Coronavirus: New Cases

Baroness Merron Excerpts

Monday 11th July 2022 Lords Chamber

Asked by

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the recent rise in Covid cases across the UK to 2.7 million infections over the last week.

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

We continue to see Covid-19 case rates and hospitalisations rise in all age groups, with the largest increases in hospitalisations and ICU admissions in those aged 75 and older. A large proportion of those hospitalised are admitted for reasons other than Covid. However, Covid is identified due to the increase in case rates in the community and the high rates of testing in hospital, including among those with no respiratory symptoms. Current data does not point to cases becoming more severe.

[Baroness Merron (Lab)]

My Lords, with a stark rise in infections, many people—particularly the clinically vulnerable, carers and older people—are feeling anxious, yet the Government have been noticeably silent, perhaps being somewhat distracted. We might be through the worst of Covid but evidently it has not gone away; individuals, organisation and businesses still want guidance. I have two questions for the Minister. Are the Government planning any campaigns, perhaps involving scientists and others, to highlight current risks and to encourage the take up of booster jabs? Are there plans to reintroduce mandatory mask wearing in hospitals, which the chair of the JCVI considers sensible?

[Lord Kamall (Con)]

I have to strongly disagree with the noble Baroness when she says that the Government are doing nothing. We are reliant on the UKHSA, which monitors rates and gives us advice, along with the JCVI. In my briefing from the UKHSA, it said it is continuing to monitor cases. As many noble Lords will remember, when we announced the living with Covid strategy we said that we are always ready to stand up measures should case rates rise so much that our health system was under pressure. We managed to break the link between infections and hospitalisations and hospitalisations and death; if that gets out of control then of course we will stand up the measures that we had previously.

Health Improvement and Food Production

Baroness Merron Excerpts

Thursday 7th July 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by congratulating the noble Baroness, Lady Walmsley, on securing this debate on the relationship between improving the overall health of the nation and food production, because the two things are inextricably linked for all the reasons the noble Baroness set out so clearly for us in the introduction. We are having this debate in the context of two crises in particular, although I am sure we could add others: the cost of living crisis and the obesity crisis. The noble Baroness, Lady Walmsley, rightly made the great claim that, despite our so-called greater affluence, we are nevertheless all the poorer in terms of our health and our access to, and provision of, good food.

From this debate, no one could be in any doubt that the food system is continuing to break. This is affecting childhood obesity, our health, farming and biodiversity, and now there is an inability to get three decent meals a day to some 10 million people in this country. If this does not say to the Government that we require a competent cross-cutting strategy, I do not know what would.

I will refer to the 2020 report by the House of Lords Food, Poverty, Health and Environment Committee, which contended:

“The UK’s food system … is failing”.


In response, the national food strategy very clearly said that

“the damage being done to our health and our planet by the food system demands urgent action.”

It would be very helpful to hear from the Minister how much he agrees with these assessments.

I will focus on the Government’s food strategy, because I am sure that the Minister will make great reference to this in his response. Of course, there were high hopes for the food strategy, following the review by Henry Dimbleby. Very sadly, however, we find that it provoked the kind of united response that we would not have wanted—namely, it was roundly criticised by Mr Dimbleby himself and by farmers, food campaigners and environmentalists. Why? Because it turned out to be vague and unambitious, the mirror opposite of what we hoped for. It would be fair to say that the proposals in the Government’s food strategy do something of a disservice to a very well-researched and well-evidenced report by Henry Dimbleby, who took a completely holistic approach to the journey of our food, the impact on our health and the connections between the two.

The review highlighted the terrible damage that poor farming practices would do to our planet. It also called out the complicity of food manufacturers, whose drive for profits is pushing highly processed junk foods on to the nation, as referred to by the noble Baroness, Lady Jenkin. This is being done in full knowledge of the ill health that we are likely to suffer as a result and the obesity crisis that will overwhelm our health service if urgent action is not taken.

This country is now the third fattest in the G7, with almost three in 10 adults being obese, while many children are going hungry because our school food system fails so many of them in need. Henry Dimbleby’s report was challenging. It said, “Change is never easy”, which is true, and went on to say that

“we cannot build a sustainable, healthy and fair food system by doing business as usual.”

