Midwives: Bullying

Baroness Cumberlege Excerpts

Tuesday 16th April 2024 Lords Chamber

[Lord Markham (Con)]

I will come back to the noble Lord with the exact number, but he is correct: the long-term workforce plan is all about making sure that we have the right resources and infrastructure to train the required number of people. Behind that, we have funded an extra 150 spaces this year and we have a target to increase them by 1,000 by 2026. It is absolutely as the noble Lord maintains: we are putting training in place domestically, as well.

[Baroness Cumberlege (Con)]

My Lords, does my noble friend share my view about the evidence that, when midwives and other clinical staff understand the importance of continuity, it leads to safer care and better outcomes for both the mother and the baby? One of the midwives quoted in chapter 2 of the report that was sent to us—I thank my noble friend for that—says that working in a continuity team was the best, most rewarding time in their career. Continuity is absolutely critical; it comes up in a number of reports, some of which I have had a part in writing. We know that you need continuity if you are going to make a real impression on the midwifery service and that the women who are party to it must really understand what continuity does and can achieve.

[Lord Markham (Con)]

I thank my noble friend, who has been a tireless campaigner on continuity of care. I challenged the chief midwife on this just this morning, and the objective behind the long-term workforce plan is to make sure that we have the resources in place to maintain that, starting with ethnic minorities. We all know that there is a disparity of outcomes in terms of inequality, so the first priority for continuity of care is that setting, but the objective is to spread that across the whole system.

Sodium Valproate and Pelvic Mesh

Baroness Cumberlege Excerpts

Monday 25th March 2024 Lords Chamber

Asked by

[Baroness Cumberlege]

To ask His Majesty’s Government what are the timescales for, and what progress has been made on, a response to the Patient Safety Commissioner’s report on options for redress for those harmed by sodium valproate and pelvic mesh, published on 7 February.

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

The Government commissioned the Patient Safety Commissioner to produce a report on redress for those affected by sodium valproate and pelvic mesh. We are grateful to the commissioner and her team for completing this report and our sympathies remain with those affected by sodium valproate and pelvic mesh. The Government are now carefully considering the PSC’s recommendations and will respond substantively, hopefully in the coming months.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that reassuring reply. However, as it has been five months since the Government received the advice from the Patient Safety Commissioner in October 2023, how much more time do patients and families need to wait for the redress that they so desperately need?

[Lord Markham (Con)]

My Lords, I thank my noble friend for her tireless work in this area. It is something which, in the Chancellor’s very own words—because it was the Chancellor who, as Health Secretary, first commissioned the report—remains a top priority to both him and the Government. That remains the case. I spoke to Minister Caulfield about it just this morning, and it is a complicated area, but it is something that we are very keen to redress in the next few months.

Maternity Services

Baroness Cumberlege Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Cumberlege (Con)]

My Lords, it gives me great pleasure to follow the noble Baroness, Lady Taylor of Bolton, and thank her for a very interesting and incisive speech. I see that congratulations are being offered to her right now and she deserves them.

One thing that struck me as the noble Baroness was speaking was how important it is that we concentrate on relationships. We must consider all the relationships involved—the parents, the rest of the family and grandparents perhaps—but the most important is the relationship of the staff with the women and their babies. We know that there is huge pressure on midwives at the moment—the noble Baroness raised that issue.

This is a very important debate, and I am extremely pleased that the noble Baroness has taken to the opportunity to raise it. She and many other Members of the House of Lords feel strongly about maternity services and the beginning of new life. The way in which women and their babies are looked after is critical to the well-being of this country. It is a very interesting debate to have raised and I thank her warmly for it.

Maternal mortality rates are at their highest for 20 years. That is quite shocking and really must be addressed. I hope that through this debate we will raise the issues that are important.

I want to say something about when I chaired the National Maternity Review. I was asked to do it by the chief executive of NHS England, who was then Sir Simon Stevens—now the noble Lord, Lord Stevens—and I was given the task of completing the review in nine months, which seemed a very appropriate time. We published our report in 2016 and called it Better Births. It set out five years in which to plan and work towards improving maternity services in England. I was fortunate to have a wonderful, expert group of people on the review team, which was hugely helpful. The important thing we did was to go out and listen to the women of England, their partners and their families, and to the staff who provided maternity services. We listened and we learned from them, not just women who were already mothers but women hoping to become mums in the near future. We heard uplifting, inspiring stories of good maternity care and good outcomes, but we also heard some truly sad stories where care had not been good or outcomes had been devastatingly bad.

