Cass Review

Lord Young of Norwood Green Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

With the wonders of modern technology, I hope I can answer two questions in one. On the previous question, yes, the regulators have been communicated with about making sure that it is very clear. On that point, I say to my noble friend that the regulators have been charged with making sure that very clear guidelines are put out on the drug use that he mentions; those are being set right now. While I am clearing stuff up, to be clear and to save me correcting it later, it will be eight clinics in total when they are all there; I might have said that it was eight additional clinics.

[Lord Young of Norwood Green (Lab)]

My Lords, I too pay tribute to the Government, and to Dr Cass especially, for a magnificent report that took both determination and courage; let us not underestimate that. She has achieved a huge amount: we now have four clinics up and running with people who understand the need to counsel young people. What we do not know is how many thousands of lives have been wrecked by the indiscriminate use of puberty blockers and hormones; it may eventually be uncovered. I also pay tribute to our party and our shadow Health Minister Wes Streeting for unequivocally backing the Cass report and committing the next Labour Government, should that be the case, to an evidence-based situation.

I put it to the Minister that puberty is not something that ends at 18. Dr Cass rightly defines it as a process that could go up to 25. She recommends that those services should include that kind of counselling, and I would welcome some confirmation from the Minister that that will be the case. There is still more work to be done on this. I have said on previous occasions that this is a cult that has invaded a lot of the institutions of government and other institutions. It is not going to just lie down quietly; there will be attempts to evade this legislation, and we should be on our guard against that.

I want to end on a positive note. I welcome the Statement. I pay a further tribute to Dr Cass, a woman who came out of retirement and was probably looking for a nicer and easier thing than this to deal with. This Chamber owes her and her civil servants a real debt of gratitude.

[Lord Markham (Con)]

I remember that it was the noble Lord who, in the round table that we had on this, made very clearly the same point I was making earlier about puberty and age. It is only when you are right the way through it that you really are in a position where you start to know your own mind and your own body. I agree with the noble Lord that it can be as late as 25, and that is why that is definitely the intention behind the eight clinics that are being set up—that they can provide that continuity right up to the age of 25, given that there is such a state of flux in a young person’s life.

NHS Dentistry: Recovery and Reform

Lord Young of Norwood Green Excerpts

Wednesday 7th February 2024 Lords Chamber

[Lord Markham (Con)]

On the targeting and how we are using those mobile vans, the thinking is that they will be rolled out quite quickly—in about six months or so. We are absolutely looking to target those areas with backlogs, such as where we know that the distance to an NHS dentist is further than normal, where there is low access according to GP patient surveys or where there is a low number of dentists per patients. This is exactly set up to try to make sure that we are going into those areas where there is the biggest backlog. Turning up in those locations and allowing people to queue up and receive a service on that day allows access very quickly to the people who really need it. At the same time, when they are calling up because they might need dental services, we can tell them, “A mobile van will be in your areas in two weeks; we can book you an appointment now”. That is designed to really hit those backlog areas. I suspect—this is just me speculating—that such will be the success of these that this will a model that we will look to roll out more widely in future.

[Lord Young of Norwood Green (Lab)]

My Lords—

[The Earl of Courtown (Con)]

My Lords, with apologies to the House, I am afraid that the noble Lord, Lord Young, was not in his place at the start of the Statement and, with the greatest apologies, it is the custom of the House that a noble Lord should be here for the start of the Statement before they ask a question.

NHS Long-term Workforce Plan

Lord Young of Norwood Green Excerpts

Tuesday 4th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord for the work he does as chair of the GDC. He will know that this is something that is quite close to my heart, given that my better half is a dentist. I completely agree that it is about far more than just the training places. I think the House has heard me discuss this before, but if we are serious about dentists who have been in practice for 10 years setting up their own clinic, maybe in an NHS Digital desert, we must give them guidance and support, as it is quite an ask to do that. We plan to produce and publish a dental plan in the not-too-distant future, in which I hope and trust that a lot of these points will be covered.

The noble Lord is correct; I do not know the exact maths behind it, but we spend roughly 12% of our economy on the health sector and so it is not surprising that roughly that number would be expected to go into the NHS workforce. In some ways, that shows the magnitude of everything we are talking about today. Probably one in eight of all people leaving school will end up in this sector—that really is a number worth thinking about and pondering over. As we all agree, it shows why this plan is timely and why it must be a living document that is continually adjusted as we go forward.

