Sexually Transmitted Infections: England

Baroness Blackwood of North Oxford Excerpts

Thursday 5th September 2019 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, I beg to move the Question standing in my name on the Order Paper. In doing so, I declare an interest as a trustee of the Bloomsbury Network and patron of the Terrence Higgins Trust.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we are seeing a mixed picture in relation to trends in sexually transmitted infections. There have been increases in some infections such as syphilis, gonorrhoea and chlamydia, but diagnoses of first-episode genital warts have fallen. We are also seeing a steep decline in new HIV diagnoses among gay and bisexual men. Condoms remain the most effective way of reducing the risk of STDs.

[Lord Black of Brentwood]

I thank my noble friend for that Answer. While the news on HIV is obviously very welcome, is it not the truth that other STIs are now on the rampage, with rates of increase for gonorrhoea, syphilis and chlamydia sky-rocketing ferociously? Does my noble friend agree that what is needed is a cross-sector sexual health strategy and some vision and ambition for what we, as a country, want to achieve around sexual health? Can my noble friend, who I know cares deeply about these issues, tell us exactly what yesterday’s spending announcements mean for sexual health funding, which has been cut by £700 million in the last few years, with appalling consequences?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his Question and I congratulate him on his important work in this area. He is absolutely right that the Health and Social Care Committee recommended a new sexual health strategy and we will respond to its report shortly. In addition to that, the Green Paper consultation on prevention sought views on priorities for a possible new strategy and we will consider those responses very carefully. As he rightly says, the spending review yesterday announced 1% real-terms growth for the public health grant, which I know will be very welcome because it means that local authorities can continue to invest in prevention and essential front-line health services, including sexual health services.

[Lord Cashman (Non-Afl)]

My Lords, I remind your Lordships that I intervene as a non-aligned Member of this House and declare my interest as a patron of the Terrence Higgins Trust. I thank the Minister for her response to the Question. What progress has been made towards PrEP being routinely commissioned for all who need it before the end of the trial in 2020? Does she agree that PrEP needs to be made available as part of routine sexual health services from April 2020 and that no gay or bisexual man should be discouraged from being placed on the PrEP impact trial?

[Baroness Blackwood of North Oxford]

The noble Lord will agree that this Government have shown significant commitment to the roll-out of PrEP since the start of the PrEP impact trial in October 2017. Over half of the 26,000 places have been filled, which is welcome progress. The trial is scheduled to continue until autumn 2020 and work is now starting to consider future commissioning for PrEP after the trial has ended.

[Baroness Jolly (LD)]

My Lords, as the noble Lord, Lord Black, said, there is good news. Walking into the House this morning through Lambeth, I saw posters telling us that HIV is on the way out, but to be aware of STIs. What proportion of the Chancellor’s money announced yesterday will be allocated to local authorities delivering public health and what guidance is given to local authorities on developing sexual health services by Public Health England?

[Baroness Blackwood of North Oxford]

We will need to confirm the distribution of the grant in due course. I am sure that will be the subject of questions as we go forward. As for the guidance that comes from Public Health England, in developing its plans, local systems work in close partnership with directors of public health to respond to local health needs and deliver on the commitments for the long-term plan. Public Health England works very closely with those directors of public health.

[Baroness Masham of Ilton (CB)]

My Lords, do the Government agree that drug resistance to some of these STIs is very serious and a strategy would help to make people more aware of the problem?

[Baroness Blackwood of North Oxford]

The noble Baroness is expert in this area and often raises this issue. She is absolutely right that antimicrobial resistance among some STIs is a growing concern. Public Health England has a world-class surveillance system to enable early detection and management of antimicrobial resistance. It is particularly an issue when it comes to gonorrhoea, and it uses that intelligence to advise the national gonorrhoea treatment guidelines. We will continue to keep on high alert when it comes to these matters.

[Baroness Manzoor (Con)]

My Lords, the number of reported gonorrhoea cases has increased by 176.6% among multi-race persons over the last six years. How exactly is the issue being tackled in this community and what funding will be made available for it?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that increases in particular STIs are worrying and we need to make sure that we drive forward our response to that. Some BAME groups are at particularly high risk of STI acquisition, particularly those from a black Caribbean background possibly due to a higher number of sexual partners. PHE’s reproductive, sexual health and HIV innovation fund is spearheading new, innovative, community-led interventions to support those at increased risk of infection and we will continue to look for new ways to respond to these challenges.

[Lord Winston (Lab)]

My Lords, it is very unwise to group all STIs together and the organism that I should like to concentrate on for the moment is chlamydia. We may not be diagnosing chlamydia in the right way. Given that the NICE guidelines now mean that we hardly ever do laparoscopies, we cannot show whether people have tubal damage, which is said to be an important part of chlamydia. In my view, that is greatly overestimated. What does the Minister think about research into whether chlamydia really does cause infertility and other problems with conception?

[Baroness Blackwood of North Oxford]

The noble Lord is of course an expert in where we should target our research. The NIHR is a £1 billion fund which is not targeted specifically. However, it is right that we should target research into STIs to ensure our response to the challenges. We know that STIs are increasing so we should include research into them.

[Baroness Finlay of Llandaff (CB)]

My Lords, how much is the Department of Health and Social Care doing with the Department for Education to ensure that in schools young people are aware of the emergence of antimicrobial resistance among STIs and to make the use of condoms more fashionable? Many young people feel that they are not the things to use, when they are actually the best form of protection.

[Baroness Blackwood of North Oxford]

The Government have made it clear that we want all young people to be happy, healthy and safe, especially when it comes to relationships. That is why we are making relationship and sex education compulsory for all secondary-age pupils from September 2020. That is intended to equip young people with the skills to maintain their sexual health and overall well-being. The noble Baroness is absolutely right that that will be effective only if it is cool and works well in terms of communication with young people.

Personal Healthcare Budgets: Sheffield

Baroness Blackwood of North Oxford Excerpts

Wednesday 4th September 2019 Lords Chamber

[Lord Blunkett]

To ask Her Majesty’s Government what was the difference in the number of people covered by personal health care budgets or Independent Living Fund payments in Sheffield between (1) January and June 2019, (2) January and June 2018, (3) January and June 2017, and (4) January and June 2015.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the department does not collect the data requested in the specified format. However, the number of people with a personalised health budget is calculated on a quarterly basis within each financial year, which ends on 31 March. Currently, 53,143 people benefit from a personal health budget nationally. I shall write to the noble Lord this afternoon with a full breakdown of all the data that we collect in relation to Sheffield and place a copy of the letter in the Library.

