bill is the right course of action, we agree with his intelligent analysis that underpins it and, as the noble Baroness, Lady Merron, said, we will debate this further.

I again thank my noble friend Lord Lilley for putting forward this proposed Bill, and for his engagement in discussing our reforms after this debate.

Organ Tourism and Cadavers on Display Bill [HL]

Debate between Lord Kamall and Baroness Merron
3rd reading
Friday 4th March 2022

(5 months, 2 weeks ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, first, I congratulate my noble friend Lord Hunt on this very welcome Bill. It is a pleasure to see the issue debated so well and regularly in this House. As my noble friend knows, he has the full support of these Benches in his endeavours. UK citizens must not be permitted to support the international organ tourism industry, where those organs are sourced illegally. I hope to see an end to the display of human cadavers in cases where the displayers have not obtained the consent of the deceased to do so. On so many levels, the issues with which this Bill deals are totally unacceptable, and I am glad that this Bill gives your Lordships’ House the opportunity, as we also had last night, to consider how to take action. This is a moral imperative, and my noble friend can count on continued support from these Benches.

As we approach the end of this Third Reading, I thank the Minister and your Lordships’ House for the time spent on and engagement with this issue. I wish the Bill every success.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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My Lords, I thank the noble Lord, Lord Hunt, for bringing this Bill to the House and for enabling further debate on the best approach to tackling transplant tourism and how to ensure that consent is always provided for the public display of bodies of the deceased.

While all noble Lords will agree with the sentiment behind this Bill and have been horrified by the way in which the Uighurs are treated by the Chinese Government, we feel that that the new provisions it would introduce could create unnecessary burdens while doing little more than the existing legislation to address their concerns about human rights abuses. Looking at the data, the Government have not seen evidence of any large-scale travel of British citizens to other regions seeking a transplant for payment or without consent. Indeed, despite our having a growing and ageing population with increasing healthcare needs, the figures from NHS Blood and Transplant demonstrate a steady and consistent decline in patients receiving follow-up treatment on organs received overseas: from 72 patients in 2006 to just seven in 2019.

In addition, existing provisions in the Modern Slavery Act and the Human Tissue Act already make transplant tourism an offence in many circumstances. Because of this, we believe that the most effective action we can now take is to work towards removing any incentive for UK residents to seek to purchase an organ by continuing our efforts in improving the rates and outcomes of legitimate organ donations, while maintaining the highest standards of care for those in need of an organ.

I turn now to the issue of the public display of bodies, on which there has been some debate, especially in terms of people who have given consent before their death for their bodies to be displayed. We believe that existing rules make it clear that any establishment which seeks to display bodies must provide proof of consent. If it cannot, it will not receive a public display licence from the Human Tissue Authority, and any exhibition of bodies without a licence, when one is required, will be breaking the law. I am informed that the Human Tissue Authority does receive requests from people in Britain who seek permission for their bodies to be displayed after their death.

That said, I thank all noble Lords for their contributions, which allowed for an important and wide-ranging debate on this topic. It also served as an opportunity to highlight the broader human rights concerns which I know all noble Lords share. I particularly acknowledge the persistence of the noble Lords, Lord Hunt and Lord Alton, in bringing these issues forward for debate. I congratulate the noble Lord, Lord Hunt, on being successful in the ballot with this Bill.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I rise to share all the concerns expressed about the open-endedness of what is in the Bill and the concerns about the lack of protection for patient data. Clearly, there has been much debate and discussion, and I think it is right that we hear from the Minister.

Lord Kamall Portrait Lord Kamall (Con)
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My goodness—I thank noble Lords for their brevity. I am afraid that I shall not be as brief as I would want to be. I would like to confine myself to single-word answers, but I do not think that would give the reassurance that noble Lords are looking for.

I begin by thanking all noble Lords who have engaged with me on this, especially the noble Baroness, Lady Brinton, and the noble Lords, Lord Clement-Jones and Lord Hunt. As they know from our discussions, this issue is very close to my heart and something I feel very strongly about, so I welcome their pressing the Government on this and their continuous engagement—in fact, right up to this morning. I do not think that this is the end of that engagement but I hope to give some reassurances. I completely understand the interest in the integrated care boards’ power to disclose information that is personal data. I hope I will be able to clarify some of the intentions.

New Section 14Z61, inserted by Clause 20, recreates the section that applies to CCGs, which sets out the circumstances in which CCGs are permitted to disclose information obtained in the exercise of their functions. The clause in question already restricts ICBs’ powers to disclose information, by limiting these to the specific circumstances set out in the clause.

In addition, the existing data protection legislation, including UK GDPR, provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data protection principles for the sharing of personal data. Health data is special category data—that is data that requires additional protections due to its sensitivity. For this type of data to be processed lawfully, a further condition must be met as set out in UK GDPR and the Data Protection Act.

In addition, the common law duty of confidentiality applies to the use of confidential patient information. This permits disclosure of such information only where the individual to whom the information relates has consented, where disclosure is of overall benefit to a patient or is in the public interest—for example, disclosure is to protect individuals or society from risks of harm or where there is a statutory basis for disclosing the information or a legal duty, such as a court order, to do so.

Every health and care organisation has a Caldicott Guardian—a senior person responsible for protecting the confidentiality of people’s health and care information and making sure that it is used properly. Caldicott Guardians decide how much information it is appropriate to share—they may decide that even legally permitted information may not be shared—and they advise on disclosures that may be in the public interest. They act in accordance with the eight principles, which are the framework to ensure that people’s confidential information is kept confidential and used appropriately. The UK Caldicott Guardian Council works closely with the independent statutory National Data Guardian, whose role is to advise and challenge the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly.

Nothing in the clause overrides the range of requirements in law that provide key protections and safeguards for the use of an individual’s personal data. I can also confirm that NHS England’s power to issue guidance for ICBs will apply to their functions relating to data sharing, and that may be a helpful route in making it clear to ICBs what their duties and responsibilities are, in respect of any confidential data they may hold, in a way that illustrates how legislation applies.

The effect of the amendment is to prevent the effective operation of the clause as drafted. This would prevent the ICB from effectively discharging its functions where it may be necessary to disclose personal patient data, including investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system where different rules apply to different organisations.

On Amendment 116, once again I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this issue before this House. Our aim is to put data and analytics at the heart of NHS delivery and remove incoherence in the organisational leadership, for the benefit of patients and their outcomes. It is a solid recommendation for improving how health and social care data is used more effectively, closing that gap between delivery and the use of data to inform and improve services.

I understand that noble Lords fear that the movement of the statutory data functions from one world-class arm’s-length body, NHS Digital, to another, NHS England, which indeed runs the NHS itself, would result in a decline in the exercise of those functions. We feel that this fear is perhaps overexaggerated but I would be very happy to continue discussions on this.

However, that movement would be accompanied by the transfer of several thousand expert staff and all their supporting expertise and technology, along with the existing statutory safeguards, which would be preserved. NHS Digital and NHS England have a history of very close working on data, most recently of course in how the management of data has underpinned efforts to defeat Covid-19, through the protection of shielded patients and the management of data on vaccinations. The Government and Parliament held NHS Digital to account for the delivery of its functions, and they will continue to hold NHS England to account for the delivery of any functions which transfer.

As to the concern about a conflict of interest, the data collections which NHS Digital undertakes are the result of directions from either the Secretary of State or NHS England, and obviously the direction-making power of the former will continue to be relevant should the proposed merger take place. Directions include details of how data must be shared or disseminated. NHS Digital is required to publish details of all such directions and maintain a register of the information it collects. There is also a rigorous process for external data access requests and audits of how data is used.

The intention here is that such safeguards would continue when the functions transfer to NHS England and would make it very difficult for the organisation to suppress or otherwise refuse to make available any data which it is required to collect and disseminate in fulfilment of its statutory role. I hope, perhaps overoptimistically, that I have reassured the noble Lord, Lord Warner—clearly not—in terms of suppressing information.

There is a rigorous process for external data access requests. NHS England’s Transformation Directorate will be assuming responsibility for NHS Digital’s functions, and for accomplishing the alignment of delivery and data proposed in the Wade-Gery review. There will continue to be external, independent scrutiny—for example, by the Information Commissioner and the National Data Guardian—of the use by the NHS, and NHS England in particular, of health and care data.

I hope that I have given noble Lords some reassurance that these important issues have been considered by the department, and that they will feel able not to move their amendments when reached. Of course, given my strong interest in this subject, I am prepared and happy to have further conversations to make sure that we close any remaining gaps and for me push the department and NHS England as appropriate.

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Baroness Merron Portrait Baroness Merron (Lab)
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This powerful debate has focused on two simple truths. First, without the full team of people in place at the right time, it will not be possible to provide the health, social care and public health services we need. The second simple truth is that this will not just happen on its own. I am therefore glad to have put my name to Amendment 80, joining the noble Baronesses, Lady Cumberlege and Lady Brinton, and the noble Lord, Lord Stevens, in so doing. I thank the noble Baroness, Lady Cumberlege, for her impactful introduction of the amendment. I share the view of the noble Baroness, Lady Walmsley, that this is the amendment to focus on, the one that will take us in the direction we need to go.

It is hardly surprising that the need for workforce planning has come up time and again during the passage of the Bill, and it is not going away. Workforce planning is at the core of all the plans, yet it remains unresolved and continues to cause considerable disquiet, including in the Health and Social Care Select Committee. We know this is an urgent requirement to tackle, and I hope that, even at this late stage, good sense will prevail and the Minister will be able to give the assurances that your Lordships’ House seeks.

The lack of sufficient staff, trained and able to deliver care, is the biggest issue facing the NHS and social care. Whatever claims are made about how many staff there are, they are meaningless unless posed against what is actually required. Since the Bill was published there has been universal opposition to the limited and inadequate provision in Clause 35. As my noble friend Lord Hunt noted, the Treasury’s robust resistance to publishing anything that sets out properly the gap between the number of staff required and of those in post is a badly kept secret. I regard that as short-sighted for all the reasons that have come up in the debate thus far.