[Lord Young of Norwood Green (Lab)]

My Lords, I welcome this historic document. I concur with some of the concerns expressed by my noble friend on the Front Bench. Nevertheless, I believe it to be very significant. It addresses many important areas, such as apprenticeships and training, all of which I welcome. I could carp and say that we will check against delivery, and of course we need to. I hope we will have a proper debate on this plan at some stage, and I would welcome an assurance from the Minister on this. It merits a much longer debate; it is probably one of the most important issues that this House has discussed.

I am interested in dentistry because I recently visited my local dentist—a man of principle who converted a private practice into an NHS practice. I always get him to do my teeth, and he cleaned and scraped them and did all the necessary things, and he then took X-rays. I went to the desk to pay and the charge was £28.50— I could not get a plumber to come out for those prices.

If you do not reward NHS dentists—that dentist’s son and daughter are both practising dentists—they will inevitably go into private practice. If we are serious —I believe we are—about doing something, of course we have to look at the charges. I do not want to end on a negative note. I agree with those who have said that this is one of the most important issues that this House has discussed in a long time, and I welcome the Government’s actions.

[Lord Markham (Con)]

I thank the noble Lord. He is quite right to say that we need to check against delivery and he is quite right to hold us to account on that. Personally, I am happy to commit whatever time we need to debate this because I completely agree on how important it is. As I say, it is quite sobering when you think about the figures: as we said, we expect one in eight school leavers to go and work in this sector, so we almost cannot spend too much time on that.

As I say, the dental plan will be published shortly, and making sure that the balance is right, and that it is seen as an attractive option to be an NHS dentist versus working in the private sector, is absolutely an important part of that as well.

Gender Identity Services: Children and Young People

Lord Young of Norwood Green Excerpts

Wednesday 19th April 2023 Lords Chamber

Asked by

[Lord Young of Norwood Green]

To ask His Majesty’s Government what steps they are taking to ensure that, during the closure of the Tavistock gender identity clinic, young people who accessed those services receive appropriate counselling, as recommended by the Cass Review of gender identity services for children and young people.

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

NHS England commissions children’s and young people’s gender identification services. All patients at the Tavistock gender clinic receive psychological or psychotherapeutic care. Following the Cass review interim report, NHS England is bringing the GIDS contract to a managed close and transitioning gender services to new providers that will deliver holistic and exploratory counselling. Existing patients will continue under the current care arrangements until they are transferred to new services based in specialist paediatric hospitals.

[Lord Young of Norwood Green (Lab)]

My Lords, I thank the Minister for his reply, but I would like to probe a little more on this. Does he recognise that 80% of the young people who are diagnosed with gender dysphoria, many of whom are girls on the autistic spectrum, realise when they reach the age of 18 that they have gone through a perfectly normal process of puberty? They might end up being gay or lesbian, but they certainly did not need to be prescribed puberty blockers, which are a serious medical risk. Can the Minister assure me that steps will be taken to ensure that those young people receive the appropriate counselling? It could be via CAMHS, but what it cannot be, as he rightly said, is through the discredited Tavistock clinic—and I would like to meet the Minister on this issue.

[Lord Markham (Con)]

Yes. As I have said before, it is one of the privileges of this job that you learn about new areas, and I thank the noble Lord for his Question; this is something I have enjoyed being educated on in the last few days. I am very happy to meet with him. The points he makes are absolutely right: a lot of these people have other issues and going through puberty is a difficult time. So the lessons have been learned and we will make sure that they are implemented.

Care Homes: Staffing

Lord Young of Norwood Green Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

The question is absolutely correct: as I said earlier, less than 10% of these 13,000 people need to be in care homes full-time. The danger is often that once you put them there, they remain. That is why the package is focused on stays of up to four weeks, and absolutely making sure that they are monitored through, because it is vital. It is a step-down situation to help people ease from the acute—where they need a bit of extra support—so that, most importantly, they can get back home as soon as possible.

[Lord Young of Norwood Green (Lab)]

My Lords, does the Minister agree that some of the best examples of care are provided by charities and faith-based organisations which pay more than the minimum wage? Is that not an example to be encouraged if we really want to improve the recognition of carers in the care sector?

[Lord Markham (Con)]

Yes, absolutely. I find—and I talk as a businessman of 30-odd years—that by paying people well, you attract and retain the most motivated staff. It is the best way to run an organisation.

General Practitioners: Shortage

Lord Young of Norwood Green Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for his question, but also pay tribute to his commitment to tackling racism in our society.

We know that there are countries that train more people than they have places for in their country. They do that, first, to help those people get a better life elsewhere, but also because remittances are much better than foreign aid for many of those countries. I frequently mention the fact that it was immigrants from the Commonwealth who saved public services in this country after the war. We should remember that and continue to encourage people from the Commonwealth to come to this country. Sadly, for some reason, noble Lords quite often do not want them and make up all sorts of excuses for trying to block non-white people from outside Europe.