[Lord Blunkett (Lab)]

I am grateful to the Minister. Can she help me with a very practical question relating to the county council’s publication last week, and that of the Institute for Government today, in respect of the funding of social and the interim grant that was due to run out at the end of March next year, which constituted a third of government spending? Can we presume that the amount announced by the Chancellor of the Exchequer this afternoon is in addition to renewing that temporary grant? If it is, is it not a strange paradox that it is half a billion pounds less than the amount that he announced in respect of a no-deal arrangement with the European Union?

[Baroness Blackwood of North Oxford]

The noble Lord has asked a very important question and I am pleased that the Prime Minister has followed through on his commitment to improve the situation for local authorities and for social care, not only by increasing funding for social care by £1 billion today but by increasing funding for local authorities. This is a welcome change for local authorities, which need to ensure that they can fund the commitments that we have. In addition to the letter that I shall place in the Library, I shall be happy to follow up on the specific challenge that the noble Lord raised regarding Sheffield following Questions.

[Baroness Jolly (LD)]

My Lords, personal healthcare budgets and payments from the Independent Living Fund can offer an individual freedom and choice, but will the Minister tell the House what advocacy support accompanies these payments, so that members of the public can be well informed and choose the best providers for their needs?

[Baroness Blackwood of North Oxford]

Personal health budgets play a really important role, not only in supporting individuals to have personalised care but by making sure that we can seek support from social prescribing and community care, just as the noble Baroness mentioned. These plans are designed not only between the general practitioner and the supporter, but with the patient; therefore, the right information is provided to the patient in an open and transparent manner so that they can ensure they get the right care. It is important to note that those in receipt of this care have an 87% satisfaction that they are receiving the care they want in a much more effective way than they were before.

[Baroness Wheeler (Lab)]

My Lords, NHS continuing healthcare is supposed to provide a lifeline when older people and their families are at their most vulnerable and face sky-high costs as the result of chronic health conditions. However, this system is confusing and the rules arbitrary, resulting in a significant postcode lottery. Since 2015 more than 4,000 adults have died while awaiting a decision on their care to be made. What action are the Government taking to ensure that every person in need gets the support they need promptly, regardless of where they live?

[Baroness Blackwood of North Oxford]

One of the actions we have taken today is increasing funding to local authorities to relieve some of the pressures on them, increasing real-terms spending on public health, and also £1 billion for social care. In addition to that, there is a clear impetus from the long-term plan to increase personal health budgets, which are a very important aspect of the solution, because it will lead to an integration of spending and an integrated assessment of NHS care and social care. This is a real gap within the solutions for those who receive this support, which is why we want to make sure that we roll this out much faster than we have before. There is a commitment to have 200,000 people on personal health budgets and we are ahead of our ambitions on that.

Adult Social Care

Baroness Blackwood of North Oxford Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the Association of Directors of Adult Social Services Budget Survey 2019 on the state of adult social care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we recognise many of the issues highlighted by ADASS. People of all ages are now living longer, sometimes with complex care needs. Social care funding for future years will be settled in the spending review, where the overall approach to funding local government will be considered in the round. Meanwhile, we have given local authorities access to up to £3.9 billion for more dedicated funding for adult social care this year, and a further £410 million is available for adult and children’s services.

[Baroness Wheeler (Lab)]

My Lords, the ADASS survey results provide yet more evidence of the ongoing crisis in social care caused by persistent underfunding and a fragile and failing care market. As the report says, there are planned cuts of £700 million to adult social care budgets in the current financial year and there have been cumulative cuts of £8 billion since 2010. On the last day of our current Session, can the Minister update the House on the timing of the social care Green Paper, which has been delayed six times and is now two years overdue? Given this inexcusable delay and the widespread consensus across social care about what needs to be done, why can the Government not commit to publishing a White Paper with actual proposals? Has the Lords Economic Affairs Committee report calling for £15 billion of extra funding, to include free personal care for people needing basic washing and dressing support, not done the Government’s job for them?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,

“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.

He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.

[Lord Forsyth of Drumlean (Con)]

My Lords, I welcome the statement by the incoming Prime Minister. However, does my noble friend share the concern about the unfairness of the current system? People suffering from dementia or motor neurone disease are not given access to free care, whereas people suffering from cancer are. People who choose to be looked after at home do not get free care until their assets have been run down to £23,500, but their home is not taken into account. However, if they go into residential care, their home is taken into account. As my noble friend indicated, what we need now is not another White Paper; we need the Government to write a cheque. We need to move away from a system where local authorities are asked to fund this out of business rates, which results in a postcode lottery and differences in care throughout the United Kingdom.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for the work he has done on this issue. It is very much welcomed. He will know that, as one of his first statements, the Prime Minister said that his job was to,

“protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care”.

This was one of the first points he made. The noble Lord will also know that one of the Government’s long-term principles is that there must be a level of personal responsibility for social care in England, as well as the safety net that supports significant numbers of people today. However, we accept that there will need to be a significant amount of funding as part of the spending review commitment. That is being considered at the moment and will be coming forward imminently.

[Baroness Jolly (LD)]

My Lords, the sustainability of adult social care is at severe and immediate risk. We too welcome the Prime Minister’s words yesterday. Could the Minister confirm that he will commit to continuing with the precept, and the social care grant or the improved better care fund after 2019-20? Otherwise, how can councils plan their finances for 2020-21? What assurances do councils have that any future funding will be protected for the adult social services budget and not be part of the overall spending at the councils’ discretion?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that the better care fund has been considered a great success. It is an important part of the integration proposals between health and social care, which the Government and the NHS are committed to. It is under review to see how it can work better. That will conclude later this year so that certainty can be given to local councils, which I hope she welcomes. On market instability, I reassure her that the overall number of social care beds has remained more or less constant over the past nine years. There are also over 3,700 more home care agencies now—so, while there will inevitably be some exits from the market, we are more reassured than we would otherwise have been.

[Baroness Pitkeathley (Lab)]

May I take the noble Baroness back to her reference to personal responsibility? There is a great deal of agreement across the House and elsewhere that personal responsibility is important as far as social care is concerned, but does personal responsibility extend to subsidies for those on local authority placements in nursing homes? Those paying for themselves privately are actively subsidising those places because local authorities cannot afford adequate rates.

[Baroness Blackwood of North Oxford]

The noble Baroness has got to the nub of the challenge, which is how we get the balance right. This is why we have brought forward the work we have been doing to make sure that, while we have the safety net in place and an element of personal responsibility, it becomes fairer. That is why the Prime Minister and the Secretary of State have made it clear that they are determined to drive this work forward faster and with more urgency than has been done until now. That has been put forward as a key priority of the incoming Cabinet.