What we heard guided us, and the five-year plan we set out was based on what women told us they particularly wanted. At the core were two things that we believed would raise the quality of care and improve safety, leading to better births. The first was that women wanted, and felt they needed, the same midwife, or small team of midwives, throughout the maternity journey. They wanted a relationship based on trust and mutual respect. They wanted a midwife, or midwives, who knew them, understood them, and respected their birth plans and the choices they were making. We call that continuity of carer.

The noble Baroness, Lady Taylor, has raised this afternoon the issue of continuity. We know that continuity leads to safer care and better outcomes for the mum and the baby. Yes, continuity may be challenging in the face of workforce pressures, but we need to be much clearer that continuity is the model of care that we want to see. I think that that is what the noble Baroness was stressing, and I support that.

Secondly, women and their partners want to feel and know that their continuity of care is shared, around them and by them. We call that “personalised care”. It is centred on the woman and her baby, based around their needs and decisions, and where they have genuine choice—informed choice, but with unbiased information. Too often care is done to women and babies, rather than chosen and shaped with and by them. I know that, when staff are under huge pressure, taking the time to understand a woman’s choices and build care around her may be really very difficult, but that is what we should strive for, for all women.

Continuity and personalised care were at the heart of the five-year strategy. They stand at the heart of turning the phrase “better births” into reality. Today’s reality falls short on both continuity and personalised care. Our country is still one of the safest in which to give birth—I want to stress that—and we have met some of those wonderful staff who run our maternity services. But the evidence tells us that we are not achieving the progress that we could and should.

The most recent MBRRACE report on maternal mortality tells us that 293 women died in pregnancy or within 42 days of the end of pregnancy in the three years between 2020 and 2022. That is a significant increase over the previous years, and it excludes Covid-related deaths.

The CQC Maternity Survey 2022 tells us that 10% of maternity services are inadequate and that 39% require improvement. I was delighted that the noble Baroness, Lady Taylor, mentioned the work of the CQC, which is so important, but the figure of 10% of maternity services that are inadequate and 39% that require improvement accounts for nearly half of all services. The CQC says that safety and leadership are particular areas of concern, and they need to be addressed. We are all sadly familiar with the series of local failings in maternity care and the inquiries that have followed. I am thinking of Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham; those are just examples. Parents who have been involved in those inquiries are now calling for a full national inquiry, and I think they are right.

My Better Births report was published in 2016 and had a five-year plan, but those years have now passed. I believe that we need a fresh strategic national inquiry and a new coherent and practical plan for the whole maternity system. We need to tackle the issues of poor quality and poor outcomes. We need to listen to women and their families, and the staff who are there to care for them, and we need to be guided by what the evidence tells us will lead to better births, to make them safer and as a good an experience as is possible.

Finally, I would like to repeat something from the letter I wrote to the women of England at the start of the Better Births report in 2016:

“The birth of a child should be a wonderful, life-changing time for a mother and her whole family. It is a time of new beginnings, of fresh hopes and new dreams, of change and opportunity. It is a time when the experiences we have can shape our lives and those of our babies and families forever. These moments are so precious, and so important. It is the privilege of the NHS and healthcare professionals to care for women, babies and their families at these formative times”.


I hope those words might play a part in setting the tone and direction for what I believe is now needed: a fresh plan for maternity care.

Sexually Transmitted Infections

Baroness Cumberlege Excerpts

Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

I will need to come back with the exact figure for the vaccination rate. I know that it is proving quite effective, which is important. On the measures we are taking, we are investing £25 million in women’s health hubs precisely to enable these sorts of vaccination programmes. I will happily follow up in writing with the detail.

[Baroness Cumberlege (Con)]

My Lords, does my noble friend the Minister agree that, in this technological age, it is very important that people are able to access everything they need from the NHS via their phone or a laptop? I am working to ensure that all women have access to their maternity record via the NHS app, but only 23% of sexual health clinics currently allow online booking. Can my noble friend tell me how the Government plan to address this issue?