[Lord Young of Norwood Green (Lab)]

My Lords, one of the disincentives for both men and women GPs is the quality of accommodation. They are in overcrowded buildings. There is a good example from a care commissioning group in my area which spent £1 million planning a new centralised health centre, which would have provided top-of-the-range facilities and would have encouraged general practitioners to remain in practice. Will the Minister look at the quality of accommodation? What plans are there to introduce new buildings? That is a really important factor in dealing with the shortage of GPs.

[Lord Kamall (Con)]

The noble Lord makes the very important point that GP practices are evolving. Some are moving premises; some are merging in larger premises; some are moving into primary care centres, where they are able to offer not just traditional GP services but some of the services that secondary care currently offers. I am not entirely sure of the specific point that the noble Lord makes. He would be welcome to have a conversation so that I can follow it up with my department.

Paramedic Services

Lord Young of Norwood Green Excerpts

Monday 4th July 2022 Lords Chamber

Asked by

[Lord Young of Norwood Green]

To ask Her Majesty’s Government what steps they are taking to prevent avoidable deaths caused by delays to the arrival of paramedic services.

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

NHS Improvement has allocated £150 million of additional funding to ambulance services to help address pressures, alongside reducing ambulance handover delays. Even though the pandemic placed significant pressure on response times, there have been improvements in all response time categories in both April and May, with average response times to category 2 emergency calls—such as strokes and heart attacks—reduced by about 11 minutes and 24 seconds in May alone. Work continues with the service to restore performance.

[Lord Young of Norwood Green (Lab)]

My Lords, it is difficult to thank the Minister for the Answer because it is a totally unsatisfactory one. I have been raising this question for about the last six months. The reality is that, as the noble Baroness, Lady Uddin, told me when her son had a stroke and 999 was called, it took nearly six hours. He suffered serious consequences as a result of that. People are dying as we sit in this Chamber, literally thousands of them. Why? Because paramedics are waiting with trolleys in hospitals for a bed. There is a simple solution to this problem, which I have been suggesting to the Minister. I have also given him a place—Wolverhampton—where they have solved this problem. Yet, still we do not seem to treat this as a matter of urgency. It is a national disgrace and I want an assurance from the Minister that real action is to be taken—and that does not mean an 11-minute improvement.

[Lord Kamall (Con)]

I begin by thanking the noble Lord for his engagement with me and the department on this issue. When the noble Lord has sent me details or suggestions, I have passed them to the relevant officials within the department. I hope I can assure that noble Lord that I have done that. As the noble Lord will know, within departments we have particular portfolios and I have to hand it on to the person responsible. In terms of the recovery plan, the NHS has published a 10-point action plan for urgent and emergency care. I will not go through the whole action plan, but it includes dealing with paramedics, recruitment and retention, and more space in A&E departments. At the same time, can requests be handled by telephone by clinicians and patients diverted to a more appropriate resource? All these have been looked at. I understand that the noble Lord thinks it is unsatisfactory, but we have been hit by the pandemic, we are trying to recover and there is a plan.

Personal Protective Equipment: Waste

Lord Young of Norwood Green Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

The right reverend Prelate is absolutely right that we should learn lessons, and there are two things we can learn: one is the benefit of hindsight, and one is the fallacy of hindsight. The fallacy of hindsight is to say that, given the same pressures, I would have acted differently. We can never know whether that is true; that is counterfactual. If we look at the benefit of hindsight, one thing we can learn is that if we buy more than enough in the future, and it is the right thing to do so, we should buy equipment that is as environmentally friendly as possible so that if it needs to be disposed of it can be recycled into other items.

[Lord Young of Norwood Green (Lab)]

My Lords, does the Minister agree that the vast majority of hospitals are using single-use PPE garments which go straight to landfill after one use? There is available on the market a product with RFI tags, which enables it to be simply laundered for 70 different uses. Should we not be investigating that if we are serious about reducing carbon emissions?

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. I am not aware of the product to which he refers, but I should be grateful if he would write to me with more detail and I will pass it on to the department.

Health and Social Care Leadership Review

Lord Young of Norwood Green Excerpts

Thursday 9th June 2022 Lords Chamber

[Lord Young of Norwood Green (Lab)]

My Lords, I echo the point made by my noble friend Lady Merron about the health service and the people who have done such sterling work within it. After all, they saved my life twice so I certainly recognise that.

