Private Low-carbon Investment: Green Finance Institute Report

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 9th December 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness is right to raise new homes but part of the issue we have is that we have the oldest housing stock in Europe and a third of our housing was built before World War II. As far as her question is concerned, I can tell her that the Ministry of Housing, Communities and Local Government has indicated that it is working on future standards. These will set new homes and buildings on a path that moves away from relying on volatile fossil fuel markets and ensures that they are fit for a net-zero future. This is likely to see a mix of low-carbon technologies used for heating, including heat pumps and heat networks. Of course, the point the noble Baroness raises is an important one.

[Lord Kamall (Con)]

The Minister raised international comparisons and learning from other countries. He also said—I cannot remember his exact words—that in the United States residential market, property-linked finance has not always been successful or well taken up. Can the Minister explain some of the reasons for that and what his department has learned from that experience in the United States residential market?

[Lord Hunt of Kings Heath (Lab)]

My Lords, one of the issues is that home owners did not really understand what they were signing up to. In California, for instance, the state enacted a preservation and consumer protection Act, which led to an almost 90% decline in originations. More generally, the Green Deal that the coalition Government brought in shows some of the problems. First, the interest rates on offer were not sufficiently competitive; secondly, it was very complex to make an application; and, thirdly, there were lots of allegations of mis-selling. Given all that, the Government withdrew it. We need to learn a lot of lessons if we are going to make progress.

It is thought that currently owners are deterred from making a major investment in energy-efficiency improvements because they do not expect to live in the home for a sufficient length of time to get the money back through energy efficiency. The whole point about the GFI proposal is for longer-term loans that are assigned to the property, to keep interest rates low and give people a much better opportunity to make this investment.

Youth Sport Trust Report

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 11th October 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, is the Minister aware that during the Covid pandemic, it is estimated that over 200 swimming pools were closed, never to reopen? Given the impact on young people’s ability to swim, can he assure me that in the latest round of cuts that the Treasury is insisting that Whitehall embark upon to enable the ludicrous mini-Budget to develop he will protect children’s sports facilities?

[Lord Kamall (Con)]

My department is having a number of conversations, particularly on the issue that the noble Lord raises, but also on understanding the challenges of rising energy prices and those that the sector faces. In September, the Government announced an energy bill relief scheme offering support, and during the pandemic the Government prioritised physical activity, providing £1 billion of financial support to sport and leisure. We will continue to review that to make sure that we are targeting that support as effectively as possible.

NHS: Access to Treatments

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 7th September 2022 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they are taking to improve access to treatments for NHS patients.

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

To improve access to treatment, the Government have committed to spend over £8 billion from 2022 to 2025, and this in addition to the £2 billion elective recovery fund and £700 million targeted investment fund made available last year. This funding is increasing capacity through community diagnostic centres and surgical hubs, supporting hospitals to prioritise treating the patients waiting longest, as well as accessing capacity via the independent sector. We are also making it easier for patients to choose treatment at different providers with shorter waiting times.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord will be aware that access to the NHS, whether in primary care, the ambulance service, A&E or discharge, has become worse and worse. All the organisations that submitted evidence this week said that the core issue is workforce. I declare my interest as a member of the GMC. Can the Minister explain why has the number of medical training places this year been drastically reduced to 7,500 compared to 10,500 for last two years, and 9,500 in the pre-Covid year? The Medical Schools Council has said that we should have 14,500 medical places. How can the Minister justify 7,500?

[Lord Kamall (Con)]

We are looking at a number of different things when it comes to doctors across the service. One is clearly opening new medical schools in areas which are underserved: sometimes we have doctors, but not in the right areas. We are also looking at overseas recruitment but, on the specific issues, we are having discussions—let us put it that way—on the cap. That is constantly being debated and I will take that back to the department.

Integrated Care Boards

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 5th September 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. The last I was aware of—and I shall look at it and write to my noble friend—was that, under the visa scheme, we were looking to bring in people from overseas to fill those vacancies. We have historically done that; as I said, after the war we looked to people from the Commonwealth, who came and saved our public services. Clearly, when we are unable to recruit enough people locally, we have to look at those issues and at whether it is something to do with the education system, and whether we can encourage them to come forward. But where there are gaps we will have to look more widely to our partners around the world.

[Lord Hunt of Kings Heath (Lab)]

My Lords, when the Minister took the Bill through the House, he argued that a restructuring was necessary to integrate services, yet outside every acute hospital dozens of ambulances are stacked up every day, often waiting for hours with patients inside, because we have a disintegrated system. Can he show me what the integrated care boards are doing today to end that dreadful practice?

[Lord Kamall (Con)]

One priority of my right honourable friend the Secretary of State—I think he is still the Secretary of State—has been to look at the ambulance system. On a wall in his office, he has all the various things; he has talked to various partners and he has brought people together to see what the problems are, why we are unable to unload patients into hospitals, what the blockages are and how we can address this from a systemic view.

Coronavirus: New Cases

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

The noble and gallant Lord makes a very important point: we have to continue with the living with Covid strategy, and keep an eye on the Covid cases, but also be aware that we need to clear the backlog, and that people have missed appointments. One of the things we are doing is looking more at diagnostics. Many noble Lords will be aware that about 80% of the waiting list is people waiting for diagnosis. Of those waiting for surgery, about 80% of them do not need to stay overnight in hospital. We want to make sure that we get the right balance between monitoring what is going on with Covid and at the same time clearing the backlog.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord just talked about clearing the backlog. He said earlier that the incidence rise is now leading to increased hospitalisations. What impact is that having on the backlog?

[Lord Kamall (Con)]

I asked that very same question when I had the briefing with UKHSA officials earlier, and they said they are still focusing on the backlog. If it gets to a point where it is affecting the backlog, clearly measures may well have to be introduced.

Thyroid Patients: Liothyronine

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 6th July 2022 Lords Chamber

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

My Lords, I am still here. While levothyroxine is the first-line treatment for hypothyroidism, guidance published by NHS England is already clear that prescribing liothyronine is clinically appropriate for individual patients who may not respond to levothyroxine alone. NHS England is currently reviewing its guidance. As part of the engagement exercise, patient groups and other key stakeholders have been contacted to provide feedback and will be involved in this refresh.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am relieved that the noble Lord is still here to answer this Question. I am grateful for what he said, but he will know that, for a certain group of patients, T3 is highly effective and much more effective than the normal medication that is given. There was a huge price hike a few years ago, and as a result the NHS restricted access; the price has come down, but, unfortunately, access is still restricted. In some parts of the country, patients cannot get prescribed it. Will the noble Lord, rather than relying on advisers, intervene and tell the NHS to stop this postcode lottery?

[Lord Kamall (Con)]

NHS England is currently consulting on this revision, for much the same reasons that the noble Lord acknowledges. At the moment, liothyronine is a second-line treatment when the other one cannot be used or is not appropriate. At a local level, doctors should be advised that they are able to prescribe it. Clearly, that is not getting through. When we went to NHS England with this, it recognised this and said that there will be a consultation.

Vaccinations

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 15th June 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, on behalf of the noble Baroness, Lady Greengross, I beg leave to ask the Question standing in my name on the Order Paper.

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

We have seen high levels of Covid-19 vaccine uptake by being flexible and innovative in how we get vaccinations into patients’ arms and being supported by strong national and targeted communications and community-led initiatives. We have sought to learn lessons from the rollout and the NHS is working collaboratively with partners to design future NHS vaccination services for Covid-19 vaccines and other vaccination and immunisation programmes, considering how we can better use data to improve access to information.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. One of lessons of the pandemic was that flu vaccines were given free to people aged between 50 and 64. The Government have said that from next autumn people will have to pay. The Minister will be aware that vaccination rates around the world, particularly in Australia, have increased dramatically. Will he reconsider this policy, given that we need to encourage that age group to have the vaccine?

[Lord Kamall (Con)]

The noble Lord is absolutely right; we have received advice on the flu vaccine and at the moment it is free to those aged 65 and over. The issue, frankly, is balancing resources. A number of people in the system are saying that if you keep mandating vaccines, it means they cannot get on with tackling the elective backlog. On balance, at the moment it seems better to focus on the elective backlog, but UKHSA and others are monitoring the situation very closely.

GP Access

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 7th June 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I remind the House of my interest as a member of the General Medical Council.

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

The Government remain committed to improving access to general practice. This will be done by increasing capacity to deliver appointments. We spent £520 million to improve access and expand general practice capacity during the pandemic. This was in addition to £1.5 billion announced in 2020 to create an additional 50 million general practice appointments by 2024. To help manage demand and help patients to get timely access, we have improved the telephone system available for all practices. This improved functionality has helped them to free up existing phone lines for incoming calls and is available at no additional costs to practices until the end of April 2023 while we work on long-term solutions.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister’s Answer seems a long way from the reality. Every day, patients have great difficulty in getting access to their GPs. It is also clear that the profession is highly demoralised, with many wanting to retire early. Only a few weeks ago, this House voted to ask the Government to develop a long-term workforce strategy, funded for the NHS. Why did the Government consistently turn that down?