[The Lord Bishop of Ely]

My Lords, we have heard, properly, about the needs of the elderly. Will the Minister assure us that the needs of people with learning disabilities will be better addressed in any action the Government are likely to take, particularly since some 41% of the helpline calls to Mencap in April were from people very concerned about the loss of community care?

[Baroness Blackwood of North Oxford]

The right reverend Prelate has pointed out something very important: a significant portion of those accessing adult social services are actually those of working age and those with learning disabilities. It is very important that does not get lost in the debate. Anything that comes forward as part of the social care solution must address the concerns of that part of the community in a much more effective and joined-up way. Integration of social care and NHS budgets, and effective delivery, will be core to that delivery.

[Baroness Greengross (CB)]

My Lords, last week, with the Salvation Army the charity the International Longevity Centre UK, which I head, published a report on the funding gap in social care, in particular for older people living in rural areas. The report summarised it very well by saying that there is not just one crisis but lots of crises and that local leadership alone cannot overturn the inequalities. As co-chair of the All-Party Group on Adult Social Care, I hope that the Minister can assure me that Her Majesty’s refreshed Government will now prioritise this issue in the way I have suggested.

[Baroness Blackwood of North Oxford]

The noble Baroness phrased that very elegantly—I shall use the term “refreshed Government” myself. I will make the gentle point that the funding available for adult social care has increased by 8% in real terms from 2015-16 to 2019-20, which is a step in the right direction. However, there is a recognition that, to put it on a sustainable footing for the future, there needs to be a settlement in the upcoming spending review. That is recognised. On the point she made about rural areas, which is important, a lot of this hinges on workforce recruitment and retention, which can be more challenging in rural areas. That is why the Government have invested £3 million in the Every Day is Different national adult social care recruitment campaign, to encourage more people to apply to work in the social care sector and to raise its profile. This has had some success already, which is an encouraging picture. We need to work harder on that.

Mental Health: Weight and Shape-related Bullying

Baroness Blackwood of North Oxford Excerpts

Monday 22nd July 2019 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the impact of weight- and shape-related bullying, criticism and teasing on long-term mental health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, bullying in all its forms can have a serious effect on mental health. Children who are exposed to frequent, persistent bullying are at a higher risk of developing mental health problems; exposure to bullying is also associated with elevated rates of anxiety, depression, self-harm and suicidal thoughts, which can last into adulthood. The Government are providing more than £2.8 million of funding up to 2020 to support schools in tackling bullying.

[Baroness Bull (CB)]

My Lords, weight-related teasing is a form of weight bias, the consequences of which can include depression, anxiety, low self-esteem, substance abuse, eating disorders, obesity and suicidality. Weight bias is on the increase and is prevalent across the population. Research shows that even health professionals are not immune to negative stereotypes that connect character and capability with weight. Is the Minister confident that adequate social policies are in place to address and reduce the incidence of weight bias? Does she believe that there is sufficient provision in the law to protect all of us, young and old, from discrimination on the basis of size and shape?

[Baroness Blackwood of North Oxford]

The noble Baroness has a record of raising this important issue. The Government recognise that poor body image is not only a common problem but is associated with mental ill health. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body, weight or shape. As she rightly points out, in the most extreme cases, that can lead to eating disorders, depression or even feeling suicidal. The Government have delivered a broad programme of body image work over the past six years. We believe that more work can be done but we are working hard to make sure that we expand our eating disorder community care work for children and young people over the next few years. I welcome continuing the debate to see what more can be done.

[Baroness Wheeler (Lab)]

My Lords, the latest Barnardo’s report, Overcoming Poverty of Hope, showed that 69% of young people,

“feel they will have worse ‘overall happiness and mental health’ compared to their parents’ generation”,

with one young person saying that social media is “massive for mental health” because of the,

“unrealistically high expectations of body image and lifestyles”.

On top of that, the report found that,

“young people with additional life challenges, such as young carers and care leavers are more susceptible to the negative impacts of social media as they are more likely to experience social isolation”.

What are the Government doing to work with mental health charities, such as YoungMinds, and young carers to address this situation?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that children exposed to persistent bullying risk experiencing these problems. This is related to the experience of face-to-face bullying, but exposure on social media can also cause the problem. That is why the Department for Education is providing over £2.8 million of funding between September 2016 and 2020 to four anti-bullying organisations—Internet Matters, the Diana Award, Anti-Bullying Alliance and the Anne Frank Trust—to support schools to tackle bullying. Of course, all schools must have in place an anti-bullying policy, which Ofsted regulates.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we have already heard from noble Lords how important this problem is, but of course it is partly the responsibility of the Department of Health. I ask my noble friend whether we are also talking cross-departmentally. Surely schools have a role to play here, so are teachers being taught about the problems this can bring? Is DCMS being taught about online bullying, et cetera?

[Baroness Blackwood of North Oxford]

My noble friend is quite right. As I have already pointed out, DfE-funded anti-bullying work is ongoing. Work is also increasing to join up the provision for young people through the children and young people Green Paper, which will put in place early intervention provision to make sure that young people do not have to wait until they are ill before they can get support. This problem needs to be challenged right across government, which is why we have also brought in the online harms White Paper to make sure that social media companies play their part.

[Lord Laming (CB)]

My Lords, does the Minister agree that in recent years there has been a marked reduction in mental health counselling services for young people? Can the Minister tell us anything encouraging about the redevelopment of specialist mental health services for young people?

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right that we must make sure we invest in the services needed to respond to the increasing reports of mental ill heath in young people. That is why we have focused on increasing mental health funding. I am pleased to report that the amount spent on mental health will be £12 billion in the next year and that all CCGs will meet the mental health investment standard. We are also investing in particular in suicide prevention over the next three years—£25 million to support local suicide prevention plans to make sure that local authorities are able to have a multiagency suicide prevention response, which I think the noble Lord will agree is extremely important.

[The Lord Bishop of Ely]

My Lords, the Children’s Society has done quite a bit of research into the profile of those involved in bullying. Many have had very unhappy lives. Does the Minister agree that it would be a good idea, in policy formation, if we spent more time talking to the children themselves and getting their case put more fully before us? The Children’s Society advocates that the Government systematically measure children’s well-being and use this to inform policy-making. Does the Minister accept the potential merits of measuring children’s well-being?

[Baroness Blackwood of North Oxford]

As usual, the right reverend Prelate raises an important point. The fundamental principle of using lived experience to develop policy is an important principle within the Department of Health and across government. Most particularly, the experience of young people—those who are bullied and those who are bullying—should be taken into account. This is the only way we will get to the bottom of this problem and stamp it out once and for all.

