Urgent and Emergency Care

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Tuesday 6th September 2022 Lords Chamber

[Lord Kamall (Con)]

I assure the noble Lord that we are aware of the situation; it is one of the reasons why this Statement was made in the first place. We know there are problems with delayed hospital discharges. That is why we have the national hospital discharge task force, which has been set the 100-day discharge challenge, focused on improving the processes but also on digging deep—not just the Secretary of State issuing an edict from afar and saying “Get on with it” but following up with NHS leadership to make sure that we are looking at this issue.

We are selecting these national discharge frontrunners from among ICSs and places to look at new ideas but also to see what has worked in a particular place. A number of noble Lords often give me an example of a hospital that they believe is doing very well. When we take it back to the NHS and say, “Can we replicate this elsewhere?”, they talk about the specific circumstances of that local area and the way that system is set up and why it could work. The ICBs and the integrated care partnerships have committees to look at this, and they know it has to be done as quickly as possible. So first there is the 100-day challenge between DHSC, the NHS and the local government discharge task force.

Adult care capacity is a problem that has been brewing for a long time. One of the things that we have been trying to do with social care, particularly through the integration White Paper but also with the Health and Care Bill, is finally to put it on an equal footing with health so that it is no longer the poor Cinderella service, and indeed to professionalise it. One of the reasons why we have the voluntary register is to make sure that we understand what is out there, who is out there, who is working and what qualifications they have so that we can build a proper career structure for people in social care to make sure that it is an attractive vocation for life and not just something that they do rather than working in Asda or elsewhere, and also that they have parity with the health service.

We are also looking in the medium to long term at some of the discharge frontrunners and at streamlining the intermediate care service, which could reduce delays by about 2,500 by winter 2023-24. Some of this stuff is to tackle the crisis now but some of it is long term to make sure that if we resolve it and get the numbers down we still do not forget about it, and that we build resilience into the system.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I phoned 999 two weeks ago after my wife had a nasty fall at home. The good news for the Minister is that the ambulance and paramedics turned up within half an hour, they were extraordinarily good and she was admitted to a major hospital—it was St George’s Hospital; I may as well name it. Unfortunately, it was just before the bank holiday. She had problems with her spine and she waited five days in a brace before they could do an MRI because, apart from the most acute emergencies, MRI scanning had closed down. In 2014, the Government were attacked for failing to provide proper services over bank holidays. They said they would look at it and change it, but here we are eight years later, and it is no different. Had it been done quickly, she could have been out, the bed would have been freed and the waiting list would have been shortened. I actually offered to pay for an MRI to be done if they would do it quickly to relieve her of the pain and torture she was going through, but they said, “Sorry, we can’t do that.” This is the problem we have with the NHS.

The real elephant in the room is that much, much more money has to go in. Those who can pay more must pay more and be willing to pay more. That will shorten the lists and produce more money to make conditions for staff even better so that they work in a different way. It would reduce the lists for everybody, but we are not radical enough and not prepared to do it. With the change that has taken place, nothing fundamental is going to happen in the next two years and this problem is, regrettably, going to continue. My question is: can the Minister please do something to make sure we use the equipment available to the maximum, which is not happening at present?

[Lord Kamall (Con)]

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

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

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

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

Diabetic Prevention Programme

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Thursday 23rd June 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what was the business case for not recording the percentage of patients who joined the Diabetic Prevention Programme between 2018 and 2019 but failed to complete the course; and whether this information is now recorded.

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

Data on completion rates is collected for specific reference periods. Rather than looking just at a yearly comparison, completion is analysed to understand the impact of changes to the programme, such as providing a digital option for consumers. Data collected at specific reference points, such as from January 2017 to March 2019, shows a completion rate of 53%.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that. He may not know it, but I have been on the diabetes prevention courses, as I am on the cusp of diabetes. I was amazed by the rate of drop-out on the course that I was on. It ran for nine months. I wondered about the cost and so asked a Written Question on the details, which the Minister has now given me. With a nearly 50% drop-out rate, surely there is something wrong with the course. I want to see more courses but they should be run properly. Can we get the NAO to look at this to see if we can have some improvements and get better returns?

[Lord Kamall (Con)]

I thank the noble Lord for the question and pay tribute to him for his work in this area over many years. He is absolutely right. One of the challenges of this programme is that it is a nine-month course. Clearly, like many things, it was impacted by Covid, with a lack of in-person consultations and appointments. However, the silver lining to the cloud was the digital service. The course was able to move some patients on to digital services and to self-referring. One impact of that has been more people signing up to this programme.

