Smoking
Lord Naseby Excerpts(2 months, 3 weeks ago)
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Noble Lords
Lord Markham (Con)
The honest answer is that we do not know yet, and that is a problem. As we know, a number of these things take time to play through. That is why we want to make sure we take a precautionary approach. In this legislation, we aim to really stop anything that is targeted at young people in terms of vaping. We see vaping as an important tool to help people quit smoking, but we are equally sure that we never want anyone to start vaping. That is why we will also look at banning anything that targets young people, such as flavouring and packaging. We want to stop anything targeted at youth vaping.
Lord Naseby (Con)
My Lords, why are His Majesty’s Government ignoring the experience of New Zealand? That country has found the idea behind this Bill—it had a similar one—to be totally unworkable. Secondly, why are we undermining the existing scheme that has done so well, with under 2% of young people even bothering to take a taste of smoking? Does my noble friend not recognise that there are other, far more important health dimensions that need the resources that are to be wasted on this useless Bill?
Lord Markham (Con)
First, my understanding about New Zealand is that one of the biggest bones of contention was that it was looking to reduce the number of smoking retailers from 6,000 to 600; that is where their Bill came into difficulty. I am afraid I must disagree with my noble friend on the importance of this. It costs the economy about £17 billion a year and causes about 80,000 deaths, and 80% of people who have taken up smoking wish that they had never started. I think those are very strong reasons which I know the majority of this House is behind, and that is why I am delighted to be introducing that legislation shortly.
NHS: Drug Shortages
Lord Naseby Excerpts(3 months ago)
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Lord Markham (Con)
I assure the noble Lord that a specific team, the medical supply team, works to manages this across the piece. It is a complex area, as we have said. There are 1,000 notifications a year about supply shortages—that has been consistent over the last so many years—that the team works to resolve. I am sure that, as this debate progresses, we will talk about some of the issues, including getting the MHRA to expedite regulatory approval, working with alternative suppliers, buying internationally where needed—we did that very well last year on strep A—and, where really necessary, introducing serious shortage protocols. It is an issue that we take very seriously, and we are managing it.
Lord Naseby (Con)
My Lords, “may” is the wrong word; there is a shortage at this point in time, certainly from the inquiries I have made. Is it not time that we had another look at the existing procedures on recompensing drug manufacturing and maybe producing a new version of the PPRS, which worked extremely well in its time?
Lord Markham (Con)
Actually, we recently reached a new agreement with the drug suppliers on this. I think we were all pleased to do that, and it will ensure we continue to get continuity of supply. I have quizzed the team at length on this and asked it to sit down with the British Generic Manufacturers Association, which produced these figures, specifically to understand where there are differences, because I must be honest: the team does not recognise those numbers. We did not see an increase over the last few years. Where there are specific instances, such as ADHD, which I worked with the noble Baroness, Lady McIntosh of Hudnall, on recently, remedial actions are in place to ensure we can manage through the supply issues.
King’s Speech
Lord Naseby Excerpts(5 months, 1 week ago)
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Lord Naseby (Con)
My Lords, it is a privilege to follow the noble Lord, Lord Thurlow, not least in his highlighting of the huge potential difficulties with the two new Bills in the housing area of freehold and rent.
The gracious Speech, in my judgment, reflects that at least now we have a Prime Minister who understands economics, who is determined to listen to what the general public, and indeed obviously our own party, wants to happen, and to give leadership. There is no better demonstration—and I admit to being one of those who campaigned hard to keep the ticket offices open, alongside the best part of a million others—than him being brave enough to say, and thank goodness, “Right, they are staying open”. For me, that is the sort of action I expect to see from a Prime Minister. I have had the privilege of serving in the other House for 23 years and in your Lordships’ House for a good few years since, and quite frankly this is the first time, since that fateful date of 31 January 2020, following the vote that was taken on Brexit—I understand why it went the way it did but the construction of the vote was wrong; there should at least have been a safeguard if we wanted to change—that I am getting it, and I am thrilled. We had lost leadership from the subsequent Prime Ministers.