[Lord Kamall (Con)]

I am sure the noble Lord will remember from the debates on the Health and Care Bill that that Act provides for workforce plans every five years. In addition, Health Education England has been commissioned to do work on workforce needs of a much more decentralised nature, rather than top-down from Whitehall and Westminster: at the trust level and the CCG level and, in future, at the ICS level to look at needs and the mix of skills that are needed to serve local populations.

North East Ambulance Service

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

Noble Lords are absolutely right to talk about the culture. Years ago, during my academic career, I looked at organisational change; one of the very difficult issues is that while you can change structures and processes, it is about how you address the culture. Quite often in organisational change, or any change, there is a cultural lag. Sometimes the lag is due to individual values and sometimes it is much more widespread than that, and there are questions about how the culture grew in the first place and how to address those roots. Sometimes it is about personnel change and sometimes it is about retraining. There are a number of issues when it comes to changing culture, which is quite often more difficult than structural change.

The Government have been clear, as has the NHS, that there are clear guidelines around the use of NDAs by the NHS, including that it should not prevent staff speaking up about concerns relating to the quality or safety of care. It will be important for us to discuss all the issues further with the trust, the CQC and others, to determine the appropriate steps to take from here, including on NDAs.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister makes a very interesting point about culture but does he not think that, whatever review is undertaken, it needs to look further? If this is proven to be so, what are the reasons why management would seek to take the action that it did, and to what extent is pressure on managers from higher up the system causing them to cover up because of punitive action? In other words, does he agree that the culture is set by Ministers at the top? If they deal with the health service in a punitive way, as they have often done over many years, they should not be surprised if the system responds by seeking to cover up what has been happening.

[Lord Kamall (Con)]

I recognise that the noble Lord was a Health Minister but I must say that, in my time as a Health Minister, I have never found it to be an adversarial relationship but always quite co-operative. In conversations that I have had with individuals I have met in the NHS, they have been quite clear that I have no power over them, as it were, but that we can discuss concerns—although, clearly, the Secretary of State does exercise certain powers. However, the culture goes deeper than this and the noble Lord is absolutely right to suggest that we have to understand the roots of that culture and the incentives and disincentives to certain behaviour. I am sure that this will all be looked at as we try to learn what went wrong in this case.

National Institute for Health and Care Excellence

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes an important point about how this fits into the life sciences vision, and NICE is very aware of it. In fact, only last week, I saw a draft business case for NICE for future years, and it takes on board the very point the noble Baroness refers to. NICE is looking at making sure that is has more timely advice and that it can respond quickly; it has also increased capacity, not only for conditions like this but for more digital devices.

[Lord Hunt of Kings Heath (Lab)]

Can the noble Lord explain what he means by a more proportionate response? Does that mean that NICE is reducing the number of stages that are involved in this process? Is it going to increase the capacity it has? How is it going to actually deliver the improvements that the noble Lord has explained?

St George’s Hospital: Patient Deaths

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 18th May 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and in so doing declare an interest as a member of the GMC.

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

NHS England and Improvement will review the coroner’s prevention of future death reports and respond within the agreed timescales. The coroner’s investigations are ongoing. The Government are committed to improving the standard of investigations into serious patient safety incidents in the NHS to create a culture of learning from mistakes and to improve patient safety.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. This is a serious issue. An independent review into cardiac surgery at St George’s Hospital found evidence of shortcomings and a number of avoidable deaths. This finding has been totally contradicted by the senior coroner for inner west London, who found the methodology used in the review completely flawed and said of a particular case that the coroner was dealing with that the doctor’s approach had been without reproach. Given the review that will now be undertaken, does the Minister accept that, if the coroner is right, the whole method used by the NHS for these reviews will come under question?

[Lord Kamall (Con)]

I understand the premise behind the assertion and the Question but, as I explained to the noble Lord yesterday, a number of issues are ongoing—the coroner’s inquest, an employment tribunal and a number of other reviews—which, sadly, I am not allowed to comment on. However, I can say at the moment that we are committed to improving the standard of patient safety investigations. We have set up the independent patient safety investigation service and HSSIB to look at this, as the noble Lord will know from the Bill, and we have a number of independent investigations guidance for standard operating procedures by NHS England and Improvement for teams to use.

Folic Acid Fortification

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 6th April 2022 Lords Chamber

[Lord Kamall (Con)]

Call me old-fashioned, but I anticipated that there would be questions about further delays. When I asked the officials about this, I was advised that once the Northern Ireland elections were out of the way, they could get on with the consultation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to come back to the level of fortification. There are rumours that the Government are going for a minimal level which will not be very effective. My understanding is that the most up-to-date research shows that folic acid is not at all harmful. Therefore, will he assure me that the technical working group that he is going to take forward at some point will look to implement a level that is going to be effective?

[Lord Kamall (Con)]

I understand the noble Lord’s question but the expert Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has advised on the level of fortification needed to prevent neural tube defects. It wants a level that is not considered to pose a risk to health. The advice it has at the moment is that supplementation of folic acid can mask underlying vitamin B12 deficiencies, particularly in older adults. If noble Lords with medical experience disagree, I will be very happy to facilitate a meeting with my officials.

Care Homes: Evicted Residents

Debate between Lord Kamall and Lord Hunt of Kings Heath

Thursday 10th March 2022 Lords Chamber

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

It is unacceptable for a care home to punish a resident for raising concerns. This would be a breach of existing regulations, and the CQC will investigate any such cases. Although the Government do not collect figures on this, the CQC collects data on care home evictions and seeks assurances that visits are allowed by care homes on an ongoing basis. We are exploring ways to improve the complaints system and the quality of care.

[Lord Hunt of Kings Heath (Lab)]

My Lords, may I urge the Minister to do even more than he suggested today? We know that some care homes are still being very highly restrictive on visits. The Alzheimer’s Society, the Relatives and Residents Association and other organisations report that many relatives are frightened to go through the homes complaints system for fear of reprisals such as visit bans, or even evictions in the most extreme cases. The CQC will not investigate specific complaints. Will he change that policy and give support to relatives who wish to make legitimate complaints?

[Lord Kamall (Con)]

I thank the noble Lord for raising this issue. I am sure he will recognise, from when we have worked together on a problem, that the first question I ask officials is: what is the problem and what are we doing about it? When I asked this question, I found that my colleague Gillian Keegan, Minister for Care and Mental Health, has met relatives and residents’ associations to hear directly about their experiences and focus on how we could strengthen the CQC role. In addition, in the Living with Covid-19 strategy, we are reviewing a range of measures in place for homes, including visitor restrictions. The updated position will be set out in guidance by 1 April. We are encouraging representatives, patients and patients’ groups to come forward and feed into that.

Organ Tourism and Cadavers on Display Bill [HL]

Debate between Lord Kamall and Lord Hunt of Kings Heath

3rd reading
Friday 4th March 2022 Lords Chamber

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

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.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to my noble friend Lady Merron for her kind remarks, and to the Minister, who has given up quite a lot of time to allow us to discuss this. As he knows, I do not agree with the Government’s conclusion. He is very busy at the moment with Report stage of the Health and Social Care Bill, and he has much to contemplate over the weekend. I just hope that he may undertake a conversion when it comes to my Amendment 162, and that next week, he will be sympathetic.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for clarifying that. Of course, we completely understand the concerns that have been raised. The Secretary of State must use regulation-making powers where they exist, rather than using the power of direction to achieve what could be achieved under regulations.

Turning to the allocation of resources to the ICBs, the Government have no ambition to use this power to interfere with individual allocations of money to the system. It will not be used to interfere with the independent Advisory Committee on Resource Allocation. NHS England will continue to make funding allocations to ICBs to support them to deliver functions via the target formula, in order to reduce inequalities between patients. We have attached safeguards to this power to make sure it is not misused. Any exercise of this power must be done transparently: it must be made in writing, be published and be made in the public interest. This will enable Parliament to challenge Ministers and hold them to account.

Turning to Amendment 84, Clause 40 and Schedule 6 will allow the Secretary of State to better support effective change and respond to stakeholder concerns, including views from the public, health oversight and scrutiny committees and parliamentarians, in a more timely way. The clause and schedule will ensure that key decisions made about how services are delivered are subject to democratic oversight.

It is a misapprehension that the Secretary of State currently has no role in the decision-making process for reconfigurations. He does and without these provisions that role will continue. However, currently, referrals usually come at a very late stage in the process, which represents neither good value for the taxpayer nor good outcomes for patients.

I understand the concerns from noble Lords, including former Ministers, about how these powers might be used. But I have been asked to make clear that we expect the vast majority of reconfiguration decisions to continue to be managed by the local system—

[Lord Hunt of Kings Heath (Lab)]

I am sorry to interrupt, but does the Minister not take my point that it is not that Ministers will have to use those powers; it is that they have powers that will change behaviour immediately in the health service? That is the issue.

[Baroness Walmsley (LD)]

Before the Minister answers that question, I wonder if he would be kind enough to answer two from me. He just gave a list of what the powers will not be used for, but could he tell us what sort of thing the powers will be used for and under what circumstances? Can he also say why previous Secretaries of State—some of whom are not very far from where I am standing now—did not feel the need for those powers and still felt themselves accountable for the health service?

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

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

[Lord Kamall (Con)]

My Lords, despite what the noble Baroness, Lady Thornton, said at the beginning about this perhaps being the end of the harmonious start to our debates so far, I feel that this has been a helpful and constructive debate. I am grateful to noble Lords for bringing these issues before the House.

