British Heart Foundation: Tipping Point Report

Lord Scriven Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

My understanding is that that is something for in-depth research, which I do not have at my fingertips. I will inquire and write back to the noble Lord.

[Lord Scriven (LD)]

My Lords, following on with prevention, prevention measures lead to fewer premature deaths from heart disease, yet this Government have slashed the public health grant by 24%, on a real terms per-person basis, since 2015-16. Some of the largest reductions over this period were in stop-smoking services and tobacco control, which fell by 41% in real terms. Do the Government not understand that decimating public health budgets means more heart disease and premature deaths?

[Lord Markham (Con)]

We are at the forefront of trying to encourage healthier eating, as per the sugary drinks levy and through product placement in shops. We have been at the forefront of anti-drinking and anti-smoking initiatives and are very much in favour of the smoke-free agenda. These are all key elements of our five-year healthier life plan. It takes these things into account because, as I say, prevention really is better than cure.

Health and Social Care Update

Lord Scriven Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord, Lord Walney. Another part of my many and varied background is as a previous deputy leader of Westminster Council, so I realise the importance of local authorities in this role. I will not confess to being familiar with that scale of unmet need at the moment, but I thank the noble Lord for raising that issue. I will make sure I go and find out more on it and, if I may, come back with a written response.

[Lord Scriven (LD)]

My Lords, I also welcome the Minister to his role and wish him well, because of the crisis that the NHS and social care face. In asking my question, I also declare my interest as a non-executive director of Chesterfield Royal Hospital’s NHS trust and as a vice-president of the Local Government Association. The Conservative cabinet member for adult social care in Devon said in the last couple of weeks:

“We are … in crisis mode … It is very difficult because you can stack shelves in supermarkets and earn more money than you can in social care. We need to see national government”


respond to this urgently. If all the £500 million given to social care—assuming that this money, because it is short term, is to last for six months—was to be equally distributed between the salaries of the 1.5 million people in social care, it equates to just 31p per hour more, which would still be below the market rate for some supermarket shelf stackers. So what is going to happen to make sure that enough resources go towards dealing with the crisis in social care, so that need can be met and staff can be retained?

[Lord Markham (Con)]

We live in a time of a very competitive jobs market and such a competitive market brings challenges with it, as the noble Lord says. We need to make sure that people feel that these jobs not only are recognised as important but make sense economically for them as well. We are investing £15 million in expanding our recruitment and resourcing to attract more people into the industry. We also need to look overseas and I think many are aware of our plans to do that. It is not lost on the team over here that we need to make sure that this is an attractive job and career for people to move into.

Care Homes: Energy Costs

Lord Scriven Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

The noble and right reverend Lord makes a really important point about this issue and the impact on social care. What we are seeing right across government is the impact of this energy crisis: that is why the Prime Minister is making this announcement. We will then have to look into the details of how that affects the different sectors. We have heard from the social care sector, we have heard from care homes and we have heard from patients themselves about their concerns about the cost. I am afraid I cannot give more details at the moment. The Government are working very closely at the moment with local authorities and are in constant conversation about how we can help reduce the burden. Once we have more details of the package, we can look at that in more detail.

[Lord Scriven (LD)]

My Lords, heating costs are just the tip of the iceberg for care homes. What does the Minister have to say to people such as June, a care home worker in Sheffield of 24 years, who is now having to leave the sector that she loves, just to get enough money to be able to feed her family?

[Lord Kamall (Con)]

The Government recognise that for a long time the social care sector has been treated like Cinderella: a poor relation of the health system. That is why we had the Health and Care Bill, to make sure that we have care right through people’s lives. One thing about social care is how disparate and fragmented it is. One reason we have the register is to understand who is out there—who is doing what, their qualifications and their levels of pay, but also how we can make sure that they feel it is a rewarding vocation and career.