It is reported that a record number of 400 members of staff are quitting the NHS every week. The United Kingdom has 50,000 fewer doctors than we need, and there are currently 100,000 vacancies. Workforce planning needs to be in place to give us the chance to assess and tackle the workforce crisis. Today we have the opportunity to put that right. As we have heard, the amendment is supported by a major coalition of some 100 health and care organisations. As my noble friend Lord Bradley said, it also takes strength from giving the opportunity to consult a comprehensive range of organisations and groups that know the reality of what is needed to run our care services. We should add our support to that.

I am grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Patel, for adding their support to my Amendment 81. It tackles the same problem, but from the bottom up. Without the foundation of a workforce plan, no ICB can plan anything properly, as they are required to do by other parts of the Bill. There is also the wider point that the national strategies or definitions of systems planning have no reality unless they transfer down to those who actually have to deliver the outcomes. We know that there are widespread and well-evidenced arguments in support of workforce planning. I urge the Minister to accept the wisdom and the reality of these amendments and to take the opportunity to fix a challenge that surely is not going away.

Lord Kamall Portrait Lord Kamall (Con)
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My Lords, I am grateful to noble Lords for bringing the discussion of workforce planning before the House today. Perhaps before I go further, all noble Lords will want to join me in wishing the noble Lord, Lord Patel, a speedy recovery. He definitely would have spoken in this debate if he had been able to join us. I should also say that I was particularly impressed by the double act of the noble Lords, Lord Hunt and Lord Stevens. Perhaps they will be known in future as the Morecambe and Wise of the House of Lords.

We all agree that the workforce is at the heart of our NHS and social care. It is right to ensure that we have the workforce that we need for the future to keep delivering world-class, safe and effective healthcare. Some noble Lords may not like to hear this, but I remind them that we have a record number of nurses. We continue to look at different ways of recruitment, and in response to Oral Questions I have referred to the way that we are looking at different pathways into nursing for British people. It is also a fact that we have always recruited people from overseas. Indeed, our public services were saved, post-war, by people from the Commonwealth coming to work in public services. I remind noble Lords that now we have left the EU we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans. We will focus on ensuring that we have equality across the world.

I will not repeat what I have said about other issues, but if you are to have workforce growth, which we all want, it must be accompanied by effective, long-term workforce planning. That is why the department has commissioned Health Education England to work with partners to develop a robust, long-term strategic framework for the health and regulated social care workforce for the next 15 years. This includes regulated professionals working in adult social care, such as nurses and occupational therapists, for the first time.

Eating Disorders

Debate between Lord Kamall and Baroness Merron
Tuesday 1st March 2022

(5 months, 2 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I think the noble Baroness is being unfair in suggesting that the Government are not taking this issue seriously. In the conversations that I have had in the lead-up to this Question, it has been quite clear that they are taking it very seriously. They recognise its granularity and the differences in types of eating disorder. As the noble Baroness rightly said, people quite often associate eating disorders with adolescents or young females and young men, but binge eating disorders in particular can occur among adults who are 30 or 40 years old. The Government are looking, first, at education. Secondly, they have made a number of investments in adult and children’s services relating to mental health, including eating disorders.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, there has been a 72% increase this year in the number of children and teenagers referred for urgent support for eating disorders, but a new, dangerous issue has emerged, that of specialist mental health services with no capacity having to bounce back even those who are at risk of suicide, self-harm and starvation to GPs, who, as we have heard, often have no specific training to deal with this. Can the Minister apprise your Lordships’ House of what assessment has been made of the incidence of this so-called bounce-back? Will he commit to tackling it by various means, including a recovery plan for mental health services that has a focus on children and young people and ensures that there is a trained workforce to deliver this support?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness’s suggestions are reasonable, and I think that many noble Lords would agree that it is important that we tackle this on a number of levels. For example, under the NHS long-term plan, extra funding has been going to children and young people’s community eating disorder services every year, with £53 million per year invested in 2021-22. That will increase the capacity of 70 new or improved community eating disorder teams covering the whole of the country. In response to Covid and to help meet the waiting time standard, we have invested an extra £79 million in 2021-22 to significantly expand children’s mental health services. In addition, as part of the additional £500 million that we announced in 2021-22, some of this is also being done via the mental health recovery action plan. NHS England and NHS Improvement have announced a further £40 million in 2021-22 to address the impact of Covid on children’s and young people’s mental health. These are some of the different ways in which we are addressing this very serious issue that a number of noble Lords have quite rightly raised.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, if the role of your Lordships’ House is to improve the Bill, I feel that this set of amendments will achieve this. I am grateful to the Minister and his officials for responding to the points which were made so powerfully in Committee and in meetings outside this Chamber. The range of amendments will take us further.

The Minister talked about the introduction of transparency and accountability, which are key in the efforts to improve the provision of mental health services. However, of course, improving transparency and accountability is not an end in itself; it is purely a way of getting us to the right place. What will be important is what this delivers. A step along the way to improving mental health services is definitely being made, but there is an awful lot more to do. For example, the Centre for Mental Health estimates that some 10 million additional people, and that includes 1.5 million children and young people, will need mental health care as a result of the pandemic. It would of interest to understand a little more about how the Government intend to make progress on this once the Bill receives Royal Assent. Will we see a recovery plan in the area of mental health services, backed by a long-term workforce plan, something which we will return to later?

On the policy to bring practice into line with aspiration, and on the funding for and redoubling of effort towards achieving parity, while we are talking about this on a national level, it would also be helpful for the Minister to clarify that it applies to all areas of the Bill’s implementation and that the new bodies set up by the Bill will be expected to treat mental health equally from the outset. For example, it would mean ensuring that the decisions about resource allocation, capital spending, waiting times and priorities were all taken on the basis that mental health must be valued equally with physical health.

The noble Baroness, Lady Tyler, was right to point out that we do not start in a neutral position, because we know that waiting times are considerable, standards of services need massively to be improved and the workforce needs to be strengthened in order to deliver those services. It is therefore extremely important that the Minister in putting forward these amendments undertakes to see the job through, so that we do not just have transparency and accountability for their own sake but we deliver for the many millions who will rely on those services.

Lord Kamall Portrait Lord Kamall (Con)
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My Lords, I once again thank not only noble Lords who spoke in this debate but those who engaged with us throughout the process. As the noble Baroness, Lady Merron, said, if the role of this House is to improve the Bill, we have learned much. As a relatively new Health Minister, I have learned so much from the various meetings that I have had with noble Lords, not only on this issue but on many others across the health and care spectrum.

I thank noble Lords who have engaged with me personally but also with my officials to make sure that we closed the gaps as much as we could. I am pleased to hear support from your Lordships for the package of amendments that I have brought forward, and I am grateful.

I stress that this package of amendments should be considered alongside the amendment placing a duty on ICBs to have an appropriate skill mix and experience necessary to deliver all their functions—I hope that noble Lords will look at those in that context—as we expect skills pertaining to the delivery of mental health services to be considered when meeting this duty at the ICB level as well as below that at place level. Many noble Lords have discussed the importance of place.

Amendment 184 would require the Government to report on our plans to improve mental health standards. Access to services is at the heart of the mental health commitments in the NHS long-term plan. The department, NHS England and NHS Improvement regularly report performance against existing waiting time standards in mental health, including improving access to psychological therapies services, children and young people’s eating disorder services and people experiencing a first episode of psychosis.

As noble Lords have acknowledged, last week NHS England and NHS Improvement took another step to strengthen mental health standards, publishing a consultation response following the mental health clinically led review of standards consultation. As noble Lords will know, this sought views on the proposed introduction of new measures, including five new waiting time standards, to support our ambitions to ensure that patients have timely access to community mental health care.

Covid-19: Lateral Flow Tests

Debate between Lord Kamall and Baroness Merron
Thursday 10th February 2022

(6 months ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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That is a valid question and if the noble Baroness could write to me, I will respond.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, in addition to the need to improve the approval process for lateral flow tests, when can we expect to see a real plan for living well with Covid? Will this include proper provision for better sick pay, improved testing and those who are clinically vulnerable.

Lord Kamall Portrait Lord Kamall (Con)
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Clearly, the noble Baroness raises a number of important considerations for when we come up with a living with Covid strategy. At the moment, we are consulting on it to make sure that we have an appropriate strategy that covers many of the issues she referred to.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I thank my noble friend Lady Chakrabarti for raising the crucial matter of countries and peoples left behind in terms of the opportunity to have a necessary vaccination programme available to them. My noble friend Lord Campbell-Savours spoke of the importance of supporting innovation, which is one of the ways in which we can ensure that, while my noble friend Lord Howarth rightly said that the subject requires exploration outside of the Health and Care Bill—something also commented on by the noble Lord, Lord Crisp, who emphasised, as do I, the need for the political will to make progress.

There is no doubt, as we have heard today, about the gravity of the issues at stake and the need to resolve them. It is the case that where public funding is provided there must be conditionality, although of course that may be complex to refine into legislation. There are of course additional issues when funding is also coming from the private sector along with a need to ensure a balance of interests. It would certainly be helpful to have a stipulation that avoided placing undue bureaucracy and restraint on smaller developments and small-scale research. We do not want to see the pace of research slowed down with researchers tied up in lengthy proposal writing, contract negotiations and legal agreements.

As my noble friend Lady Lawrence has said, we know that the pandemic is not over until it is over everywhere, so the amendment raises the opportunity to explore whether the immediate waiver of intellectual property rights would mean an end to the pandemic everywhere. It is relevant to assess what contribution or otherwise intellectual property rights make to the promotion of technological innovation and the transfer and dissemination of technology. There is an advantage for producers and users of technological knowledge and the consideration of rights and obligations, and that needs to be considered in the round.

In respect of the response and actions to a pandemic declared by the World Health Organization, while I understand the intention behind the amendment, in order to be consistent I would comment with some caution about the Secretary of State being compelled to immediately take actions, particularly without any form of oversight—something that we will return to later in Committee.