Let me start with Amendment 9, as I understand the wide interest in the membership of the committees of the board and potential conflicts of interest. We firmly agree that conflicts of interest must be handled carefully, and have included multiple references to that in the Bill. We also recognise the concern that ICBs should not allow private providers to control commissioning decisions, which is why we added the amendment relating to private providers in the other place, in paragraph 4 of Schedule 2.

Furthermore, in the helpful discussions we have had with noble Lords since then, there has been mutual recognition that we need to balance the importance of protecting the core values and public nature of the NHS while not overly restricting the membership of ICBs. I am pleased that the amendment to Schedule 2 balances on that tightrope and gives appropriate reassurance. We think that it is reasonable to allow private providers and social enterprises to sit on some committees and sub-committees of the ICB, as barring them risks blocking sensible integration and joint working.

I am also aware of the mixed reactions to this amendment from stakeholders. Many noble Lords will have seen the NHS Providers Report stage briefing, which states that

“there could be circumstances where a local private or voluntary sector provider would be well placed to join a joint committee with a focus on integrated service delivery whereby the usual arrangements to identify and manage conflicts of interest would, and should, apply.”

It goes on to say:

“It does not seem reasonable … therefore to further restrict the membership of those committees in a way which is prescriptive in law.”


Further, the NHS Confederation stated in its Report stage briefing that this amendment

“risks critically undermining integration by reinforcing a rigid, out-dated purchaser-provider split and derailing the fundamental purpose of these reforms.”

As it so eloquently put it:

“The current reforms aim to facilitate collaborative working by bringing all partners in local areas around the table to plan the most effective and the most efficient way to deliver care. This, by its nature, involves bringing providers of services, alongside commissioners, into committees and sub-committees of the ICB to plan how care is delivered”.


Potential conflicts of interest are inevitable in commissioning, especially when we are looking to increase integration and bring multiple bodies together. The ICBs will be required to manage conflicts of interest as part of their day-to-day activities. That is set out in the Bill and will be part of their constitution as well.

For all committees, the board of the ICB will have to determine what functions they exercise, their membership, and the level of oversight of their decisions. The board of the ICB cannot delegate a function and claim to be no longer responsible for how it is discharged, and will be held to account for this by NHS England.

Also, ICBs will be clear and transparent about interests, and how they are being managed. We think that transparency will prevent poor decision-making. New Section 14Z30 makes it clear that an ICB must maintain and give public access to a register of interests for members of its committees or sub-committees. There must be arrangements in place to ensure that conflicts are managed not just for ICB members but within committees. The constitution of the ICB must also include the arrangements to be made to discharge the functions under new Section 14Z30 and a statement of principles to be followed by the board in this regard. This will all be supported by guidance from NHS England. We are quite determined to tackle conflicts head on and not shy away from this issue.

[Lord Hunt of Kings Heath (Lab)]

My Lords, if NHS England is determined to tackle conflicts of interest head on, why is it building them into the whole structure of integrated care boards? Let us think about an integrated care board discussing future strategy: it would inevitably discuss where the priorities will be. That inevitably means that money will follow the priorities. At what point in those discussions do the major providers, who will be sitting round the table, have to withdraw from because of a conflict of interest? At heart, this ambiguity is built in, so it is not surprising that my noble friend wants to see consistency right through the system, including the sub-committees.

[Lord Kamall (Con)]

I thank the noble Lord for that intervention because I was just about to come to it. I should add that new Section 14Z30 very clearly requires ICBs to manage conflicts of interest at sub-committee level.

We think that the approach we have outlined will be more appropriate and possibly more effective than simply barring individuals with a conflict of interest—which, I encourage noble Lords to note, would also include NHS Providers and local authorities— from all committees with a commissioning function. First, this approach is broader than what the noble Baronesses might have intended. Secondly, many committees will have a range of functions, and commissioning may be only a small part of their activity. This approach risks creating a series of duplicated committees with similar interests to enable commissioning decisions to be taken in line with the amendment. This risks undermining one of the very purposes of this reform: to reduce bureaucracy and increase integration.

On Amendment 10A, we are clear that chief executive pay should be value for money. The pay framework is based on our ability to attract the highest-quality candidates. ICB roles, such as the chief executive, are some of the more complex in the health system. Experienced chief executives of trusts already exceed the suggested £150,000 per annum remuneration. Therefore, we do not believe it would be realistic to expect them to take a pay cut to take up a role with such a portfolio.

I remind noble Lords that putting the salary of an ICB chief executive into the Bill would be inappropriate. Such a lack of flexibility would be extremely unusual for a senior position and risks salaries declining in value over time, precisely as ICBs take on more responsibility as they become more established. This would fundamentally weaken ICBs’ ability to recruit and retain senior management. I also warn that directly tying pay to performance is likely to make it significantly harder to recruit chief executives to more challenging ICBs—precisely the organisations that we would want to recruit the very best leaders.

I hope I can reassure noble Lords that the recruitment process will ensure that only the most qualified people can take up these roles. All ICB chief executive appointees across England need to demonstrate how they meet—

Covid-19: Lateral Flow Tests

Debate between Lord Kamall and Lord Hunt of Kings Heath

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I must say to my noble friend that I was not aware of that, and therefore I will have to go back to the department. If he could write to me about that, I will be happy to respond.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the Minister say how many British companies are caught in this and waiting for approval? Can he also say how many billions of pounds we have spent importing these tests from China?

[Lord Kamall (Con)]

I will try my best to answer the questions, but if I do not, I hope the noble Lord will accept a written response. Some 25% of approved devices are from UK manufacturers, but it is important, as a fair and neutral regulator of market access that all applicants are treated equally. The Government are working to review applications for devices submitted by the process. At the same time, while we want to make sure that the British tests are of the highest standard, we are determined to harness the power of the UK’s leading diagnostic industry. We will continue to be enormously engaged with UK manufacturers and trade bodies to support a thriving domestic diagnostic industry.

Elective Care Recovery

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 7th February 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, will the plan contain workforce assumptions? In particular, what will it say about the retention of current staff, the recruitment of more staff and more training places?

[Lord Kamall (Con)]

The noble Lord rightly raises the issue of our brilliant workforce, who are at the heart of our plans for recovering services. The NHS’s delivery plans are focused on how we can transform these services and do things differently, not just asking staff to do more of the same. The monthly workforce statistics for November 2021 show that a record number of staff are working in the NHS, with over 1.2 million full-time-equivalent staff, which is over 1.3 million in headcount. This includes record numbers of doctors and nurses. In addition, we are recruiting new staff and focusing on different recruitment programmes and on retention, which many noble Lords have raised. We want to make sure that the excellent staff in our health system are happy and kept happy.

NHS Dentistry

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 31st January 2022 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government, further to Healthwatch England’s report What people have told us about NHS dentistry, published on 20 December 2021, what steps they are taking to address the issues faced by those attempting to access NHS dental care.

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

Practices are currently prioritising patients based on clinical need, and a new activity threshold has been set at 85% to safely increase access. A one-off additional £50 million, recently secured for NHS dental services this financial year, will urgently give more people, including children and others who are vulnerable, access to vital dental care. We are working with the NHS, Health Education England and the British Dental Association to improve access through dental system reform.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the £50 million one-off payment for 350,000 appointments is a drop in the ocean compared to the 38 million appointments that have been lost during Covid. The Healthwatch report shows that parents are having great difficulty accessing NHS dentistry for their children, who may be suffering pain and unable to eat, and we know about adults who are indulging in self-care because they cannot find an NHS dentist. When will the Government get to grips with this problem and develop a proper strategy for dealing with it?

[Lord Kamall (Con)]

As the noble Lord will know, anyone can have access to an NHS dentist—they do not have to be registered with the practice in question—and when they are unable to find a practice, they can ring 111 to get information. In addition, over 700 urgent dental care centres remain open across the country.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Kamall (Con)]

The Secretary of State will be advised by the Independent Reconfiguration Panel, especially where there is a difficult decision that takes time, just as in the case of the Medway.

On Amendment 182, the Secretary of State’s decision-making process must already take into account the public law decision-making principles, all relevant information and his legal duties, including the public sector equality duty. The Secretary of State is also under several duties in the National Health Service Act 2006, including to promote a comprehensive health service and to support continuous improvement in services.

[Lord Hunt of Kings Heath (Lab)]

There are a lot of marginal seats, and there is going to be a general election in two and a half years—maximum. A lot of the reconfiguration proposals usually relate to smaller places with smaller hospital or DGHs because their viability is often in doubt. So it is quite clear to me that any MP, particularly government MPs, will immediately take any threat of that sort to their local services to the Secretary of State. That will not speed up the process; it will guarantee the opposite. The signal that I would get from the health service as a result of this is: “Forget reconfiguration proposals until after the next election because you ain’t going to get any through.” That is why we think this is a disastrous move.

When the Minister says there will not be many interventions, that is just nonsense. The moment that MPs know the Secretary of State has the power to intervene at any stage, they will be knocking at the door of the Government, who will wilt under that pressure, because that is what happens. Then they will go back and say, “We need to have an independent review of that before you start the process.” There are so many dodges available to a Minister, if you want to dodge making a hard decision in this area, that it will completely paralyse the health service. That is why this debate is so important because it is related to the last one; the result of Ministers gaining direct control will be to delay and reverse, and I am afraid that the hopes that Ministers have for a dynamic, forward-looking health service will come to nothing.

