Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Lord Markham Excerpts

Monday 9th January 2023 Grand Committee

Moved by

[Lord Markham]

That the Grand Committee do consider the Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022.

Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee

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

I thank noble Lords, and declare what is a kind of interest, in that my wife, as many noble Lords have heard me mention before, is an international dentist. For my sins, I had the joy of helping her to fill out one of these international GDC registrations—so I have a little bit of knowledge in this space. It was not the most riveting exercise of my life, but I do have some knowledge.

I beg to move that the order be approved. International dental care and nursing professionals form a vital part of the NHS workforce and make an important contribution to the delivery of healthcare in the UK. The GDC and the Nursing and Midwifery Council are the independent statutory regulators for the dental and nursing and midwifery professions in the UK, and nursing associate professionals in England, respectively. They set registration standards for healthcare professionals who wish to practise in the UK.

International professionals who wish to practise here must meet the same rigorous standards that we expect of UK-trained professionals. We believe that it is in everyone’s interests that such professionals can use registration processes that are a fair test of their professional competence and that provide them with a clear route to registration. We are reforming the legislative framework for the regulation of healthcare professionals to better protect patients, to support our health services and to help the workforce to meet future challenges. Ahead of this, action is required to provide the GDC and NMC with greater flexibility to amend their international registration processes. This will help the regulators ensure that future international registration pathways are proportionate and streamlined, while continuing to robustly protect patient safety.

We plan to take forward all the proposals we consulted on and have made one small amendment to the order in the interests of patient safety. This relates to the requirement that a qualification relied on by international applicants to the dental care professionals register can no longer be a diploma in dentistry. This change introduces fairness and consistency between the UK and international routes, as UK-qualified dentists cannot apply to join the DCP register using their dentistry qualification. The GDC also expects that increasing the capacity of the ORE exam will support international dentists applying to join the GDC’s register. The amendment will allow the GDC to process applications from dentists to join the register as DCPs that are received up to the day before the order comes into force. This guarantees that any live DCP title applications submitted before the legislation is passed will be processed.

I draw the Committee’s attention to an issue raised by the Secondary Legislation Scrutiny Committee, which noted that the Committee may wish to seek reassurance on how appropriate safety standards will be maintained. The primary purpose of professional regulation is to protect patients and the public from harm. Any new or amended registration pathways will be based on applicants meeting the same standards of training and knowledge as UK-trained professionals. These standards are set by the independent regulators in consultation with the professions, the public and education providers.

The order provides the GDC with greater flexibility to apply a range of assessment options for international dentists and dental care professionals. The GDC will have much greater freedom to update its overseas assessment fee, content and structure, now and in the future, as these will no longer be set in legislation that requires Privy Council approval to be changed. The requirement that dental authorities provide the ORE is removed, allowing the GDC to explore alternative providers. Candidates who were affected by the suspension of the exam during the Covid pandemic will be provided with extra time to sit it.

I understand that the GDC will first consult on the new rules in its international registration processes, which will come into force 12 months after this order is in force. It plans to increase the capacity of the ORE exam and support greater numbers of international dentists to join the register more quickly.

The order also includes a charging power, so that fees can be charged to international institutions for the cost of recognising their qualifications. This will support the GDC in registering individuals either based on an assessment of their qualifications, skills and training or by recognising the qualifications they hold.

On changes to the Nursing and Midwifery Order 2001, the NMC will have the flexibility to use two pathways in addition to its test of competence, which will remain its primary registration assessment. The first is recognition of an international programme of education. The second is qualification comparison, whereby the NMC may ascertain whether an international qualification is of a comparable standard to a UK one. The draft order also clarifies the NMC good health and good character declaration requirements. I commend this order to the Committee.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I first declare an interest as a member of the General Medical Council. I welcome this order and pay tribute to the NMC and the General Dental Council for their work—and particularly to my noble friend Lord Harris, who so eminently chairs the GDC.

As the Explanatory Memorandum makes clear, this is in a sense an overture for a suite of orders that the Minister will bring in relation to all the registering bodies, essentially to streamline the fitness-to-practise processes—in the case of the GMC, to enable the statutory registration of physician associates and anaesthetist associates—and to update the governance of these bodies.

I noted in paragraph 10.4 of the Explanatory Memorandum the statement:

“The Department’s view is that it is for the regulators as independent bodies”.


I ask the Minister to assure me that in those new arrangements and governance processes the Government are as committed to these bodies continuing as independent entities as they have said during the consultation process.

I also raise with the Minister the one area in which I think the consultation produced disagreement in relation to the proposals, which is in regard to the DCP register and the fact that, as I understand it, dentists qualifying overseas are not to be allowed to come on to the DCP register. This was raised in Committee in the Commons. The Minister said:

“The change introduces fairness and consistency between UK and international routes because UK dentists cannot qualify or apply to join the DCP register using their dentistry qualification in other countries.”—[Official Report, Commons, Delegated Legislation Committee, 6/12/22; cols. 7-8.]


The point I want to put, which has been put to me by a dental practitioner, is that we are biting off our nose. We are disallowing future working by dentists from overseas in the professions covered by the DPC. The dentist said to me:

“I am working alongside four experienced dentists, three in the UK under the Homes for Ukraine scheme and one under the Afghan resettlement scheme.”


If this change occurs in the future, I think that they may be covered by the current grandparenting provisions. However, if this were to happen in the future,

“their livelihoods and contributions that they could make to our society would be severely constrained. Even with excellent English, overseas dentists are waiting some time … to sit the overseas registration exam”,

which allows them to practise as dentists, although I know that the GDC is considerably improving their performance to allow them to. The dentist went on to say:

“In the meantime, if the GDC implements this restrictive measure, overseas dentists could then take employment only as trainee dental nurses”,


which is really wasteful of their abilities.

I would like further clarification from the Minister about why this is taking place. Given the workforce challenges in the dental profession at the moment, I question whether this is the time to implement a new provision simply because dentists in the UK cannot be recognised in other countries. Perhaps the Minister would be prepared to look at this again.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I thank the Minister for bringing this order before us. On these Benches, as across your Lordships’ House, these changes are welcomed as sensible and as part of a suite of measures that we will continue to consider. Certainly, the increased flexibility that they bring to the work of the General Dental Council and the Nursing and Midwifery Council by amending the registration and examination processes and procedures so that they are as effective and practical as possible is very welcome. This is about harnessing the capacity and meeting the standards that are needed so that we can ensure that we have the right professionals in place. The noble Lord, Lord Patel, raised important points that I hope the Minister will consider on how the practicalities of this need to be done.

I am grateful to my noble friend Lord Harris, who laid out what the order does but also what it does not do—in our deliberations it is important that we understand that. I noted his comment that there was no ministerial claim that this will solve a workforce crisis, but, as my noble friend Lord Hunt said, we have a challenge in getting a workforce in place to provide the services that we need. In that regard, it is important that we consider the changes today in the current context of the health system in the United Kingdom.

It is important to say that, sadly, in 2021 alone, 2,000 dentists and over 7,000 nurses quit the NHS. There are more than 46,000 empty nursing posts across hospitals, mental health, community care and other services, which means that one in 10 nursing roles is unfilled across the service overall. As we have spoken about many times in your Lordships’ House, the number of NHS dental practices fell by more than 1,200 in the five years before the pandemic, and there are 800 fewer midwives than just three years ago. That is the context in which we are discussing this.

I turn specifically to the order. If, as expected, the GDC begins recouping costs incurred around international registration, including charging applicants more to take the overseas registration exam, could the Minister give an indication of what effect this might have on the number of dentists operating in the UK? I am sure he understands that, given the number of dental deserts that we already face, we cannot afford to lose the capacity of any further dental professionals.

As well as the overseas registration exam, non-EEA dentists also have to go through the performers list validation by experience process to practise here. The Minister will be aware that stakeholders expressed concern about dentists’ PLVEs being disrupted—for example, by being endlessly rearranged or cancelled—and that that is acting as something of a deterrent to working here. Can the Minister confirm whether there is recognition of that difficulty, and whether the department is looking at what needs to be done to make the process as coherent and smoothly run as possible?

In the other place, the Minister of State committed to write further on the breakdown of positive and negative responses to the consultation that was carried out. Can the Minister of State’s response be made available to Members of your Lordships’ House so that we might also better know what stakeholders were thinking when they responded to the consultation on these changes?

The Government’s Explanatory Memorandum states that policy changes that the regulations make following this order

“may potentially impact international applicants and existing registrants with different protected characteristics, particularly with regards to age, sex and race”

but does not provide detail on what that impact might be. Can the Minister offer any insight into this, if the department has correctly forecast what the regulators are planning?

As we have discussed today, the intent of the order is that there will be changes to application processes and so on. Can the Minister indicate what plans there are to review and audit changes to ensure that there is consistency of decision-making, fair treatment of all applicants and the achievement of the right standards?

In conclusion, while we all support the substance of the order, I hope the Minister can give an assurance that its impact and implementation will not be beset with logistical hitches and unforeseen consequences, because we are keen to ensure that changes are made to deliver the right result to get the workforce more into place than it has been hitherto. I look forward to hearing what the Minister has to say about how the order may assist that, if not entirely cure it.