However, I have to say that, like the report, the NHS is a bit of a curate’s egg, and we know it; it is good in parts. When it is good, it is very, very good, but when it is bad, it is dreadful—really dreadful. People die unnecessarily, as we saw in the gynaecology scandal at Telford. What worries me about that case is that I still do not see anyone being held to account for those appalling management failures. Even worse than that is the report yesterday from Birmingham of the consultant who was removing non-existent cancers from breasts and went on to practise for years without being uncovered, not only in the NHS but in private practice. We have to ask ourselves how on earth such appalling failures in accountability, management and checking are possible. I would welcome the Minister’s response on that.

I recommend that the Minister look at the Twitter account of a guy called Roy Lilley, because it is worth a look. I will give a flavour of it:

“There’s a problem with bullying and racism in the British Army. A BBC Three documentary shone a light on racism in the Army and there is still the shadow, cast by the events at Deepcut. It’s a hot topic for the Top-Brass. They’ve had reviews and all-sorts to try and stamp it out”—


and they failed. He continues:

“If they can’t fix racism and bullying in a small outfit like the Army, what chance does the NHS have … with around a million and a half people, a budget of about £3bn a week, a million customers a day and if it were a country it would be the thirtieth largest in the world. In the Army, the NHS, sport and wider society we’ll find good people, bad people, energetic, lazy, thieves, thugs, saints, angels, bullies and racists”—

[Baroness Penn (Con)]

My Lords, I encourage the noble Lord to reach his question.

[Lord Young of Norwood Green (Lab)]

I will, but hardly anyone has contributed to this debate. I have posed one question and I will pose a few more—I do not see why I should not take the opportunity. I would see why if the Chamber were full of people participating, but it is a bit rich that there is hardly anyone—

[Baroness Penn (Con)]

My Lords, attendance in the Chamber does not change the guidance in the Companion about questions on a Statement being brief and direct.

[Lord Young of Norwood Green (Lab)]

I have posed one question, and I will pose a couple more. I will move to further questions and my criticism of the report. First, I agree with a lot that the noble Lord, Lord Lilley, said. On diversity, we recently had a situation, on which I would welcome a comment from the Minister, where the NHS could not bring itself to define a woman in gynaecological circumstances—I find that somewhat unbelievable.

What are we doing about fixing the situation in A&Es where paramedics stand by trolleys for hours on end while people are dying of strokes outside? I have raised this question with the noble Lord a number of times. It can be fixed, but you have to be determined. If the noble Lord wants an example of best practice, I recommend that he look at Wolverhampton, where he will find an example. There is no mention of best practice in this report, which I find astonishing. I also note the importance of new technology being adopted in a coherent way. I look forward to the Minister’s answers to those questions.

[Lord Kamall (Con)]

I thank the noble Lord for his questions. I say up front that I am not a fan of Twitter, even though I am still on it. Frankly, I do not like social media and I try not to look at it too much—but I welcome that the noble Lord shared some of his concerns.

The noble Lord is absolutely right on bullying and harassment; they are not acceptable in any form and should not be tolerated—this is part of the NHS people plan. This goes to the heart of the review: it is about leadership and culture. We have to make sure that there is a culture where bullying and discrimination are not tolerated. Frankly, it is about not diversity officers but greater diversity, which are not always the same. As I said, we have a diverse workforce, but why do we not see more diversity in the upper echelons of our health service? It is important that bullying is tackled and that we have that culture—but this also comes from local leadership.

I am grateful to the noble Lord for the number of times that he has suggested thinking outside the box on A&E. We have looked at various pressures on it; sometimes people go to it because they cannot get a GP—how do we address that? Sometimes, people do not want to go to A&E and try other routes but end up there—so how do we make sure that those other routes are available? We are looking at how to triage better and how people can use 111 instead. There are a number of issues and, as the noble Lord rightly said, technology can play a role.

Covid-19: Antiviral Pills

Lord Young of Norwood Green Excerpts

Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Earl will be aware, given all the news stories around it, that many people will be concerned about the effects of long Covid. I know there have been studies and interesting stories in the press about the long-term impact. As I said to the noble Baroness, I will find out what is being done in detail and write to her.

[Lord Young of Norwood Green (Lab)]

My Lords, for the Minister’s information, a trial is currently going on using xenon gas and MRI scans, which is looking particularly at the damage to lungs as a result of long Covid. It might be useful for him to get his officials to advise him on this.

[Lord Kamall (Con)]

I thank the noble Lord. Maybe next time I get a question like that I will ask the Lord Speaker whether I could delegate the answer to him.