[Lord Warner (CB)]

My Lords, following on from the noble Lord, Lord Hunt, I ask the Minister to consider the point that I was trying to make about Amendment 183. The Minister and the Government have got this the wrong way round: if he is actually concerned about levels of efficiency, the supply of services and the issue of scale—and the issue of scale is a very real one—then he needs to be at the front of the process, not the end of it. It is a bit late in the day to be having these ideas about scale in a particular set of services when you have gone through the agony of the local consideration of reconfigurations. As a Minister, it would be better, if I may say so, to set out your views at the beginning with the clinical arguments for why this makes sense. Doing it at the end is bound to lead to suspicions. That is why I was asking the noble Baroness, Lady Cumberlege, to look at the wording of Amendment 183. I say to the Minister that he is putting his involvement at the wrong part of the process.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Kamall (Con)]

If my noble friend will allow me, I will have to consider that and write, and make that available to all noble Lords.

We have included a number of exceptions to the power of direction in the Bill to ensure that the Secretary of State is not able to intervene in day-to-day operational matters. For example, there is no intention to use the power to direct NHS England on procurement matters.

On Clause 64, the rationale for removing these duties is twofold. First, the pandemic has highlighted the importance of different parts of the health and care system working together. The clause removes some barriers in legislation that hinder collaboration between system partners. It facilitates collaboration between NHS England and system partners and enables broader thinking about the interests of the wider health system. Secondly, removing the Secretary of State’s duty to promote autonomy will put increased accountability at the heart of the Bill.

Overall, these clauses encompass flexibility, allowing Ministers to act quickly and set direction, while balanced with safeguards and transparency requirements to ensure that they can be held to account. I understand that there are a number of concerns about this group of amendments and others. I am sure we will have a number of discussions, but in the meantime, I ask noble Lords not to press their amendments.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this has been a very significant debate, because when the Minister referred to the fact that Ministers needed to have the answers, I realised that the intention is to go back to command and control from the centre. It was quite clear: that is the intention. I think that is very depressing, because I do not believe that the NHS is going to benefit at all. When he said that this will strengthen local accountability—oh no, it will not. There is no local accountability whatever in this structure. I am sorry to say this again, but the fact that the Government are taking local authority councillors out of ICBs is a visible demonstration that this is a centrally driven health service from the Department of Health.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Kamall (Con)]

They were. Good. I got the answer just in time.

I will turn to Amendment 147, which would mandate a role for a member drawn from each area of primary care. With all amendments relating to the ICP membership, we want to be careful to give space for local areas to find a model of membership that works best for them. As the noble Lord, Lord Stevens of Birmingham, raised at Second Reading, it is right that in a country as large and diverse as ours, one size will not fit all. Therefore, it is right that local areas should be able to determine the model and membership that best represent their area.

We fully expect primary care professionals to be involved in the work of ICPs. Each partnership will need to involve a wide range of organisations and representatives from across the system, including professionals from primary medical, dental, pharmaceutical and optical backgrounds as they prepare their strategy. The department has published a draft list of representatives for ICPs to consider involving, which includes clinical and professional experts, including those from medical, dental, pharmaceutical and ophthalmic settings. The mechanism of how this is done will be down to local discretion. For example, one ICP may wish to formally appoint certain members, whereas a neighbouring ICP may wish to have an extensive range of consultees, and a third may decide to invite primary care representatives to join a subcommittee instead. We believe it is right that local areas are able to determine the model of partnership that best works for them, and this amendment would prevent that from happening.

A similar argument applies to Amendment 148. While we welcome the contribution of directors of public health and the voluntary, charity and social enterprise sector, I do think that we risk limiting the flexibility of ICPs. We expect public health experts to play a significant role, especially given their role in developing the joint strategic needs assessments that are crucial to guiding all planning, and their role in supporting, informing and guiding approaches to population health management.

Similarly, we expect appropriate representation from the voluntary, charity and social enterprise sectors, which will be able to contribute in respect of a number of different interests and perspectives. A number of noble Lords have spoken very eloquently about the reasons we should involve these sectors. We believe it would not be prudent, for example, to suggest that it may be appropriate for only one person to represent the local voluntary sector on a partnership, given the diversity of their involvement in health and social care.

I turn to Amendment 150, tabled by the noble Lord, Lord Davies of Brixton, and I also thank the noble Baroness, Lady Thornton, for her advice on that. I appreciate that the noble Lord might want to prevent anyone who works for, represents, or has a financial interest in a private health and care company, from being a member of an ICP. However, I would draw the noble Lord’s attention specifically to the recent experience of coronavirus, which showed that independent and voluntary providers were a vital part of the health and care picture. This amendment could exclude a significant part of the health and care sector, as the noble Baroness, Lady Thornton, rightly said. Given their scale and the central role they play, adult social care providers in particular would be potentially useful members of an ICP. It also risks leaving out, for example, dentists, pharmacists, opticians and many others working in primary care, and doctors other than GPs who work both in the NHS and privately.

We expect every ICP to have robust measures to ensure that formal conflicts of interest are managed carefully and transparently. It is also important to note that ICPs, as the noble Baroness, Lady Thornton, says, are not commissioners, and so will not be making decisions on the allocation of funds. Fundamentally, the ICP is working solely for the interests of people in the area. The experience of the health and well-being boards is helpful here, as they have similar flexibility in membership, and there have not been significant issues with conflicts of interest as they have developed their plans. We really expect the ICP strategy to be rooted in the people and communities they serve, and to be directly informed by the health and well-being boards and the joint strategic needs assessments. We are refreshing the health and well-being boards’ guidance to ensure that there are strong foundations in place at neighbourhood levels that the ICP can consult and build on.

Having said this, I thank noble Lords for their contributions on this important matter. However, as I have explained, we believe that these amendments run contrary to the principles of flexibility and subsidiarity that the Bill is based on, and therefore I hope that noble Lords will not press them.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. First, I thank my noble friend Lord Davies for his amendment. I think, notwithstanding what the Minister said about some of the technical details, the principle that he put forward is absolutely right: clearly, the consistency with ICBs that he mentioned is really important. I am also very sympathetic with the noble Baroness, Lady Walmsley, and her amendment on the importance of public health and voluntary organisations.

We come here to the principle that some of us continue to be puzzled by the architecture we see before us. The Minister says that this was consulted on and the Local Government Association is fine and dandy about it but, with respect, that is not sufficient in terms of your Lordships and the rigour and scrutiny that we need to put into this legislation. Frankly, as my noble friend Lady Thornton suggests, it looks much more like a fix between representative institutions to preserve the current arrangements as much as possible.

I remain somewhat confused about the structure. The Minister said that health and well-being boards will feed into ICPs, but why? Think about what he said about the role of integrated care partnerships; it sounded to me like the role of the health and well-being boards. I just do not understand the differences. I understand that, in some parts of the country where the ICP will cover a lot of local authorities, there is an argument that you should continue with health and well-being boards at the local level, but I do not see why they cannot be sub-committees of the integrated care partnerships; the Minister referred to that. Why on earth do we in Birmingham need a health and well-being board as well as an ICP? I simply do not understand it.

If the Minister believes that this should all be set out at the local level, why can people decide locally not to have a health and well-being board? He may say, “Ah no, you need a framework”. Our argument is that you need a framework in relation to membership as well. The compromise here might be to set out in legislation, as we will want to do, certain conditions around local governance and then leave it up to the local level. In relation to ICPs, however, we cannot leave it as it is. Having said that, I beg leave to withdraw my amendment.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Lords Hansard - Part 2 & Committee stage
Monday 24th January 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Lord will recognise, when I was appointed to this job, I did say that I wanted to consult as many previous Health Ministers as possible, as well as people who have worked in the field. It is clear from this debate that more consultation and discussion are needed, so I would welcome noble Lords’ advice. On that note, I beg that Clause 70 stand part of this Bill and hope that the noble Lord will withdraw his amendment.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the hour is late. We cannot have the extensive debate that we probably require. I shall be very brief. I should have declared an interest as president of the Health Care Supply Association, the NHS procurement professionals.

On social value, I am very grateful to the Minister because he said that guidance will be issued to the health service on this, which is gratifying. On social enterprise, my noble friend Lord Howarth, the noble Lord, Lord Warner, the noble Baronesses, Lady Bennett and Lady Walmsley, and my noble friend Lady Thornton of course, all referred to the value of social enterprises. The Minister is not convinced that we need to put anything in the Bill. The point I need to put to him is this: it is clear from intelligence from the health service what the people running what I call the shadow ICBs want. I do wonder what we are doing legislating when obviously, everything is up and running; it is very difficult to know why we are here tonight debating these issues. Clearly, the NHS wants it, so it has got it and it is Parliament’s job, presumably, to just legitimise what it is already doing.

Having said that, these integrated care boards believe that social enterprises are not to be invested in in the future. So, my appeal to the Minister is this: fine, do not put it in the Bill, but please get a message out to the 42 ICBs telling them not to be so silly as to think that they should carve social enterprises out of the new regime.