[Lord Markham (Con)]

I thank noble Lords for their contributions to the debate. I shall attempt to answer the questions set. As ever, I will happily follow up in detail afterwards.

I accept the premise that no one believes that this is a silver bullet that answers all the issues around recruitment and workforce needs. At the same time, I think there is a belief that this is one of many things that can, hopefully, help increase access at the end of the day. I reiterate our commitment to independence, in answer to the question from the noble Lord, Lord Hunt. That is fundamental to this issue and, hopefully, something that the noble Lord, Lord Harris, has recognised through this process.

Probably the point I would like to devote most time to is the one about the DCP register. I must admit that it is something I brought up specifically and wanted to go around the houses on. I absolutely understand the issue: are we cutting off our nose to spite our face? On the equivalence argument—our dentists cannot apply overseas—part of that, as it was described to me, was also the feeling that even in the UK our dentists cannot use the DCP route, so to speak, in that they might be a qualified dentist but want to use some other qualifications, rather than be a dentist. So it was felt that there was no consistency there either.

Hospital Beds: Social Care

Lord Markham Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Dubs]

To ask His Majesty’s Government what assessment they have made of the number of hospital beds currently occupied by patients who could be discharged to their own homes or to residential care if social care support were available.

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

There are around 13,000 people in hospital who do not meet the clinical criteria to reside, including, but not limited to, people waiting to go home and people awaiting access to residential care. We constantly look to reduce these delayed discharges to ease flow in the system, and we have provided a £500 million discharge fund to support people to be discharged at the right time, to the right place and with the right support.

[Lord Dubs (Lab)]

My Lords, I am grateful to the Minister for answering the Question. Does he understand that many of us will think it is a complete disgrace that, for a long time now, hospital beds have been blocked by people who could be discharged into the community or residential care? These people would be better off and have a decent quality of life. Should we not be making this a high priority, instead of saying that we are planning to do this? We have heard that for so long.

[Lord Markham (Con)]

It absolutely is a high priority. Noble Lords have heard me say many times that the key to the whole system is flow through the system, to relieve times in A&E and ambulance wait times. That flow depends on us discharging the 13% of beds that are currently held up. That is why we put the £500 million discharge fund in place and will put £2.8 billion of funding next year, and £4.7 billion the year after, to solve exactly this problem.

[Baroness Berridge (Con)]

My Lords, I currently serve on the Joint Committee that is scrutinising the mental health Bill. Could my noble friend the Minister outline whether that 13,000 includes those who are perhaps in secure mental health beds, awaiting discharge? That of course causes backlogs, and not only into A&E: currently, some of those people could be being held in a police cell, which is not an ideal place if you need admission for assessment to a mental health bed.

[Lord Markham (Con)]

I will happily write on the detail, but, yes, it includes everyone who could be provided a space, either in a care home or a mental health home, and those who are fit to go home but need domiciliary care.

[Baroness Brinton (LD)]

My Lords, Our Plan for Patients, which was published at the end of September, says:

“This winter, the NHS will open up the equivalent of 7,000 beds so that every hospital has space to see and treat patients more quickly.”


Winter is clearly here, so how many of those virtual beds are in operation now?

[Lord Markham (Con)]

I thank the noble Baroness. She is absolutely right that the target of 7,000 beds is a key part of this. All Ministers have been talking about it with every ICB over the last few days to see exactly where they are on the target for both real beds and virtual beds. I will happily provide exact information on the target, but I know that we are making good progress.

[Baroness Merron (Lab)]

My Lords, an estimated one in four hospital beds is occupied by people living with dementia. Many of the admissions would have been avoidable if they had had better community support. Of course, their stay in hospital is typically twice as long as those of other people who are over the age of 65. Does the Minister acknowledge that those dementia patients need to be discharged to a place of their own, or their carer’s, choosing, after a holistic assessment? What steps are the Government taking to ensure that this happens, so that people with dementia do not experience discharges that are inappropriate and unsafe?

[Lord Markham (Con)]

I thank the noble Baroness. We are all seeing different shapes and forms of describing how we need a local care system set up by the integrated care boards that can have an overview of all the needs in their area. That is exactly what we are doing, and exactly what the Patricia Hewitt review is reviewing. It will give advice on how best to do that by looking at the best needs of mental health care patients, or any other kind of patient, to make sure that the proper institutions and places are set up to give them the up-front support so that, as the noble Baroness said, they never need to go to hospital in the first place.

[Lord Patel (CB)]

My Lords, while recognising the current problems caused by bed blockages in NHS hospitals due to capacity and social care issues, does the Minister agree with the report from the Health Foundation, which, looking ahead, suggests that, because of changing demography and disease patterns in future, we will require between 25,000 and 40,000 more beds in the NHS if we are going to cope with the pressures on both the NHS and social care? What plans do the Government have to address that?

[Lord Markham (Con)]

We are absolutely aware that we need long-term plans and forecasts. That is also one of the things that the healthcare workforce plan will take into account: it will look at exactly where the capacity needs to be on a regional basis going forward so that we have the right number of hospital beds and social care places for an elderly and growing demographic in terms of age groups.

[Lord Turnberg (Lab)]

My Lords, is it not the case that patients are stuck in hospital because social care staff are leaving in droves? They are leaving because they are not respected, not given a career and not paid sufficiently. Should we not be doing something about retaining these vital social care staff?

[Lord Markham (Con)]

The number of care workers is key to all this and I delighted to say that the latest data shows that we are back to the levels of April 2021. Too many people have left, but we have managed to fill the gaps with the international recruitment fund and other measures. We all agree that we need to progress that further, but we are now making the increases that are needed in this space.

[The Lord Bishop of London]

My Lords, we have heard how important a sustainable workforce is, both in social care and healthcare. Can the Minister tell us what the Government are doing to listen to the concerns of health and social care workers about patient safety and their own working conditions at this time?

[Lord Markham (Con)]

Clearly, if we are going to retain and recruit the key staff in this area, it has got to be a good career, and that means that we must listen to their concerns. I know that Minister Whately is talking to and visiting them all, so it is a key part of the plan. As I say, the fact that we are managing to grow the workforce again shows, I think, that we getting on top of it—but absolutely we need to keep close and make sure it is a good place to work.

[Lord Kirkhope of Harrogate (Con)]

Does my noble friend agree that there are main concerns in some hospitals that dialysis patients are having to be retained in hospital over the Christmas period because of their deep concerns about transport arrangements, partly through the threatened ambulance strikes but also in other ways? Is this not another problem with regard to the bed blocking that we are looking at at the moment?

[Lord Markham (Con)]

The best hospital trusts I have seen have got that absolutely organised. We see a difference in different trusts between as low as 6% bed blocking for social care and over 30%. That depends somewhat on local demography and the amount of care homes, but also on how quickly they can arrange transport, and that is what the best ones are doing, so that cases such as the ones brought up by my noble friend do not exist.

[Lord Laming (CB)]

My Lords, the report from the Adult Social Care Committee that was published just a few days ago—which I commend most warmly to the Minister—highlights that in the past 10 years there has been a 29% real-terms reduction in local government spending power. This is despite the increase in the population during that period. Can the Minister assure the House that the Government are taking seriously the reality of life in social care?

[Lord Markham (Con)]

I thank the noble Lord. Yes, we are, and I think that is shown by the investment we are putting into place. As I say, that will be up to £2.8 billion next year and up to £4.7 billion the year after, which will be a 22% increase. That shows that we are very serious about this.

[Baroness Tyler of Enfield (LD)]

My Lords, we have already heard about the crisis in the social care workforce. NHS leaders are calling on the Government to introduce a new national minimum care worker wage of at least £10.50 an hour to stem the flow of social care staff to other sectors. Can the Minister say what plans they have to introduce such a minimum wage, which could hardly be said to be stoking inflation at that level?

[Lord Markham (Con)]

Of course, the noble Baroness is aware that it is the third parties, whether it be the local authorities or the private sector, that employ them. But what we have done in terms of setting the national living wage, which I believe is around that amount, is exactly making sure that there is a minimum amount that these people can get. About 65% of the funding going into the system goes through to wages, so the £2.8 billion increase next year will flow largely into wages and salaries.

[Baroness Pitkeathley (Lab)]

Every one of the interventions we hear about points to the inadequacy of the social care system and every one of the interventions that the Minister makes, however well intentioned—and I do not dispute that they are well intentioned—concerns piecemeal reforms. Will the Government ever accept that the only thing that is going to solve this ongoing problem, which is only going to get worse, is a wholesale reform of the social care system?

[Lord Markham (Con)]

There are a lot of questions that we need to answer in this space—I absolutely accept that—and lots of things that need long-term thought. I think and hope that noble Lords are starting to see that thinking emerge. A lot more needs to be done at the moment, but I think that we accept that this is a long-term issue that needs to be resolved with help from all sides of the House.

Plastics: Health Research

Lord Markham Excerpts

Monday 19th December 2022 Lords Chamber

[Baroness Meacher]

To ask His Majesty’s Government what plans they have to fund research into the health impact of plastic through a new National Plastic Health Impact Research Fund.