I shall speak mainly on housing, but there are three issues on energy that I would like to raise. First, I welcome the fact that we are going to drill in the North Sea, for the future. It is a crucial decision to safeguard our supplies. Secondly, I am following Rolls-Royce’s efforts on mini nuclear reactors. We could have signed a document and had those mini reactors being built now—nobody suggested that it should have an exclusive right to the mini reactor market, but at least we could have got going. But we have not. Will my noble friend on the Front Bench at least try to move this forward, so that we get some decision on mini reactors? They are important. Thirdly, on hydrogen, we all know that Infrastructure UK appeared to be totally anti-hydrogen. We have only to look at our German colleagues. Germany has now got to a state where it believes it can do tests, and that there is a market for a combination of gas and hydrogen for domestic premises. If we think back to the period when we went from coal to LPG for our heating, we see that no wonder it is a big project—it affects the vast majority of homes in the United Kingdom. We know that Germany is doing the work. Imperial College has come out with a report saying that it is going to move things forward, and there are a host of others doing work in that area. I would like to see some support from His Majesty’s Government in that area.
That brings me to housing. It is my privilege to have been in public service for 50 years. I was the first leader of the London Borough of Islington and chairman of its housing committee. I have saved squares in Islington, along with my colleagues. We got rid of the Crumbles, which was a terrible old Victorian tenement block, with not even bathrooms or toilets on the floors—people had to go down to the ground floor. Thanks to the architect in Islington, we built low-level, high-density council housing and encouraged young people to get grants to renovate the infrastructure that they bought. In 1974, I was elected in Northampton, a new town, which I support totally, and I once wrote a pamphlet called The Disaster of Direct Labour. The challenge that every family faces is housing. So many of my colleagues here today have raised the issue, and I certainly believe that it is key to the future.
The Secretary of State produced his vision in his speech of 24 July 2023. He talked about:
“The regeneration and renaissance of the hearts of 20 of our most important towns and cities … Building beautiful … Greener homes … A new deal for tenants”—
he has this Bill coming forward—
“And extending ownership to a new generation”.
Unfortunately, we have lost the right to buy, so I am not quite sure how we will encourage new generations. It sounds wonderful, but in reality we find the Grenfell problem. Only 9% of those affected have been restored. That is not good progress. It is not helping tenants. Many must be in dire worry about where they are living.
What about tenanted properties? In Bedford and half a dozen other places, there are empty properties all the way down the high street, yet we charge 20% VAT on anybody who wants to renovate them. If we want to renovate those properties, for heaven’s sake let us offer local authorities the option not to have to pay that 20%. I notice that the Secretary of State does not think that Marks & Spencer, as a key retailer in Oxford Street, should be allowed to alter its building, although everybody else accepts that it is a good idea.
The time taken on planning has trebled since 1990, which is not that long ago. No wonder it is taking time to get moving on anything. The Home Builders Federation points out that some of the hardest hit are our smaller builders, who have to grapple with this time dimension. The number of new homes forecast for 2024 is just 120,000—a record low—compared with 204,530 in 2022. With a demand of 340,000—not 300,000—and people wanting their own home, lifetime ISAs needing modifying because they are out of date and the whole population having gone up by 600,000, we now have a real need for 380,000. We have to take action. I hope my noble friends on the Front Bench and those who can make a difference will do so. Two of us in this room know about new towns in particular. Why not have perhaps 50 new garden towns around the United Kingdom, with the benefit of single-family homes at low density, alongside a successful town? That would produce really good homes for the future.
Food: Two-For-One Offers
Lord Naseby Excerpts(9 months ago)
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Lord Naseby (Con)
My Lords, if a product is marketed legally in the United Kingdom, why should His Majesty’s Government feel they have to interfere at all with the marketing of that product? I understand the point about education and totally accept it, but is it not wrong for His Majesty’s Government to restrict what is a legally marketed product?
Lord Markham (Con)
We are trying to educate, inform and nudge. The best example of all is encouraging the industry to reformulate its foods to be healthier. At this point, I am glad to say that, since we introduced these restrictions, Mars, Galaxy, Bounty and Snickers have reformulated, and even Mr Kipling’s Deliciously Good cakes are compliant.