However, I hope that today we can obtain some reassurances from the Minister about the Government’s intentions and plans in order that we can find a way forward so that low-income countries and their peoples have access to vaccines both now and in future.

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness, Lady Chakrabarti, for bringing this debate before the Committee today and for the heartfelt speech that she gave. The noble Baroness will be aware of the view of this Government following her recent Question in the House on the subject of patient waivers. As my noble friend Lord Grimstone set out, the Government remain open to all initiatives that would have a demonstrably positive impact on vaccine production and distribution. However, we believe that waiving intellectual property rights would have the opposite effect. Doing so would dismantle the very framework that helped to develop and produce Covid-19 vaccines at the pace and scale now seen. It would risk undermining the continued innovation in vaccines and technological health products that is required to tackle a virus, especially as it mutates and evolves, so we believe that doing so would be a mistake.

Instead, the success of the Covid-19 vaccine rollout vindicates the value of public and private co-operation. While university research departments are great at research, large-scale manufacturing and global distribution are not their function, so we recognise the importance of their working with partners with expertise in this area.

The intellectual property framework is key to those efforts. It has incentivised the research and development that has led to the development of Covid-19 vaccines. It has given innovators the confidence to form more than 300 partnerships, an unprecedented number, and has contributed to the production and dissemination of vaccines and other health products and technologies across the world, with global Covid vaccine production now at nearly 1.5 billion doses per month.

I share the noble Baroness’s intention that research funded through taxpayer finances should benefit the taxpayer, but we do not consider that that is best achieved through particular constraints in primary legislation. Research contracts afford greater flexibility and more powerful levers than the amendment, through provisions such as those requiring the dissemination of intellectual property for patient benefit, revenue sharing with the Government of commercialised intellectual property, and requirements around access to medicines in the developing world. Contractual protection mechanisms in funding arrangements can also ensure that intellectual property funded by taxpayers results in the creation of taxpayer benefit.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, we are very pleased to support the government amendments that we have heard outlined. Crucially, they focus on cancer outcomes. As the noble Baroness, Lady Morgan, underlined, that includes survival, quality of life, experience of treatment, end-of-life care as well as diagnosis—in other words, the whole experience in treating somebody as a whole person on a journey that they may have to face. I congratulate the Minister on bringing the amendments forward. I also thank the noble Lord, Lord Moylan, supported by the noble Lords, Lord Aberdare and Lord Vaizey, and others, for highlighting the fact that pancreatic cancer has such an aggressive nature, and yet the symptoms are so silent and often misunderstood that it presents a particular challenge in the context of the care that we are speaking of today.

A focus on outcomes that covers matters other than treatment will be particularly crucial following the backlogs that the pandemic has inevitably led to, with delays in people seeking check-ups and treatment. Macmillan has let us know that more than 31,000 people in England are still waiting for their first cancer treatment, and it has also said of the Bill that for those living with cancer

“not a lot will look different.”

It is therefore crucial that the Minister assures noble Lords that stakeholders are supportive of the changes outlined in this group.

On the point about survival rates lagging behind those of other countries, that is not because the National Health Service is worse than other healthcare systems at treating cancer once it is detected but because it may not be as good at catching cancers in the crucial early stages. In other words, late diagnosis lies behind our comparatively poor survival rates. A key advantage of focusing on outcome measures is that it will give healthcare professionals much greater freedom and flexibility to design their own solutions, which could include running wider screening programmes and better awareness campaigns, and establishing greater diagnostic capabilities at primary care. A further advantage of this new focus is that it will better align NHS priorities with patient needs, which, after all, are core to our discussions on the Bill today.

I have a final and gentle word for the Minister to back up the introductory comment of the noble Baroness, Lady Walmsley. It is of course usual to consult the Opposition and others in advance to ensure that amendments are acceptable and do what is required—in other words, to strengthen the case. I know that this did not happen until very late in this case, and I am sure the Minister will not wish to repeat that practice. In summary, however, we very much welcome these amendments.

Lord Kamall Portrait Lord Kamall (Con)
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I thank the Opposition Front Benches for being so gracious given the fact that we notified them late and did not use the correct procedure. I apologise for that once again and I know that the Bill team also apologises for it. We are all on a steep learning curve, as I am sure all noble Lords acknowledge. I thank both noble Baronesses. I hope the lesson has been learned, and we will not have an excuse next time.

I will address Amendment 294 before I come to our amendments. I thank my noble friend Lord Moylan for tabling it. To reassure him, the pancreatic cancer audit is included in the national cancer audit collaborating centre tender, which is currently live. Some reporting timelines are included in the specification for this audit, developed in partnership with NHS England and NHS Improvement, but I am told that during a live tender the document is commercially sensitive and cannot be shared beyond the commissioning team, as this could risk jeopardising the procurement process. The future contract is anticipated to start in autumn of this year. However, it is not possible to confirm the timelines for a new national audit topic for pancreatic cancer until the procurement completes and the contractual deliverables are signed. Unfortunately, therefore, this cannot be aligned with the passing of the Act.

My noble friend will be aware that NICE clinical guideline NG85 recommends that pancreatic enzyme replacement therapy, or PERT, should be offered to patients with inoperable pancreatic cancer and that consideration should be given to offering PERT before and after tumour removal. NICE acknowledges that this is a priority area for improving the quality of health and social care and has included PERT in its quality standard on pancreatic cancer.

We have taken and will continue to take steps to support Pancreatic Cancer UK’s campaign to encourage greater uptake of PERT by doctors treating pancreatic cancer patients, in line with NICE guidance. We are in the process of commissioning a PC audit and, while the scope of this is not confirmed, we will certainly include this in the scoping of the topic. As I said, NICE acknowledges this as a priority area and, while its guidelines are not mandatory for healthcare professionals, the NHS is expected to take them fully into account in ensuring that services meet the needs of patients.

NHS: Nurse Recruitment

Debate between Lord Kamall and Baroness Merron
Thursday 27th January 2022

(6 months, 2 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I am afraid I disagree with the noble Lord, because we are on track to reach our 50,000 target, particularly because we are not just using one route in. We are using a number of different routes; people can retrain from other courses, and we have apprenticeships. We are looking at completely different, innovative pathways into nursing.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the Government’s own impact assessment suggests that mandatory vaccination against Covid could lead to the loss of some 73,000 NHS staff in England. When designing their policies, did the Government take into account how many nurses might be among this number? Will the Minister take the opportunity of the Health and Care Bill to bring forward a long-term workforce plan to address the shortages of nurses and other staff?

Lord Kamall Portrait Lord Kamall (Con)
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I congratulate the noble Baroness on bringing up an issue for the Health and Care Bill. In terms of VCOD—vaccination as a condition of deployment—most NHS staff are vaccinated, and those who are reluctant to be vaccinated are being offered one-to-one conversations with management to see whether they can be persuaded to take the vaccine or be redeployed elsewhere.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I am grateful to the noble Lord, Lord Farmer, for introducing this important debate and to other noble Lords who have supported the amendments before us and spoken about how we can improve the support that families will receive through this Bill. As the Family Hubs Network rightly observes,

“prevention is simply listed in the Bill as one of several commissioning requirements of ICBs with no broad mention of children’s health”.

This group of amendments gives us the opportunity to sharpen this.

As we have heard, the issues that families face, in whatever form or shape, do not exist in isolation. In addition to the impact of financial, housing, social and other pressures, the physical and mental health of a child or young person affects the physical and mental health of not just their parents, but their wider family, and vice versa. It makes common sense to facilitate a healthcare system that is designed and resourced to actively take a holistic approach to the many issues that face children and those who care for them.

I cannot help but feel that the points raised today are not new. We have the experience of Sure Start to show us how effective properly integrated family services can be. As the Institute for Fiscal Studies confirmed:

“By bringing together a wide range of early years services for children under 5, Sure Start centres dramatically improved children’s health even through their teenage years.”


Early investment is crucial.

I hope the Minister will be keen to embed change in this Bill to replicate the success that we saw through Sure Start. The first step towards doing this is to make sure that integrated care partnerships are properly required to consider how family help services can be thoroughly integrated into our health and care system, so that family members—no matter what form those families take—are seen as both individuals and groups who have an effect on each other.

Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend Lord Farmer and all noble Lords who spoke about their experiences. The creation of integrated care boards represents a huge opportunity to support and improve the planning and provision of services to make sure that they are more joined up and better meet the needs of infants, children and young people.

Before I go into the specific amendments, I make it quite clear, as my noble friend said, that the Government set out in their manifesto a commitment to championing family hubs. We want to see them across the country, but at the same time we must give democratically elected councils the choice to shape how services are delivered, bearing in mind some of the points made by the noble Lords, Lord Mawson and Lord Warner, whom I thank for their experience on this.

The Government agree that it is vital to ensure that ICPs work closely with a range of organisations and services to consider the whole needs of a family when providing health and care support. In preparing the integrated care strategy, the integrated care partnership must involve local Healthwatch and the people who live or work in the area. We are working with NHS England and NHS Improvement on bespoke draft guidance, which will set out the measures that ICBs and ICPs should take to ensure they deliver for babies, children and young people. This will cover services that my noble friend considers part of family help.

In addition, the independent review of children’s social care is still considering its definition of “family help”, and the definition published in The Case for Change may well be further refined as a result of ongoing consultation. It would be inappropriate to define the term in legislation at this stage, pre-empting the full findings of the review and the Government’s response to it. Also, it is important that there should be a degree of local determination as to what should be included in the strategies of ICBs and ICPs. In order for them to deliver for their local populations, a permissive approach is critical.

On Amendment 167, we agree that family hubs are a wonderful innovation in service organisation and delivery for families. The great thing about them is how they emerged organically from local councils over the last decade. I pay tribute to my noble friend for the key role he has played in advocating family hubs and bringing this innovation to the heart of government. The Government strongly support and champion the move but we are clear that they have to be effective and successful—they need to be able to adapt to local needs and circumstances. They also need to be able to operate affordably, making use of a diverse range of local and central funding streams.