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

The Government are funding a broad portfolio of research in this area through UK Research and Innovation and the National Institute for Health and Care Research; both funders welcome applications for research into any aspect of human health. Since 2018 the Government have committed over £100 million for research and development and innovation support, to tackle the issues that arise from plastic waste.

[Baroness Meacher (CB)]

My Lords, I thank the Minister for his reply and assurance that the private sector and trusts and others are investing in this area. But when almost four-fifths of people in this country have plastic particles in their blood, which means most of us in this Chamber if you think about it, and when these particles are associated with cancer, diabetes and other, serious, chronic illnesses, does the Minister accept that this really is a priority? Does he accept that a proportion of the Government’s R&D spending—we suggest 0.1%, which is hardly great—should be allocated as a priority to investigating the impact of plastic particles on human health, and how to tackle the problem?

[Lord Markham (Con)]

I have had the opportunity to speak to the chief scientific officer in this space, so I am guided by the science here, and I have also heard the impact from the Food Standards Authority, which considers it unlikely that the presence of plastic particles in food would cause harm. Further research in this space will be reporting in March 2023, but currently there is limited evidence to suggest that there is any harm.

[Viscount Colville of Culross (CB)]

My Lords, the Environment Act includes the power to be able to charge for single-use items, including plastics, to reduce consumer consumption. Can the Minister tell the House whether or not the Government intend to use this power and, if so, when?

[Lord Markham (Con)]

I am mindful that my brief as Health Minister is fairly large but maybe not quite that large. But I note that in this space we have already replaced plastic bags, very successfully introduced a usage charge, and reduced consumption by 95% in the main supermarkets, so that is a tool that we know works. But currently there is limited evidence suggesting that it is a health hazard.

[Lord Allan of Hallam (LD)]

My Lords, while the global production of plastics continues to grow, the literature tells us that there is still very limited information about their long-term health effects. As we are trying to shift behaviour so that people and businesses reduce their use of plastic, for a variety of reasons, would the Minister agree that more research into the health effects would be helpful to support that public awareness effort?

[Lord Markham (Con)]

We have set up a research fund; as I say, £100 million has been spent around plastic waste in the last few years. Again, I have spoken to the chief scientific officers on exactly this, and if there are good research proposals in this space, they are ready to look, assess and commission them if they will be valuable here.

[Baroness Merron (Lab)]

My Lords, air pollution is the largest environmental risk to public health. Can the Minister say what assessment has been made of the contribution to that risk by the burning of plastic in landfill?

[Lord Markham (Con)]

Again, my understanding from the science is that that is not a concern here. The presence of nanoparticles in the bloodstream has not caused concern to date. However, again, if there are good research proposals in this space, that is exactly what the research council was set up to look at.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister has said a number of times that there is limited evidence, yet we know, as the noble Baroness, Lady Meacher, said, that there are microplastics in our blood. There is evidence that nanoplastics cause change and inflammation in skin and lung cells, and plastics also contain additives, including bisphenol A, phthalates and polychlorinated biphenyls, which are endocrine disruptors and alter reproductive activity. Is a lack of knowledge, in the light of the Government’s supposed attachment to the precautionary principle, an excuse for not acting while all these risks are clearly evident?

[Lord Markham (Con)]

Again, the research bodies are very happy to look at any good proposals. The only place I would disagree with this is on whether you would want to ring-fence a certain amount to a space when you do not know whether there is a health risk there. Therefore, if there are good research proposals, we are definitely ready to take that forward. I will caution against some of the quotes where they are based on a sample size of 22 people, in terms of the common-sense study. That is why we place caution on this, but if there are good research proposals, I say: absolutely, please bring them forward.

[Lord St John of Bletso (CB)]

My Lords, while welcoming the plastic packaging tax in April this year, I noted an alarming OECD report recently that plastic waste entering the oceans is set to treble in the next 40 years. What are our Government doing to fund credible plastic alternatives so as to mitigate the problems at source?

[Lord Markham (Con)]

I understand that this is part of the £500 million Blue Planet Fund that we put in place to help developing countries support the marine environment, and we are a contracting party to the OSPAR convention to participate in marine-limited monitoring programmes.

[Lord Kamall (Con)]

As the Department of Health and Social Care moves towards prevention, is my noble friend the Minister aware of initiatives within the National Health Service and across the health and care system to reduce the use of plastic across our system?

[Lord Markham (Con)]

I thank my noble friend. Yes, the NHS is committed to a 10% reduction in clinical single usage by 2045, and these plans are set out in the NHS long-term plan document, Delivering a “Net Zero” National Health Service.

[Lord Harris of Haringey (Lab)]

My Lords, the Minister has said several times that there is no credible evidence that this is harmful. I just ask him to contemplate whether it really can be good for the human body to be pumped full of foreign material in this way. Would he have given the same answer in respect of smoking, which, when it was first promulgated and mass-marketed, was also seen as beneficial to health?

[Lord Markham (Con)]

The phrase I used was that there is “limited evidence” in this space. I reiterate that if a good research proposal is put forward, funds are available there. The only point of difference on this is that I do not believe we should ring-fence a definite amount each year when the evidence does not yet exist that it is a health risk.

[Lord Patel (CB)]

My Lords, the Minister suggested that his scientific advisors told him that there was no evidence. Finding “no evidence” does not scientifically prove that there is no evidence. It has been said several times that if a scientific proposal was put forward, it would be looked at. Accepting that plastic pollution is a problem, should the NIHR not put out tenders inviting research proposals?

[Lord Markham (Con)]

Again, my wording was “limited evidence”. There are many demands. It feels as though every day I am up here being asked to spend money on something else. As a responsible Minister, I must prioritise spend in areas where it is needed. At the moment, I am being guided by the science, which tells me that there is very limited evidence in this space. If a good proposal is put forward, we will welcome it and look into it. Until then, this is not good use of public money.

Streptococcus A: Antibiotics

Lord Markham Excerpts

Thursday 15th December 2022 Lords Chamber

[Baroness Taylor of Stevenage]

To ask His Majesty’s Government what steps they are taking to address reported shortages of supplies of antibiotics, given the increase in cases of Streptococcus A.

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

We are working at pace with manufacturers and wholesalers to expedite deliveries, bring forward stock and boost supply. UKHSA and the NHS are co-ordinating communication to healthcare professionals, including advice on using alternative effective medicines as necessary to ease pressure on supply. Early treatment is vital, so in addition to bolstering supply we are providing information to parents to understand the trigger points for urgent referrals.

[Baroness Taylor of Stevenage (Lab)]

I thank the noble Lord for his Answer, but despite Ministers saying that there is no problem—the Health Secretary has said that—worried parents across the country are going from pharmacy to pharmacy to seek the antibiotics their children need. Can the Minister update your Lordships’ House on the improvements in availability since the Health Secretary said, as in the statement repeated this morning, that he was

“working urgently with manufacturers and wholesalers to explore what can be done to expedite deliveries”?

Further, are there any plans within DHSC to update the concessionary price for amoxycillin and penicillin, so that pharmacies do not have to foot the bill for the rapid increase in costs they are experiencing?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important matter to us all. Yes, they are working very strongly; I had a series of meetings yesterday on this very subject to go through all they are doing on the supply front. Importantly, as we speak, they are putting out advice to medics about suitable alternative antibiotics that can also be used in this case. I am satisfied that they are doing everything they can towards this. Clearly, where there are price problems such as those the noble Baroness mentions, we will also act in that area.

[Lord Sikka (Lab)]

My Lords, the cost of producing strep A antibiotics has not changed but the selling price has rocketed in recent weeks from 80 pence to £19 per packet, mainly because of profiteering by companies. Will the Minister launch a publicly owned company to manufacture generic drugs, which would provide jobs and exports, secure long-term supplies, protect the NHS budget and end the profiteering by drug companies? Does he have any objections to that?

[Lord Markham (Con)]

My general thinking—this is a personal view—is that the market is normally very well placed to supply these things. There was the excellent example of the vaccines, whereby it acted incredibly quickly and got Covid vaccines out as necessary. I think we are always better placed using the strength of the whole market and looking to international suppliers as well. They are always going to be able to provide the necessary medicine to a quicker timescale than our own company would.

[Baroness Finlay of Llandaff (CB)]

My Lords, since the risk of invasive group A streptococcal infection is increased in the presence of other viral infections—any of them; it could even be chickenpox in children—what guidance are the Government giving to all schools on public health measures to decrease cross-infection between children and ensure parents are encouraged to keep those who might be unwell away from school, rather than sending them to school, as is the tendency, because of attendance registers?

[Lord Markham (Con)]

The noble Baroness is correct; it is the coincidence of more than one condition, particularly respiratory conditions, which causes the more extreme cases. The advice is definitely to keep children away from school if there is any question on that at all, especially as we are about to enter a period of school holidays. It is very much the view of the experts that the school holidays should flatten the curve of infections. I should also say at this point that while we are all quite correctly concerned about this, and doing everything we can regarding supply, the current levels are still lower than those we saw in 2017-18, when March and April had the normal peaks of around 2,000 a week. We are currently at around 1,200 cases a week and, as I say, we expect that to flatten out a bit with the firebreak, so to speak, of the Christmas holidays.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Lord, Lord Campbell-Savours, is participating remotely.