I believe that this debate challenges “doing business as usual”, yet that seems to be the exact approach the Government are taking.

Can the Minister tell your Lordships’ House why the response from the Government barely covered 10% of the Dimbleby review; why it did not respond to the 14 very well-argued recommendations in the report; and why we still do not have a blueprint to tackle the major food issues facing this country?

Where are the policies that would address the situation of 7.3 million people who live in poverty, including 2.6 million children? I ask the Minister: where are the policies to make food banks a thing of the past? That includes food banks which, shockingly, are being set up by hospital trusts to meet the demand from their staff. Where are the policies to tackle the rise in adult obesity, which is putting our health service and individuals under such strain? Why have the Dimbleby plans to improve child nutrition been ignored. Why have the proposals to extend entitlement to free school meals been rejected?

We know that food prices are rocketing and the food system is under strain, but the food strategy fails to address the root causes. Costs are rising dramatically for farmers and food producers, which is putting further pressure on the price of food. As we have heard from noble Lords during this debate, however, crops are rotting in the fields and over 40,000 pigs have already been culled because of labour shortages.

Perhaps the Minister could tell your Lordships’ House about plans to support British business and ensure that British food is affordable. How do we support our farmers and prevent them being undercut by imports with lower animal welfare and environmental standards? Why was the commitment to tackle low-quality imports taken out of the paper at the last minute? We need a plan to ensure that what we buy, sell and grow is more of our British food, to entrench Britain’s reputation as a beacon for quality food, high standards and the ethical treatment of animals. Does the Minister recognise that we ended up with a food strategy that pleases nobody, lacks ambition and represents a missed opportunity? It would be helpful to hear his response on these points.

I should like to pick up the point about the efforts the Government should be making to encourage the food industry to reformulate its products to reduce high-fat, high-sugar, high-salt foods. Perhaps the Minister can help us with this. Can he confirm, in the context of contrary media reports, whether the Government are committed to removing unhealthier foods from checkouts?

It would be remiss if I did not comment on the backtracking on the restrictions on advertising unhealthy food. There was much debate on this matter in the course of the Health and Care Act. Yet, we saw backtracking not driven by evidence but, sadly, by the Government’s wish to calm what might be called somewhat choppy political waters. They were certainly choppy at the time; nobody knew at that point how much choppier they would get. Now that we find ourselves in a new world, perhaps the Minister could commit to reviewing the introduction of those restrictions, because the evidence says that it makes an impact on childhood obesity and we cannot wait.

The Government also said in the course of the food strategy that they were committed to using public sector food procurement policy to improve the quality of food and catering services in the public sector. This would be very welcome. This becomes especially pertinent when we look at the challenges that inflation poses to school and hospital food. Can the Minister advise the House on how the Government intend to do this and whether the Procurement Bill will be one such means to address this directly?

The national food strategy also has a target of halving childhood obesity by 2030. Perhaps the Minister could comment on where we are in terms of being on track to meet this. If he considers that we are not on track, what measures will be taken to get us back on track?

I refer to the helpful briefing by the Food Foundation, which addresses the consumption and production of fruit and vegetables. Is there an intent to use the food strategy to join up the efforts to increase fruit and vegetable production and consumption and to reform the Government’s buying standards to include portions of veg in every main meal, to increase demand? It would be helpful to hear from the Minister a consideration of the amount of fruit and veg that should be consumed and the messages that are conveyed. The five-a-day message has been widely communicated as the recommended quantity but, as indicated in the Eatwell Guide, the recommendation should be closer to seven a day. On the basis that it is accepted that we should be eating more, can the Minister advise us what might be done on this?

It seems that we have a challenge, as the noble Baronesses, Lady Jenkin and Lady Bennett, mentioned, with the onslaught of ultra-processed foods. We are in danger of increasing the distance between the origin of food and the actual intake. What is the plan to guide us towards healthier foods that we can afford, source, prepare and enjoy? Unless all those aspects are dealt with, we will not find ourselves in the situation of encouraging people into a healthier zone—as the noble Lord, Lord Kirkham, referred to—without further direction.

A number of very important questions are raised by this debate. I look forward to the response of the Minister, who I hope will acknowledge the inextricable link between food production and healthier eating but will also have some answers about how we will get there.