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[Lord Kamall (Con)]

The noble Lord makes an important point. The Office for Health Improvement and Disparities is looking at a number of these areas and where the health service or the ICS locally has to target more resources. Clearly, one of the big concerns is disparities. The noble Lord has given the example of the north-east; as he rightly said, there will be parts of the country where those checks are not happening. It is vital that we tackle those disparities.

[Lord Brooke of Alverthorpe (Lab)]

I am sorry to be so persistent, but we are spending millions on these programmes. Since some work is being done to try to improve them, could the Minister give the House a report in six months’ time to tell us what progress is being made and give us some targets that are being delivered?

[Lord Kamall (Con)]

I am not entirely sure that I can give the noble Lord what he asks for, but I suggest that he asks me a Question about progress in six months’ time. Given that the noble Lord asked this Question, I will go back to the department and see what answers we can give.

Health and Social Care Leadership Review

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Thursday 9th June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. It is important that we recognise that not only do we have more doctors and nurses than ever before, but we need staff to be good leaders. That includes understanding diverse workforces and, as I said earlier, making sure that we have good leaders at the top. Why do we have a diverse workforce? In fact, that diversity is not represented right at the top, in the leadership. Sometimes, when you want to change an organisation—I am sorry, but I did an PhD in organisational change—there are a number of aspects and one of them is the culture and the leadership. Sometimes a new leadership comes in that can drive that change in the organisation. It is not just about structures but about making sure that we improve the standard of care we give to people. This issue came up in the report, because we have to have the right leadership and focus on patient care and on making sure that we have a proper integrated health and social care system for patients all the way through their lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the report, and particular work needs to be done in the area the Minister has just described. The NHS is very diverse, more than most public sector groupings. Therefore, if there is a problem there, it needs addressing and it should be given high priority.

First, the real issue that worries the public at the moment concerns the little statement sneaked out by the Secretary of State that he has now agreed to a 15-year work strategy being prepared. The public are worried about the great number of unfilled vacancies in the National Health Service. That number continues to rise, and we now have more than 100,000 vacancies. The public expect the Government to move in a number of ways to try to fill those vacancies, rather than simply waiting for a long-term strategy. Will the Minister tell the House what new ideas the Government have to fill the vacancies? I know that is not an easy question to answer.

Secondly, I suggest that the Government have conversations with the agencies, which supply staff to so many different places in the NHS at such high costs, to see whether some accommodation could not be reached with them. Thirdly, I have personally had experience recently of being treated in the private sector. I spent some time talking to the staff, many of whom were ex-NHS and said they would never return to it. I would like to know what work has been done by the Government in exploring the views held by those people who have left NHS service to establish why they have gone, and what they would need to see change in the NHS to encourage them to return to it.

[Lord Kamall (Con)]

I thank the noble Lord for that question. We should look at the context of the different environment and the challenges that our health service and health and social care system is facing compared to in earlier years. A number of different factors have come together. One is that we have an ageing population and people are living longer but not necessarily living longer well, and therefore, where before the focus was mainly on physical treatments, we are now far more aware of issues like dementia and the challenges presented by ageing populations. On top of that, we are simply aware of more conditions. I have just come out of a debate on neurological conditions, of which I was told that there are probably 600. When I was a child, that probably would have been dismissed—no one would have thought that there were such a number—so there is more awareness of the issues to be treated.

Mental health is now treated more seriously. It was never taken seriously before; it was always about “pull yourself together” or the stiff upper lip, but now we understand that people have mental health conditions. We need to make sure that we have a health and care system, including private and independent, that can meet those needs.

One of the challenges is that we need more doctors and nurses. The funny thing is that we actually have more NHS doctors and nurses than ever before, but we recognise that on top of that we still need more. Investing in the workforce is therefore a key priority.

There is the 15-year plan, as I have said. The NHS also has the people recovery task force to make sure that all NHS staff are not only kept safe but retained. There are a number of initiatives, which I am happy to write to the noble Lord about, about helping staff who feel burned out, as well as retention programmes.

On top of that, we have increased the number of medical school places. We have found that students are sometimes more likely to stay close to areas where they have studied, so new medical schools have opened in some of those places which have found it hard to recruit. We also have more new nurses coming through the system but, despite that, there is still demand for more. We are looking at various ways to improve retention but also attract new staff.

Sugar Reduction Programme: Bread

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Wednesday 25th May 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government why the recent sugar reduction programme, which challenged businesses to reduce the amount of sugar in food, did not include bread.

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

The sugar reduction programme focuses on those products which contribute the most to children’s intakes of sugar. Sweeter bread products such as buns, fruit loaves and bagels are within scope of the programme. Plain and savoury breads—for example, garlic bread—are included in the salt reduction programme, as these products make greater contributions to salt intakes than sugar intakes. Garlic breads are also included in the calorie reduction programme.