[Lord Markham (Con)]

I thank my noble friend. As she knows, I am a big advocate of everything that we can do with the app. We are absolutely looking to extend its services, which will include sexual health clinics. In the past year alone, we have increased from around 10% of GPs allowing someone to see their records to around 70% today. Sexual health clinics are clearly an area that we need to look at next.

King’s Speech

Baroness Cumberlege Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Cumberlege (Con)]

My Lords, it is a great pleasure for me to follow Sarah Mullally, the right reverend Prelate the Bishop of London. She has a very interesting—I was going to say “past” but I think they call it a “back story” today. She has done a huge amount in the National Health Service. We know that she was the Chief Nursing Officer; she did so much for all of us who work in the service and especially for the patients who use it.

I want to say something about Sarah because we so often dismiss people; we just think that they are in a certain position, and that that is their life and how they run it. However, Sarah has three distinguished university doctorates and was made a Dame Commander of the Order of the British Empire for her contribution to nursing and midwifery. She was of course much admired when she was the Chief Nursing Officer in the Department of Health, where she made a great contribution to the NHS. I must say that it is a great pleasure to have you, Sarah, in this House and on these Benches, making the sort of contribution that you have made this afternoon.

I want to put forward to noble Lords an idea to correct a terrible shame and injustice. When medicines and devices do harm, redress or compensation is too often withheld. Sadly, many victims are dead before they could receive any contribution. The Government have urged people to settle their claims—they mention pharmaceutical companies in particular—in court. That is quite a cruel, unjust proposition because redress and compensation are often withheld until many of the victims are no longer alive; we have seen exactly what can happen all too clearly with the infected blood tragedy. Pharma companies have huge powers and resources to delay proceedings, which can bankrupt a charity or group, pending the settlement of ginormous legal costs. The United Kingdom is not the only country to experience harm caused by sodium valproate, vaginal mesh and Primodos—the subjects that I studied for my report, First Do No Harm. We must find a solution for people in need of redress that is delivered speedily when it is needed. Unreasonable and unnecessary delays inflict more agony for individuals, their families and their friends.

When considering the then Medicines and Medical Devices Bill, I and my team concluded, after very careful consideration, that there should be a new post in the management of the NHS: a person whom we named the Patient Safety Commissioner, because we were back thinking about the patients all the time, we wanted to ensure their safety and we thought a commissioner would have a standing that would actually make a difference. The Bill was enacted in February 2021. Dr Henrietta Hughes was appointed in June 2022, and she took up her post last September. She is a force for good, and she has already embarked on—embraced, indeed—her new role and made a difference to professionals and to patients; and after all, it is the patients we must all think about.

I and my colleagues suggested that the Patient Safety Commissioner should explore the redress options for those who have already been harmed by pelvic mesh and sodium valproate. Those were the areas I studied with my team. I understand her report is due to be launched in the new year, and I urge the Government to respond with speed, as there are still too many women who have been waiting and suffering for too long. Our report, which we entitled First Do No Harm, discovered scandals that had already happened, but a number of our recommendations were not looking at the past but looking forward. We recommended a redress agency to administer funds provided to cover future harms. This was not acceptable to the Department of Health, and I felt it was really an opportunity lost. Even the best pharmaceutical producers may, despite their clinical trials, fail to realise that a product may, especially after time, prove to be harmful. The funds I am suggesting will provide a safety net when this happens. We also suggested that no medical product should be approved for sale without a levy paid into a fund wholly independent of the Government. At the very least, it should be a condition of sale in the UK. Where Governments bear some responsibility for approving harmful products, they should contribute to the fund.

Also, there should be an expert team to assess the claims of harm that have been clearly recognised by producers and make them clear to people, especially the users. They need to know what is going on with the products they are taking, and to understand the huge impact of marketing, which is on a global basis. Is not it time to work with our neighbours in Europe and possibly worldwide to seek specialist input and views on the harms caused by these products? The fund I am suggesting would provide redress to those who are harmed by medicines and devices, without them having to go through long, drawn-out adversarial lawsuits. We saw, first-hand how litigation had failed women who had already been failed by the healthcare system. We must provide a better way for the future, particularly regarding the blood issues.

I suggest that the fund be administered independently of both government and industry to ensure that it can command the confidence of injured patients. I urge the Minister to consider this and to act with speed on the points I have made.