[Baroness Brinton (LD)]

My Lords, as the co-chair of the APPG on Bullying, I have seen the reports that other noble Lords have referred to. It is good that more investment is going into mental health in the NHS, but schools still need front-line support for many bullied children. Over half of children report that bullying about their size and body image is the leading cause. What can the Government do to ensure that there really is access to front-line services for children in school?

[Baroness Blackwood of North Oxford]

As I have said, we are making sure that we bring the investment into the front line with this £2.8 million. In addition to that, all schools are legally required to have behaviour policies with measures to prevent all forms of bullying. They have the freedom to develop their own anti-bullying strategies to make sure that they are appropriate to their environment, but they are held to account by Ofsted. This is at the forefront of the Department for Education’s guidance to schools on how to prevent and respond to bullying as part of their overall behaviour policy.

National Health Service: Healthcare Advice

Baroness Blackwood of North Oxford Excerpts

Tuesday 16th July 2019 Lords Chamber

[Lord Patel]

To ask Her Majesty's Government what analysis they have conducted of the impact of the National Health Service introducing the use of devices such as Amazon’s Alexa for health care advice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, digital technology will play a key role in making the NHS sustainable. The Secretary of State’s technology vision sets the foundation for a new generation of digital services focused on user need, privacy and security, interoperability and inclusion. The collaboration with Amazon simply connects people to medical information and is already freely available through the NHS website. This service does not provide advice or any form of diagnosis. More modes to access medically verified NHS information can only give UK citizens a better understanding of different medical conditions. The agreement with Amazon is convenient for those who rely on voice-activated technology, in particular blind and visually impaired people.

[Lord Patel (CB)]

My Lords, I thank the Minister for her response and might I say it was a good defence? While I have absolute confidence that Matthew Gould—our previous ambassador to Israel who leads on the project—will get it right, voice-recognition technology has its problems. It must recognise the correct phrase, word and accent. It might be interesting to hear the answers that the Opposition Chief Whip were to get if he asked a question with his accent. I asked five questions at the weekend; all health-related. One I repeated twice and got two different pieces of advice: one was to call 999 and the other was to go to bed and rest.

I know that it is not a diagnostic technology, but it runs the risk of a diagnosis being made, so the key questions are what trials are being carried out, what data protection do we have against Amazon collecting vast amounts of data, and what is the risk of misdiagnosis?

[Baroness Blackwood of North Oxford]

The noble Lord makes very important points. It is important to understand that this is not a technology to offer advice or diagnosis. NHS Digital and NHSX have built an interface to connect the NHS website so that other organisations can make NHS information available on their own sites. That is so that a greater number of people can access NHS information. It has already been made available through a number of other examples such as NHS Go, which is designed to inform young people, accuRx and eConsult. No health data is collected by Amazon. No money is exchanged via this route and all data protection laws, such as GDPR and the NHS data protection rules, still apply. Data protection is still required to protect data through this system.

[Baroness Thornton (Lab)]

My Lords, it is exciting to contemplate the new world of communication technology and how it might help in all kinds of ways, but the noble Lord, Lord Patel, has raised some important points. The NHS-Alexa partnership has to be seen in the context of Amazon’s ambitions for our wider healthcare industry. I seek assurance. I am sure that at the moment the data is being protected, but I want to know what will happen in the future. If Amazon collects yet more data on patients raising medical concerns, what use might be made of that in the future?

I do not know how other noble Lords are getting on with their Alexa in the corner of the sitting room, but ours regularly joins in with conversations and tells us very bad jokes. My granddaughter thinks it is wonderful because she knows what noise a unicorn makes, so I am not sure, as the noble Lord said, how that plays if one is trying to have a serious discussion about a medical condition.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that. I would be interested to know what jokes she has heard from Alexa in her family conversations. However, patients look on well-known search engines for medical advice and at the moment they may receive advice from all sorts of untested sources. NHS.uk is clinically based advice which has been approved by NHS England. The purpose of making that advice more available through the Open API, which is available through the developer system, is to ensure that that clinically based advice is more widely available and more readily searchable for patients. A reasonable point has been raised which is to ensure that the right advice reaches patients and that patients go through the right triage system, whether it is 111 or another system, but that is the intention of the programme. It will be carefully monitored and managed by NHSX, NHS England and the department.

[Lord Fox (LD)]

My Lords, there is a wider principle here. Even if effective, anonymised data is gathered and generated, where does the value lie in that data? Can the Minister tell us whether the Government have discussed and agreed with Amazon where the value lies and who gathers that value? On the overall principle, can the Minister tell us that when this data generates value, it is the NHS that benefits and not the private sector?

[Baroness Blackwood of North Oxford]

Amazon is not sharing any of the information that it gathers from third parties. It is not selling products or making product recommendations based on health information, nor is it building a health profile on patients. It has strict technical and operational safeguards in place so that Amazon employees will not have direct access to information that can identify any person or account. As I have already said, it does not have access to any health data based on this contract. No health data is being shared between the NHS and Amazon. Just yesterday we launched some new data-sharing principles which are designed to improved clarity around health data-sharing between the NHS and private companies so that we can improve public and clinician confidence on this issue.

[Baroness McIntosh of Hudnall (Lab)]

The Minister has just given a very eloquent explanation of her view of the relationship with Amazon, but does she agree that it is a bit counterintuitive to assume that a company as big and commercially successful as Amazon is not getting some value from the relationship with the NHS? Can she explain what that value is?

[Baroness Blackwood of North Oxford]

Amazon is seeking to ensure that it provides a service to its customers. In this instance, we have ensured that we have provided an open API: any company that chooses to develop a service linking to the information on the NHS website is able to do so. This is not an exclusive contract with Amazon. As I have already said, other companies are able to do so and some already have done. It is not a specific benefit for Amazon. It is something that other companies have already availed themselves of and is of benefit to the NHS and NHS patients.

Childhood Obesity

Baroness Blackwood of North Oxford Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Jenkin of Kennington]

To ask Her Majesty’s Government what action they are taking to combat childhood obesity.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we are delivering a world-leading plan to tackle childhood obesity. Later this summer, we will set out further action through a prevention Green Paper. In addition, the Chief Medical Officer is reviewing what more can be done to help us meet our ambition of halving childhood obesity by 2030. The review, due to report in September, will consider the approaches taken internationally, regionally and across the country, and will make a series of recommendations.