In both these regards, local democratically elected councils should hold the ultimate decision-making power over whether to adopt a family hub model and how it should function. As such, I regret that we cannot support the amendment, which would place too much prescription on the decisions and actions of local authorities and risk imposing significant new financial burdens. For this reason, I ask my noble friend to consider withdrawing his amendment.

Sugar

Debate between Lord Kamall and Baroness Merron
Monday 24th January 2022

(6 months, 3 weeks ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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I always turn to the noble Lord for his experience and advice. It is well known that diabetics, for example, do not look at their sugar content but at their intake of carbohydrates when looking at their diet. I say this as someone whose family has both type 1 and type 2 diabetics, so I understand this issue. I would welcome more information from the noble Lord.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, since its introduction in 2018, the sugar tax on soft drinks has successfully reduced sugar intake and raised more than £880 million, which the Government had promised to spend on tackling childhood obesity. However, it is no longer directly linked to any specific programmes, nor to departmental spending. Can the Minister explain this turnaround to your Lordships’ House, and what assessment has been made of the effect on public confidence that similar taxes will be dedicated to expenditure on improving people’s health?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising the success so far of the programme in reducing sugar in drinks. Between 2015 and 2019, we saw a 44% reduction in sales-weighted average total sugar in retailer and manufacturer-branded drinks subject to the soft drinks industry levy. The money raised through the soft drinks industry levy was not linked to any specific programmes or departmental spending. As the noble Baroness will be aware, departmental spend is allocated through spending reviews by the Treasury, and there is quite often some scepticism over hypothec—sorry, probably too much sugar, or not enough sugar—or hypothecated taxes, but we are committed to tackling childhood obesity through a number of different programmes.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I am grateful to noble Lords for putting forward these amendments, all of which seek to strengthen the Bill and build on what the noble Baroness, Lady McIntosh, opened with: the need for clear lines of responsibility and for a joined-up strategy—in other words, for us to get to the point that we are looking for.

My noble friend Lord Hunt spoke of the embodiment, perhaps, of that through a chief innovation officer, who could be a reminder—not on their own—of the need to build in research and innovation as core throughout commissioning. I am sure that the Minister has heard that this debate is a cry for us to embed in the Bill and in our NHS not just a requirement for but a delivery of research and innovation to the appropriate standard to serve the country. It will not just happen on its own.

We have seen significant variation of opportunity for patients to engage in research and disparities in participation reported on geographic and socioeconomic lines, by ethnic origin and across different disease areas. This is due to the fact that the NHS has been unable to prioritise resourcing and delivery of research, which has been a particular feature over the past decade.

In the Bill, we have a major opportunity to embed a research-active culture—words used by the noble Baroness, Lady Harding—within the NHS which could build on the response to Covid-19, which the noble Lord, Lord Patel, emphasised. That response saw more NHS sites, staff and patients engage in research than ever before. Let us not waste this opportunity.

The Bill offers little different to the Health and Social Care Act 2012, which also did not and does not mandate clinical research activity, stating just a duty for clinical commissioning groups “to promote” research. Your Lordships will notice the similarity in wording in the current Bill. The noble Lord, Lord Sharkey, is quite right, as are other noble Lords, to speak of the weakness of just using the words “to promote”. This set of amendments is about how we make it actually happen. The amendments are about mandating integrated care boards to conduct research and to monitor and assess innovation, because without that, it will just not happen.

Legislation is indeed a critical element, but it is important to stress that it must be accompanied by the necessary infrastructure: for example, through staffing levels—to which we will return in our next debate—research capability, digital resources and tools and access to services, as well as efficient trial approval processes, the ability reliably to recruit patients, the offering of guidance and, of course, dedicated staff time for research. All of those will make the legislation actually mean something.

As well as a strengthened legislative mandate which moves beyond the current duty simply to promote research, it would support patients, clinicians and NHS organisations across the country to have equal access to the benefits brought about by research participation. This will be better for patients, give greater staff satisfaction and deliver economic benefits not just for the NHS but for the broader economy. The noble Lord, Lord Kakkar, talked about the life sciences being a major player as a contributor to our economic well-being and prosperity in this country—something also emphasised by my noble friend Lord Davies.

Such a mandate would also ensure support for levelling up and make it possible to address health inequalities. This in turn would support the ambition set out in the Government’s clinical research vision: to make access and participation in research as easy as possible for everyone across the UK, including those in rural, diverse and underserved populations. I hope the Minister will take the opportunity to reflect on the points made in this debate, because this group of amendments provides an opportunity to strengthen the Bill to actually deliver.

Lord Kamall Portrait Lord Kamall (Con)
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Like many of the debates on this Bill in Committee, this has been a fascinating one. It has been really interesting to hear from experts who themselves have engaged in clinical research. I start by thanking my noble friends Lady McIntosh of Pickering and Lady Blackwood and the noble Lords, Lord Sharkey and Lord Kakkar, for bringing this debate before the Committee today. I also thank the noble Lord, Lord Howarth, for his points about the arts and social prescribing.

Before I turn to the amendments, perhaps I could make two personal reflections. One is from my early academic career as a postdoctoral research fellow. I saw the benefit of taking the results of my research directly into my teaching. It made the courses more dynamic—it was not just a repeat of last year’s slides for this year’s students—and it showed what progress we were making in that field of research.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I start by acknowledging—as I am sure we all do in your Lordships’ House—the value, commitment and contribution of the workforce who are the backbone of our health and social care services. We owe them our gratitude. The noble Baroness, Lady Finlay, and my noble friends Lady Whitaker and Lord Bradley are all absolutely right to acknowledge the breadth and depth of the workforce: that it is a team, and that each part of that team is absolutely connected with the other.

I very much agree with the noble Lord, Lord Kakkar, who said that this debate is absolutely central to all that we are here to discuss and to all that patients need from our health and social care services. I am extremely grateful to noble Lords who have tabled and supported amendments and spoken in this debate. All of them have made a compelling case for a workforce plan that will, if these amendments are taken on board by the Minister, feature a laser-like focus on valuing the entire staff team, along with providing planning, financial resources, responsibility, reviewing and reporting—all essential features of any effective strategy. This begs the question: if we see these pillars in a strategy in every other part of our economy and of the way that our whole society functions, why can we not have this for the NHS and social care?

I am glad to have tabled an amendment that calls for a duty on the Secretary of State to ensure that there are safe staffing levels—this was very clearly emphasised by the noble Baroness, Lady Walmsley, in her opening to this debate. This is extremely important because it places a duty where it ought to be and allows examination and transparency.

Of course, we all know that the situation we are discussing today is not new: the noble Lord, Lord Stevens, spoke to your Lordships’ House about a litany of unfulfilled promises and missed opportunities in workforce planning. The noble Baroness, Lady Harding, spoke of her efforts to resolve this and explained the need, which we see in these amendments, to introduce improvements to the Bill to resolve the matter of workforce supply against the demand that is there. All of that requires a lead-in time, and it has to be underpinned by the requisite funds—there is no shortcut to this. In England, we now have a whole website that is full of guidance, and NHS boards are required to take this into account, and yet there is no national workforce plan or credible plan for funding. Until there is, the ICBs will not be able to plan either. The noble Lord, Lord Warner, rightly pointed out that this is not an either/or situation: we need a national workforce plan, and it has to have the funds to deliver it.

I will draw the Minister’s attention to particular aspects of the amendments: explicit recognition of the need to consult with the workforce through trade unions; that planning must cover health and social care; that timescales for reporting should be testing but not too onerous; and that the financial projections in any workforce plan should be subjected to some level of independent expert verification, through the Office for Budget Responsibility, for example.

Behind all of these discussions, we started in a place highlighted by the noble Baronesses, Lady Masham, Lady Walmsley, Lady Watkins and Lady Bennett, and other noble Lords, who spoke of the crisis of the levels of vacancies that we now see and the impossibility of dealing with this without preparation and resource. Any national plan for the workforce needs to be built from the bottom up and not imposed from the top. I hope that the Minister will consider this when he looks at ways to improve the Bill.

I will raise a couple of related points. The scale of the workforce challenge is well established, but it goes far deeper than just numbers and structures. It goes to issues around workforce terms and conditions and career development, particularly in social care, which the noble Baroness, Lady Hollins, brought our attention to. It also has to deal with cultural issues; there is a clear indication that all is not entirely well in the NHS when it comes to diversity, whistleblowing and aspects of how staff are or are not nurtured and supported.

I have one final specific issue to raise, which we have heard about in the debate today and that I would like to extend: international recruitment. I ask that the Government do more to prevent international recruitment, particularly of nurses and midwives, from countries where it is unethical to recruit, and that this be a part of any future strategy. The existing code of practice on international recruitment is not legally enforceable, so when Unison or others report breaches of the code by recruitment agencies, there is no provision for sanctions to be brought against rogue operators. I ask the Minister to confirm that the code of conduct will be promoted and will be enforced.

The situation in which we find ourselves is fixable. I hope the Minister, in his response tonight, will show your Lordships’ House that he understands the situation, that he understands what needs to be done and that he will do it.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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Well, this has been another fascinating debate, and I welcome the contributions from all noble Lords speaking from many years of experience, including former chief executives of the National Health Service and former Health Ministers, medical experts and practitioners. I am grateful to the many noble Lords who have laid amendments in this group; there clearly is a strength of feeling, not only in this Chamber but in the other place. To cut a long story short, this will clearly require more discussion.

However, I am duty bound to give the Government’s perspective on this. We have committed to publishing a plan for elective recovery and to introduce further reforms to improve recruitment and support our social care workforce, as set out in the White Paper, People at the Heart of Care: Adult Social Care Reform. I take the point of the noble Lord, Lord Stevens, that he is aware of many expectations that have passed, and I hope that this time we surprise him. We are also developing a comprehensive national plan for supporting and enabling integration between health, social care and other services that support people’s health and well-being.