Sodium Valproate

Baroness Cumberlege Excerpts

Monday 5th June 2023 Lords Chamber

Asked by

[Baroness Cumberlege]

To ask His Majesty’s Government what further steps they are taking to protect patients and families from the harmful effects of sodium valproate taken during pregnancy, and what is their timetable for doing so.

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

Our aim is to reduce and finally eliminate the harms of valproate in pregnancy. In December, we announced additional measures to protect women and families through a requirement for two prescribers, further warnings in the valproate product information, and improved educational materials. No woman of childbearing potential should receive valproate unless no other treatment is effective or tolerated. Implementation plans are now being finalised, with engagement with healthcare and patient organisations.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that Answer. It goes some way, I think, to reassure many of us who have been very concerned about sodium valproate being given to pregnant women, and the result that that has had. I am seeking to ensure that, with the plain boxes which contain sodium valproate, those tablets are not actually opened without a clear warning, so that people know exactly what is contained in those boxes and the harmful effects it could have on their babies. Can the Minister tell me what is actually happening to those plain boxes, because sodium valproate should not be prescribed without a really clear warning about what it could do to babies and women?

[Lord Markham (Con)]

First, I thank my noble friend for all the vital work that she has done in this space. She is absolutely correct. The key thing is that there are circumstances where sodium valproate is the only effective treatment for bipolar and epilepsy-type disease problems. However, we have to ensure that if people are taking it, they are going into it with their eyes completely open, so that they fully understand the risks. That is absolutely to do with the packaging. It is also about making sure that if that packaging is split up there are leaflets in every part, and that everyone signs a consent form at least once a year, fully acknowledging the risks. Thereby, if people take the treatment, they are doing so with their eyes fully open.

Life Expectancy: Pensions, Health and Insurance

Baroness Cumberlege Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

As noble Lords are aware, we have been putting significant investment into mental health; from memory, there has been a £2 billion-plus increase over the last year. In recognition that learning disability is an issue we particularly need to tackle, as the noble Baroness is aware, we are putting investment into schools so they can identify it early on. Some 35% of schools now have the right educational leads in this space, and the figure will rise to 50% next year. It is a big improvement, but do we need to do more? Absolutely.

[Baroness Cumberlege (Con)]

My Lords, my noble friend will be aware that for many years, the UK has enjoyed increases in life expectancy but now we are getting reports that the rate of increase is declining. What plans—I have given my noble friend notice of this question—do the Government have to reverse this trend?

[Lord Markham (Con)]

My noble friend, whom I thank for that question, has characterised this issue in exactly the right way. Life expectancy is still increasing, but not at the rate it was. That is why the major conditions strategy was launched. I can give one example: cancer is one of the six major killers, and we are seeing 20% more cancer patients this year than we were pre-pandemic. So there are improvements in this space, and that is what the major conditions strategy is all about; but clearly, the record investment we are putting in needs to show that sort of output.

Maternity and Neonatal Services

Baroness Cumberlege Excerpts

Tuesday 25th October 2022 Lords Chamber

Asked by

[Baroness Cumberlege]

To ask His Majesty’s Government what steps they intend to take to implement the recommendations of the report by Dr Bill Kirkup Maternity and neonatal services in East Kent: “Reading the signals”, published on 19 October.

[Baroness Cumberlege (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in so doing, I declare that I am remunerated for chairing the independent maternity review.

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

I am grateful to Dr Kirkup for this report. Our intention is to review the recommendations alongside existing work to improve maternity outcomes, including the recommendations from Donna Ockenden’s final report. With NHS England, we have established an independent working group chaired by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists that we will use to support our considerations.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that reply. Does he agree that as this has been a series of maternity tragedies across England, we must do all we can to prevent further disasters? Will he, with NHS England, introduce a maternity signalling system that identifies units providing poor care before they cause widespread harm?

[Lord Markham (Con)]

I thank my noble friend. I agree. This was captured in recommendation 1 by Dr Kirkup about having early warning indicators in place. That is what we have set up in the maternity quality surveillance framework, which has the oversight in this area and can escalate concerns and effectively report to the national maternity safety surveillance and concerns group, which can then put the trust into special measures.