Urgent and Emergency Care

Lord Scriven Excerpts

Tuesday 6th September 2022 Lords Chamber

[Lord Kamall (Con)]

I start by thanking my noble friend for sharing that very personal experience with us. One of the reasons why my right honourable friend the former Secretary of State wanted to issue this Statement was that when he came in he saw that they were sadly far too many such stories—my noble friend will not be the only one with such a story; undoubtedly, there will be other noble Lords with similar stories—and it was important for him to say, “Look, this has gone on long enough. Let’s get all the people together in the room”. That is why he made this a priority. He wanted to put the numbers on the wall but was told he should not do so for various reasons—but at the same time he wanted to make sure that he spoke to the leadership of trusts as well as NHS England to make sure that they were really focused on this.

Some of the measures announced in the Statement will take time to filter through while others, hopefully, will be immediate, such as the St John Ambulance. All I can say is that I will continue to push and, if I stay in post, I will encourage my right honourable friend the current Secretary of State to continue the work that their predecessor put in place to really make sure that we get a grasp of this issue and try to pull as many levers as we can to tackle it.

[Lord Scriven (LD)]

My Lords, I declare my interest as a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust and as a vice-president of the Local Government Association.

It is not hubris when I say that the Minister needs to understand that this is a crisis and the health service is at the point of breaking, when you see what is happening to patients and to staff trying to deal with the total number of procedures and patients coming into the health service. An absolutely breathtaking statistic from analysis shows that in July only 40% of patients who were ready for discharge were discharged on the day that they were medically fit. That meant that 60% of beds were blocked in England by people who could not get social care or go home.

It is anticipated that at a bare minimum £7 billion per year is required to deal with the social care issue. The Government have a vision but no road map, no timetable, no milestones and no measures of success for social care. What is happening with social care? It is one of the key issues that are leading to ambulances being held at A&E and potential deaths before people can get into hospital for the medical care that they need.

[Lord Kamall (Con)]

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

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

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

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

Coronavirus: New Cases

Lord Scriven Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

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

[Lord Scriven (LD)]

My Lords, I declare my interest as in the register as a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust. Following on from the last two questions, last year, the Government awarded £6 billion extra to the NHS to deal with Covid cost pressures. There was an assumption that there would be no Covid in the NHS by June, and all funding stopped. In the light of rising cases and the issues caused by the pressures, will the Government reinstate NHS Covid money? If not, this will eat into the day-to-day budgets of our NHS.

[Lord Kamall (Con)]

As I said, we are keeping everything under review. We called our strategy Living with Covid-19 as opposed to “We’ve Got Over Covid-19” because we knew it could come back at any time. We have seen that, with the omicron variant, some medication is less effective. We continue to monitor that, and we are ready to stand up the measures that may be needed if the number of cases dictates that, on the advice of the JCVI and the UKHSA.

Diabetic Prevention Programme

Lord Scriven Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

As my noble friend will be aware, there are always debates in scientific circles on this. There are different types of fasting regime as well. For example, during Ramadan lots of mosques expounded it as a great example of something that is not only spiritual but good for your physical health. It does depend. Other studies show that it depends on who is doing it and their other circumstances.

[Lord Scriven (LD)]

My Lords, could the Minister say what is being done regarding the latest statistics, which showed that just 34% of people in the north of England who have diabetes have access to the eight health checks that they should have?

Social Care: Adults

Lord Scriven Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Lord Kamall (Con)]

I wonder if I could correct my noble friend. The Government implemented a comprehensive review of the programme on adult social care with a £5.4 billion investment over three years from April 2022, of which £1.7 billion will be used to begin major improvements across adult social care in England, including but not limited to £500 million investment in the workforce and £150 million to improve technology. As many noble Lords recognise, for too long this sector has been neglected. In some cases, there is a lack of understanding about the breadth of the sector. We are trying to understand it and get people to register, and then we can improve it.

[Lord Scriven (LD)]

My Lords, I declare my interests as set out in the register. Some hospital NHS trusts have a third to a quarter of their beds bed-blocked by people who are clinically ready for discharge but cannot leave because of no social package being available. What are the Government doing now to deal with this problem? It undermines the NHS waiting list backlog as well.