[Lord Campbell-Savours (Lab) [V]]

My Lords, as someone on a six-day lockdown and on intermittent antibiotics to deal with a lung condition following surgery, can I suggest, on these shortages, that guidance on antibiotics such as amoxicillin should be updated to allow for greater flexibility of expiry dates? There is too much wastage, and with careful prescription advice and labelling, antibiotics can have a far longer shelf life before deteriorating. Rigid advice on packaging should be relaxed in favour of more flexible expiry dates, as current advice only serves the manufacturers, who sell more.

[Lord Markham (Con)]

I thank the noble Lord and I agree. We are looking at every sensible measure we can to ensure we have the greatest flexibility of supply. Expiry dates are clearly one thing we can look at, and I will take that back to the department. I wish the noble Lord well and hope that he feels better soon.

[Lord Allan of Hallam (LD)]

My Lords, community pharmacies in Northern Ireland were warning back in October of serious problems with the supply and pricing of a range of drugs. While it is welcome that there now appear to be investigations into the wholesale supply chain for antibiotics, may I also urge the Minister to look at whether there were missed opportunities for earlier intervention?

[Lord Markham (Con)]

Absolutely—clearly, we always need to learn in such circumstances, so we will be happy to do that.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Can my noble friend give reassurance that dispensing doctors, pharmacists and others will be reimbursed for the full cost of the increased price of antibiotics?

[Lord Markham (Con)]

My understanding is that there are measures in place to ensure that the people supplying in those circumstances are not losing out because of profiteering. The most essential message today is that that supply is available to anyone who needs it, so I will take that back.

[Lord Turnberg (Lab)]

My Lords, is it the manufacturers in the pharmaceutical industry or the wholesalers—the middlemen—who are making the profits? What mechanisms are available to clamp down on them?

[Lord Markham (Con)]

The key mechanisms always involve broadening the supply chain. I have given exactly that instruction to the department, which is very much taking it on board. It is looking at supply across a number of sources, not just from the UK but worldwide, as well as the substitution of antibiotics. Penicillin is currently the advised one, but a number of others are being advised right now which will also work well, so that there is as much choice as possible.

[Baroness Manzoor (Con)]

My Lords, my noble friend will be aware that, while some people are making profits, 16 children under the age of 15 have died as a result of strep A. Exactly what advice is being given to GPs so that parents have direct access to them very quickly? Of course, there is also a concern about antibacterial resistance as a result of overprescribing antibiotics.

[Lord Markham (Con)]

I thank my noble friend and will take this opportunity to offer that public health advice. A rash, which is often the first sign of a bacterial infection in this case, or a child being floppy, drowsy or dehydrated are all key signs that they should urgently seek medical help. People can call 111 or 999 and be guided through the triaging process to make sure that they get help quickly. At the same time, medics have been told to lower the barrier for prescribing, so to speak, so that they can make sure that people get it early. Although every death is a tragedy, we are clearly now seeing some reduction in the death rate, which is welcome.

[Baroness Merron (Lab)]

My Lords, while many pharmacies are being forced to sell the antibiotics they can get their hands on at a considerable loss, as wholesale prices soar, the Government have been saying that no company should be using this as an opportunity to exploit the NHS. Can the Minister assure the House that the Government have learned from previous mistakes with procurement and are taking measures to ensure that no company profits unduly from the increased demand for medication?

[Lord Markham (Con)]

As I mentioned, no one wants to see profiteering in these sorts of situations. The absolute focus right now is on expanding supply, because that is clearly the first thing you need to do. But you then absolutely need to learn lessons and see that appropriate action is taken against companies doing that.

NHS and Social Care Workers

Lord Markham Excerpts

Thursday 15th December 2022 Lords Chamber

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

I thank noble Lords. I particularly thank the noble Lord, Lord Allan, for introducing the debate. I look forward to working with him, just as I have enjoyed working with the noble Baroness, Lady Brinton—I hope he does pass muster. I am pleased to respond to this Question for Short Debate on the steps we are taking to support the NHS and social care workforce. We all agree that this is an important issue and that we are all indebted to the people who work tirelessly in our health and care services.

Helping the health and social care workforce manage their mental health and well-being is important and we are committed to helping staff recover. That is why we encourage adult social care providers to invest in mental health and well-being services for their staff. The NHS People Plan and the NHS People Promise set out a comprehensive range of actions to prioritise staff well-being. Boards, leaders, non-exec directors and managers across the NHS are being asked specifically to consider the health and well-being of all their staff as a priority.

As the winter approaches, we know that the system has not rested over the summer. It has been fighting the pandemic for years and we know the drain that that has caused. We know that this winter, with rising cases of Covid and flu, we are putting more pressures on staff, alongside the pressures of the cost of living. We understand those pressures and the need to support the workforce. I will try to answer some of the questions more directly later, but we understand the need for the £500 million fund to help with discharge and workforce support.

We understand the importance of pay in making people feel looked after in what they do. We have accepted the recommendations of the latest independent pay review body in full. I apologise if I made a mistake. I thank the noble Baroness for kindly and gently putting that forward. I will go away and make sure I correct that. I thank her again for the way that was put forward.

We have given more than 1 million non-medical NHS workers a pay rise of at least £1,400 this year, which is equivalent to 4% to 5%. We deeply regret that some feel the need to take industrial action despite that. I will address the specific questions on the pay review and the impact of inflation later.

This is more difficult with care workers, because they are paid by people outside our control, so to speak. Our only hope is that with around 70% of the total payments in this area going to wages, the £2.8 billion and £4.7 billion of additional funding will find their way into the pockets of the people who need it. That is something we will encourage. At the end of the day, if you cannot recruit and motivate a workforce, you will not have the care you need—it is simple.

Alongside looking after our staff, we know that demands on the NHS and social care are increasing. Expanding the workforce has to be a priority. While the numbers are increasing—I will not repeat the statistics I often give out—we know we need to do more in this space.

I may be going a little off-piste here, but I think we can be more creative and flexible in the way we do that. I do not think we are making enough use of apprenticeships and other routes in. I give the example of my mother, who left school at 15 with no qualifications, became a mother with three kids and then, in her 30s, found a way into nursing, first as an SEN—an easy entry path—and then as an SRN. Eventually, she became a midwife and worked for more than 20 years in the health service. We need more of those sorts of routes.

Would it not be great if we had a modular system so that a person working at a dentist’s for two years could qualify as a dental nurse? Instead of working in Wetherspoons for most of their training, their part-time work could be in that profession, using and honing their skills. Would it not be great if a dental nurse who was good at their job knew that their qualifications were part of the way towards becoming a dentist? The team is looking at those modular systems in terms of that flexibility. Training and development is clearly a key part. We are funding more places. In the nurse space, it is not limited. There are more than 70,000 nurses in training as part of that, but clearly the workforce plan needs to set out whether we need to be doing more in this space.

I know that we all welcome the workforce plan and I appreciate the comments from all Members of the House, particularly those opposite, that have for a long time been, quite rightly, that we need to do it. I think that we are all pleased that we are doing it. I completely accept the need to ensure that it is detailed enough to be useful, for want of a better word, and that it needs to be iterative, which will involve other people. I understand that such transparency brings pain, because you have inputs from other people who do not always agree with you. However, you get a better product at the end of it. I am afraid that I cannot give more information on a timetable yet, but I will press for more information.

I accept that inflation makes annual pay reviews more difficult. That is the problem with inflation. We have tried to make exceptions for the nurses in the past. Offering what I hope is a sensible view, as we were saying in the debate yesterday, April is not that long away. If we could expedite a process for the independent pay review body, maybe that would be a sensible way forward, where people feel that there is recognition of the impact that inflation has. Sometimes inflation can mean that you need quicker answers than you might normally expect.

On the social care space and the long-term strategy, I know that Minister Whately is very focused on this, to an amazing degree of detail, and on the impact of that £500 million fund and the results. I accept that it took a while to get that money out, and I partially take the blame. We wanted to ensure that it was going out in the right places, which took a bit more time. I hope and expect it to have been worth that time to ensure that it is targeted in the right place. That £500 million is the first instalment, with up to £2.8 billion next year, particularly in the places that work.

I know that it is a favourite thing for the noble Baroness, Lady Brinton, to bring quotes to the Chamber. I liked this one, and look forward to hearing more, particularly as Aldous Huxley is one of my favourite authors. Clearly, we need to make science and technology work for the NHS and not the other way round. On the point around productivity and the IFS, candidly, a lot of that is down to poor systems and the work that must be done to improve that, as the IFS rightly states. We are looking to address these things through the estates programme and the £10 billion per year capital spend, which is a big increase on previous years. In some areas, productivity has gone backwards, but in many areas it has not. We must understand what conditions are enabling us to increase productivity and how we can use that to help those areas that are not as productive as before to catch up and overtake.