--- Later in debate ---

[Lord Kamall (Con)]

The noble Baroness makes an important point, but we have to recognise the reality: not where we want to get to, but where we are at the moment. People do eat food that will need to be reformulated if we want to make it healthier. Of course, we know that fruit and vegetables are healthy, but not everyone, as we help them transition, will eat fruit and vegetables, or make stuff from the raw products. They will buy products in supermarkets, and therefore if they are buying them, we have to make sure that they are healthier and reformulated. We do not yet live in that ideal world where everyone buys fruit and vegetables, and cooks everything for themselves.

Given that, we also need new regulations on out-of-home calorie labelling. As we know, many people go to restaurants, buy takeaways or have their food delivered. It is important that we have calorie labelling for food sold in large businesses, including restaurants, cafés and takeaways, which came into force on 6 April 2022. As noble Lords are aware, there will be further legislation, on restricting the promotion and advertising of products high in fat, salt and sugar, which will come into effect in the next few years. I know that many noble Lords disagreed with the Government’s views on delaying some of those measures. We will continue to have the end-of-aisle promotion on the target date, but others, such as “buy one, get one free”, are delayed because of the trade-off with the cost of living crisis, but will come. It is delayed, but we have set target dates.

Once again, we have to be open—

[Baroness Merron (Lab)]

I thank the Minister for referring to the delay, which I accept is a delay, to the restrictions on advertising. Can he explain what that has to do with the cost of living crisis, because I have heard that before?

Bread and Flour Regulations: Folic Acid

Baroness Merron Excerpts

Wednesday 6th July 2022 Lords Chamber

[Lord Kamall (Con)]

Perhaps I have not made it clear enough that we are proceeding with this; there is no stopping the process or review. We are clear that the scientific debate should not hold up progress, so we want to launch the consultation in August/early September. The closing date will be 12 weeks after that, and we should have a government response on the final position in Q1 2023. We would then notify the WTO and European Commission, and once that is all cleared, it should result in legislation being ready to be laid in Q4 2023, and the transition period for the industry would be discussed after that. When I spoke to the noble Lord, Lord Rooker—I hope he would acknowledge this—he believed that I was one of the few Ministers who is very intent on progressing this.

[Baroness Merron (Lab)]

My Lords, as the noble Lord, Lord Patel, has said, the scientific evidence is readily available and evidenced across the world. Can the Minister tell us what, on this new timeline, he thinks the new consultation and process might reveal that we have not seen so far?

[Lord Kamall (Con)]

The reason we have a consultation is so that we are aware of unforeseen circumstances and that, hopefully, we deal with unintended consequences before they occur. It is all very well saying that the science is settled; we have reached a level of consensus where both sides can agree, and that is what we are progressing from. Once it is implemented, we can start reviewing whether it should be a higher level and whether there are unintended consequences. The history of contestation in science goes back a long way; think of the heliocentrism versus geocentrism debate. People thought that the universe revolved around the earth, but Aristarchus of Samos, al-Battani, Islamic philosophers and others challenged that, and Copernicus proved that heliocentrism was right.

Paramedic Services

Baroness Merron Excerpts

Monday 4th July 2022 Lords Chamber

[Lord Kamall (Con)]

The right reverend Prelate raises an important issue for those of faith who want to share their last moments of life with someone. I am afraid that I do not have a detailed answer, but I will go back to the department and write to the right reverend Prelate.

[Baroness Merron (Lab)]

My Lords, as other noble Lords have said, ambulance delays are a symptom of pressures elsewhere in the health and care system. At the end of April, 62% of over 20,000 patients in England who were medically fit to be discharged remained in hospital, largely due to a lack of appropriate social care provision. Can the Minister say how and when there will be a fully costed workforce plan to ensure that the relevant staff are in place to urgently tackle this bottleneck?

Mental Health: Advertising and Body Image

Baroness Merron Excerpts

Thursday 30th June 2022 Lords Chamber

[Lord Kamall (Con)]

If I have been accurately briefed, I will begin by wishing my noble friend a very happy birthday.