[Lord Kamall (Con)]

The noble Lord makes an important point, and the fact is that if some patients do stay in hospital too long, they can lose control of certain faculties and see muscular deterioration. So it is our priority to ensure that people discharge safely, as quickly as possible, to the most appropriate place. Local areas should work together to plan and deliver hospital discharge, and the department is working with NHS England, NHS Improvement, local government and social care providers to monitor and understand the underlying causes and do something about them.

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

Lord Scriven Excerpts

Monday 20th June 2022 Grand Committee

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

My Lords, this statutory instrument seeks to ensure operational continuity as the changes under the Health and Care Act 2022 are implemented. It relates specifically to the transfer of functions from clinical commissioning groups, or CCGs, which were abolished by the 2022 Act, to newly established statutory integrated care boards, or ICBs.

Under the National Health Service Act 2006, amended by the 2022 Act, NHS England must set rules so that integrated care boards have “core responsibility” for every person who is provided with NHS primary medical services through registration with a GP practice in their area of England and every person usually resident in their area who is not registered with a GP practice. This means that, where a person is seeing a GP in an area, the relevant integrated care board is responsible for commissioning secondary health services that that person may need. This instrument provides an exception to this obligation for individuals who are usually resident in Scotland, Wales or Northern Ireland but are registered with a provider of NHS primary medical services in England.

This SI does not prevent those who are resident in Scotland, Wales and Northern Ireland accessing healthcare services in England. Instead, it simply makes clear where the commissioning responsibility sits for these patients. It promotes autonomy for devolved Governments to commission secondary care services for their residents, while still allowing these patients to continue to access secondary healthcare services in England. It is about which authority commissions and pays for a patient’s care, not the patient’s right to access care. This instrument is vital to ensure consistency and clarity between authorities in England and those in Scotland, Wales or Northern Ireland regarding who commissions and pays for a patient’s secondary care.

This statutory instrument allows for the continuation of the approach to devolved health policy introduced by the disapplication regulations 2013, which are being revoked as a consequence of the Health and Care Act 2022. Just to be clear, this instrument does not change existing cross-border commissioning arrangements; it simply transfers existing commissioning exceptions from CCGs to the new ICBs. We hope that these regulations will ensure operational continuity of services for patients as the English health system implements ICBs and are supported by the devolved Administrations, providing clarity on the role of integrated care boards within the existing cross-border arrangements.

I commend these regulations to the Committee.

[Lord Scriven (LD)]

I thank the Minister for his clear explanation. One can see from the number of noble Lords who wish to take part in this debate that this is not very controversial.

The instrument appears to tidy up the problems of people in different countries in the UK who may need to use NHS services in a neighbouring country and of who purchases those services. However, despite Ministers telling Parliament repeatedly that noble Lords could not vote on certain amendments because they had pre-agreed the legislation in the then Health and Care Bill 2022 with the Scottish Parliament, the Welsh Senedd and the Northern Ireland Assembly, it now appears that they had not made arrangements to continue the status quo—the very basic—of who commissions cross-border issues. These regulations enable that to happen. It would have been easier if such amendments had been allowed when the Bill was going through, rather than Ministers telling noble Lords from across the parties that such amendments around cross-border issues could not be voted on.

Many in the House along cross-party lines complained that, as the Health and Care Bill was progressing through the House, Ministers were taking considerable powers on themselves to create regulations. The Bill was enacted only two months ago yet we are already seeing their errors in the legislation being tidied up by this statutory instrument. How many more are still to come to ensure that all tidying-up arrangements are in place by 1 July? Would it not have been better for hard-working civil servants, both in the department and in Parliament, for the Bill not to have been brought out when there was still considerable focus on Covid and the omicron outbreak? Errors such as this are basic and waste civil servants’ and Parliament’s time.