The monthly workforce statistics for October 2021 show there are record numbers of staff working in the NHS, with over 1.2 million full-time equivalent staff, which is about 1.3 million in headcount. But I am also aware of the point of noble Lord, Lord Warner, that it should not just be about the number of people working—it is about much more than numbers and quantity; it is about quality and opportunities. We are also committed to delivering 50,000 more nurses and putting the NHS on a trajectory towards a sustainable long-term future. We want to meet our manifesto commitment to improve retention in nursing and support return to practice, and to invest in and diversify our training pipeline, but also, as many Lords have said, to ethically recruit internationally.

On that, I want to make two points. The first is this. When I had a similar conversation with the Kenyan Health Minister and expressed the concern we had about taking nurses who could work in that country, the Minister was quite clear that they actually train more nurses than they have capacity for in their country—they see this as a way to earn revenue. There have been many studies on how remittances are a much more powerful way of helping countries, rather than government-to-government aid. With that in mind, we recruit ethically, and we have conversations.

The second point is also from my own experience. I was on a delegation to Uganda a few years ago and I remember speaking to a local about the issue of the brain drain and our concerns. We were talking about immigration, and he said, “You do realise, though, it is all very well for you to patronise me and say that I should stay in this country, but sometimes the opportunities are not here for me in this country. You talk about a brain drain; I see my brain in a drain”. Sometimes we have to look at the issues of individuals who are concerned that they do not have opportunities in their countries, even if the numbers dictate otherwise. Having said all that, we are committed to the WHO ethical guidelines, but I also think that we should be aware. Look at the way that, post war, the people of the Commonwealth came and helped to save our public services. I hope we are not going to use this as an excuse to keep people out, though I understand the concern that we have to make sure that we recruit ethically internationally.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I think it is fair to say that the debate today across your Lordships’ House has shown that it is impossible to understand how specialist palliative care can be regarded in any logical, practical or humane sense as something so different. I am sure that the Minister will do his very best to address that in his consideration of these important amendments.

I am grateful to noble Lords for making this debate possible by bringing forward these amendments and making sensitive, informed and often personal contributions to underline the need to ensure that specialist palliative care features in the Bill. I am particularly grateful to the noble Baroness, Lady Finlay, for setting out the fact that if we are to say that the NHS is cradle-to-grave, that must absolutely shape how we approach such services. The noble Baroness and others, including the right reverend Prelate, talked about inequality and the fact that, when we speak of specialist palliative care, inequalities are not just in the course of someone’s life but actually to the very moment they leave this world. That really had an impact on me, because that surely is an unfairness too far for us to just stand by.

Taking action could not be more pressing a need. We know that the UK’s population is ageing rapidly. The Office for National Statistics predicts that, in 20 years’ time, there will be twice as many people over the age of 85, while Marie Curie’s analysis for Cardiff University has concluded that the number of people needing palliative care will rise by 42% by 2040. This is a challenge to our society which will not go away. As the noble Lord, Lord Patel, said, we should be able to live our lives in anticipation of a good death. The right reverend Prelate spoke of the difference of witnessing a good death, as opposed to a death that is less than what it should be.

It is important to say that, even before the pandemic, experts at the Royal College of Physicians, the Care Quality Commission, the health service ombudsman and Compassion in Dying were all sounding the alarm on how those approaching the end of their life, and their loved ones, did not, in so many circumstances, feel supported to make the decisions that faced them and that it was impossible to turn away from. They did not know what choices were available, and, sadly, were not given an honest prognosis.

The amendments in this group offer dignity to the greatly increasing numbers who will need this care, and would bring in moral and well-evidenced measures essential to providing the tailored care that is needed in the final stages of one’s life. This includes sharing information about a person’s care across the different professionals and organisations involved in that care, and providing patients and their loved ones with specialist advice, 24 hours a day, every day of the week—which expert practitioners, including those at Cicely Saunders International, have been crying out for.

My noble friends Lord Hunt and Lord Howarth, the noble Baroness, Lady Finlay, the noble Lord, Lord Patel, and others underlined the work, role and contribution of the hospice movement, and also spoke about their incredulity at the reliance on charitable funding. Who in this Committee can be surprised at that feeling? I hope the Minister will be able to speak to that absolutely crucial point because, even before the pandemic, many hospices were suffering from poor decisions from clinical commissioning groups, poor practice, and a lack of support and recognition of the vital role that they play. That impacts on the individuals who so sorely need their services.

Marie Curie reported that 76% of carers who lost a loved one during the pandemic felt that they did not get the appropriate care that they needed. This is an opportunity to fix the problem. Every day, pandemic or none, the quality and personalisation of specialist palliative care will dictate how dignified and comfortable —or not—the end of a life will be, and how much of a burden will be borne by the carers and loved ones: whether, as the noble Baroness, Lady Hollins, reminded us, those left behind are adults or children. These amendments seek to get it right, and the feeling of this Committee could not be clearer. I look forward to the Minister’s response.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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My Lords, as we reach the closing minutes of today’s debate and reflect on the wonderful contributions from across the Committee, perhaps it is fitting that we also talk about the final chapter of life, as the right reverend Prelate the Bishop of Carlisle said.

I thank all noble Lords who spoke very movingly today, particularly the noble Baronesses, Lady Meacher, Lady Hollins and Lady Walmsley, the noble Lord, Lord Patel, and my noble friends Lady Hodgson and Lady Fraser, who spoke about their own experiences. I also thank the noble Baroness, Lady Merron, for pointing out the 42% figure, which is very important to recognise. I thank the noble Baroness, Lady Finlay, for the engagement we had prior to this debate and for her helpful engagement with our officials and the Bill team. I hope that will continue.

What is interesting about this is that when I was younger, we as a society found it very difficult to talk about death. I was once told by my parents that the British find it very difficult to talk about death, except in faith groups. It is interesting that, over time, as we have become an ageing society, we are talking, as a matter of fact, about death. We talk about our wills, financial planning, and planning for care at the end of our life. It is appropriate that we recognise this. The fact is that, nowadays, when we look at the hospice movement, we do not think of it as a quaint little service or a charity; we think that it provides an essential service to help someone at the end of their life, and we recognise the difference between palliative care and end-of-life care.

I hope that I can reassure the Committee that the Government are committed to ensuring that people of all ages have the opportunity to benefit from high-quality, personalised palliative and end-of-life care, if and when they need it. I also pay tribute to the noble Lords, Lord Howarth and Lord Scriven, for their contributions. The noble Lord, Lord Howarth, talked about the role that the arts play in helping those at the end of their life, which he has talked about in a number of discussions we have had on this issue. Like the noble Lord, Lord Scriven, he made the point that while you want to see the state do more, you do not want to push or squeeze out the hospice movement, as we need the right balance.

Eating Disorders

Debate between Lord Kamall and Baroness Merron
Monday 17th January 2022

(7 months ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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The issue of poor body image that my noble friend raises is very important. The Government are addressing known risk factors through both universal and targeted interventions. At the top level, that means looking at the Better Health and Every Mind Matters content, which focuses on support for mental health and well-being. Poor body image and low self-esteem are topics addressed there. It is also about looking at what pupils expect and at the prevention concordat for better mental health programmes, as well as working as part of the anti-obesity strategy to make sure that we get the right balance. Sometimes when you focus on information on packets, for example, it can have unintended consequences for those with eating disorders. Every time we look at labelling, we have to make sure that we have addressed those unintended consequences on people with eating disorders, so that they do not react negatively to it and perhaps indulge in behaviour that we do not want to see them indulging in.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the Royal College of Psychiatrists has warned that the hidden epidemic of eating disorders has surged during the pandemic, with many community services overstretched and unable to treat the number of people who need help. Will the Minister publish data about the number of people waiting for eating disorder treatment better to understand and meet the scale of the demand? Will he deliver a workforce plan to tackle staff shortages in eating disorder services so that it may be possible to treat everyone who desperately needs this help?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for raising the issue of the backlog as a result of the pandemic. We have seen eating disorder services continue to face increasing demand, especially as a result of lockdown and its mental health impact. The number of young people entering urgent treatment has increased by 73% between 2019-20 and 2021, and the numbers waiting for treatment have also increased from 561 to 2,083. To make sure that we meet the standard and get those waiting times down, we have invested an extra £79 million this financial year, and we are working with systems across the country to see how we can make sure that we address young people and adults who need access to this treatment.

Vaccination Strategy

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

(7 months ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I pay tribute to the staff of the NHS, volunteers and others, who have made extraordinary efforts during the vaccine rollout to save lives and build a world beyond Covid, while a particular debt of gratitude is owed to the Deputy Chief Medical Officer, Jonathan Van-Tam, who is standing down from his role.

To drive up vaccination rates, there is a growing need to tackle anti-vax propaganda and stop intimidation and abuse. Will the Minister commit to a communications campaign to tackle misinformation, particularly focusing on places and people with lower rates of take-up? Following the Labour amendment to the policing Bill that was agreed last night in your Lordships’ House, will the Government now take the opportunity to fast-track buffer zones around schools and vaccination centres?

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 these issues. The first issue, that of anti-vaxxers, is really important. In a free society we always have to get the balance right between freedom of speech, making sure that people are free to go about their daily work, and making sure that those who want the vaccine get it as soon as possible. The Government are aware of this and are looking at it, but it is really important that we get the right balance. Whatever we think of the anti-vaxxers’ message, they have a right to say it, but we have to make sure that it does not impinge on the liberty of others to get their vaccine, especially since we are encouraging as many people as possible to get vaccinated.

I join the noble Baroness in paying tribute to the Chief Medical Officer, Jonathan Van-Tam. He appears on our daily omicron calls and I have had a number of conversations with him, and I know that there is incredible respect for JVT across the country. Indeed, I know that a number of people tuned in to his Christmas lectures on the virus; as the noble Baroness says, they were an excellent explanation of the virus and how to tackle it.