[Baroness Jenkin of Kennington (Con)]

My noble friend will have seen coverage in the weekend’s press of food companies which are continuing to breach the government advice that a child should not be weaned until six months of age. They are also still failing to reformulate infant foods. For example, one portion of baby porridge contains 9.4 grams of sugar in a 24 gram portion. That of course leads to further childhood obesity, dental decay and addiction to sugar. Can my noble friend tell us what conversations and discussions the Government are having with food companies, in particular Heinz, Danone and Nestlé about reformulation and the age at which infants should be weaned?

[Baroness Blackwood of North Oxford]

My noble friend is a great champion on this subject and has been an expert in it for a long period. Through the prevention Green Paper, which is due to be published this summer, we are determined to look at a range of further options to tackle obesity. We have publicly committed to taking action on infant and baby food. She will know that we are making progress on the reformulation section of the obesity strategy. However, we have further to go, and I am grateful to her for her Question on this issue.

[Lord Bird (CB)]

Is it possible to consider something very clever? Rather than accepting that the poorest among us are the ones who deal with obesity, why do we not give them a Waitrose lunch and dinner and subsidise it, and stop having to pay further upline in the NHS? Why do we not start thinking globally rather than just a bit at a time?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question; I hope that we can occasionally think cleverly in government. He is absolutely right that obesity is strongly correlated with socioeconomic deprivation, and that is why chapter 2 of our plan tries to target those areas that are most affected by delivering a childhood obesity trailblazer programme, working with local authorities to address this. They have been provided with £100,000 in the first instance to try to improve the impact of the childhood obesity plan. We shall see how that goes, but I am very happy to pass on his suggestion.

[Lord Dubs (Lab)]

My Lords, the Minister will no doubt be aware that the British-Irish Parliamentary Assembly some time ago produced a report on childhood obesity. Does the Minister agree, dipping into that report, that we need not only a national strategy but—as demonstrated to the committee in Amsterdam—a local strategy, where the local authority can take the initiative, and there can be education and pregnant mothers can be helped to see their way through their own diets and therefore to help their children? Does she agree that we need a local strategy as well, and can the Government initiate that with local authorities?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right that the national plan must be implemented locally. Public Health England works with local authorities to do that and has set up a number of tools, such as the Change4Life plan, which includes food scanners that have been downloaded several million times to help parents and families make better food choices. We have more to do on this, and we very much welcome proposals to do it. I know that the Amsterdam model has been particularly effective; indeed, my noble friend raised this with the previous Public Health Minister, and I am sure she will continue to raise the issue.

[Lord Addington (LD)]

My Lords, does the Minister not agree that activity is an important part of tackling obesity? We have had some wonderful examples of sporting success in women’s football, cricket, netball and other activities at the moment. What are we going to do to make sure that these examples of sporting success are fed down to children and made available on free-to-air when possible?

[Baroness Blackwood of North Oxford]

We should all be incredibly proud of the sporting achievements over this weekend; we should not hesitate to do whatever we can to promote them throughout our schools and make the most of the moment. The noble Lord is absolutely right that regular physical activity has been linked not only to improved physical health but to improved mental health and academic achievement. That is why the Chief Medical Officer has recommended 60 minutes of physical activity every day. We know that only one in five achieve this; that is why the money from the sugar levy is going into schools activity. But we have more to do. We have announced the national plan and now need to implement that effectively, and I hope that the noble Lord will hold us up to the mark in delivering it.

[Baroness Bull (CB)]

My Lords, notwithstanding the importance of anti-obesity guidance in supporting the long-term health of the general population, is the Minister aware of the concerns of eating disorder specialists about its unintended consequences on those for whom “Eat less, exercise more” is not an appropriate message? Clinicians are reporting an increasing number of young people citing anti-obesity guidance to justify excessive behaviours in exercise and diet restriction. Does she agree that, while anti-obesity policy is vital, it needs to be sufficiently nuanced that it does not cause unintended collateral damage to these vulnerable groups?

[Baroness Blackwood of North Oxford]

The noble Baroness presents a sensitive and sophisticated point: the whole point of the obesity message is that children should be eating a healthy, balanced diet and exercising in an appropriate way.

[Earl Attlee (Con)]

My Lords, does the Minister agree that obesity will break the NHS model if we do not do something about it?

[Baroness Blackwood of North Oxford]

I absolutely agree with my noble friend. Obesity is a crisis that will not only create misery for those who will then experience increased risk of tooth decay and of diseases such as cancers, diabetes and other severe illnesses, but it will also create significant unsustainability within our health service, which we are able to prevent. Since we know the tools that we have to prevent it, we should all be working together to make sure we do.

[Baroness Thornton (Lab)]

My Lords, we know—and the noble Lord, Lord Bird, made this point—that it is the poorest children who are obese. This is largely because their parents buy food which is high in fat, sugar and salt, because it is cheaper than fresh food. It may or may not be from Waitrose, but the noble Lord makes an important point there. I have two questions for the Minister. First, is it true that two-thirds of the deadlines of the plans that have been put forward for the obesity strategy have been missed? Secondly, what is the Government’s strategy for dealing with summer hunger—those children who will not get proper meals during the summer break?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right to raise inequalities. This is exactly why chapter 2 of our plan is focused on childhood obesity trailblazer programmes, where we have identified areas of highest deprivation to provide specific support to local authorities in those areas. We have also recognised this issue around school holidays: around 50,000 disadvantaged children will be offered free meals and activities over the upcoming summer holidays, funded by £9.1 million from the Department for Education. That follows a successful programme last summer, which saw improvement, with football play sessions and cooking classes for more than 18,000 children across the country. However, the noble Baroness is right to recognise that this is a real challenge that we need to address.

NHS: Automation

Baroness Blackwood of North Oxford Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Seccombe]

To ask Her Majesty’s Government what steps they are taking to increase the use of automation in the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Topol review, published earlier this year, outlines recommendations for preparing the health and care workforce, through education and training, to adopt new technologies such as artificial intelligence and robotics. It is clear that the use of AI will not replace clinical staff but instead allow them to be more human. The use of new technologies will ensure that patients receive safer, more productive, more effective and more personalised care. The recommendations of the Topol review have informed the interim NHS people plan, which sets out how we prepare the workforce to build an NHS that is fit for the future.

[Baroness Seccombe (Con)]

My Lords, the success of any organisation is dependent on the people within it. I believe that the most precious asset that the NHS has is its human resource of dedicated staff, but in these days of sophisticated IT, and now artificial intelligence, can my noble friend tell the House what developments can be safely and securely harnessed by the NHS?