NHS: Doctors’ Strikes
Lord Naseby Excerpts(9 months, 2 weeks ago)
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Lord Markham (Con)
As we have seen, it is having an impact, regrettably. We saw that from 14 to 17 June: almost 100,000 appointments were lost during that strike. We are now looking to cover that up. That is why we are firm in our conviction that we want to resolve this situation. These sorts of things are not good for anyone. We have a formula that worked; we have managed to do this with nurses and the Agenda for Change unions, which make up the vast majority of the health service. Our hope is that we can sit down and have sensible conversations and do the same with doctors and consultants.
Lord Naseby (Con)
My Lords, I thank my noble friend for his ingenuity and the work he has put in since taking over this role. All we hear of pay rises is that they should be 12%, 19%, 39% or whatever. Has the time not come for a slightly different approach? We should calculate the capital cost of whatever sections of the health service claim they have lost, pay them that cost and then revert to the normal process of review bodies.
Lord Markham (Con)
I thank my noble friend for his kind words. We are willing to look at all solutions. We have to balance the salary wishes of doctors with making sure that we keep the money in front-line services. Everyone is aware that pay rises of 35% would eat heavily into what we can do and afford on the front line. We need to get that balance right.
Healthcare (International Arrangements) (EU Exit) Regulations 2023
Lord Naseby Excerpts(9 months, 2 weeks ago)
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Baroness McIntosh of Pickering (Con)
My Lords, I congratulate my noble friend on bringing forward what I view as very welcome regulations for us this afternoon. I have to declare an interest, as I currently have an EHIC, which I assume will expire at the end of this year, and visit a very small number of the countries on this list. Given that the list on page 5 in the Schedule seems very full, I take this opportunity for my noble friend to put my mind at rest, because originally—it was a year ago, 2022—it was pointed out that the GHIC, which my noble friend explained will replace the EHIC in the regulations, originally did not cover countries such as Norway, Iceland or Liechtenstein, but they appear on the list. Is that because the original primary legislation did not cover them, or were we just waiting for the regulations before us this afternoon? Can he confirm that the EHIC covers those three countries and that the GHIC will also cover them?
From a practical point of view, I have never yet had to make a claim. I once, rather unfortunately, contracted salmonella poisoning as a Conservative candidate at a hotel which will remain nameless in north London, which rather sorrowfully served chicken drumsticks but did not have the foresight to defrost them. Unwittingly, I was so hungry I ate the chicken drumsticks, and within 36 hours I was in a very sorry way, but not as bad as some of my older colleagues at the time, who had to be hospitalised because of salmonella poisoning. I was then fortunate enough to be injected, not in my arm but in another part of my anatomy by a French doctor and had to have a course of whatever tablets they were.
Are we under these arrangements required to pay similar costs to those in that scenario up front, keep receipts and claim them back when we are back in the UK? Is that how it works? I think most of us are covered, and I know the department and the Foreign Office encourage all of us who travel outside the UK to have the fullest possible medical insurance that we can. Is it reciprocal? Does, say, a Norwegian, a Dane, a Liechtensteiner or someone from whatever third country pay here and is then reimbursed by their medical authorities—just to be absolutely clear on the reciprocity of the situation?
I give the regulations before us this afternoon a very warm welcome.
Lord Naseby (Con)
As I understood it, the Schedule on page 5 covers overseas territories and dependent territories. I note that the Cayman Islands is not listed. I have not had time to check whether anywhere else is off the list, but I wondered whether my noble friend could find out and let me know. I ought to declare an interest: one member of my family is working in the Cayman Islands, and there may be others. I recently attended a conference of all the overseas territories and dependent territories, and there seemed to be rather more than appear here, but that may be me and my memory bank. I leave that question with my noble friend.
Lord Allan of Hallam (LD)
My Lords, I also welcome this statutory instrument, which seems to be a helpful tidying-up exercise overall. Of course, it is humane and to our credit that we seek the maximum number of reciprocal arrangements so that people in the UK travelling to other countries can get healthcare when they need it and people coming here can benefit from our health service. That is important as a humane response.