--- Later in debate ---

[Lord Brooke of Alverthorpe (Lab)]

I thank the Minister for that reply. Sugar is in so many products these days and is so damaging. As the Minister knows, we have a crisis with diabetes and with obesity. Does he not agree that we should endeavour to remove sugar wherever we can? There was no sugar in bread 60 years ago. Why is there sugar now? Why do the Government not look at this again and stop it?

[Lord Kamall (Con)]

I pay tribute to the noble Lord. Since my first day at the Dispatch Box, he has challenged me on both sugar reduction and alcohol abuse. There comes a stage where it is diminishing returns. I know that the noble Lord and I are very keen on puns and dad jokes. When bread is being made, sugar is needed—kneaded; excuse the pun—because it extends shelf life by reducing the oxidation which causes food to deteriorate, it reduces the rate at which bread becomes stale, it activates yeast for fermentation, it adds the colour during the baking process, and it adds to the texture. The sugar contributes only about 2% of free sugars intakes in children. Therefore, it is much more worth while and targeted to focus on products that are higher in sugar.

NHS Dental Services

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Tuesday 24th May 2022 Lords Chamber

[Lord Kamall (Con)]

“Delay” means not the same date that was originally proposed. We clearly understand the children’s issues. During the pandemic, NHS dental practices were asked to meet as many priority needs as possible. One of the reasons that £50 million of additional funding was put in was to target them at those most in need of urgent dental treatment, including children.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not true that many of these deserts are in fact areas that need levelling up? I come from one of those areas originally and, when I was a child, a dentist visited the school to check all the children annually. Why do we not have a programme to ensure that schools in these deserts are visited by a dentist per annum?

[Lord Kamall (Con)]

It is important for any review to look at out-of-the-box thinking and to learn from the past. The suggestion made by the noble Lord may indeed be sensible and affordable, so I will take it back to the department. There are clearly concerns about the dental deserts, some of which may be resolved by negotiations with the British Dental Association, work practices, incentives and training. Can you train dentists and dental technicians close to those dental deserts, so that they stay there afterwards?

NHS Dentistry

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure the right reverend Prelate will acknowledge that one of the things we have learned from Covid, the lockdown and its subsequent impact has been about the health inequalities that exist across the country. Both my right honourable friend the Secretary of State for Health and I believe strongly in tackling inequalities; that is one of the reasons why we are keen that this comes to the forefront of the forthcoming Health and Care Bill. But we acknowledge the inequalities and are working with the NHS and the BDA to address them.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is the Minister aware that, as a child of a working-class family in the 1940s, I was given a periodic free check on my teeth, as were all children alongside me at my school? Is it not a shame now, when we talk about inequalities and levelling up, that such a facility is not available for working-class children in this country? When will the Government, with their policy of levelling up, set out a programme that ensures an annual check on the teeth of all schoolchildren, regardless of their background?

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion, which I will take back. The BDA, the NHS and the Department of Health and Social Care are well aware that we need to tackle a raft of health inequalities in this country, including in dental care. The Covid pandemic has highlighted some of those inequalities, and so we can focus on them.

Sugar

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Monday 24th January 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what assessment they have made of the effect of sugar on health in England; and what steps they will take to reduce its consumption.

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

My Lords, consuming too much sugar can lead to weight gain, which in turn increases the risk of serious diseases such as cancer, heart disease, type 2 diabetes and Covid-19. It also increases the risk of tooth decay. Through the healthy weight strategy, we are delivering a sugar reduction and reformulation programme, including the soft drinks industry levy, and legislating to restrict the promotion and advertising of products high in fat, salt, and sugar.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for his reply. He would agree that we need a suite of different approaches—

[Lord Brooke of Alverthorpe (Lab)]

—to try to make some headway. One of the great successes has been the sugar tax, yet the Government, for reasons which he previously explained, have decided not to extend it over a wider front because of unforeseen contingencies which created problems. Would he examine the prospect of taxing those unforeseen consequences so that the major driver for changing behaviour—pricing—will start to deliver the real results for us?

[Lord Kamall (Con)]

I thank the noble Lord for what I am sure was his unintended pun. I will try not to sugar-coat my response too much. We will see who can descend to the worst pun by the end.

We take seriously the issue of unintended consequences. As the noble Lord has rightly said, there has been evidence of people deciding to go to a different brand. In the case of Irn-Bru, it introduced a newer version, which I think it called “Irn-Bru 1901”, which has in fact a higher sugar content. We are very aware of that, which is why all the measures that we take must be evidence based.