East Kent Maternity Services: Independent Investigation

Baroness Cumberlege Excerpts

Monday 24th October 2022 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is right to say that it is clear that we have not got it right to date, as shown by the fact that these instances have come up. We are taking the right steps with the Maternity Safety Support Programme that we have put in place, and its ability to put trusts into special measures—as I say, that has already been done on 23 occasions and it is being considered for another 10. I believe we have got those early warning indicators in place now, and trusts are being held to account. At the same time, we have to be open, to make sure that we continue to look at and review this, to see whether it has sufficient teeth and, dare I say, intelligence to properly identify these areas. If it does not manage to do that, we must make sure we put in something else, in addition to what is there already.

[Baroness Cumberlege (Con)]

My Lords, I have had a very long interest in maternity services, and it seemed to me, on this occasion, that I could make a few comments. This report is truly remarkable. It is investigating the tragedies and failures, the lack of care, the divisive attitudes among professionals, and the lack of teamwork and much else. The report is really here partly due to the pressure of patients and the public, who wanted to bring to the attention of the Government the failures in East Kent.

I thank my noble friend for his report. The recommendations are different from the usual recommendations, in that they go much wider than just East Kent; they go across the country as a whole, and they are very important. On reading that report, has he any ideas about how to stimulate the doctors, nurses, midwives, obstetricians, managers and leaders not only in East Kent but across the country to take note of what it is saying? It very much affects not just them but parents, families, friends and childbearing women, and it is important that they have optimal care that is kinder, compassionate, more personal and safer. What action are the Government going to take, working with NHS England, because there are a lot of partners in this area of maternity? Will he ensure that the recommendations are not ignored—that they are not just put on a shelf and forgotten—and will he come back to Parliament within, say, four to six months to explain what progress has been made in implementing them in the four areas cited for action? I would very much welcome that, because I want to see this report implemented and not just put on another shelf.

[Lord Markham (Con)]

I thank my noble friend for her question; I know this is an area in which she has longstanding interest and expertise. She refers to embedding compassionate care and, perhaps like all of us, I am surprised to learn that, unfortunately, we may need training in this area; but I agree that it needs to be done because it is fundamental. A culture and leadership programme has been put in place, and we have set up national guardians, the idea being that everyone in every trust has the freedom to speak up. There are 800 of them as of today. I take this issue seriously and I commit—if I am here—to come back within four to six months to report to the House on the progress made, as requested.

Health and Care Bill

Baroness Cumberlege Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

Moved by

[Baroness Cumberlege]

At end insert “, and do propose Amendment 29B in lieu—

29B: Clause 35, page 42, leave out lines 14 to 19 and insert—
The Secretary of State must, at least once every three years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.
(2) This report must include—
(a) an independent assessment of health and social care workforce numbers, current at the time of publication, and the projected workforce supply for the following five, ten and 15 years, and
(b) an independent assessment of future health and social care workforce numbers based on the projected health and care needs of the population for the following five, ten and 15 years, taking account of the Office for Budget Responsibility long-term fiscal projections.
(3) NHS England and Health Education England must assist in the preparation of a report under this section.
(4) The organisations listed in subsection (3) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence and plans provided by local organisations and partners of integrated care boards.””

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that wide-ranging introduction on workforce. There are a lot of issues that we will want to consider later, but at the moment we have before us the issue of what the Commons have done. They have returned our amendment back to the Lords, and it is now for us to consider whether we wish to pursue it.

I want to go back to the situation on Report in this House, and the amendment to Clause 35 of the Bill on the subject of workforce planning. That was passed by your Lordships with an overwhelming majority in this House. I thank noble Lords who gave their support and welcomed that we wanted to return this issue to the Commons on that occasion. I want to stress strongly that it was supported not only in this place but by over 100 different organisations throughout the country—charities, patient groups, think tanks, royal colleges, professional bodies and organisations representing NHS management and those working in the service. They are extremely worried about our workforce numbers and the future. What is going to happen to our services if we do not have enough people in the workforce? We need a proper plan. We need to know how we are going to take this forward.