--- Later in debate ---

[Lord Kamall (Con)]

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

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

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

[Lord Scriven (LD)]

I hope that the Minister takes it in the spirit in which I asked the question, but this is an example of senior officials in the department—not for the first time—being involved with a commercial company and there being a revolving door going into that commercial company when specific multi-million-pound contracts are made. Do the Government feel comfortable that that is correct or do they feel that rules such as those for the Civil Service—where there are rules about revolving doors and taking this up—should also apply to NHS England employees? If not, does the Minister think that it should be looked at and that such rules should apply as they do for the Civil Service?

[Lord Kamall (Con)]

I thank the noble Lord for that clarification. My initial reaction was that I wanted to take this back to the NHS and ask. If the noble Lord will allow me, I will make that point directly, as the noble Lord made it so eloquently, to the NHS officials. Of course, as he rightly says, it is not just about the reality; we also have to address perception. We know that in a number of areas, for politicians but also officials, people are very concerned about revolving doors for those who have recently left and potential conflicts of interest. If the noble Lord will allow me, I will talk to NHS officials about this and get back to him.

On the particular issues, there will be more SIs. I am advised, but I will clarify it once again, that these regulations are made under the powers of the 2022 Act; it was previously done by regulation, and this will replace previous secondary legislation on disapplication from 2013. However, I take the point about whether this could have been done in the Health and Care Act. I will get a clear answer for noble Lords from my officials, if that is acceptable.

To conclude, I reassure the Committee that this instrument will not change how residents from devolved nations can access healthcare services in England. It is right that patients from Scotland, Wales and Northern Ireland continue to access secondary healthcare services in England as they do now, in a seamless way. Nor will there be any adverse financial consequences for devolved Governments or newly established ICBs, relative to the previous CCGs, in developing these regulations. This will continue the existing arrangements, which have been in place for several years and have the support of the devolved Administrations.

Given the outstanding questions, I hope that noble Lords will accept that I will write to everyone who took part in the debate—that should not be too difficult. I commend these regulations to the Committee.

Personal Protective Equipment: Waste

Lord Scriven Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness will recognise that I was not in post at the time, but I have been advised by officials in the department that they put feelers out to as many people as possible. Government officials, Members of the House of Lords and politicians from all parties were suggesting companies, and that was put through a process whereby the department made an assessment of whether it was able to award contracts.

[Lord Scriven (LD)]

My Lords, the National Audit Office found that the department is currently spending approximately £7 million a month on storing 3.9 billion PPE items that it does not now need. That is the equivalent of employing 2,400 extra nurses a year. Why are Ministers allowing this waste of taxpayers’ money to continue?

[Lord Kamall (Con)]

The noble Lord is absolutely right that we are paying storage costs, and over the last few months there has been a reduction in storage and the Government have been looking at more cost-effective ways. However, the overall strategy—and why we have two lead waste providers looking at the issue—is to ask how we can sell, donate, repurpose or recycle wherever we can. For equipment where complex chains of polymers cannot be broken down—chemists would understand this better—we are looking at how we can dispose of it in the most environmentally friendly way.

NHS: Abuse of Nurses

Lord Scriven Excerpts

Tuesday 5th April 2022 Lords Chamber

[Lord Kamall (Con)]

The NHS is looking at a number of different ways of tackling violence towards staff, as well as supporting them in how to handle difficult situations and giving them well-being support. On the specific issue that the noble Baroness raises, it is probably better if I commit to writing to her.

[Lord Scriven (LD)]

My Lords, the individuals who abuse healthcare staff should understand and then pay for the harm they cause and be helped to change their behaviour. To augment existing arrangements, will the Government therefore look at implementing an NHS restorative justice scheme?

[Lord Kamall (Con)]

We are looking at the way in which abusers are treated. On 13 November 2018, the Assaults on Emergency Workers (Offences) Act 2018 came into force, and since 2020 we have also been working with the Ministry of Justice in consulting on doubling the sentence for such assaults to two years. The Government are now legislating for this through the Police, Crime, Sentencing and Courts Bill. In addition, a Joint Agreement on Offences Against Emergency Workers was agreed between NHS England and NHS Improvement and the Crown Prosecution Service in January 2020.