More generally, on procurement, it is very interesting to be debating with the noble Lord, Lord Lansley. We fought tooth and nail for days on Section 75 of the 2012 legislation. Along come the Government, now saying, “Oh, we’re going to get rid of it. We don’t know what we will replace it with, but it is all right because we can have some negative regulations which mean we can steam it through without any scrutiny apart from a desultory debate as a dinner-break business sometime in the future. Oh, and by the way, there’s procurement legislation coming along too, but we can’t tell you what will be in there.”

Somehow, between now and Report, collectively we need to find a way through. I confess to the noble Lord, Lord Lansley, that I am rather pleased to see Section 75 go. However, something has to be put in its place, or we will just leave the NHS to get on with it and await future regulations and legislation. One thing for sure is that the idea of leaving the Bill with Section 70 and not even accepting the noble Lord’s sensible suggestion of the super-affirmative procedure is quite remarkable, and clearly it will not run. Having said that, I beg leave to withdraw my amendment.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Committee stage
Thursday 20th January 2022 Lords Chamber

[Lord Kamall (Con)]

One of the reasons for the introduction of integrated care boards and integrated care partnerships is to give local systems, both NHS and local authorities, a platform on which to build new ways of working. That includes social care. If the noble Lord feels that this duty is not explicit enough or that we should bring it out, we should have further conversations.

[Lord Hunt of Kings Heath (Lab)]

The architecture is very curious regarding why we must have an integrated care board and integrated care partnerships. It has never been clear to me why the Government have not attempted to set up a health and care board to bring those services together. We know that the funding systems will be different and that there is a clear difference between free at the point of use and means-tested social care, but surely that is what an integrated board, jointly owned by the NHS and local government, with councillors at the table not officers, is trying to sort out. Why have we ended up with this nonsense of a structure? We are carrying on with health and well-being boards as well. That is the great puzzle here.

If the Government are not willing to move on that, we must come back to the point made by the noble Lord, Lord Scriven. By splitting it, you then must say to the integrated care board, “Ah, but in your duties, you must ensure that you integrate with social care as well.” It really is a mess. The Minister said earlier that this is what the NHS wanted. Yes, this is an NHS Bill designed by NHS managers with a focus on the NHS. I do not know why it is called a care Bill, because it has nothing to do with care.

--- Later in debate ---

[Lord Kamall (Con)]

I thank all noble Lords who have spoken in this debate, both to the amendments and in making wider points about NICE. I take this opportunity to pay tribute to Gillian Leng, who recently stepped down as chief executive of NICE after a number of years.

I turn to Amendment 54. I am sure noble Lords will appreciate that we all want NHS patients to benefit from proven and cost-effective treatment; no one would want otherwise. That is why we see NICE as playing a vital role in supporting patient access to new treatments. I have heard the criticisms from previous Health Ministers, who were responsible for NICE. I sometimes feel in debates such as this, when I am with former Health Ministers, that it is like a special edition of “Doctor Who”, with previous regenerations. I hope we do not create a fracture in the space-time continuum. NICE recommends the vast majority of new medicines for use by the NHS. In fact, in 2020-21 100% of new medicines were recommended by NICE and many thousands of NHS patients have benefited from access to some of the most cost-effective treatments as the result of its work.

Another interesting thing is that when a decision is made and it is difficult to access medicines, patients will get frustrated—rightly so, given that they know it is available or maybe has been recommended. At the same time, on the global stage NICE has a well-earned reputation. It is one of my three priorities; I have mentioned technology, the second is life sciences and the third is international health diplomacy—how we use our position on health as part of UK soft power. One of the institutions people across the world look to and want to learn from is NICE. NICE is looking to be at the centre of a number of global networks on the issues where it has a reputation.

NHS England and clinical commissioning groups are already under a statutory obligation, under Regulations 7 and 8 of the snappily titled National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013, to fund any treatment recommended by NICE through its technology appraisal or highly specialised technologies programmes, usually within three months of guidance being issued. As the noble Lord, Lord Stevens, mentioned, NICE also operates a separate medical technologies programme, which supports faster and more consistent adoption of medical devices, diagnostics and digital products.

I assure noble Lords that these funding requirements will apply to the ICBs once established. Therefore, we do not see the amendment as necessary at this stage for clinicians to prescribe NICE-recommended treatments for their patients. I also thank the noble Baroness, Lady Merron, for pointing out some of the unintended consequences and scope of such amendments. I remind your Lordships that, since April 2021, NHS England’s medtech funding mandate has supported faster access to some of these innovative technologies recommended by NICE.

I know that I am going to try to reassure noble Lords on a number of things but, on Amendment 74, I hope they note that the funding requirement on ICBs for NICE-recommended treatments goes even further than the requirement to promote what the noble Lords propose in the first part of the amendment. This will ensure that clinicians will continue to be able to prescribe NICE-recommended treatments for their patients.

The second part of the amendment would replicate existing arrangements that are in place to measure uptake and use of NICE-recommended medicines. Since 2013, NHS Digital has published an innovation scorecard that reports uptake of medicines that NICE has recommended in the last five years at a national and local level. Data on the uptake of NICE-recommended medical devices is not currently reported in the innovation scorecard as it has been more complicated to collect. However, I assure noble Lords that work is under way, by both NHS Digital and the Accelerated Access Collaborative, to address this gap. The Government consider that it is more appropriate and proportionate that this information is collected and published by a single national body using an agreed methodology, not by multiple organisations that will each have different ways of measuring and presenting the data.

On Amendment 97, I can tell noble Lords that NICE works closely with the MHRA—I thank the noble Lord, Lord Stevens, for pointing out the distinction —which issues marketing authorisations to ensure that licensing and appraisal timescales are aligned wherever possible. The NHS in England usually funds any treatment recommended through NICE’s programmes within three months of positive final guidance. We believe that three months is a realistic framework for providers to prepare for and introduce a new technology, and I hope I can assure the Committee that NICE and NHS England already work closely to facilitate the adoption of recommended technologies as quickly as possible.

As the noble Lord, Lord Stevens, again alluded to, there is a high level of transparency in the operation of local formularies. Formularies have their own public websites, which list the selected medicines and associated guidance, and area prescribing committees publish the minutes of meetings, which identify the medicines added or removed from formularies. We believe that there is therefore no need to publish an annual list.

Although healthcare providers are encouraged to use local formularies when prescribing, they are not restricted to them. The decision as to what to prescribe lies with the prescriber, who will act in the best interests of the patient. Indeed, some of the correspondence I get as a Minister for Health often refers to when people cannot get access to a medicine that is not recommended, but the clinician has the authority to suggest that that medicine can be available to the local area.

[Lord Hunt of Kings Heath (Lab)]

I am sure the Minister is right about how this system is meant to work, but there are far too many examples of clinicians seeking to prescribe medicines that have gone through the technology appraisal and then finding that CCGs have set up the various devices that the noble Baroness, Lady Brinton, mentioned to delay or stop it. Does he recognise that CCGs are engaged in a process of seeking to delay implementation for as long as possible? Will this be accepted under ICBs or will it be tackled?

[Lord Kamall (Con)]

I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Brinton, for raising this issue. I should be honest; I was not aware of the suggestion that CCGs often delay and whether that situation will be transferred to ICBs. I ask noble Lords whether I can look into that situation further to understand it more. I simply say that I was not under that impression.

Health and Care Bill

Debate between Lord Kamall and Lord Hunt of Kings Heath

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I accept that but how can NHS England give guidance to say that no local authority councillor can be on the ICB? That is not for NHS England to say, and how can it do it prior to the Bill going through Parliament? It is for Parliament to decide these matters, not a quango.

[Lord Kamall (Con)]

I apologise to the noble Lord because I was coming to answer that point, but maybe in too long-winded a way. One issue that was clearly raised, and very strongly felt in the contributions from more than one noble Lord, was about banning councillors from sitting on boards. There is nothing in the Bill that expressly bans this. We recognise the points raised in this debate and will raise them directly with NHS England. It is not statutory guidance.

[Lord Hunt of Kings Heath (Lab)]

I am sorry but this is a very important point. They have made the appointments and are not going to start again, which of course they should, because this is an absolutely hopeless position. No one from NHS England has ever had the guts to come here to explain why they are making this decision, and who will believe it? The chair of the ICB is appointed by NHS England. They know that NHS England does not want local authority councillors on the boards. Who are they going to take notice of? They are going to take notice of NHS England. The Minister has to tell NHS England to stop sending out this ludicrous guidance and telling the NHS that the new arrangements will start from 1 July. It cannot possibly do so if we go through what is contained in Clause 14.

I sympathise with the noble Baroness, Lady Walmsley, but the fact is that we must have a three-month consultation process on the proposals. This is the problem we are in: none of this stands up because Parliament is being treated with absolute contempt by NHS England.

[Lord Kamall (Con)]

I hear the strength of feeling from the noble Lord. I will take this back to the department and discuss it with my right honourable friend the Secretary of State. I hope noble Lords are reassured by that. I may not get the perfect answer, but I will try. I understand the strength of feeling on this issue; no one can fail to do so. Let us put it this way: it was not subtle but direct. It is really important that, as the Minister here, I take this back and reflect the feeling of the House in my conversations with the Secretary of State, and his subsequent conversations with NHS England. I will take that back and look at the consultation process and the CCGs consulting all the relevant local authorities.