First, on the comments from the noble Baroness, Lady McIntosh, I have a GHIC card; I think I was one of the first out of the traps in 2021. My understanding—the Minister will confirm this later—is that the “G” is rather more aspirational than material; that the GHIC is really an EHIC because it does not count in any other places, such as Australia or New Zealand; and that it is really a version of the EHIC rebranded with a rather fetching union jack. I am interested to hear from the Minister whether I have understood that correctly. Of course, it seems to be the Government’s aspiration that, one day, the “G” in your GHIC will be meaningful but as I say, as I understand it today, it is an “E” rather than a “G”.
We are pleased that there was consultation with Ministers in Northern Ireland, Wales and Scotland. Again, a regular theme of the stuff that we debate in this House is that there have been a number of other instances where that has not happened, such as with the minimum service levels Bill. It is good to see that, here, Ministers have given their approval.
I want to ask a few questions. The first is a material one on the scope of UK-insured persons; that is some of the language used in the instrument. My understanding is that there is a difference. For example, as long as they are a UK-registered resident, somebody who is resident and a taxpayer in the United Kingdom—whatever passport they hold—can get a GHIC card and use it in the European Union but they would not be able to do so in Switzerland because it has a narrower category of people who qualify; people there would, I think, need a UK passport to take advantage of the relationship.
That opens up a wider question: what is the Government’s policy? Is it that anyone who is a UK resident and taxpayer here should benefit from the reciprocal arrangements, or are the Government content to leave it such that we limit the scope in some countries? I followed the links to look at the information provided to people on GOV.UK. Oh my God; I am not sure whether I regret going there because it is incredibly complex. If noble Lords look at it, they will see that some countries want a driving licence, some want a passport—some want a UK passport while others want any passport—some want proof of residence and some want the magic card. There is a huge plethora of proofs of identity and qualification. Again, people’s expectations would be that, if they live in the UK and pay their taxes here, they should be able to benefit from the reciprocal arrangement. However, that is not what we see at the moment.
Regulation 6 says that the NHS Business Services Authority has a duty to
“maintain a service making available to the public information”.
Something useful could be done on the BSA working with GOV.UK to give people a much easier way to say, “I am going to country X: do I qualify? If I do, what documents do I need? At the moment, there is a long list that is incredibly confusing”. This is just a thought for the Minister as to whether Regulation 6 would include asking the Business Services Authority to improve the quality of the information offered at present.
My second substantive point concerns Regulation 7, which says that the
“BSA must assist the Secretary of State with the Secretary of State’s exercise of functions”.
Another critical piece of information here is understanding what is happening through this arrangement. What are the costs in and out? How many people from another country are using the NHS? How many people from the United Kingdom are using services in another country? Can the Minister clarify whether, as well as information about the workings of the reciprocal arrangement being provided to the Secretary of State, he anticipates such information being provided to the public and to us as parliamentarians? I do not mean to penny-pinch—as I say, the starting point should be that it is humane to offer treatment at both ends—but it is a matter of information.
The Minister referred to how additional countries might be added to the list. We would all welcome that but, again, when that happens, there will have to be a business case that must make predictions about how much usage of the scheme there will be. I welcome the fact that the Minister says that the addition of another country will come back to us for approval, but I hope that he can also commit to us being given the information we need on existing arrangements and predicted future arrangements to help us make those determinations.
Clarifications on those substantive points about eligibility and the provision of information and data on how the arrangements are working would be really helpful but, substantively, we welcome the instrument.
General Practitioners: Recruitment and Retention
Lord Naseby Excerpts(10 months, 1 week ago)
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Lord Markham (Con)
All the things that the noble Lord points towards are covered in our plan for recruitment and retention. The things that we have announced, particularly on pensions—a key reason why people were leaving—were welcomed by the sector and the fact that we have record numbers in training is also a step in the right direction. But, as we freely admit—this is what the primary care plan is all about—a lot more work needs to be done and is being done.
Lord Naseby (Con)
As my noble friend knows, we have an Armed Forces scheme for young doctors to train and they have to commit to five years in the Armed Forces. Is he also aware, as I am sure he is, that Singapore’s health service has a scheme whereby young medics who qualify have to work in the Singapore national health service? At a time when we see an increasing number of our qualifying young doctors going abroad, is it not time that we looked at both these schemes and modified them to the UK situation?