As for how we reach local communities, particularly those communities that have not come forward, I have had a number of conversations with noble Lords and Baronesses with their own experience of working with local communities in a bottom-up way. We have seen a number of local activities; indeed, my local masjid, or mosque, has a walk-in vaccination centre, and we have seen that in other faith places. A number of faith-based and interfaith networks have worked closely with the local community, because often some communities do not have the trust in authority that they have in priests, vicars, bishops—if I may say so—imams, et cetera. That is really important. We have also recorded promotional films in a number of languages, including Punjabi and Urdu in Birmingham, and got some celebrities to come up. I know I have gone on too long but I am very excited about what we are doing.

Health and Care Bill

Debate between Lord Kamall and Baroness Merron
Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I feel that today’s debate on this important group of amendments should carry much weight because, at its core, this is about treating people as whole people and seeing them as physical, mental and social beings. Our welfare on each of those fronts is absolutely key to the others. It is not possible simply to treat one without regard to the others, and it is crucial that we enhance people’s well-being across our whole complexity as human beings.

I am glad to speak to this group of amendments because, as we have heard across all sides of the Committee throughout today’s debate, the reality is that, despite the best efforts encapsulated in the mandate, and many times in policy, we find that competing priorities, an avalanche of guidance and instructions, and events—the pandemic has been referred to several times, of course—mean that mental health services can be, and indeed have been, relatively left behind. As the Centre for Mental Health reports:

“Mental health problems account for 28% of the burden of disease but only 13% of NHS spending.”


In the debate today we have also asked ourselves: where is the accountability? For example, we know that in many clinical commissioning groups the actual spend on mental health was below what it was supposed to be, yet there have been no consequences. We need to address not just the finances but the mechanisms around it and the impact on individuals.

The founding National Health Service Act 1946 rightly spoke of a comprehensive health service that secured the improvement of both physical and mental health, and subsequent Acts, quite rightly, have confirmed this. In operational terms, the Government require NHS England to work for parity of esteem for mental and physical health through this NHS mandate, but we know, and have heard again today, that this requirement falls down when we go to a local level.

One way or another, we will all be familiar with a whole range of stories of people who have not been able to access treatment in a timely manner or who find that they are pushed around a system with very little effect and discharged from care before it is appropriate, with consequences that are all too clear to see. It is difficult to overestimate just how challenging this is, not just for the individuals but for local commissioners, because they face competing pressures in trying to deal with this.

As has been emphasised, this group of amendments is about not just getting on the road to financial parity, important though that is, but changing the culture and the whole means of monitoring and implementation, so that disparities can be addressed—indeed, if possible, so that difficulties can be headed off at the pass. It is a well-worn phrase, but it sometimes seems that mental health is a Cinderella service—the one that can be cut first, to the benefit of the more visible services. Some of the recent statistics show that one in four mental health beds has been cut in the last decade, while just last year 37% of children referred by a professional to mental health services were turned away. That is a shocking statistic that we need to move away from.

I thank noble Lords for promoting these amendments and for their contributions illustrating what they mean and the reason we need them today. The noble Lords, Lord Stevens and Lord Patel, made timely points about the impact of the pandemic. If this is not a moment for focusing more on mental health, I do not know what is. The challenge we have and the difficulty presented by the pandemic is that while there is a focus on cutting waits for operations—and we know that is important—this could be a reason for mental health services to get somewhat lost, when in fact the pandemic reminds us of the importance of mental health and the need for the NHS to meet the needs that there now are.

The amendment by the noble Lord, Lord Stevens, encourages and directs the actions necessary for transparency on expenditure. I recall that they were referred to in the debate as legislative levers, and that is indeed what they can be. For me, they encourage not just accountability and transparency but actual action and change—the change we need to see.

The noble Baroness, Lady Hollins, referred to parity of esteem having to be applied locally, not just at a higher level. That is the only way we will see a difference in mental health services and improve the mental health of people in this country.

The noble Lord, Lord Crisp, made reference to the fact that legislation is trying to catch up with where we are as a society, and the noble Lord, Lord Warner, referring back to the meeting he attended, said that the public are well ahead of the game. I believe that is true. Indeed, as the noble Baroness, Lady Watkins, said, we have to prepare for tomorrow. It is not satisfactory that we stay stuck in today, or indeed in the past.

In my view, these amendments move us on. They bring mental health services into real parity with physical health services, but they also connect mental and physical together. I hope they will find favour from the Minister.

Lord Kamall Portrait Lord Kamall (Con)
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I begin by thanking all your Lordships for the wide-ranging debate. I want to say how much more I learn, listening to the contributions in each of these debates, before I stand up to speak. I thank all noble Lords for their contributions. As the noble Baroness, Lady Merron, says, this debate carries some weight for our understanding that social, mental and physical well-being are equally important. We should not seek to suggest that one takes precedence over another. I also thank the noble Lord, Lord Stevens, for kicking off this debate with his encouraging and not critical amendments; I take them in that spirit.

Following on from that, and before I go to some of the specific amendments, I will just reflect on some of the contributions made thus far. I first thank the noble Lord, Lord Howarth, for raising social prescribing. I know we have discussed this a number of times since I became the Minister, with particular contributions from the noble Baroness, Lady Greengross, on the importance of art and music in helping to unlock the mind and touch the soul.

As has been made clear, social prescribing is a key component of the NHS’s universal personalised care, and I know that, crucially, this can work well for those who are socially isolated or whose well-being is impacted by non-medical issues. The NHS has mechanisms to ensure that social prescribing is embedded across England: for example, the primary care network directed at enhanced services specification outlines that all PCNs must provide access to a social prescribing service.

I also thank the noble Lord, Lord Patel, for raising the importance of the mental health of children and for making sure that we do not forget, even within mental health, that many sections of our society can quite easily be forgotten.

I agree with the right reverend Prelate the Bishop of London: we have come a long way. I remember as a child in the 1970s going to visit my uncle who was a psychiatric nurse at Claybury Hospital and looking at the patients, with the innocence of a child, and thinking, “These people don’t look ill to me.” We have come far since then. I remember the Rampton hospital scandal in the late 1970s, where the patients were treated appallingly, almost not as humans, and with a lack of dignity. The fact that today we are discussing the parity of mental with physical health shows how far we have come as a society.

We also spoke about loneliness and isolation. The noble Baroness, Lady Watkins, and I have had conversations about loneliness and some of the civil society projects that, for example, bring together lonely older people with children from broken homes so that both can benefit and learn from each other. I remember a story that I have mentioned in the past: in one of the projects I visited, a rather old man said, “I lost my wife five years ago and I had almost given up on life. The fact that I am now working with children from broken families and am almost being a mentor to them gives me a purpose to live—a reason to get up in the morning. I have no longer given up on life.” There are so many of these civil society projects, and no matter how we legislate, sometimes those local projects get to the nub of the problem in their local communities.

I have to pay attention when not only two former NHS chief executive officers but the former Chief Nursing Officer speak in the debate. The noble Lord, Lord Crisp, talked about the focus on outcomes, not inputs and how it is important to make sure that we are not gaming the system, mentioning mental illness and mental health but not doing anything effective about it.

Autism was mentioned by the noble Lord, Lord Warner, a former Health Minister. We are fully committed to improving access to and provision of health and care services for autistic people and people with a learning disability. I know that we have had at least one debate on the treatment of patients with autism and sometimes the terrible conditions they experience. That just shows how important this is.

I am trying to say that in many ways that the Government are absolutely committed to supporting everyone’s mental health and well-being and to ensuring that the right support is in place for all who need it. I therefore welcome the amendments which look to ensure parity of esteem across physical and mental health. I assure noble Lords that we support the sentiments behind these amendments and take mental health seriously.

Indeed, one of the considerations in weighing up the many arguments for further measures in response to Covid—from those who were asking for lockdown, for example—is that we also had to recognise that there was a mental health impact to lockdown. As a Government, we had to look not only at the societal and economic impacts but the mental health impacts within health considerations.

On the amendments, I will first address those tabled by the noble Baroness, Lady Hollins—I add my voice to those of the many noble Lords who have paid tribute to her work over many years in promoting this issue and ensuring that we take it seriously. I also pay tribute to the noble Baroness, Lady Walmsley, for making sure that we are informed about this. These amendments would explicitly reference both mental and physical health and illness in certain provisions of the Bill. I understand that the intention is to ensure that due attention is given to both “mental and physical health” and “mental and physical illness”. Indeed, you cannot separate mental and physical illness, as the noble Baroness, Lady Jones, said. We have moved way beyond “Pull yourself together, man” or a stiff upper lip attitude. We see how mental health plays a role, for example, in terrorism, with those who are recruited to be terrorists, or in those with eating disorders, or the number of people in prison who suffer from mental health issues. It is important that we fully recognise that.

Public Health: Night-time Working

Debate between Lord Kamall and Baroness Merron
Thursday 6th January 2022

(7 months, 1 week ago)

Lords Chamber
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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, night working can place a strain on people’s health through increased incidents of depression, diabetes and cardiovascular disease. Can the Minister tell the House what work the Government are doing with unions and employers to reduce this link between night working and ill health, and what account they are taking of the TUC report which calls for greater attention to the pressure of night working on home life and relationships?

Lord Kamall Portrait Lord Kamall (Con)
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A number of noble Lords have made the very important point that there is clearly an impact on individuals of working at night, including fatigue, wider pressures and disruption to family life. The sleep review has looked at this and reported just before Christmas, after consulting a wide range of stakeholders. The Office for Health Improvement and Disparities will publish its report in the summer of 2022, I hope.

Medical Schools: Training Places

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

(8 months ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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There has rightly been much discussion of workforce planning for the NHS and adult social care, and the Bill will build on this. Clause 35 will bring greater clarity and accountability in this area, requiring the Secretary of State and the NHS to produce a workforce plan.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, with the intensification of the Covid booster programme, more doctors will, of course, be diverted from their usual roles, making it even harder for people to get an appointment at their local surgery, and record waiting lists will continue to increase. What revisions will the Minister make to existing plans for numbers of training places to meet the need for more trained staff, including doctors, nurses, lab technicians and auxiliaries? How will the Minister respond to the report from the Royal College of Surgeons that 13,000 planned operations have been cancelled in the last two months alone?