I understand the point made strongly by the noble Lord, Lord Scriven, that we have to be careful about prescribing in a top-down way how to work locally. I have always been a strong believer in localism and making sure that powers go down to a local level rather than being taken away. Let me again assure the noble Lords, Lord Scriven and Lord Hunt, and other noble Lords that I will take this back, because clearly there is concern. I had not appreciated the strength of that concern. At Second Reading the noble Lords, Lord Stevens and Lord Adebowale, said, “We are already doing this. It makes sense to go ahead and put it on a statutory footing”. But I have now heard the other side of the argument, and it suggests that I should go back and have a stronger conversation with, in effect, my boss—my right honourable friend the Secretary of State. I hope that gives some reassurance.

On Amendment 44, in the name of the noble Baroness, Lady Thornton, I assure your Lordships that we intend to provide as much stability of employment as possible while ICBs develop their new roles and functions. I hope that noble Lords are aware that there is already an existing commitment that staff transferring into ICBs will transfer across on their current terms and conditions in line with the NHS Terms and Conditions of Service Handbook. NHS pension rights will also be preserved. As a result, staff transferring into ICBs will not see any change to their existing conditions.

However, the Government are concerned about forcing ICBs to adopt conditions and practices that the ICBs do not believe work best for new staff. We believe that it is important to give ICBs flexibilities relating to staff terms and conditions; they are there for a reason. For example, when it is difficult to recruit and staff are going elsewhere, this would include allowing ICBs the flexibility to diverge from collectively agreed pay scales in order to attract staff from elsewhere or with unusual or valuable skills, or to reflect local circumstances. It will also give ICBs the flexibility to support joint working and bring in staff currently working in local authorities or foundation trusts, for example, supporting integration and the joint working approach that the Bill hopes to encourage.

I also note that ICBs having the independence and flexibility to choose whether to adopt collectively agreed pay conditions and pensions for new staff is not unique, as the noble Baroness, Lady Thornton, acknowledged. NHS foundation trusts, which are already free to exercise their discretion in adopting such conditions, overwhelmingly choose to honour and apply such terms to their staff unless there are good reasons to diverge.

On the proposals for very senior managers, existing procedures are in place to ensure that the most senior staff within the NHS are appointed with fair and equitable salaries. Proposals to pay very senior staff more than £150,000 must be similar to those for other equivalent roles or be subject to ministerial oversight.

The Government are in the process of finalising the procedures that will apply for ICBs. The specifics may differ but the effect and intention will be the same: to afford ICBs agency in setting pay at competitive rates so that we can continue to attract the most senior and experienced leaders, while putting adequate checks and balances in place to ensure appropriate use of taxpayers’ money and keep senior public sector salaries at an appropriate level. The Government believe that this amendment, which also asks for ICPs to approve annual salaries in excess of £161,000, is unnecessary. I am happy to have further conversations.

I now turn to the amendments on how the ICBs will function once established, starting with that in the name of the noble Lord, Lord Davies of Brixton, which relates to the question of treatment outside the ICB area. The new clause in question provides that NHS England must publish rules for determining the people for whom integrated care boards have responsibility. Importantly, this clause ensures that everyone in England is covered by an ICB.

We intend that the rules set by NHS England should replicate the current system for CCGs as closely as possible. This means that the ICB will be responsible for everyone who is provided with NHS primary medical services in the area—for example, anyone registered with a GP. It will also be responsible for those who are usually a resident in England and live in their area if they are not provided with NHS primary medical services in the area of another ICB.

It is important to remember that no one will be denied healthcare on the basis of where they live. We want to ensure that, under the new model, bodies that arrange NHS services—decision-making bodies—are required to protect, promote and facilitate the right of patients to make choices with respect to services or treatment. This means allowing patients to choose to be treated outside their ICB area. Choice is a long-standing right in the NHS and has been working well for some time. The Bill continues to protect and promote it. However, I am afraid that we have concerns about this amendment, as it places a requirement on providers rather than commissioners. It would not be reasonable to expect providers to provide services regardless of whether they were funded by an ICB to do so, and it is important that ICBs should be able to make decisions about with whom they contract and where they prioritise their resources.

On Amendment 53, in the name of the noble Baroness, Lady Walmsley, I hope I can assure the Committee that the Government are committed to ensuring continuous improvement in the quality of services provided to the public. As your Lordships will be aware, there is already a wider range of duties in relation to the continuous improvement of services. Clause 20 imposes on ICBs a duty as to the improvement in quality of services. Furthermore, the ICB must set out how it proposes to discharge that duty at the start of each year in its joint forward plan and explain how it discharged the duty at the end of each year in its annual report. I hope this goes some way to meeting the noble Baroness’s concerns.

Clause 16, which this amendment seeks to alter, recreates for ICBs the commissioning duties and powers currently conferred on CCGs in the NHS Act 2006. It ensures that ICBs have a legal duty to commission healthcare services for their population groups. It also recreates Section 3A of the 2006 Act, which provides the commissioning body with an additional power to commission supplementary healthcare services in addition to the services they are already required to commission. This power enables ICBs to arrange for the provision of discretionary services that may be appropriate to secure improvements in the health of the people for whom it is responsible—or improvements in the prevention, diagnosis and treatment of illness in those persons—so it is important that the clause remains as it is currently drafted.

The Bill will ensure that the existing local commissioning duties conferred by the NHS Act 2006 will transfer over to ICBs. This is set out in proposed new Section 3, which is also to be inserted by Clause 16 on page 13. I hope that the noble Baroness, Lady Walmsley, will be reassured that it rightly uses “must” rather than “may” when referring to the arranging of services. I can therefore assure the Committee that ICBs will continue to commission the services previously delivered by CCGs. That will ensure that service delivery for patients is not impacted.

Amendment 159 in the name of the noble Baroness, Lady Wheeler, touches on the important relationship between ICBs and ICPs. I remember that, when we had an earlier consultation, the Bill team had a diagram about how ICBs and ICPs would work together; It might be helpful if I ask for that to be sent to noble Lords so that all of us can have more informed conversations about the intentions of the amendments and the issues that noble Lords want to raise. I will make sure that that is done.

This amendment would add a requirement for the Secretary of State to make regulations to establish a dispute resolution procedure if an ICB fails to have regard to an assessment of needs, an integrated care strategy or a joint local health and well-being strategy in respect of the ICB’s area. The Bill was introduced to ensure that existing collaboration and partnership, working across the NHS, local authorities and other partners, is built on and strengthened; I recognise the concerns raised by the noble Lord, Lord Scriven.

We intend for these assessments and strategies to be a central part of the decision-making process of ICBs and local authorities. That is why we are extending an existing duty on ICBs and local authorities to have regard to relevant local assessments and strategies. The ICB and local authorities will be directly involved in the production of these strategies and assessments through their involvement with both the ICP and health and well-being boards at place—that is, at a more geographical level. As a result, they have a clear interest in the smooth working of the ICP.

More widely, there are several mechanisms to ensure that ICBs and local authorities will have regard and not intentionally disregard the assessments and strategies being developed at place in their areas. First, health and well-being boards have the right to be consulted.

Dementia: Art and Music-based Interventions

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 22nd November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question. As an amateur musician—I stress “amateur”—I know that there is no better feeling than when you connect with your audience as a live musician. Music tugs at your heartstrings. Music touches your soul. But it can also unlock the mind. This shows the importance of music in social prescribing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I hope that patients get the benefit of what I am sure is the Minister’s excellent playing. He has been very positive in his responses, but he will know that the arts sector has been very stretched financially during the Covid years in particular. Will he open discussions with organisations such as the Alzheimer’s Society, with an offer of some funding to develop some of the schemes that we have heard about today?

[Lord Kamall (Con)]

I thank the noble Lord for his invitation to perform live—I am not sure that he will feel the same way after hearing my blues band. Last year, NHS England and NHS Improvement, in collaboration with the National Academy for Social Prescribing, the Alzheimer’s Society and Music for Dementia, facilitated a series of webinars. We are working in consultation with them. In February 2021, Music for Dementia also published social prescribing guides for link workers to help expand music prescriptions. The important thing here is that we are consulting with stakeholders.

New Hospitals

Debate between Lord Kamall and Lord Hunt of Kings Heath

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

The Government have said that we will deliver 40 new hospitals by 2030 and in October 2020 we published the full list of the 40. This includes eight schemes that were announced by previous Governments but are to be delivered this decade and 32 new hospitals. We have also confirmed that we will identify further new hospital schemes, the process for which is ongoing, with a final decision to be made in spring 2022. This means that 48 hospitals in total are to be delivered over the decade.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have here the New Hospitals Programme Communications Playbook, which the noble Lord’s department has put out and which makes it clear that if you build a new wing of a hospital, that counts as a new hospital. What is worse is that NHS bodies are being instructed to lie and propagandise on behalf of the Government. Will he withdraw this disgraceful communication?