We had hoped that the Government would listen to the strength of the arguments put last time and the strength of feeling, not to mention that in the Commons. We also hoped that the Government would agree that workforce planning is the greatest problem facing the NHS and social care and that we are in crisis. We have to handle this problem. We hoped there would be agreement that we need better planning, because we know that, without improved planning, we will not be able to tackle the growing backlog in procedures and appointments, with people waiting to be treated by the service. Even this morning, on the “Today” programme, one of our charities—Macmillan Cancer Support—came forward to speak about cancer services and to strongly say, “Please will you sort this problem because it needs sorting?”

Regrettably, despite the extraordinary consensus in favour of the amendment, it was, as noble Lords know, rejected in the other place. The case for improvements to workforce planning has been made by me and many others many times during the passage of this Bill. The current NHS waiting list stands at 6.1 million, and it is rising. More people are joining the waiting list every day—more than those who are being treated. This is not a new problem; according to the King’s Fund, it has been like this since 2016. Of course, we have had to deal with the pandemic, which has made matters a great deal worse.

I thank my noble friend the Minister very sincerely for the time he and the Bill team have spent with me trying to sort this problem out. But today, and often in previous debates, we are told that there are record numbers of staff in the health service. The fact remains that this does not seem to be enough—but of course we do not really know. We can experience it but we have not got the figures. We do not know whether we have the right people in the right place at the right time. We do not know if we have a plan for retention of the wonderful staff already working within the NHS and social care. As the backlog figures suggest, we are not meeting, and we will not meet, the public’s expectations when they turn to the NHS for care and support.

--- Later in debate ---

Given all this, I humbly ask my noble friend Lady Cumberlege to consider not moving her Motion and ask that the House accepts the Motions in my name.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend Lord Kamall for that masterful summing up. It has been such a wide-ranging debate, so full of interest, and I thank all those who have supported the amendment, which is rather narrow compared to the enormous expanse of interest that we have had—and it has not only been about the UK. People have gone abroad and talked about China and all the things that are happening over there.

I particularly thank the noble Baroness, Lady Brinton, who has been such a stalwart friend of mine and a great supporter of workforce planning. The noble Lord, Lord Stevens, has, of course, had more experience of this than most of us, running the great NHS England and NHS Improvement. I very much want to thank the noble Baroness, Lady Harding, who has been a really strong supporter. I remember that in an earlier debate she said that no great organisation would run without knowing their workforce. Here we are with the NHS, this tremendous organisation that we have in this country, and we really do not know where it is going or how many staff are employed. We must look forward to see how it is going. As the noble Baroness, Lady Harding, said, it is a wicked problem that we have to solve.

I thank the noble Lord, Lord Blencathra, so much. The noble Lord said that he supported this amendment, and then we had this very interesting segue to China and other countries, about the way in which certain products are sourced from around the world and how we have to be very careful that they are not subject to slavery. Certainly, that was true of the remarks of the noble Lords, Lord Hunt, Lord Alton and Lord Rooker, and I thank them all very much for that very interesting part of the debate.

I also thank the noble Baroness, Lady Finlay, who really works in the NHS. She knows what it is like, and she can understand what it is like not to have enough staff to do what you want to do, and her figures were so worrying and interesting. She described it as a dereliction of our duty if we do not grab this issue and come to some resolution on it.

I thank the noble Baroness, Lady Tyler, so much, too, for her support, as well as the noble Baronesses, Lady Watkins of Tavistock, Lady Bennett of Manor Castle and Lady Walmsley, who again has always supported the workforce plan. Finally, I thank the noble Baroness, Lady Merron, very much for what she was saying, and for the support that she has given us. We have to face this challenge and come to some resolution.

I say to my noble friend Lord Kamall that I really am very grateful for the work that he has tried to do on this, and the meetings that I have had with him and the Bill team. He has explained the other issues that he and the Bill team want to explore. However, rhetoric is very compelling. We have the most wonderful wordsmiths in the Department of Health, and in the Civil Service generally. They can win our hearts with the words that they use—the rhetoric—but that is not good enough. We want the numbers; we want to know exactly where people are working, what their skills are and what the future is, to take this forward.

I thank my noble friend, whose patience is amazing and inexhaustible. We have been round this issue so often, but I am afraid that I was not convinced by what I heard today. I am not convinced by strategies or reports, unless they really have the figures, and I have no confidence that the reports that he mentioned, and the strategy, will have that. So with great regret, I would like to test the opinion of the House.