[Baroness Blackwood of North Oxford]

Tremendous innovations are being introduced, including in robotics and AI-based automation, particularly in diagnostics, which have the potential to transform how healthcare is delivered in the NHS, but the role of automation to carry out basic administrative and repetitive functions, and of robotics in surgical operations in particular, is due to increase over the next decade. The main purpose of this automation in health is not to replace staff with machines or to reduce the role played by humans in providing care but, rather, to enable staff to spend more time delivering personalised care. But it is also to improve the productivity of health services and systems so that we can ensure that the NHS becomes more sustainable in future.

[Baroness Thornton (Lab)]

My Lords, the noble Baroness, Lady Seccombe, made a valid point about the need for human beings to be involved in the delivery of healthcare, but the use of AI and other technology is also very exciting, as is the fact that it features so largely in the long-term plan. Are the experiments in automation taking place across the country, where are they taking place, when will we see the results and who is delivering automated healthcare and AI? Is it the NHS or are private contractors being commissioned to do this work? I accept that the Minister may not be able to answer all those questions in detail, but if she cannot, I would appreciate a letter being placed in the Library.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.

[Baroness Brinton (LD)]

My Lords, while the delivery of automation and AI has much to commend it to the NHS, CyberMDX reported last week that anaesthetic machines can be hacked and controlled from afar, including silencing alarms that would alert anaesthetists to danger. Four months ago in Israel, a cybersecurity firm demonstrated that computer virus malware could add tumours to images of scans. What protections, such as digital signatures and encryption, does the NHS now put in place, following the malware alarm two years ago, to ensure that automation and digital services cannot be attacked by malevolent forces?

[Baroness Blackwood of North Oxford]

The noble Baroness is correct to say that patients and clinicians have a right to expect their data to be held securely. Since the WannaCry attack in May 2017, we have taken steps to ensure that NHS security measures are of the highest standard. This includes £60 million to improve cyber resilience in local infrastructure, support for NHS organisations to update their Windows operating systems, procuring a new cybersecurity operations centre, and boosting the national capability to prevent, detect and respond to cyberattacks. We are also committed to achieving much greater operational visibility across all NHS digital systems. This is one of the ways in which we can respond to attacks. Lastly, we expect the highest ethical standards from all data-driven systems and that is why we have introduced the code of conduct for data-driven health and care technology. That is how we will ensure that we have some of the best AI and data-driven technologies.

[Viscount Ridley (Con)]

My Lords, does my noble friend agree with one of the key points made by Professor Topol that one of the benefits of artificial intelligence is the “gift of time”, as he has put it? In other words, patients can spend more time with their doctor if certain more routine things are automated. Will my noble friend make sure that that is one of the key aims of bringing automation into healthcare?

[Baroness Blackwood of North Oxford]

My noble friend is right. One of the key recommendations is that by automating routine analyses such as radiology, diagnoses and pathology and routinely bringing in AI to sequence bed management, we will reduce the burden on clinicians so that they are able to see more patients. The review makes specific recommendations to help the workforce become more digital ready, which means increasing capacity and capability, and building the right environment. That is exactly what we have embedded into the NHS people plan and all that we are working on through NHSX.

[Lord Ravensdale (CB)]

My Lords, I declare my interests as set out in the register. Robotic process automation—RPA—is an emerging software technology that can undertake repetitive tasks in place of human workers. Many industries are seeing the benefits of using this technology and thus releasing people to do more value-added work. I believe that it has been used in a small number of NHS trusts. Can the Minister say whether there are any plans to deploy this technology more widely across the health service?

[Baroness Blackwood of North Oxford]

The noble Lord is right to say that technologies such as this offer the most potential to reduce repetitive work and transform how our healthcare is delivered. This is what we are focusing on to ensure that we can give health and care staff the ability to spend more time delivering personalised care in medicine while also ensuring that we improve systems to make them more efficient and productive.

NHS Dentistry Services

Baroness Blackwood of North Oxford Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what assessment they have made of the availability of National Health Service dentistry services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, nationally, access to NHS dentistry remains high, with 22 million adults and 7 million children seen by a dentist in the 24 and 12-month periods ending 31 December 2018 respectively. However, we know that there are areas of difficulty and more work remains to be done. NHS England, in its role as commissioner, is responsible for commissioning NHS dental services to meet local need and is actively looking into dental access issues.

[Baroness Gardner of Parkes (Con)]

That is rather a disappointing Answer, although it certainly ties in with my experience: it was declared in Manchester that no children could have operations done under general anaesthetic because all slots were taken for the clearance of baby teeth. When I saw that, I wrote to the Mayor of Manchester, who has great experience in the field of health from when he was in the House of Commons. I did not even get an acknowledgement, so after a time I wrote again, saying that perhaps my letter never reached him so I was resending it, but to this day I still have not had an acknowledgement. The press reports get worse and worse about the shortage of these possibilities.

[Baroness Blackwood of North Oxford]

I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.

[Baroness Thornton (Lab)]

My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?

[Baroness Blackwood of North Oxford]

As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.

[Baroness Benjamin (LD)]

My Lords, patients’ dental fees in England have been increasing at an unprecedented rate. These charges are discouraging patients from seeking treatment; they are made to think twice before treatment. Delayed treatment means that they end up seeking free help for dental pain from their GPs and the local A&E, piling huge pressures on other parts of the NHS. Will the Government take urgent action and start proper investment in NHS dentistry to end these extortionate dental fee increases?

[Baroness Blackwood of North Oxford]

The noble Baroness raises an important point. Patient charges are an important contribution to the overall costs of the NHS, and they were driven by some really difficult financial circumstances in the NHS, but she is right that it is critical that no one be deterred from seeking care by the cost. As part of this year’s uplist, the Government and the department have committed to looking further at evidence as to whether patients are being adversely impacted so that this can be taken into account in next year’s—and any future—decisions.

[The Countess of Mar (CB)]

My Lords, the Care Quality Commission recently published a pretty damning report on dental care for people in residential care and nursing homes; most of these people do not have access to a dentist. What are the Government doing to ensure that people in residential or nursing home care get regular dental treatment?

[Baroness Blackwood of North Oxford]

My friend the noble Countess, Lady Mar, raises a vital area. Overall care for those in care homes, whether healthcare, mental health care or dental care, must be provided in a suitable manner. This is being considered in the social care Green Paper.

[Lord Tomlinson (Lab)]

My Lords, I declare an interest as a former chairman of the British Fluoridation Society. Does the Minister agree that prevention is much better than cure, and that you can prevent the need for dentists through a substantial increase in the use of fluoride in our water supplies? Is she satisfied with the progress being made on fluoridation of water? If not, what plans does she have to encourage it?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right: prevention is always better than cure. That is why the programme for oral health improvement in both the NHS long-term plan and the dental contract being tested focuses on a more preventive approach to oral care. Water fluoridation is obviously a very effective way of improving oral health, particularly for children. According to the 2012 Act, it must be a local decision supported by Public Health England in the lead. We want to see more decisions. PHE’s guidance on delivering better oral health sets out clear expectations on this, but there are also other ways in which fluoride can get to children. One is through fluoride in toothpaste, which is now at effective concentrations; the other is that all dentists are expected to deliver fluoride to teeth directly, at clinically appropriate intervals, to all children in their care.