I will try to answer some of the other questions. On pensions, as the noble Lord, Lord Davies, mentioned, there will be a further debate on this in the new year. It is a serious issue that, let us face it, we need a solution for, because we know it means that people are voting with their feet and leaving the service. Clearly, we need a solution to it all. It is something that we are taking seriously, with detailed work. We can discuss it further in the new year.

I have to admire the passion for prevention in the speech from the noble Lord, Lord Bird. One of the pleasures of this job is sharing an office with, or being fairly close to, Chris Whitty, and seeing many of the things that he brings such intelligence and value to. If you speak to him about prevention, he will talk about his concern right now for those people who missed out on heart checks—the 50 to 65 year-old cohort who did not have a heart check during Covid. That is one of the things that needs to be high up the list of the things to address in the prevention agenda.

On the other points, I will need to give the noble Baroness some more detail in writing on the findings of the report she mentioned. Given that we are running out of time, as ever, I will provide a detailed response to anything I have not managed to cover.

In conclusion, I again thank noble Lords. I agree with the sentiment that it would have been nice to have had a lot more contributions, but through this programme of work, including by supporting care employers and commissioners, we are helping to build the robust and resilient workforce the NHS and social care systems need for the future. We are working to ensure that the country has the right people, with the right skills and in the right places, and that they are well supported and looked after so that they can in turn look after those who need our great NHS and social services.

NHS Industrial Action: Government Preparations

Lord Markham Excerpts

Tuesday 13th December 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Royal College of Nursing and UNISON have said that they are prepared to call off strikes if the Government will negotiate with them seriously regarding pay. So the key question to the Minister is whether his Government will confirm whether they are prepared to do this in order to avoid disruption to patients in the NHS. As today’s devastating King’s Fund report on the state of the NHS, which was commissioned by the Government, so clearly shows, these strikes are not just about pay. Can the Minister give his view on the wider factors that have led to the strikes and give some commentary as to why the Government have not taken preventive action?

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

I thank the noble Baroness. On the other actions, so to speak, we have already met a couple of times with the union and are very happy to meet to talk about other things we can do on terms and conditions. As regards the main element around pay, we are following the results of the independent pay review body, which, as the House will be aware, has been in existence since 1984. Parties from each side have taken its expert advice and followed it, and that is what the Government have done in this situation.

[Lord Allan of Hallam (LD)]

My Lords, patients will naturally feel very anxious whenever there is disruption to services that they need, but this anxiety can be mitigated by effective communication. Many of us will have had experiences of great communication by the NHS, such as during the Covid-19 vaccination programme, but also of frustrations, where letters are lost or delayed or we are playing telephone tag with hospital administrative staff. What steps will the Government be taking to ensure that patients receive clear, timely and relevant information during the forth- coming industrial actions?

[Lord Markham (Con)]

I thank the noble Lord for the question. Clearly, we want to ensure that there is as little disruption as possible, and appointments will go on as normal where possible. The general advice is that, if you have not been communicated with, you should turn up to your appointment as normal. As ever, there is a bit of fluidity in the situation, because, as I am sure noble Lords are aware, a nurse does not have to give notice of whether they are going to be attending work that day, so there needs to be some fluidity. But the expectation is that, if you have not heard from us already, you should turn up to your appointment and, in all likelihood, you will receive your planned treatment .

[Lord Robathan (Con)]

My Lords, if the military personnel are going to drive ambulances, for which they are paid less than the ambulance drivers and paramedics, will my noble friend ensure that all military personnel get paid a bonus for the work they do?

[Lord Markham (Con)]

First, I will take the opportunity to thank the Armed Forces and anyone else who will be helping at this difficult time. I appreciate that that might cut into some of their plans for Christmas and I appreciate what they are doing in the circumstances. I cannot speak beyond that in terms of any financial support that they might be given, but they will definitely have our undoubted thanks.

[Lord Balfe (Con)]

My Lords, does the Minister accept that many working families are much worse off because of inflation? The image given by the Government is that they have no coherent strategy. We seem to be in a sort of playground situation of shouting at each other, whereas what we need is understanding from the Government as to how they are going to tackle the inevitable fall in the standard of living caused by the excesses that happened during Covid. Will the Government try to get their act together, because the sympathy of the general public is not with the Government? It is not against the strikers. At best it is neutral and at worst it is moving the other way as we get nearer to Christmas.

[Lord Markham (Con)]

We appreciate of course that these are difficult times. Unprecedented circumstances have caused the current inflationary environment, which we appreciate provides challenges to many people. We are trying our best to help them navigate through that. Obviously, the energy support package was a good example of where we are trying to make sure that probably the biggest component of inflation—the increased energy bills—is covered. We will seek to act and do what we can in all circumstances to help people through the crisis.

[The Lord Bishop of Chelmsford]

My Lords, even prior to the strikes, agency nurses were being brought in to ensure that shifts were safely staffed. I should be grateful if the Minister would set out what assessment the Government have made of the cost to the NHS of employing agency staff, compared with that of a pay rise that would work towards an arguably better and more stable workforce?

[Lord Markham (Con)]

I do not have those figures to hand, but I believe there is a Question on this subject tomorrow, when we will be talking very much about the use of agency staff and bank staff. From memory—the right reverend Prelate will get the exact figures when I have done a bit more swotting up overnight—I think the cost of agency and bank staff work this year is around £3 billion. Clearly, the workforce strategy will be all about making sure we can recruit staff to minimise that.

[Lord Lansley (Con)]

My noble friend referred to the NHS Pay Review Body. As Secretary of State, I thought it was rather important that I did not determine the pay of nurses, for example; the pay review body made recommendations and I adhered to them. Will the Government continue to explain that they are not refusing to negotiate on pay with the trade unions but adhering to a long-established principle? The trade unions appear to be seeking somehow to overturn last April’s pay award, when they should be providing evidence to the pay review body on what the pay award should be next April, with the remit letter already published.

[Lord Markham (Con)]

I thank my noble friend for his question. He is quite right. As mentioned before, this body was set up in 1984 and extended to other areas of the health service in 2007. Since then, Governments of all colours have followed its recommendations because, after all, it is the expert in this field. We have honoured that in full because it is right that the experts determine it. Working towards making sure that the next settlement in April—which, let us face it, is only three or four months away—covers the latest situation would be a good way ahead.

[Lord Rooker (Lab)]

Is not the total silence of all members of the pay review body since it delivered its report to the Government remarkable? Has anyone asked them, bearing in mind that they delivered their report when inflation was about 3% or 4%, whether they believe the figures in their report are still relevant today? Forget last April or next April—we are talking about today. The pay review body has been loaded up with a responsibility by the Government which in a way is not solely its responsibility. The Government do not have to accept its recommendations, as the Scottish Government have not. Has anybody asked it whether, in the present circumstances and with inflation so high, it still stands by the report it delivered in the middle of last year?

[Lord Markham (Con)]

My understanding, based on the long time that this has been in place, is that this is an annual review. April is now quite close; for that April review, it can take into account all the factors, including what happened to inflation during the year. I expect it will take all that into account, quite rightly, in what it comes up with for that next pay review. It is a long-established principle that it is there to do this. I trust it to get the right answer in time for April.

[Lord Deben (Con)]

Will my noble friend be very careful to stick by the case being put forward? We know that those arguing it want to hide behind some discussion of the mechanisms in order not to say what they really think about the pay rises. The Government have a responsibility to stick by the system. If we lose that, it will be the Minister who makes decisions always, which is what we have tried to avoid since the 1980s.

[Lord Markham (Con)]

I agree. Clearly, there are difficult choices; if we changed the position, we would have to take money away from other parts of the system, such as the elective care fund and other front-line services, which we clearly do not want to do. It is absolutely right that we let the experts guide us in this, as all Governments have done for more than 30 years.

Food (Promotion and Placement) (England) (Amendment) Regulations 2022

Lord Markham Excerpts

Tuesday 6th December 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is a pleasure to follow the noble Baronesses, Lady Walmsley and Lady Merron. They have said practically everything I wanted to say, and as the Minister may find it depressing for me to say it a third time, I will not.

What I do want to focus on is the key role of Parliament, and in this case your Lordships’ House, in scrutinising statutory instruments. We all have to accept that the period during which Liz Truss was Prime Minister was a somewhat extraordinary, though very short, one. I note in parenthesis that the Minister was appointed on 10 October, after these incidents had happened, so I think we need to recognise that he is responding to something that happened before he was in post. He was, however, appointed by Liz Truss.

The key thing is the sleight of hand in turning something that was absolutely openly discussed during the passage of the Health and Care Bill, and which was only to be used as a very short-term emergency measure, into what has clearly become a highly political move. While I have perhaps been slightly harsh on the time during which Liz Truss was Prime Minister, her successor has chosen not to reverse this, which tells me that this is a move by the Government.

I have to echo the points made by the noble Baroness, Lady Walmsley, about the evidence to our eyes during the passage of the Health and Care Bill of those who had heard the lobbyists and were fighting hard against the amendments the Government wanted.