Lord Kamall Portrait Lord Kamall (Con)
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The focus and priority for the next three weeks is on omicron and making sure that people get their boosters as quickly as possible. It is not only doctors who are involved: nurses, pharmacists and, incredibly, a number of civil servants are now taking part in that programme. For the next three weeks, the focus is on getting more jabs into arms.

Coronavirus Act 2020 (Early Expiry) (No. 2) Regulations 2021

Debate between Lord Kamall and Baroness Merron
Tuesday 30th November 2021

(8 months, 2 weeks ago)

Grand Committee
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Lord Kamall Portrait Lord Kamall (Con)
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Thank you. I appreciate it.

Baroness Merron Portrait Baroness Merron (Lab)
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Before we go off the issue of face masks, I appreciate the explanation about restaurants, but my question was about large gatherings—for example, cinemas, theatres and conferences, to name but a few. The explanation about restaurants does not apply there. I hope the Minister will take this back as it is simply a question of where is the logic regarding the venue. It seems to make no difference; it is about the fact of there being a number of people.

The real point I would re-put to the Minister, which links with that, is my question about the comments of Dr Jenny Harries on Radio 4. She said that we should decrease our social contacts, whereas the spokesperson for the Prime Minister says that we will not be doing that. I am very concerned about mixed messaging, as I am sure the Minister is—I know he is from what he has said. It would be extremely helpful to put on the record where we are on whether decreasing social contact makes a difference.

Lord Kamall Portrait Lord Kamall (Con)
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I apologise if I was not clearer before. I thank the noble Baroness for taking advantage of the opportunity to ask that question and finding the urge to do so irresistible. On theatres and cinemas, one of the things that was put to us was that in a restaurant, you are constantly taking a mask on and off, whereas in a cinema or theatre you are not really eating that much. Okay, you might well go to buy your ice cream—I do not know whether they still sell ice cream and jelly babies in theatres, or whatever it used to be; this will look very odd in Hansard when someone reads it—but you are not constantly doing and you are more or less constantly wearing your mask. However, I will take that back. It is a fair point, and one thing that I do when I am being briefed is to challenge because I know that noble Lords will rightly challenge me on this issue.

In response to the comments by Jenny Harries, I hope I have been clear that we take advice from a range of advisers and there is not yet consensus, but we have been relying not just on making mask mandatory when necessary as a precaution, but at the same time on people’s individual behaviour and them acting responsibly. It is about getting that balance right. We listen to Dr Jenny Harries, but she is one of a number of experts whom we listen to. We weigh up the different views; it is as simple as that. As we have been clear, there is no one trigger for any of these measures. We always consider a range of measures, including capacity in the NHS, the trends et cetera. I have listed them in previous debates. It is not one person whom we listen to. We listen to a range of experts.

Food (Promotion and Placement) (England) Regulations 2021

Debate between Lord Kamall and Baroness Merron
Tuesday 23rd November 2021

(8 months, 3 weeks ago)

Grand Committee
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Lord Kamall Portrait Lord Kamall (Con)
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Once again, I thank my noble friend for making that request. I always make it clear that it is important that we publish as much evidence as possible and let it be challenged; that is part of a healthy debate. If things do not work as intended, we should see what works and what does not. I am always very sensitive when someone says, “the evidence suggests”. We need to have that challenge but also make sure that we know what works. At the end of the day, we all want to see less obesity across our country, so surely it is important that we make sure that the evidence is there. Where something does not work, we will just have to try other ways.

On compliance, it is for local authorities to decide how best to enforce the requirements. Where an enforcement officer suspects that HFSS food or drinks may be inappropriately promoted, they should request further information to verify. If the product is in scope and has been promoted contrary to the law, an enforcement officer will consider what action should be taken.

Baroness Merron Portrait Baroness Merron (Lab)
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I thank the Minister; it is generous of him to give way. I would be very interested in how he sees the greater responsibility on local authorities. Picking up my question again, does he feel that local authorities are resourced suitably? Can they expect some recognition of this new and extremely important role, because the regulations require their co-operation too?

Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for that question. The Government are committed to ensuring that enforcement is proportionate and fair, and we intend to support local authorities and the judicial system on additional costs incurred as a result of enforcing the policy. Up front, I cannot say what those costs will be, but we want to understand what they will be to help enforcement.

I was asked whether we had watered down the policies for some products. We have excluded some products that are not among the highest sugar or calorie contributors to children’s diets or are not heavily promoted, but we will continue to keep the policy under review.

The noble Baroness, Lady Brinton, asked about weight management and other ways of tackling weight issues, including exercise. In March 2021, we announced an extra £100 million for healthy weight programmes to support children, adults and families in achieving and maintaining a healthy weight.

On infant foods, we will shortly consult on proposals to improve the marketing and labelling of commercial food and drink products for infants and young children. I acknowledge many of the concerns expressed by the noble Baroness, Lady Brinton.

The noble Baroness, Lady Merron, asked why we are using secondary legislation. The different legislative approaches being pursued reflect the current legislative framework and implementation routes available to the Government. For the promotion restrictions, we used existing powers in the Food Safety Act 1990 to lay secondary legislation before Parliament in July 2021. The statutory instrument has been subject to the affirmative parliamentary procedure.

On how we look at issues of inequality, noble Lords made a very fair point. Perhaps I may be so bold as to suggest that one issue for people I talk to in many of the communities that we are supposed to be reaching out to is that, for far too long, the public health industry has been dominated by white middle-class people who feel they know better than immigrant and working-class communities. It is really important that we understand those communities. As someone who comes one of the communities that have been patronised, I recognise that we have to make sure that we work with them and do not just sit in a place like this and assume that we know better. It is important that we really understand them. What is really good about the Office for Health Improvement and Disparities is that “disparities” are on the label, on the tin, which means that we have to look at how we address them.

There were some questions about why smaller businesses are exempt. I hope that I have answered them.

On people not being able to afford to eat a healthy diet, anyone who has watched daytime TV will know that some of those programmes can show you how to cook a meal very quickly and much more cheaply than is the case with many of the convenience foods that you can buy. The problem is how we translate that from the TV and entertainment to people’s lives in reality. In many ways, it means understanding families, where the decisions are made and what they have access to in many of their communities. Anyone who has been to many of the immigrant communities, for example, will know that there are plenty of shops that sell and openly display fresh food, but how do we make sure that we translate that into healthy diets?

On their own, these regulations will not be enough. We also have to look at how we translate all this into understanding people’s lives right at the family and the community level. It is our goal to improve children’s health and to reduce obesity. The shopping environment plays a vital role in the way products are marketed to us—for example, the pumping out of the smell of fresh bread from bakeries. We know that marketing people are experts in understanding consumer behaviours, with factors such as the location of products at the end of aisles affecting what we buy. The Government are committed to getting the right balance between stopping bad practice and working constructively with industry. We also want to evaluate the evidence of the restrictions once the policy is implemented.

We believe that retailers can play a vital role in creating a healthier food environment that does not promote the overconsumption of less healthy products. The Government hope that these regulations will enable us to achieve a healthier food environment and make progress to halving childhood obesity by 2030, and allow us all to live longer lives in good health. I commend the regulations to the Committee.

Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

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

(9 months, 1 week ago)

Lords Chamber
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Lord Kamall Portrait Lord Kamall (Con)
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Maybe it is because I speak rather quickly, but in my remarks just now I talked about the difference between the negative and affirmative procedures, and the affirmative procedure needing parliamentary scrutiny—so I do agree.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, this Motion has given an opportunity to put dissent and concern on the record, and we have heard that through voices from across the House. I am left thinking as a result of this debate that any reorganisation, particularly one such as the one we have discussed, would have greatly benefited from proper parliamentary scrutiny. I literally regret that this was not the case.

I am grateful to noble Lords for their thoughtful contributions and consideration. I echo the words of my noble friend Lord Howarth of Newport in giving thanks and appreciation of Public Health England and the entire team, led by the chief executive as was, Duncan Selbie.

Improvement of the health of the nation and the equal chance to live a long, happy and healthy life is paramount. As my noble friend Lord Stansgate said, sidelining Parliament is not the way in which to tackle this advance. Similarly, my noble friend Lord Hunt highlighted the fact that there had been a shift of blame from Ministers to officials—which again, as we have heard in this House, cannot be an acceptable way forward. I hope that the Minister heard his noble friend, the noble Lord, Lord Lansley, who called for an inquiry and for Ministers to think again about the best way in which to manage public health responsibilities. I am sure that the Minister will listen to those words as well the others that we have heard today.

While I appreciate that the Minister has been left somewhat holding the baby on this one, I have heard what he has said. Although I am disappointed in many of the conclusions that he has drawn, I beg leave to withdraw.

NHS: Fracture Liaison Services

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

(9 months, 1 week ago)

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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, there is no inevitability about osteoporosis and broken bones as the result of getting older, and yet osteoporosis affects 50% of all women, with those going through the menopause and after menopause experiencing it at a higher rate of incidence due to the reduction in oestrogen levels. Does the Minister acknowledge that two-thirds of women are not getting the treatment that they need, and that this was the case even before the pandemic? What steps are the Government taking to improve access by women to HRT and treatment for osteoporosis?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness raises an important point. A number of people are still waiting to be seen; NHS England is very much aware of the backlog and wants to address it. As a key part of the elective recovery plans, NHS England is working with a number of local integrated care systems to establish a greater number of clinics, as well as with community diagnostic centres, and is developing business cases. NHS England is also working with experts in the field of musculoskeletal health to improve patient pathways and to find new opportunities that, over time, will improve patient care and access.