This is a really important issue concerning ethnic minorities and people of different colours. First, young people want to see people who look like them on TV and in the media as role models, to show that they are part of everyday society. Also—I am sure my noble friend will be aware of this—sadly, there is the issue of colourism, whereby sometimes there is a preference for people of a lighter colour within certain ethnic minority groups. People who are darker are quite often discriminated against; they are not necessarily abused, but there is this preference for lighter colours. This is all being looked at. What my noble friend says shows what an incredibly complicated area this is. It is really important that we look at all these issues: is it size, is it appearance, is it colour?

[Baroness Merron (Lab)]

Advanced early intervention is crucial. Treatment for mental health conditions such as eating disorders has consistently unacceptable waiting times. At the end of last year, a record 2,100 children and young people were waiting for treatment, with demand continuing to rise. Can the Minister tell your Lordships’ House when the waiting times will mean timely intervention? What are the Government doing to recruit, retain and train the necessary levels of staff to provide the treatment that is so desperately needed?

[Lord Kamall (Con)]

I hope the noble Baroness will recognise that before the pandemic, we were meeting the waiting times targets for many younger people. Clearly, as with many things in our health and social care service, the pandemic has had a huge impact—not only delaying the treatment of people who should have been treated before the pandemic, but increasing the number seeking help with mental health issues. As I am sure noble Lords will recognise, for young people those two years were a massive proportion of their lives compared to us. Those are lost years for them, and it has led to many mental health issues. As the noble Baroness will know, we have announced the draft mental health Bill. The NHS long-term plan will have an additional £2.3 billion a year for mental health services by 2023-24, and an extra 2 million people will be able to access support. This will all take time, and we will have to work through that.

Draft Mental Health Bill

Baroness Merron Excerpts

Tuesday 28th June 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by thanking Professor Simon Wessely for his independent review of the Mental Health Act 1983, an outdated piece of legislation that far too often has facilitated the inexcusable treatment of those with mental health problems.

Yesterday, the Secretary of State for Health said that the report made “uncomfortable but essential reading”, and indeed it did. When it is at its best, legislation supports the saving and improvement of people’s lives, and I am sure that all sides of your Lordships’ House intend that this Bill will get us to this point.

In supporting this overhaul of the legislation, pre-legislative scrutiny will be crucial, not least because it gives an opportunity to build consensus. Can the Minister provide details of timescales and arrangements for this scrutiny? While the Government have adopted most of the recommendations of the review, can the Minister comment on the ones that have not been accepted and the reasons for doing so?

It is welcome that this Bill contains a number of improvements. It gives people more say over how they are treated. It prevents the use of Section 3 of the Act on those who are autistic or have a learning disability but do not have a mental health condition. There is the new duty on clinicians to consider a person’s wishes and feelings and involve them in decision-making before deciding whether to treat them. There is access to advocacy and statutory care and treatment plans, which will give more transparency and accountability to clinical decision-making and put people’s choices first. All of these and others are welcome.

However, there is a need for the Government to go further. In the debate in the other place, the Secretary of State replied to many of the concerns raised by saying that the new, cross-government Building the Right Support plan would answer a lot of them. Can the Minister confirm when we can expect the plan and what it is likely to cover? When will we see the proposed new 10-year mental health plan and 10-year suicide prevention plan?

Black people are over four times more likely to be detained under the Mental Health Act. Can the Minister confirm whether the Government have any intention to review community treatment orders, which are evidenced as coercive, as not reducing readmissions, and being disproportionately applied to black people? Will the guiding principles suggested by the independent mental health review be included, as these would strengthen people’s rights and help focus decision-makers on eliminating racism? How will the mental health equality framework be advanced so that there are culturally appropriate services and the freedom for local areas to respond to the needs of their specific populations?

On young people, will the Minister look to see the Bill strengthened in making reforms for those young people? Will he address the failure to give under-18s the right to make advance decisions to refuse treatment? Without this, they will be unable to access enhanced treatment safeguards in the same way as adults. Will he also look at the lack of a statutory decision-making test for those who are under 16 which could also render many of these reforms ineffective for the youngest and often most vulnerable people in the system? It is of note that Anne Longfield, the former Children’s Commissioner for England, said that the profit-driven care system was failing vulnerable children. Following reports in today’s media and the MacAlister social care review, what action will the Minister take to put this right?