I have just a couple of questions. We do need to see the evidence. The Secondary Legislation Scrutiny Committee was right: it is not appropriate to ask Parliament to scrutinise something without the evidence. Where is it, when will we see it and why do claims about the cost of living contradict the Government’s own evidence in the impact assessment available at the time? It is important that Parliament sees the detail of the responses to the Government’s consultation from every sector—food and drink, supermarkets, health bodies, not-for-profit organisations and charities—and the public, in whatever way they responded. Do the Government plan to publish that consultation?

Given the concern expressed by everyone who has spoken this evening, and indeed the Secondary Legislation Scrutiny Committee, and the evidence of our own eyes in your Lordships’ Chamber during the passage of the Health and Care Bill, it might be helpful if Ministers could publish all the meetings that all Ministers have had with food and drink industry members this calendar year, which about ties in with the beginning of the passage of the Health and Care Bill—at least, the first consultations prior to legislation arriving here in your Lordships’ House.

Finally, I suspect this may be slightly beyond the power of the Minister, but I do hope he will go back to the usual channels and seek guarantees that this sleight of hand will not be used again, especially given the delay on advertising HFSS products on TV and online before the provisions are due to come into effect on 1 January 2023. We absolutely must have that 21 days to decide whether we want to pray something in aid and bring forward regret Motions. However, there is a bigger issue here: the reputation not just of your Lordships’ House but of the Executive, and the power of the Executive just to ignore the systems that are in place. We need to make sure that scrutiny can be done effectively.

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

My Lords, I thank the noble Baronesses, Lady Merron and Lady Walmsley, for securing this important debate to discuss the Food (Promotion and Placement) (England) (Amendment) Regulations 2022. I also pay tribute to the Secondary Legislation Scrutiny Committee for its 15th report of the 2022-23 Session, which considered the amendment.

I thank noble Lords for their constructive and thoughtful contributions to the discussion on tackling the significant challenge of obesity. From this debate and our previous discussions, the good news is that we are all agreed on the need to take action. We are all aware of the stats: 40% of kids are overweight when they leave primary school, 25% are obese and, as the noble Baroness, Lady Walmsley, said, there is a huge impact on the economy of £58 billion per annum and a huge impact on the NHS of £6.5 billion. That is notwithstanding the huge impact on individuals’ personal health and well-being as well.

We are also all agreed on the strategy that we need to take: reducing overconsumption of food and drink high in calories, sugar, salt and fat. I think we all know the main levers available to achieve that but, to paraphrase the OECD, there are four key steps: information/education, increasing healthy choices, modifying costs and restrictions on promotions and product placements. We have made good progress on each of those. We have extensive education programmes and traffic-light labelling on food, we are working with industry to reformulate food recipes, we are putting calories on menus to signal healthy choices and we are ensuring a healthy start to life through nutritionally balanced school recipes. Furthermore, the sugary drinks tax levy has had a huge impact, with a 47% decrease in sugar.

Finally, the introduction of restrictions on product placement has had a high impact on the look and feel of our supermarkets. It is early days but a year-on-year change in the consumption of these types of products—two months into this, I guess—shows an 8% fall in sugar content, a 5.7% fall in salt consumption and a 6.4% fall in fat, which shows that these restrictions on product placement are working. Furthermore, analysts calculate that the steps we have taken here will account for 96% of the reductions in calorific intake. I repeat: the actions that we have taken, thanks in large part to all of us in the House, account for 96% of the projected reduction in calories. The early signs from the evidence that I gave show me that those actions are working.

I turn to the 4% and the thing we have not done, the subject of the regret Motion tonight: the delay to the ban on promoting foods high in fat, sugar and salt—the so-called BOGOF, or “buy one, get one free”, promotions. I emphasise that this is just a delay to the ban to give people time to adjust. I am delighted to say that Tesco and Sainsbury’s, accounting for 42% of the market, have already voluntarily banned BOGOFs of these types of food products. I am confident that the rest of the market will voluntarily follow, whether they are supermarkets following the lead of Tesco and Sainsbury’s or food companies reformulating their recipes to reduce fat, sugar and salt to avoid the so-called BOGOF ban.

By working with the food industry, we have taken action to address 96% of the problem, and we are working collaboratively with industry to implement the remaining 4%. Those figures probably give the best answer for the delay, though I concede that maybe I say that as a data analyst—and it was before my time.

I agree with the noble Baronesses, Lady Merron and Lady Brinton, that the so-called sleight of hand clearly was not great. I am pleased to take that from this debate, and I commit to doing better for as long as I am here.

The noble Baroness, Lady Walmsley, asked about the benefits challenge. The action that we have taken is focused on 96% of the forecast decrease in calorific intake, which again shows that we have acted where the benefits are most likely to accrue. My rough maths says that, if 42% of the market—Sainsbury’s and Tesco—voluntarily introduce this, we are now looking at addressing about 98% of the calorific intake that we had forecast to reduce. By any measure, that shows very strong analytical evidence of good reasons for doing so, and for giving people time to adjust and make the other changes.

On the 21-day rule, a consultation on this instrument was conducted between 3 and 17 August 2022. This was a short consultation shared with key stakeholders, including trade industry bodies and organisations, non-governmental organisations and enforcement officers. We sought views on the proposed text of the instrument. A summary of the outcome of the consultation was provided in the published Explanatory Memorandum. We explained that the consultation received 11 responses, including from organisations that represent over 50 health organisations, and industry trade bodies that represent manufacturers and retailers. All proposed changes suggested as part of the consultation were considered in the light of ensuring that this instrument served the intended purpose of delaying the implementation of the volume price promotion restrictions by 12 months.

[Baroness Brinton (LD)]

My question was whether the detail of the consultation responses would be published in the future. I appreciate that the Minister may not be able to answer that now, but even though there may not have been responses from many people—and it sounds as though there were not—it would still be useful for us to see that to do our job. Can he take that back? It is the normal convention that the results of public consultations are published; if not word by word, there is certainly more of a summary provided than there was in the Explanatory Memorandum.

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Baroness and am happy to take that back.

I hope that I have answered the questions. In all honesty, I cannot go into some of the details of whether there were other reasons behind it. As ever, being the data anorak that I am, I will fall back on the fact that what we did addresses 96% of the forecast reduction in calories. As ever, I will happily follow up in writing on anything that I have not covered.

I thank the noble Baronesses, Lady Walmsley and Lady Merron, for bringing forward the debate tonight. We are all agreed on the need to tackle obesity, and I want to focus on those things that we agree on. We are agreed on the actions and that those implemented already, such as the sugary drinks tax levy, have resulted in an almost 50% reduction in sugar, and that those recently implemented account for 96% of the projected reduction in calories. Our only slight disagreement is over time, concerning the remaining 4%, but by working collaboratively, we have already brought the biggest two supermarkets on side, and we will have 100% implementation within the year. We are working with the industry and we are backed by the science in what we are doing. Most of all, the action taken to date is working.

Children in Care: CAMHS Waiting Times

Lord Markham Excerpts

Monday 5th December 2022 Lords Chamber

[The Lord Bishop of Southwell and Nottingham]

To ask His Majesty’s Government what assessment they have made of the length of the waiting times for children and young people in care who need to access the support of Children’s Adolescent Mental Health Services; and what steps they are taking to reduce those waiting times.

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

We do not have a national waiting time standard for these services, so this data is not available. However, increasing access to these services is a priority. We are expanding mental health services through the NHS long-term plan. Funding for mental health services will increase by at least £2.3 billion a year by 2023-24 so that an additional 345,000 children and young people, including those in care, can access NHS-funded mental health support.

[The Lord Bishop of Southwell and Nottingham]

I thank the Minister for his Answer and declare an interest as a foster carer of more than 10 years. In my diocese, in Nottingham city and Nottinghamshire, 1,040 children and young people waited more than 12 weeks between referral and second contact last year. Surely, those delays are unacceptable. Does he agree with the president of the Association of Directors of Children’s Services, Steve Crocker, that His Majesty’s Government need urgently to undertake a full review of children’s mental health services to ensure they are able to meet the growing demand we have seen placed on them, especially for looked-after children, who are four times more likely to experience mental health issues than their peers?

--- Later in debate ---

[Lord Markham (Con)]

I have some personal experience in this area, so I agree that we need to see people as quickly as possible. On the investigation, we have recently undertaken a call for evidence, which closed in July with 5,000 responses that we are going through. I think that our response to that will answer many of the questions, but I would be happy to meet the right reverend Prelate and discuss this further when we have those results.

[Baroness Tyler of Enfield (LD)]

My Lords, the Select Committee looking at the Children and Families Act 2014, which I have had the honour to chair, is publishing its report tomorrow, and the frankly dire state of children’s mental health services runs through it like a stick of rock. Our inquiry received harrowing evidence of waiting times of up to two years for children already in crisis; specifically, we heard that there are very long waiting lists for post-adoption trauma support. What are the Government doing to improve mental health support for this particular group of children?