[Lord Clark of Windermere (Lab)]

Is it true that more than a million people were unable to get a dentist under the health service last year?

[Baroness Blackwood of North Oxford]

I do not have that figure in my briefing pack, but I am very happy to write to the noble Lord to confirm or deny whether that is the case.

Restaurants: Calorie Labelling

Baroness Blackwood of North Oxford Excerpts

Tuesday 9th July 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we welcome the ongoing commitment of Diabetes UK, including the Food Upfront campaign, which, together with its encouraging support for our proposals, makes a valuable contribution to improving the nation’s diets. The impact assessment published alongside our consultation last year estimates the number of businesses that will be affected under the various policy options considered. An updated impact assessment will be published when the Government publish the outcome of the consultation later this year.

[Baroness Thornton (Lab)]

I thank the noble Baroness for that Answer. It is a shame that the consultation, which ended in December, has yet to be published. Diabetes UK tells us that three out of four people want to see calorie information on restaurant, café and takeaway menus, and that nine out of 10 say that clearer food labelling will help them make healthier food choices. Diabetes UK is worried that the Government intend to limit compulsory calorie labelling to companies with 250 employees. If that is the case—I would like to know whether it is—only 520 businesses would be included out of the 168,000 eligible, rendering this meaningless. What are the Government doing in this regard and when will we see the results of the consultation?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important question. She will know that we remain committed to delivering the actions we set out in chapter 2 of the childhood obesity plan, which included the consultation on calorie labelling in the out-of-home sector. We will publish it shortly. She will also know that our ability to introduce changes to the labelling system depends on EU legislation. We are committed to exploring whatever additional opportunities we can to have food labelling in the UK display world-leading, simple nutritional information, as well as information on origin and welfare standards. We will bring that forward as soon as possible.

[Baroness Walmsley (LD)]

My Lords, I was alarmed to read the Public Health England report about unacceptably high levels of sugar in baby foods, even some labelled as being healthy. What steps are the Government taking to ensure that such products give parents the information they need to make healthy choices for their children?

[Baroness Blackwood of North Oxford]

I know the noble Baroness has raised issues around baby food on several occasions. The reformulation programme taking place under the obesity plan takes account of sugar in a number of different products. So far, I do not think baby food has been one of these, but the Secretary of State has commissioned the CMO to urgently review what can be done to help the Government meet their ambition of halving childhood obesity by 2030. The report is due for publication by September and I will pass on the noble Baroness’s comments.

[Baroness Neville-Rolfe (Con)]

Does my noble friend agree that two other policies on obesity are not adequately focused on? The first is helping parents to teach self-control and good eating habits. The second is increasing physical activity—for example, through the daily mile and school sports. I was horrified to learn from the Diabetes UK briefing that only 18% of children in the UK reach the recommended target for physical activity so vital to lifetime health.

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question; she is absolutely right that increasing physical activity is a key part of the childhood obesity plan. That is exactly why the revenue from the soft drinks industry levy is being invested in improving childhood health and well-being in this way, including doubling the primary PE and sport premium to £320 million a year. This has included a commitment to every school in the country including the daily mile, or something similar. We are particularly pleased about that, but we also believe that work needs to be done in supporting parents, and PHE is working on that.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, parents carry some responsibility. What disturbs me—I would like to know whether the Minister agrees—is that I often see parents with young children who have a scooter. The child will stand on the scooter and the parent pushes the child all the way to school, so the child gets no exercise whatever. It seems to defeat the whole purpose. Are the Government doing anything to remedy this by means of advertising?

[Baroness Blackwood of North Oxford]

The noble Lord has asked a most innovative question, to which I do not have an immediate answer in my notes. I hazard a guess that scooters offer some balance benefits, but I shall get back to him on that.

[Baroness Young of Old Scone (Lab)]

Are the Government losing their grip on this issue? We were promised the Public Health England sugar reduction data in April, when it did not appear, and then “in late summer 2019”. Can the Minister tell us how late summer will be this year?

[Baroness Blackwood of North Oxford]

Based on the weather, I cannot really answer that, but I absolutely reject the premise that the Government are losing their grip on this issue. We have seen some real successes since the publication of the 2016 plan. The soft drinks levy has resulted in the equivalent of 45 million kilograms of sugar being taken out of soft drinks, which is a genuine success. Some products in the sugar reduction programme have exceeded their first-year targets: a 6% reduction in sugar in yoghurts has been achieved. As I mentioned, significant investments are being made in schools to promote physical activity and healthy eating. We accept, however, given the obesity crisis, that much more needs to be done and the noble Baroness will be glad to hear that the Secretary of State has, as I said, commissioned the CMO to urgently review and drive this agenda forward, which is exactly what we intend to do.

[Baroness Boycott (CB)]

My Lords, I urge the Government to follow up on the point of the noble Baroness, Lady Thornton, about how many of these places are small companies. When I ran the London Food Board, we did research in Tower Hamlets and I found one single takeaway where a portion of chips—a large one, admittedly—was 1,800 calories. That is completely insane, and parents and children do not know about it. I would be grateful to hear the Government’s view on how we might publicise that fact.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her point. As I said, we remain committed to exploring what additional opportunities leaving the EU presents for food labelling. At the moment, we have some world-leading simple nutritional information, but we want to work with the devolved nations and Administrations to explore the potential for common approaches. Obviously, the consultation on mandated calorie labelling has received a high level of interest—there were over 1,000 responses—and that is partly why we are in the process of going through that at the moment.

NHS Pensions: Taxation

Baroness Blackwood of North Oxford Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we will be consulting shortly on proposals to make NHS pensions more flexible for senior clinicians in response to evidence that shows that pension tax charges as a result of the tapered annual allowance are having a direct impact on retention and front-line service delivery. These proposals aim to maximise the contribution of our highly skilled workforce, who are crucial to delivering the NHS long- term plan.