Public Health Grant to Local Authorities

Debate between Lord Kamall and Baroness Merron
Tuesday 2nd November 2021

(9 months, 2 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend for that very important question. We continually assess our preparedness plans for infectious disease outbreaks and pandemics to ensure that they remain as robust as possible. This assessment includes, as appropriate, incorporating lessons learned from exercises that test the readiness of our plans and from our experience in responding to pandemics, disease outbreaks and other types of incident in the UK. The UK Health Security Agency will be dedicated to ensuring that we are protected from all future threats, including pandemics.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, areas of greater deprivation have disproportionately borne the brunt of cuts to the public health grant, despite many people in these areas having poorer health. In Blackpool, ranked as the most deprived upper-tier local authority in England, the per capita cut to the grant has been one of the largest, at £43 per person per year. Can the Minister explain to the House how and why these decisions are made, and will he ensure that fairness in funding is restored for those who need it most?

Lord Kamall Portrait Lord Kamall (Con)
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The noble Baroness raises a very important point about needing to tackle disparities across our nations. The ring-fenced grant that we provide to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. Also, the grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived. In addition, noble Lords will be aware of the new Office for Health Improvement and Disparities. The pin-light focus of that office is on health disparities and how we tackle them.

Alcohol Duties

Debate between Lord Kamall and Baroness Merron
Tuesday 2nd November 2021

(9 months, 2 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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The Office for Health Improvement and Disparities, as well as many other bodies, will continue constantly to review the impact of this change in taxation. In addition, the Government remain committed to supporting those who are most vulnerable and most at risk from alcohol misuse. Alcohol is a cross-cutting issue affecting several government departments. A strong programme of work is under way to address alcohol-related harms and their impact on life chances, including an ambitious programme to establish specialist alcohol care teams in hospitals and support for children of alcohol-dependent parents. There are a number of other alcohol harm reduction strategies that are too numerous to list now, but I am happy to write to the noble Baroness.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, alcohol-misuse experts have warned that the Government’s reforms of alcohol taxes are undermined by their failure to address the issue that alcohol from high-strength beverages may remain cheaper, in many cases, because the price per unit of alcohol is lower in many of those high-strength beverages. What plans do the Government have to introduce minimum alcohol pricing? Does the Minister share my concern that the Chancellor, in the Budget, appeared to be investing more in Prosecco than in the public health budgets that we need to see to cover the cost to society of alcohol harm.

Lord Kamall Portrait Lord Kamall (Con)
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The World Health Organization and a number of other organisations have criticised the current system of taxation of alcohol, and urged the Government—and the EU when we were a member of it—to move toward taxation based upon the volume of alcohol. To answer the noble Baroness’s specific question, there are no current plans to implement minimum unit pricing in England, but the Government continue to monitor the impact of minimum unit pricing as evidence emerges from Scotland and Wales. It has been in place in Scotland for more than three years, and the Scottish Parliament will not consider its extension until April 2024. In all my conversations with various public health experts, one of the things that they make quite clear is that this has to be evidence-led, and we want to look at evidence from elsewhere.

COVID-19: Type 2 Diabetes

Debate between Lord Kamall and Baroness Merron
Thursday 21st October 2021

(9 months, 4 weeks ago)

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Baroness Merron Portrait Baroness Merron
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To ask Her Majesty’s Government what steps they are taking to support people at high risk of developing type 2 diabetes who have gained weight during the COVID-19 pandemic.

Lord Kamall Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
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My Lords, helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, as I am sure many noble Lords agree. Our world-leading strategy to meet this challenge was published in July 2020 and reflects the significant work undertaken over recent years to halve childhood obesity and create a healthier environment to help people maintain a healthy weight.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, new NHS research reveals that people seeking help to lose weight are significantly heavier now compared with those who sought help pre-pandemic. With type 2 diabetes closely linked to obesity and local public health services shown to be highly cost-effective in helping people to lose weight, what assessment has the Minister made of the link between the cuts in funding and the increasing levels of obesity and diabetes, and will the NHS evidence now drive the Government to commit to reversing public health grants and properly funding services that are essential to tackling obesity?

Lord Kamall Portrait Lord Kamall (Con)
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I am sure that noble Lords will agree that it is really important that we tackle these issues and respond to the weight increases over the Covid-19 lockdowns. In March, the Government announced £100 million of extra funding for healthy weight programmes to support children, adults and families to maintain a healthy weight. Additionally, more effort has been put into providing access to information.

Drugs: Black Review

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

(10 months ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank the noble Baroness for her question and for her point that it is important to continue to invest in drug treatment services, but also to make sure that we stop drug users from engaging with drugs in the first place.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, among some 32 recommendations, Dame Carol stressed the importance of getting more people into treatment who require it, diverting people away from the criminal justice system, and ensuring that service users are given a wider package of support for housing, employment and mental health. With drug-related deaths in England and Wales rising for the eighth year in a row in 2020, what conclusions might be drawn about the effectiveness or otherwise of the current cross-government approach to tackling addiction? Can the Minister assure the House that wisdom will prevail such that funding for substantive health support services to tackle addiction will be announced in the comprehensive spending review?

Lord Kamall Portrait Lord Kamall (Con)
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The Government have committed to answering in full the recommendations of Dame Carol Black’s review. In terms of joined-up thinking across government, the Government established the new Joint Combating Drugs Unit—the JCDU—in July 2021 to co-ordinate, and drive a genuinely cross-government approach to, drugs policy. The JCDU brings together different government departments, including those that the noble Baroness mentioned—the Department for Health and Social Care, the Home Office, the Department for Levelling Up, Housing and Communities, the Department for Work and Pensions, the Department for Education and the Ministry of Justice—to help tackle drugs misuse across society by adopting a cross-government approach.

HIV Action Plan

Debate between Lord Kamall and Baroness Merron
Monday 18th October 2021

(10 months ago)

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Lord Kamall Portrait Lord Kamall (Con)
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As noble Lords will have seen, there is agreement with the noble Lord’s point. As part of the Government’s commitment to reaching zero new HIV transmissions in England by 2030, the department is currently developing a new sexual and reproductive health strategy and an HIV action plan. Officials will continue to engage in discussions with the Department for Education during the development of these publications to relate them to how HIV is covered in the statutory curriculum in schools and as part of the intimate and sexual relationships lessons under personal health and social education.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, HIV can affect anyone, as we know. Despite the success in combating it, further reducing the number of people who remain undiagnosed with HIV will become very challenging unless testing uptake is improved, as my noble friend Lord Cashman said. This is particularly the case for heterosexuals who do not consider themselves at risk of HIV. What assessment has the Minister made of why people who visit a sexual health clinic may leave without testing for HIV? Will he make it a priority to ensure that all those attending sexual health clinics are offered, and encouraged to accept, an HIV test?

Virginity Testing

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

(10 months, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend for that question. I think we all agree, as he said, that conversion therapy is an awful practice and should be outlawed. The Government have made a commitment to outlaw it. There is an interesting thing, when we talk about the history of various commitments from the Front Bench and whether they were implemented: around Christmas time, we often see advertisements saying, “A dog—or a puppy—is for life, not just for Christmas”. As we know, with ministerial life, it is the opposite: a ministerial portfolio is for Christmas, not for life. However, when I look back at my time, I would ask people to judge me on my actions.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, I welcome the Minister to his place and wish him well. In addition to private examinations performed by gynaecologists and other medical professionals, campaigners report that victims are often subject to extremely crude examinations performed at home by family members, involving such means as inserting fingers into the vagina to check if the hymen is intact. What steps are the Government taking to tackle such hidden forms of abuse?

Lord Kamall Portrait Lord Kamall (Con)
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One issue we have to think about whenever we bring in any new law or ban is the unintended consequences. One unintended consequence that has been raised is that doing so might drive this practice not only into the home but underground. If we make it illegal, it is illegal; we must make sure that, when someone subjects a woman or girl to that awful experience, everyone knows it is illegal and that they will face the full force of the law.

Health: Type 2 Diabetes

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

(10 months, 1 week ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend. I have done my homework and I have read a little about what has been happening up to now, especially about the NHS diabetes prevention programme, which identifies those most at high risk of developing diabetes and refers them on to behavioural change programmes and personalised education to reduce their risk of developing diabetes, including things such as bespoke exercise programmes and learning about healthy eating and lifestyle. The programme achieved full national rollout in 2018 and 2019, with services available to patients in every system in England.

As we know, tackling diabetes is multifactorial. Nevertheless, the NHS long-term plan sets out plans for increased action on diabetes and related issues. I shall mention just a few, including the healthy weight strategy launched in July 2020 to help adults and children maintain a healthy weight, and the restrictions on the promotion and advertising of foods high in fat, sugar and salt, as was mentioned earlier. It is really important with programmes such as this that we look at these studies on a longitudinal basis and look at the evidence. Some of these programmes will work, and some will not. That is just the way the world is. We have to make sure that we tackle unintended consequences first of all, and that any future policy is very heavily based on evidence rather than a wish. That will be the most effective way of tackling diabetes.

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the rise in diabetes means that millions of people are at risk of devastating complications, including heart attacks. In 2009, to improve heart health, checks were introduced for the over-40s. However, by 2019, only half of those invited actually received those checks, and the checks were paused during the pandemic. Does the Minister agree that it is vital that these preventive checks are relaunched, and will he commit to putting in place a plan to ensure that people are able and willing to attend them?

Lord Kamall Portrait Lord Kamall (Con)
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I do not think anyone will disagree on the importance of making sure that these checks are reinitiated, or on what is being put in place to make sure either that patients are able to continue with or that new patients can start some of these programmes. Also, as noble Lords can imagine, there has been better use of technology in all fields during the Covid lockdown. For example, the NHS used Facebook to reach millions of men aged 40 or over who were at risk of developing type 2 diabetes. We also know that, in some cases, there are online consultations between patients and medical experts. Of course, with better tools, such as remote monitoring and flash blood readers, it is important that information can reach clinicians and be reviewed remotely. But there is no substitute for face-to-face meetings, and we hope very much that many of these can be resumed as soon as possible.