HIV and AIDS

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an incredible point. Not many people are aware that there is no cure as such yet. It is about ensuring that you reduce the risk of transmission and that those who contract HIV can live longer, as opposed to the beginning of the 1980s, when this epidemic hit us, and sadly many people lost friends, loved ones and others prematurely. On looking for a cure, I assure the noble Lord that the department is very aware of that. In my briefing for this I asked how come we still do not have a cure after so long—a question that continues to be asked. Let us pay credit to the pharmaceutical industry and the medical profession. They have tried.

[Lord Brooke of Alverthorpe (Lab)]

What steps are being taken with those members of the Commonwealth who have difficulties accepting or supporting the gay community?

[Lord Kamall (Con)]

The noble Lord makes a very important point that we should be aware of and address. We are aware of certain countries—I have been warned not to name and shame them, sadly—which stigmatise, discriminate, or have some other explanation. One of the best ways to deal with this sometimes is not via government-to-government help but by ensuring that we get to NGOs that are working with people on the ground. Also, at the macro level, in international forums, we can raise this issue. The UK, to its credit, is seen as a world leader when raising these issues at different diplomatic forums.

Alcohol Duties

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Tuesday 2nd November 2021 Lords Chamber

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

The reform of alcohol duties will simplify duty rules and tax drinks in proportion to their alcohol content. This should create a financial incentive for manufacturers to reformulate their products, therefore giving consumers a greater choice of lower-strength products. This would support individuals to drink within the Chief Medical Officer’s guidelines. The Office for Health Improvement and Disparities plans to make an assessment of the potential impact of these proposals on consumption and associated harms.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I regret that the Minister has not actually answered the Question. All the evidence indicates that if the price of alcohol goes up, people drink less and are healthier. If the price of alcohol goes down or the duty goes down, people in fact drink more. More people go into hospital and more people die. Instead of relying on the industry to decide whether manufacturers will reformulate their drinks, as the Minister just indicated, the Government should take a firm lead and put the health of the nation first. They should not be handing out a £3 billion cut in this way. Will the Minister please go back to the Chancellor and tell him that we need a policy that will lead to better health, not worse?

[Lord Kamall (Con)]

Many public health officials, for many years, have criticised the system of alcohol taxation, particularly the EU’s system of taxation. Now that we have left the EU, we are free to set our own law in this area. Given the criticisms from the World Health Organization and many other think tanks, we can now set taxation based on the volume of alcohol.

Health: Type 2 Diabetes

Debate between Lord Kamall and Lord Brooke of Alverthorpe

Tuesday 12th October 2021 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what assessment they have made of the data analysis by Diabetes UK, published on 6 October, which suggests that one in three adults in the United Kingdom could be at increased risk of developing type 2 diabetes by 2030.

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

I thank noble Lords for giving me a pause for breath; I appreciate the patience they have shown me today. The Government welcome Diabetes UK’s research in increasing our understanding of diabetes and are committed to reducing and preventing type 2 diabetes, particularly in those groups who are more at risk of developing it and face poorer outcomes. This is why the Government launched the NHS diabetes prevention programme and the healthy weight strategy to look at ways to tackle weight gain and reduce children’s exposure to high-fat and high-sugar foods, including using digital tools to reach key groups.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that reply and welcome him to his new post. He has had a baptism of fire today and has come through reasonably well—so far. We wish him well and good health too. Does he agree that one of the major and most successful initiatives of recent years was Mrs May’s move in 2018 to introduce a sugar tax on fizzy drinks? Employers have been persuaded to reformulate their product. Will the Government now extend that taxation over a wider front on food and drinks? Can they start giving some thought to possibly following the substance of that approach on fat and see whether we can move towards taxing it?

[Lord Kamall (Con)]

I first thank the noble Lord very much for his warm welcome and his modest appraisal of my performance thus far. I am told that, coming from him, that is high praise indeed; he may disagree afterwards. As he knows, the Government are committed to this, but one thing we always have to look at in introducing new laws, bans or taxes is unintended consequences. Before I came to this role, I read some research which said that there were unintended consequences of some of the sugar taxes; for example, did they force people from poorer families or poorer communities to buy alternative, cheaper brands of the same drinks with the same sugar content, or did they just take the hit to their pockets and pay more? Were the outcomes any better? When looking at some of the programmes being put in place to tackle type 2 diabetes and the taxes proposed, it is important that we make sure it is all evidence-based and work out whether there are unintended consequences. If there are, we must find other ways to make sure we tackle obesity and some of the other issues that lead to type 2 diabetes.