[Baroness Finlay of Llandaff]

My Lords, I declare my interest as a past president of the BMA. Can the Government state exactly when the consultation will begin, how long it will run for, how it will be organised and when it will report? Do they recognise that, of 4,000 consultants recently surveyed, 60% said that they would retire at or before 60 years of age, and over half of those cite the sudden unexpected tax bills as a reason? This is particularly urgent because in August we have new graduates starting, who need additional supervision as they begin to get used to working in the clinical arena, yet we are already seeing consultants dropping sessions, which will adversely impact on clinical services. Doctors seem to have only two options now: to retire or to leave the NHS pension scheme, and until they can do that, they are financially penalised for working. One paediatric intensivist I was talking to said that he is £300-plus out of pocket by working a weekend.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question, which she has asked before. Retaining and maximising the contribution of our highly skilled clinical workforce is crucial to the delivery of patient care. We are preparing to provide pension flexibility that appropriately balances the benefit of new flexibilities with their affordability. We have listened, and we are discussing the issue with the Treasury. As a first proposal, the consultation will set out a potential 50:50 option, offering 50% pension accrual and halved contributions. The BMA requested this as an option earlier this year and has welcomed it as a step in the right direction. The consultation will be an opportunity to listen to a range of views and will be genuinely flexible and open; we will bring it forward as a matter of urgency. I hope that that is a reassuring answer for the noble Baroness.

[Baroness Thornton (Lab)]

The briefings that I have received from the BMA and other places say that the 50:50 solution may not prevent the problem. How many people will have to wait longer for their operations before the Minister’s colleagues, the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care, concentrate on their day jobs—that is, getting together and talking about how to solve this problem instead of campaigning for whoever they are campaigning for to be the leader of her party? Surely their time could be better spent sorting this problem out.

[Baroness Blackwood of North Oxford]

The noble Baroness knows that I cannot answer for the Chief Secretary to the Treasury, although I know that this issue has been raised with the candidates as part of the leadership campaign and that they see it as a priority. As I said in my Answer to the noble Baroness, Lady Finlay, we recognise that the 50:50 flexibility option does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth. Other options, such as additional pension accruals to purchase individual units alongside a pension, may be considered as part of the consultation. The message going out to the sector is that we want as much flexibility as possible to try to find the right solution to meet the complex needs of the system.

[Lord Naseby (Con)]

My Lords, is my noble friend aware that this issue was raised on the Floor of the House? I was one of those who contributed; I hastily declare an interest as a trustee of the Parliamentary Contributory Pension Fund. Against the background of what was raised some three weeks ago and the evidence that was already in the field, I do not blame any particular Minister, but is there not a pensions section in Her Majesty’s Treasury that must know what options are available to Her Majesty’s Government in coming to a decision that will ensure that the consultants affected will not be forced to retire when they reach 60? That evidence must be there by now; surely, we can have some fast decisions on this major issue.

[Baroness Blackwood of North Oxford]

I absolutely share my noble friend’s desire for a speedy response. He is right that the evidence has come forward and that the issue is affecting front-line services, which is why we are keen to bring the consultation forward as quickly as possible and resolve it. He is also right that those in the Treasury will have seen the evidence and it is right for them to consider it. It is important to understand that the consultation is about the implementation of tax policy, not changing it. That would be a separate question for the Treasury team.

[Baroness Jolly (LD)]

My Lords, the Nuffield Trust found that two-thirds of GPs are retiring early for tax reasons, and because of burnout, the level of extra training required and stress. The Secretary of State is reported as saying that this tax issue is the area that concerns him most about the GP workforce—and well he might worry. Given the Minister’s earlier reply to the noble Baroness, Lady Finlay, when will we see the figures on the decline in GP early retirement?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that this is an important aspect of the recruitment and retention of GPs in particular, which is why we are bringing forward the consultation. As I said, we have been working closely with representative bodies, including the BMA and others. When we brought forward the five-year contract for general practice, announced in January, part of that was to provide greater certainty for GPs to plan ahead. Part of the work we have done is looking at other aspects that will ensure recruitment and retention. This includes, as we have discussed before, funding towards 20,000 extra staff working in practices, remaining committed to recruiting an extra 5,000 GPs and looking at targeted enhanced recruitment schemes, which include a £20,000 salary supplement to attract doctors into GP specialty training. The noble Baroness will understand that it takes a little time for these policy changes to be reflected in the data, but she can have no doubt that this is a policy area in respect of which the Government are absolutely determined.

[Lord Patel (CB)]

My Lords, there is currently a disparity in pension arrangements between clinical academics and NHS consultants. Can the Minister confirm that any discussions the Department of Health and the Treasury have will include the university sector? Otherwise, a disparity between pension arrangements will be created, which might affect the recruitment of clinical academics.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The noble Lord raises an important point. I am afraid I do not have the specific details about NHS clinicians and academics within the university sector. I will ask about this and write to him.

[Baroness Kramer (LD)]

My Lords, the BMA makes it clear that the Defence Medical Services are the most impacted group of medics. Will the Minister confirm that we are today sending medics out to battlefields such as Afghanistan, who work all hours to serve their wounded comrades and are having to call home to tell their families to take out a second mortgage to pay an unexpected £20,000 to £40,000 tax bill, which hits them because of the peculiar pension consequences? Will this be remedied immediately?

[Baroness Blackwood of North Oxford]

I can confirm that it has been made absolutely clear that NHS clinicians have been impacted by these reforms, and front-line care has been impacted. This is unacceptable and that is why we are bringing forward the review to find a solution as quickly as possible. The noble Baroness is right to raise the issue and we are determined to resolve it.

[Baroness Altmann (Con)]

My Lords, I am sure the Minister agrees that this was an unintended consequence of changes to the tax system. The reality is that the cliff edge of the taper is forcing consultants to pay tens of thousands of pounds for doing one small extra shift, sometimes voluntarily. Could she look at offering financial advice to each individual consultant who may be affected? They will not all face this tax charge, but they are all frightened that they might, so they are not undertaking the extra shifts we need them to undertake. Can she also note to her departmental colleagues that high-paid people potentially affected by the taper in other areas of the public sector received some assistance and mitigating measures from their departments, whereas it has been almost impossible for consultants to plan ahead? We are now seeing the problems occurring belatedly.

[Baroness Blackwood of North Oxford]

My noble friend speaks with particular expertise on this issue. As the whole House will appreciate, NHS consultants are often asked to take on additional shifts at short notice and they face peculiar challenges when calculating the consequences for their pensions. This is one of the reasons why the BMA has put up its calculator. However, the pension rules we are discussing today mean that some who take on extra work may find they have inadvertently incurred a substantial tax charge in moving into the taper. This is why we have brought in the consultation. It is obviously important that those facing pension charges should seek advice. NHS England is considering this issue closely at its most senior levels and working with the department to better understand the impact on clinicians, but also on NHS performance, and we are determined to resolve the situation to get it right.