Lord Markham (Con)
My noble friend makes a good point: if we are investing eight years in training, in the case of a GP, to ensure that they are at the top of their profession, so to speak, it is reasonable to expect them to work for a number of years in the UK so as to make good on that investment.
Covid Pandemic: Testing of Care Home Residents
Lord Naseby Excerpts(1 year, 1 month ago)
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Lord Markham (Con)
We all agree that visiting should be allowed as much as possible. I know that the policy is that people can receive at least one visitor, but I know that there are also examples where that is not happening enough. It is very clear, from our side, that it is a priority that everyone should have visitation rights, because they are vital. Can we say that that will always be the case in every circumstance in the future? Well, clearly no one foresaw the pandemic, so this is one of those situations where we can never say so definitively, but we all firmly agree that visitation is a key part of people’s care and well-being.
Lord Naseby (Con)
Is my noble friend aware that I should declare an interest, in that my wife is a retired GP? In the period February-March 2020, it was very clear to those of us who were in contact with the medical services that things were not right in care homes. On 21 April 2020, I put down a Question—and I have a copy for my noble friend—which read:
“To ask Her Majesty’s Government what has been the COVID-19 testing policy for hospital patients that have been discharged to nursing and care homes over the last four weeks.”
That took us back to 23 March 2020. I got an Answer some three weeks later, which read:
“As outlined in the Adult Social Care Plan, published on 15 April 2020, any patient who moves from the National Health Service to social care will be discharged in line with the current NHS COVID-19 Discharge Requirements. NHS England and NHS Improvement published a letter on 16 April addressed to all accountable officers of all hospitals (public and private sector) working for the NHS and discharge teams outlining the new requirement to test patients being discharged from hospital to a care home.”
This did not answer the Question that I had asked about what had happened between the latter end of March and early April.
I recognise that my noble friend has only recently joined the Front Bench but, as far as I am concerned—I have taken a detailed interest in this—it is fundamental that we are honest. If things went wrong, as I am sure they did, they must come out in the public inquiry. I am happy to give a copy of my Question to the opposition parties, so that they do not have to scratch around to find it.
Lord Markham (Con)
Yes, it is vital that we understand exactly what happened when and that we learn lessons. I am sure we will see that some mistakes were made, and we need to learn from those. From our side, that was the whole point of setting up the Covid inquiry. We will ensure full co-operation.
Tobacco Control Plan
Lord Naseby Excerpts(1 year, 4 months ago)
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Lord Markham (Con)
I will need to write to the noble Lord on that. I am aware that different methods exist, but I think we are all united on the need to do everything we can to prevent any circumvention.
Lord Naseby (Con)
Is not any plan meaningless when at least a third of the market is supplied by illegal imports? His Majesty’s Government appear not to have done anything to stop this, and it is the young people in our country who are smoking the cheap, illegally imported cigarettes.
Lord Markham (Con)
We are working very hard with HMRC on this. I think we can all agree that one thing that Brexit was good on was restricting the number of cigarettes that people can bring in legally from other parts of Europe.
Social Care Sector: Staff Shortages
Lord Naseby Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
I thank the noble Baroness. In the past few days, local authorities have been notified of the £500 million discharge fund. That funding will go out in December and January, so it is very much going out there. It is very much designed to address the issues of discharge, creating new places and helping to recruit.
Lord Naseby (Con)
My Lords, is there not a case for formally involving the Commonwealth in this aspect? There is already a trial going on with Sri Lanka for nursing. I suggest to my noble friend the Minister that there are other Commonwealth countries that would be more than willing to have a two-way flow and help reduce the huge shortage that we have.
Lord Markham (Con)
I agree with my noble friend. Overseas and Commonwealth recruitment is a key area here, which is why I am delighted that we have addressed the visa restrictions and entered social care on an essential workers list. We have already seen 15,000 people come in this space, and that figure is increasing month on month. My noble friend is correct that this is a critical area for recruitment for us.