[Lord Markham (Con)]

I will need to write to the noble Baroness to give a specific response in that case. It is an area of concern where I think we are increasing awareness, and any diagnosis needs to start with awareness. By definition, that means that more people are diagnosed or come forward, which is a good thing, but it then means that often it takes longer to see those people—I do not say that as any sort of excuse but just as an explanation. As we increase our understanding in this area, and I think that we would all agree that over the last 10 to 15 years there has been a huge increase in understanding, that means that more people are coming forward, but it means also that we need up our game in terms of supporting them.

[Lord Laming (CB)]

My Lords, following the noble Baroness’s question, the Minister will well understand that children do not come into care for trivial reasons; most of them have had a very poor and traumatic start to their young lives. The state has taken on the responsibility to be a good parent to those children. Would it be possible for them to be given priority in the waiting lists for these essential mental health services?

[Lord Markham (Con)]

I would agree. In any case, especially where there is high demand in an area, we need a form of triaging so that we can agree the clearest areas of priority, such as those mentioned.

[Lord Porter of Spalding (Con)]

My Lords, my noble friend has quite rightly mentioned the amount of money that the current Government are finding to attach to this issue, and predecessors of his at the Dispatch Box would have all said similar things. The country is investing billions of pounds in children’s mental health, quite rightly—that has a huge effect on people’s lives, and it also has a huge knock-on cost to other parts of the Government’s spend if it is not done properly. What assurance can my noble friend give to the House that those billions of pounds are being spent properly on the services they are being given for, and are not being used to subsidise bad management decisions such as PFI contracts?

--- Later in debate ---

[Lord Markham (Con)]

I thank my noble friend. As ever, we need to make sure that every pound is well spent. These services come under the regulatory and inspection regime of the CQC. Also important in this space—probably most important of all—is understanding and getting early intervention, which means having more people in schools who understand and can help assess and identify some of those children early on. That is why the programme to intervene in schools and develop a senior mental lead is critical. Half of all secondary schools are taking that up right now. Half is not all, so there is more work to be done, but it is good progress.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, the Minister may be aware that all young people who get sentences from youth courts get CAMHS assessments, which is a good thing. However, does he think that young people who have out-of-court disposals through YOTs should also get CAMHS assessments, because a very high proportion of them would have mental health needs?

[Lord Markham (Con)]

Generally, we need to try to assess as many people as we can. I remember in my school there was a child in our class who we just thought was naughty and got into all sorts of trouble, but now, having had my own personal experience later on, I know that he had an autistic spectrum disorder. Clearly, he needed help and he was not assessed, so, as a statement, I agree that we need to increase assessment as much as we can for all these cases.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the provision of services in schools, which is very welcome, but does he accept that thousands of young people are now being home educated? Will he ensure that there is parallel support for those children in terms of mental health provision?

[Lord Markham (Con)]

I agree. Arguably, if you are being home schooled, you probably need a lot of help. As the noble Lord will be aware, a lot of the services are related to social prescribing, where often people with mental disorders can be helped by involving them more in community activities. Clearly, those who are home schooled are much more likely to be isolated.

[Baroness Altmann (Con)]

My Lords, I congratulate my noble friend on his previous answer about triaging so that those in care can get urgent mental health support. Does he have any targets in mind as to the proportion of children in care with mental health needs who could be seen within, let us say, six months rather than the current waiting time of up to two years?

[Lord Markham (Con)]

I thank my noble friend. The NHS has recently set out a national framework for the practical pathways that it expects ICBs to follow in terms of getting diagnoses. To be very open with my noble friend, given demand, setting targets in this space is probably not the wisest thing to do, but we understand that we need to get on top of this.

[Lord Stirrup (CB)]

My Lords, clinical staff are at crisis point throughout the NHS. What contribution are staffing levels in this area making to current waiting lists, and what is being done to address it?

[Lord Markham (Con)]

I do not know what contribution it is making to waiting lists. However, I do know that the long-awaited workforce plan—which noble Lords opposite have quite rightly asked me about many times, and I am very glad to say we are now producing it—will include these types of people as well, because they are clearly a very important component of the workforce that we need.

[Baroness Merron (Lab)]

My Lords, care-experienced children and young people are disproportionately affected not only by mental ill-health but by barriers to getting support. Bearing in mind that this group of young people often experience multiple placement moves, which are often far away from home, can the Minister say what work is going on to ensure that services are designed around this specific requirement?

[Lord Markham (Con)]

I thank the noble Baroness. As noble Lords are aware, we think that in-patient care should happen only in the most extreme and serious cases. It is much better to have care in the community and local support around that. That is very much where we are coming from. The response to the independent review of children’s social care, which the DfE is leading, will be published in the new year, and I would be happy to update the noble Baroness when we have those findings.

Invasive Group A Streptococcus and Scarlet Fever

Lord Markham Excerpts

Monday 5th December 2022 Lords Chamber

[Baroness Brinton]

To ask His Majesty’s Government what assessment they have made of their guidance to doctors and to parents in light of the increase in Strep A, iGAS and Scarlet Fever cases.

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

The UK Health Security Agency has declared a national standard incident to co-ordinate the public health response. It is working with schools and GPs where there are outbreaks to provide information on scarlet fever and iGAS. A rapid surveillance report and communications to the health system have been published to ensure heightened awareness among front-line clinicians. We are also putting out key messages for parents to understand the trigger points for urgent referrals of children with more serious cases.

[Baroness Brinton (LD)]

My Lords, UKHSA has reported today that, in the last 10 weeks, it has received 4,622 notifications of scarlet fever, compared to an average of 1,200 for the same period over the previous five years—that is more than three times. Parents with very sick children report being turned away from hospitals or GPs not prescribing antibiotics. Local directors of public health are talking to schools and GPs, but can I ask the Minister what else can be done to ensure that all cases of potential strep A and scarlet fever are tested for, and treated as appropriate at the earliest moment, to avoid serious illness and death?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, the UK Health Security Agency is to work in collaboration with the public health agencies in Scotland, Wales and Northern Ireland. What level of collaboration has taken place on issues around strep A and scarlet fever, and what have been the results and outcomes? I am aware that there have been some cases in Northern Ireland.

[Lord Markham (Con)]

I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will be aware that, on social media, there have been a number of recommendations by health professionals that concerned parents should go to their GP to seek advice. Yet he will know that GPs are under considerable pressure. The GP patients survey showed that over a third of people did not see or speak to anyone when they could not get an appointment at their GP practice. What special arrangements are being made to ensure that parents can get through the system to get advice?

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Lord. At this point, I put out the general message that, if parents are aware that their child is unwell, particularly drowsy or dehydrated, that is when they should look to seek medical advice. They should start by using paracetamol and ibuprofen. Clearly, if there is no response, they should be particularly concerned and absolutely making sure that they are getting access to the surgery—to a nurse, as well as a doctor, in this case. This is clearly a priority area. We need to make sure that there is access for those people.

[Baroness McIntosh of Pickering (Con)]

Following on from the question by the noble Lord, Lord Hunt, if the child presents symptoms after 6 o’clock at night or over a weekend, they will clearly be dependent on out-of-hours service. What is the department recommending that they do? Should they go to A&E in these circumstances? It is obviously absolutely vital that, if the child has meningitis or scarlet fever that may develop complications, they should be attended to and given medical assistance as soon as possible.

[Lord Markham (Con)]

I can probably draw on a personal illustration. In answer to a question a couple of weeks ago, I mentioned how I used 111, and in this case I think the advice would be to use 111. In that instance, I was able to get access to a doctor. On that basis, if the symptoms are there, to take that example, a doctor can arrange for a prescription to be sent to an out-of-hours pharmacy. The most important thing in these circumstances is to get antibiotics quickly. The first thing I would say is to use 111. Obviously, A&E is always there, but a more effective route would be through 111.

[Baroness Merron (Lab)]

My Lords, the Minister and noble Lords will know that parents across the country are deeply worried by this situation. To pick up the point that the Minister has just made about the 111 service, perhaps he can respond to the concerns that have been raised by some medical experts that the NHS’s 111 service is not fit for purpose in effectively identifying and triaging critically ill children.

[Lord Markham (Con)]

All I can say on that is that, clearly, that is not acceptable and we need a situation where it can, and that is why we should have inspectors. If we are using 111 as a backbone service, as we are in this case, it is vital that people are getting proper advice. By the way, I see a lot of that, and it is something that I am personally involved in now, as well as using it digitally—a lot of these things can be done through the use of the apps and so on—but, clearly, we need to make sure the advice people get is sound.

[Lord Cormack (Con)]

If a parent has not had a response from 111 within an hour, should they not then ring 999?

[Lord Markham (Con)]

I would advise—and again this is personal advice—that, if they have not got a response and they are concerned about their child, it is probably better and quicker for them to drive, if they are able to. Clearly, if there is a 999 ambulance response because they cannot get to the hospital quickly, then that is a fallback, but if they are able to drive with their child and they are concerned in that way, my advice would always be to go for safety first in this. Again, as a parent of a four year-old and seeing the chatter on social media over the weekend, I know this is an area of concern. Clearly, we need to make sure that reassurance is there for everyone.