[Lord Kamall (Con)]

I hope that the noble Lord will recognise that whenever a new project is started and there is a decision to build a new hospital in a community, it surely makes sense to look at whether there is space on existing sites. Otherwise, if we start criticising new hospitals on existing sites, there may be a perverse disincentive for a hospital to say, “Well, let’s build elsewhere”. when there is a perfectly good site. It is important, whatever you call it, whatever the semantics, to recognise that we are building modern, digital, sustainable hospitals for the future.

Covid-19

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

On future vaccinations, my noble friend raises an important point, and many will have seen in the media and elsewhere all the discussion about living with this vaccine. At the moment, we have boosters at six months; as the technology and the understanding get better, it seems likely that we will move to annual vaccinations, as we do flu jabs. I cannot say that for definite, but the trend is going that way, given the development of the virus, the variants and the waning immunity over time. The effectiveness of each vaccine at the moment is six months, but one can see the longer term. However, please do not take that as a given—if that is incorrect, I will update the House.

On public transport: I went to a funeral today, and as I was travelling back on the underground, it said, quite clearly, that you must wear a mask, so that is being encouraged. It is part of plan B if we have to move to plan B, but all that data is being analysed and constantly updated with different factors. There is no one trigger for moving to plan B. In previous appearances at the Dispatch Box, I have read out the list of all the factors that are considered. At the moment, the main message is: the vaccine works. We want to encourage people to get the vaccine and especially try to reach those communities that have not even had their first or second vaccine yet.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a trustee of the GMC and the Royal College of Ophthalmologists. Can I ask the Minister about the impact on the NHS generally and the pressure it is under? He will be aware that the Academy of Medical Royal Colleges issued a statement a few weeks ago on its concern about the abuse of NHS staff. What are the Government doing to ensure that NHS staff are able to go about their work without the horrific abuse that many have had to endure?

Secondly, I refer the Minister to the report of the Royal College of Physicians, a census that shows that 48% of advertised consultant posts across the UK were unfilled last year? Does this not show that Covid has exposed the frailties in the NHS? Unless the Government grip this workforce issue quickly, the pressures on the service are going to get worse and worse. What are the Government doing?

[Lord Kamall (Con)]

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

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

Clinical Negligence Claims

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises an important point. However, in looking at the system overall, there is no evidence to suggest that the rise in overall costs is due to a decrease in NHS safety. Nevertheless, safety and learning from incidents are essential in their own terms. Our ambition is for the NHS to be the safest in the world and for maternity safety to be a priority, and there are various schemes in place.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the Minister tell me why the Government do not move to repeal Section 2(4) of the Law Reform (Personal Injuries) Act 1948, which essentially disregards treatment that the claimant may receive under the NHS? Can he also do something about the record of NHS Resolution in paying damages in 80% of litigated cases, with its lawyers being paid on a win-or-lose basis and therefore incentivised to carry on with unsustainable defences?

[Lord Kamall (Con)]

The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.

In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.

David Fuller Case

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 9th November 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am sure that the appointment of Sir Jonathan Michael will be very welcome; I have no doubt that he will do a very robust piece of work. My noble friend mentioned support for families, and the Minister made a number of comments about the support given, including care worker support and compensation. If families wish to appear before the inquiry, will the department consider making financial support available to those families in relation to legal advice, so that they can articulate their concerns before the inquiry?

[Lord Kamall (Con)]

I am afraid I am not able to answer the noble Lord’s question directly, because clearly there are some legal issues around it. I am sure he will understand if I try to find an answer and write to him.

NHS: Fracture Liaison Services

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

I am not sure about the specific case that the noble Baroness raises, but I will write to her. However, generally, there is an investment of £2.3 billion to increase the volume of diagnostic activity and to roll out at least 100 community diagnostic centres, to make sure that we are taking diagnosis closer to patients in their communities.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I do not understand. The noble Lord and his Ministers are taking powers in the health Bill going through the Commons at the moment to issue directions to NHS England. So why on earth can he not issue a direction to NHS England to simply say that every integrated care system must have one of these services, given the evidence that noble Lords on his side of the House have given about the benefit of doing so?

[Lord Kamall (Con)]

The Government recognise the importance of FLS, as does the NHS. That is one of the reasons why they are looking to roll out these community diagnostic centres, to make sure that the technology and the scanning is as close to the patients as possible. Just this morning, I had a meeting with one supplier who is talking about a partnership with a number of integrated care systems to make sure that they roll out the systems as close to patients as possible.

Cancer Drugs: Licensing and Approval

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her Question. Clearly, there is distress and concern at the delay between MHRA approval and NICE licensing. The drug Trodelvy was licensed by the MHRA for both unresectable locally advanced and metastatic triple-negative breast cancer through Project Orbis. On NICE’s appraisal of Trodelvy to determine its clinical and cost-effectiveness for use in the NHS, NICE hopes to have guidance next year but, in the meantime, NHS England, NHS Improvement and NICE continue to work with the manufacturer to explore options for interim access to Trodelvy.

[Lord Hunt of Kings Heath (Lab)]

My Lords, despite what the Minister says, the fact is that innovative new drugs such as the cancer drugs the noble Baroness mentioned are reaching patients in this country far too slowly. We lag behind many other countries. How can we expect to be a centre of science and research if the NHS is so slow to develop the medicines that are produced?

[Lord Kamall (Con)]

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

Smoking Cessation: Prescription of E-cigarettes

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 2nd November 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the MHRA a considerable number of times, which is a great tribute to the work that it is doing. Can he tell us why it is facing budget cuts at a time when we need our independent regulator in this country to be doing all it can to regulate and encourage new innovative products, including pharmaceutical products, to the market?

[Lord Kamall (Con)]

As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.

Public Health Grant to Local Authorities

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

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.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I must say that that is a rather surprising answer. The Minister will know that the Prime Minister has promised to help level up the health expectancy of the poorest areas, but I take the Minister to his answer. The Health Foundation stated in the summer that there is no sign of concerted action to do this and:

“Current plans appear to be partial and fragmented, and many deprived areas where people are likely to have poorest health have not been identified as priorities for investment.”


Will the Minister reconsider his answer to my noble friend?

[Lord Kamall (Con)]

The noble Lord raises a very important point about how we tackle these disparities. This is one of the reasons. Given that a lot of powers to intervene at local level are in the form of local authority grants and local public health officials, it may well sometimes come across as fragmented. This is why the Office for Health Improvement and Disparities is very important to take an national overview of areas of disparity and target them.

Health Care and Adult Social Care

Debate between Lord Kamall and Lord Hunt of Kings Heath

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

I do not see myself as someone who is able to offer jobs advice or careers advice. But the points made by the noble Lord help to explain in many ways some of the pressures that care home providers are facing when recruiting in a competitive market. The Government have looked at funding and how we can work with care providers, particularly as many are in the private sector, as I said earlier. They are not directly controlled by the Government and we can therefore work with local authorities and care providers on how to make sure that they pay a competitive salary to attract care workers to work in the social care system, as opposed to some of the more competitive sectors that the noble Lord mentioned.

[Lord Hunt of Kings Heath (Lab)]

My Lords, one of the areas where there is most pressure has been that of unpaid carers. Not only are they having to take on a much greater load but for a long period they could not even visit their loved ones in care homes. In all the programmes that the Government are taking on, can the Minister say explicitly what is going to be done to support carers in their invaluable role?

[Lord Kamall (Con)]

I think that all noble Lords will agree with the point made by the noble Lord about the importance of unpaid carers and also paid carers. In relation to unpaid carers, we hope that as the social care reforms, in particular, come through, patients will be able to take advantage of social care. That will remove some of the burden from unpaid carers and free up their time. We are, however, looking closely at the implications and consequences of some of the proposed reforms.

Coronavirus Act 2020

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 26th October 2021 Grand Committee

[Lord Kamall (Con)]

My Lords—apologies while I remove my mask—I thank all noble Lords for their valuable contributions to this important debate, and for the range of views expressed in the best tradition of our debates. The Government see extending the No. 3 and self-isolation regulations until 24 March next year as vital to allow local authorities to respond to serious and imminent threats from Covid-19, but also to ensure that the self-isolation system continues to protect the public during the challenging winter ahead. I have listened to and have taken on board—and will take on board—many of the concerns raised here today.

The Government believe that the Coronavirus Act continues to be a critical part of our country’s response to this awful virus, which has touched every corner of our society. In terms of parliamentary scrutiny, I understand the points that have been made by many civil libertarians here today. The Government believe that the Coronavirus Act has enabled them to provide help and support to people, businesses and our public services, and to boost the healthcare workforce at a critical time of need. I assure noble Lords that we will continue to review every aspect of coronavirus legislation, but we are now able to expire seven provisions and part of a further power in the Coronavirus Act. I hope this demonstrates the Government’s commitment to, and progress towards, winding down the emergency powers.

The Government see themselves as taking only those powers that are critical to our response and recovery—for example, powers that help make sure that the NHS is properly resourced and that statutory sick pay is available to those who are self-isolating. It is always a very difficult balance; we heard from the noble Baroness, Lady Merron, that she would have preferred us to keep some of the other emergency provisions. The Government’s autumn and winter plan sets out how we hope to sustain and bolster the progress that we have made thus far.