[Baroness Browning (Con)]

My Lords, I had scarlet fever twice as a child, two years running. I seem to recall a doctor called at my home, diagnosed and prescribed. Also, at that time—it was the late 1950s—my library books were taken away for fumigation, and I was kept in isolation. Why can we not have that sort of service today?

[Lord Markham (Con)]

That is a serious question, and I think many of us would love that kind of service, but we know we are living in an age where the community doctor in that way does not exist. It was way before my time, but I think changes were made to GPs’ contracts which means that, unfortunately, that is not part of the standard service that people have any more, which is why we rely on 111 and other services as back-up.

Health Promotion Bill [HL]

Lord Markham Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

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

Like the noble Lord, Lord Addington, I would like to declare an interest in that I still play rugby. If noble Lords take nothing else from this debate, I hope they will find that they have another willing, if perhaps not that able, rugby player to join the team. I hope that my contribution on the pitch will elicit a bit more than apathy, some sympathy and maybe a bit of empathy from my noble friend Lord Kamall. As a keen sportsman, I thank the noble Lord, Lord Addington, for providing the opportunity to debate this important issue. I hope I can do rather better than his impersonation of what I might say in this debate.

On the rationale for OHID’s creation, I must admit to not knowing the genesis or etymology of the change of name, but I will find out. As we know, it was established in 2021 as part of the Department of Health and Social Care, following the closure of Public Health England. Its core aim is to reduce preventable ill health and health disparities. It works towards this under the professional leadership of the CMO, which we felt was key, and the director-general of OHID within the department.

Many noble Lords, including my noble friend Lord Lansley, asked why it was felt that it would be more effective as part of the department. When reforming the public health system, this was carefully considered. This was before my time, but my understanding is that many stakeholders were engaged in this and the feeling was that having it as an in-house, in-the-tent department was the best way to go. The option of creating an arm’s-length body to sit alongside the UK Health Security Agency was considered, but it was felt that establishing those functions within government outweighed the strengths of an independent ALB. The fear was that the proposal outlined in the Health Promotion Bill would create an office for health promotion with limited advisory functions. This would simply replace or duplicate many activities which are already under way in OHID.

In forming OHID, we were clear about the distinct advantages of convening functions—something I have become very aware of in the short time I have been a Minister—and the ability to access expert advice, analysis and evidence, alongside policy development and implementation. The decision to make OHID a core part of DHSC was taken because influence and proximity to decision-making matters. In addition, advice is offered widely from across the system and there needs to be a mechanism for summarising it for Ministers.

OHID is empowered to work across national government, using evidence to influence policy and ensure greater consideration in cross-government decision-making of the links to and importance of preventing ill health and tackling disparities. We only have to think of policy considering the health impacts of housing, the potential of indoor and outdoor air quality to promote or negatively impact health, and the consequences of ill health, including for high levels of economic inactivity, for current and important examples. OHID is taking action on the major preventable conditions which drive ill health and early death, including cardiovascular disease and some cancers, and the risk factors that cause those conditions, including tobacco, obesity, alcohol and drugs. OHID does this work alongside local government, the NHS, academia and industry.

I would like to highlight some of the achievements that have resulted so far. To answer my noble friend Lord Kamall’s point on the health promotion task force, the real north star for the cross-government action we see now was publication of the levelling-up White Paper and the commitment in it to improve healthy life expectancy by five years by 2035 and narrow the gap by 2030. This provides a clear, ongoing framework and commitment—covering DfE, DCMS, DWP, BEIS, DLUHC and the Department for Transport to name just a few—to work across government and really address the major drivers of ill health.

Last December, we published a cross-government drug strategy, backed by new investment totalling almost £900 million over three years, with more than £500 million for local authorities. They are required to provide 54,500 new drug and alcohol treatment places over the next three years. Going back to last week’s debate on tobacco, my belief is that we are on target for our smoke-free objectives, but again, I will check on this and confirm. Another great example is our effort to tackle health inequalities early on. The investment of over £300 million in family hubs and Start for Life will deliver new and expanded family health networks in 75 local authorities.

We are improving joint local working on population health and reducing health inequalities through integrated care systems. This includes an expectation that local directors of public health will play a vital part in informing the strategy developed by the integrated care partnership and the forward plan of the integrated care boards.

In all of this, as was so wonderfully put, exercise is the “wonder drug”. We really recognise its importance. That came through very strongly in the contributions of many noble Lords. The drivers of physical inactivity are deep-rooted and influenced by the places we live, work and play in. Change will not happen overnight.

During preparation of the national plan for sport and recreation report, which lays the foundations for the Health Promotion Bill, noble Lords provided the Government with plenty to consider. The evidence is clear that physical activity is good for health. Being active offers wide social benefits, brings people together, maintains friendships and through active travel, as was mentioned, can help connect people and places. We remain committed to the former Prime Minister’s commitment on active travel.

As we are all aware, activity levels have declined due to the pandemic—I am probably more aware than most of how hard it is to get 15 out on a rugby field on a Saturday. This is not good for children’s healthy development and is putting adults at greater risk of disease. Furthermore, there is a disparity in physical activity levels, as was identified by many speakers. This affects groups including women, older people, people living with long-term conditions, people from lower-income areas and people from black and Asian ethnic-minority groups. The Government recognise the challenge and the renewed efforts needed to ensure people have the access, opportunities and motivation to be active in their everyday lives. Our commitment to the sport and physical activity agenda will continue.

In quarter 1 of 2023—not quite 2022, I accept—the Government will publish a new sport strategy and a new school sport and activity action plan. We believe there is an opportunity for this refreshed strategy to focus on two areas: strengthening action to address inactivity levels, and making the sector more sustainable for the future. We will continue to proactively engage across government and with the wider sector to effectively inform and shape the strategy. This will allow us to ensure that action is focused on the key issues and the right direction for the future.

As mentioned by the noble Baroness, Lady Bennett, everyone should have access to local, safe and inclusive opportunities to play sport, get active and stay fit to benefit their health.

At the heart of the government policy on physical activity are the UK Chief Medical Officer guidelines, which set out how much and which forms of physical activity are essential across a healthy life course. Through our work on the Everybody Active, Every Day physical activity framework there is consensus that long-term, system-wide action is required; physical activity is everyone’s business.

The Government provide primary schools with £320 million per year for PE premium and school active sport, to support schools to provide high-quality PE and at least 30 minutes of physical activity within the school day. This is at the heart of the school sport activity programme, which enables schools to use a whole-school approach to embedding PE and school sports. I will write to my noble friend Lord Moynihan on the specific points he made on access to those activities.

Our action includes continuing to provide ways for people to access local parks and green spaces through the Department for Transport’s walking and cycling initiatives, and the setting up of Active Travel England to support local councils to help people walk and cycle to work, the shops and to school.

Our world-leading digital and social media campaign Better Health provides digital resources and signposts to opportunities to support people to start to become and stay active. As I have part of the digital agenda, I will look to the use of wearables as another way in which we can increase participation and information. Digital health behaviour change approaches such as Couch to 5K have now had 5 million downloads, and Active 10 provides opportunities for people to build up activity levels.

We recognise that progress has not always been as fast as we would like. Our plans should help to change that. Sport and physical activity are golden threads that run through and align actions of government departments, local government, the NHS, sporting bodies and communities. Understanding the data and evidence on what works and what does not is vital to delivering our ambition to shift the status quo and address inactivity. By doing so, we can create access to more opportunities for everybody, especially people living in underserviced communities, to enjoy leading more active and healthier lives.

I am aware that many questions have been raised in this debate. As a new boy I understand that my response to a Private Member’s Bill is slightly different, but nevertheless I commit as in other debates to follow up in detail and writing on all the points, because I want to make sure that the points raised today have an appropriate response.

It is a privilege to be speaking after such accomplished speakers: some of the sports athletes here today, former Ministers and Secretaries of State for Health, chairs of sporting organisations such as ukactive and others, and top health professionals. They make my Saturday afternoon rugby efforts look rather weak in comparison.

We are all united in wanting to find the best way to promote healthy living through sport, education and active lifestyle. I know we want the same thing, which was probably put best by the noble Lord, Lord Crisp, as health creation, prevention and services. Some strong and passionate views were expressed on that and some excellent points were made.

I think noble Lords are also aware that I have a very broad background, with many leadership roles in businesses, charities and arm’s-length bodies, and I have been involved in four government departments and now government itself. Honestly, I have seen many different organisational models, both centralised and decentralised, setting up ALBs and having departments inside government. I can say from personal experience that in every one of those, in each instance it took a while for a new organisation to bed down and become effective. It took probably at least a year before you could really see its effects, and I believe that is the same in this instance. Therefore, while I understand and support the reasons expressed today, it is important that we need to give OHID time to take root, to see the publication of the sports strategy by DCMS with our involvement in quarter 1, and judge it on the results. However, I undertake, having listened to this debate today, to come back to the House and speak again on this subject when I believe it has had a proper amount of time to see whether it is working or whether we need to think about some other ways of setting it up.

For these reasons, I maintain my belief that the best way to achieve the objectives set out—which, as I said, were described so well as health creation, prevention and health services—is by OHID as a key and central part of government.