I turn to some of the specific points made by noble Lords; I hope I will have the time to respond to as many as possible. If I do not respond to every point, I will make sure that I write to noble Lords in answer to their specific questions. The noble Lord, Lord Hunt, asked when an SI would be laid. He also talked about unlawful convictions and incorrect charges, as many other noble Lords spoke eloquently about. I thank them for their contributions about the incorrect charging decisions under Schedule 21 to the Act. Of course it is regrettable that 295 incorrect charging decisions have been made under the Coronavirus Act. The primary issue that the Crown Prosecution Service has identified is that individuals were erroneously charged under Schedule 21 rather than under other legislation such as various health protection regulations. Since April 2020, the CPS has agreed to review all prosecutions made under the Coronavirus Act and it continues to do so. I hope, in some ways, that that reassures the noble Lord.

The noble Lords, Lord Hunt and Lord Scriven, my noble friend Lady Foster, and the noble Baronesses, Lady Fox and Lady Brinton, asked about parliamentary scrutiny. I know that this is an issue of concern to many noble Lords. The Government are confident that they have upheld their promise to allow for proper scrutiny and accountability of the powers in the Act. Many criticisms were levelled, which I understand, and I hope that noble Lords will continue to hold us to account on accountability. Maybe I can have some conversations offline with some noble Lords to make sure we do this as much as possible.

My noble friend Lord Balfe talked about living in the same street as former MEPs and doctors. He then went on to say that the doctors were his friends, but he did not say anything about whether the former MEPs were also his friends. I hope so, but I assure him that he still remains my noble friend.

On occasion, it has been necessary to introduce urgent measures to protect the NHS and save lives. The Government have committed to debates in advance of regulations coming into force wherever possible for measures of national significance. This included Parliament being recalled to debate the national lockdown in January, and debates and votes on regulations covering the tiers system; the steps regulations in March, which set the path for implementing the Government’s road map out of lockdown; and, in June, pausing the move to the next step of the road map.

The noble Baroness, Lady Fox, talked about impact assessments. On the evidence for decision-making, a full regulatory impact assessment was not prepared for many coronavirus regulations, as they fell under the civil contingencies exclusions of the better regulation framework. The Better Regulation Executive will not seek to enforce the current administrative requirement for validating impacts for temporary coronavirus legislation in advance of the wider reform of the better regulation framework.

The noble Baroness, Lady Brinton, and the noble Lords, Lord Hunt and Lord Scriven, accused us of ignoring the scientific advice by not implementing plan B now and asked who is advising us and what the trigger points are. Our approach has always been informed by scientific and medical evidence, and by the latest data. We take evidence from the Chief Scientific Adviser, the Chief Medical Officer, SAGE, of course, as part of that, the UK Health Security Agency, the NHS and others. They remain valuable when we balance the evidence of scientific opinion. Scientific experts have contributed directly to ministerial discussions.

As we have heard in this debate, many noble Lords have contested the science or referenced certain reports. It shows that, even around this area, science is contestable. That has been revealed in the way the Government assess all these trade-offs. What is also interesting is that many people in other parts of the health sector are concerned about some of the provisions, such as the impact on mental health and other unintended consequences. All these have to be balanced. The Government have benefited from the expertise of their science and medical advisers through the pandemic and remain deeply grateful for the role they have played in saving lives and protecting the NHS.

In our debate on Thursday last, I mentioned the work of Professor Mark Pennington, professor of political economy at King’s College London, who talked about the response to the pandemic via decision-making. He talked about the situation being almost a Hayekian, complex system, with many individuals having incomplete knowledge or, as Hayek said, the conceit of knowledge. That expresses and shows the difference of opinion. This is a case where we have to weigh up many different views, particularly among the scientific community, and, in addition, some of the papers referenced today by many noble Lords.

Noble Lords have asked what the set threshold is. The Government and our scientific advisers monitor a wide range of Covid-19 health data, including on cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infection, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. In assessing the risks to the NHS, the key metrics include: hospital occupancy for Covid-19 and non-Covid-19 patients; intensive care unit capacity; admissions of vaccinated individuals; and the rate of growth of admissions. The Government also track the economic and societal impacts of the virus to ensure that any response takes those wider effects—that is, socioeconomic effects as well as those in the medical and scientific professions—into account and assesses that range of views. It is not necessarily a binary decision but a range of views that must be considered and weighed up. Noble Lords have expressed eloquently in this debate the range of scientific views and papers on Covid.

A number of noble Lords, including the noble Lord, Lord Hunt, and the noble Baroness, Lady Brinton —forgive me if I do not remember the others—asked how regularly SAGE meets. Throughout the pandemic, SAGE has been a vital source of co-ordinated scientific advice and technical support to help guide the Government’s response. However, as I have said previously, we also consider other bits of scientific advice. Committee members utilise the latest scientific research, insight and analysis from across government, academia and industry. As new evidence or data emerges, SAGE updates its advice accordingly. As Covid-19 was completely unknown to us less than two years ago, this means that some of the guidance provided in the earlier stages of the pandemic has now been superseded or amended to reflect our ever-evolving understanding of the virus.

The noble Lord, Lord Scriven, asked about face coverings—

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister for explaining the Government’s approach to SAGE, but I have to say that it is rather confusing since SAGE clearly encompasses a wide range of scientific views. The Minister seems to be saying that it has been given a subordinated role, meeting only monthly, and, in essence, the Government are looking for other bits of scientific advice. I would like clarification on this because, for me at least, this is clearly a significant change in policy and practice.

[Lord Kamall (Con)]

I thank the noble Lord for that question. As I laid out earlier and have said formerly, the Government listen to a range of scientific advice, including from SAGE but also from the Chief Scientific Adviser, the Chief Medical Officer, the NHS and a range of other views.

[Lord Hunt of Kings Heath (Lab)]

I am sorry to pursue this but it seems to me that the Minister has made a very significant statement because all those people are on SAGE, as far as I am aware from looking at the minutes. I do not think that the Government can get away with simply saying, “We listen to a whole range of advice, including from SAGE”. Surely SAGE is the primary place from which the Government get advice.

[Lord Kamall (Con)]

I can only repeat what I have said previously but I will look at this in more detail and respond to the noble Lord if he is not satisfied with my response. I will try to make sure that I send a satisfactory response.

A number of noble Lords talked about the evidence around face coverings. Some noble Lords said that they definitely work. Others said, “No, there is no evidence that they work”. Others said, “Actually, they are useful as part of an overall package of other measures”. If the data suggests that the NHS is likely to come under unsustainable pressure, the Government will implement their prepared plan B. That is why we have explained it in advance: so that we cannot be accused of doing things at the last minute. Plan B would include legally mandating face coverings in certain settings, but we are not yet at that stage. The continued efforts of the public in practising safe behaviours and getting fully vaccinated will be critical to ensuring that the NHS does not come under unsustainable pressure.

NHS England Funding: Announcement to Media

Debate between Lord Kamall and Lord Hunt of Kings Heath

Tuesday 26th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question. Last week we had a discussion on healthy ageing and making sure that the population of the UK is able to live healthy lives for longer. That is very much part of the overall thinking on health reform and we hope to have more details in due course.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister says that Ministers are dealing with workforce shortages. But surely he knows that, throughout the health service, there is a critical crisis. No one is in charge; it does not seem to be the responsibility of Ministers, Health Education England or NHS England. Who will sort this out and who will be held to account?

[Lord Kamall (Con)]

The noble Lord makes a valid point on workforce shortages. The Chancellor will confirm wider health budgets at the spending review, which is in only a few more days. We have already increased training places this year and will feed through into the available workforce. Ensuring that we have the workforce necessary to support this expansion will be driven by a combination of things, such as enforced workforce productivity, including from the spending review digital diagnostic investments, which are expected to deliver a 10% to 15% workforce productivity uplift. We are also looking at existing Health Education England funding, which will provide a pipeline for growth in training numbers.

Men’s Health Strategy

Debate between Lord Kamall and Lord Hunt of Kings Heath

Monday 25th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for his warm welcome and hope that this continues for some time. To answer his question, the Government regularly consider the social determinants of health, especially how they contribute to our life and healthy life expectancy. We have seen growth in life expectancy slow in line with many countries, which is a challenge that has been exacerbated by the Covid-19 pandemic. We have not yet made a specific assessment of how social determinants drive male life expectancy. On the point about men’s loneliness, since the beginning of the pandemic we have invested £34 million in organisations supporting people who experience loneliness, including men.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am not sure from the first Answer whether the Minister was actually saying that there would be a strategy with resources and led by someone senior in the NHS. He will probably know that the All-Party Group on Issues Affecting Men and Boys has looked into some of the poor health outcomes for men. There is an acceptance in the NHS that this is almost a biological norm. This is a real problem that needs to be reversed and I hope that the Minister will agree that we need a firm strategy.

[Lord Kamall (Con)]

I thank the noble Lord for the advice that he has given me to date on many issues relating to this portfolio. In terms of a specific men’s health strategy, it was quite clear that we needed a women’s health strategy because for many years women’s health had not been given the consideration that it needed, including on a whole range of issues such as clinical trials and data, for example. On male life expectancy, the issues that men face are quite disparate, so we target particular issues such as systemic heart disease, cancers, particularly prostate cancer, the fact that more men than women die from suicide, alcohol-related deaths, drug-poisoning, smoking and obesity. We look at those and target them specifically, rather than putting them into an overall men’s strategy.