On the new criteria for detention, will the Minister review this too? Ensuring that fewer people are inappropriately detained is a crucial intention of the reforms, and changes are very much needed to significantly reduce this practice.

Staffing levels are crucial to ensuring quality mental health services. These Benches have been calling for the recruitment of 8,500 mental health staff to treat 1 million additional patients a year, so can the Minister confirm when we will get the Government’s vision for their workforce strategy?

I look forward to the Minister’s response, and if he is unable to answer all my questions today, I would be grateful if he would write to me. Modernising the Mental Health Act will undoubtedly help make mental health services more equitable, compassionate and effective. I am sure that these are aspirations we all agree we must work towards.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely.

Diabetic Prevention Programme

Baroness Merron Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.

[Baroness Merron (Lab)]

My Lords, the national paediatric diabetes audit shows that the impact of type 2 diabetes and the cost-of-living crisis is disproportionately felt by children living in the most deprived areas. What preventive measures specifically geared towards children are in place so that they may avoid type 2 diabetes? What are the Government doing for the almost 4 million children, and their households, who are struggling to access and afford enough fruit, vegetables and other healthy foods to meet official and basic nutrition guidelines?

[Lord Kamall (Con)]

One of the NHS programmes that will be repeated by integrated care boards when we have them is the eight annual diabetes checks for people of all ages. Certain factors—HbA1c, which is your average blood glucose level, or your glycated haemoglobin; blood pressure; cholesterol; serum creatinine; urine albumin; foot surveillance; BMI; and smoking—are checked for patients of all ages to identify early onset of diabetes.

Polio

Baroness Merron Excerpts

Thursday 23rd June 2022 Lords Chamber

Asked by

[Baroness Merron]

To ask Her Majesty’s Government what action they have taken in response to the national incident declared due to the polio virus being found in London sewerage systems.

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

The established UKHSA public health response mechanism has been stood up in line with national polio guidelines. This national incident means that a national team has been set up to manage and co-ordinate these actions across areas, which is standard procedure for many of the health threats that the UKHSA foresees and manages. Although samples have been detected in London, the UKHSA is working to ensure that other areas are aware and are taking actions necessary to protect populations, including encouraging people to take the vaccine.

[Baroness Merron (Lab)]

My Lords, while the risk to the public is considered low, the declaration of a national incident will of course give cause for concern, so the Government need to communicate swiftly and clearly about the situation and to ensure that children in particular are vaccinated against polio, especially as there is lower vaccine coverage in London among younger children. What is being done to address this situation and how will the Government roll out their messaging, working with local authorities, schools, the NHS and GPs, who already have added pressure from being contacted in greater numbers by the public who are concerned about vaccinations? Can the Minister reassure your Lordships’ House that he is working closely with the Treasury to ensure a properly funded communications and vaccination campaign?

[Lord Kamall (Con)]

We should start by being clear about what has been found. As part of routine surveillance, the MHRA analyses sewage from a number of treatment works and looks at what may be identified—it is world-leading in this. We should pay tribute to the UKHSA for its world-leading work and for being ahead of the game in spotting potential health risks early. It is normal for one to three vaccine-like polio viruses to be detected each year in UK sewage samples, but those are usually one-off findings. In this case, a vaccine has been detected; it is probably related to someone having had the polio vaccine and having shed it as part of their faeces. A couple of things will now happen. First, the MHRA will go further down the system to see whether it can isolate where that came from. Secondly, the messaging is quite clear: you must get your vaccine. Most people get their vaccines as part of a routine. They get it twice in preschool and then at school at 14 as their final booster. However, there are some areas of low vaccination, and we are making sure that we are rolling out that message along all the channels mentioned by the noble Baroness.

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

Baroness Merron Excerpts

Monday 20th June 2022 Grand Committee

Does the Minister agree that, for the individuals in these two senior NHS roles, who were directly associated with the FDP contract and NHS data use, to be poached and then immediately work for Palantir Technologies raises serious ethical issues that will give Palantir an unfair commercial advantage, and raises issues about senior NHS staff working for commercial companies immediately after leaving the NHS—more or less allowing a revolving door to a career with these companies and creating issues with the letting and award of multi-million-pound contracts?

[Baroness Merron (Lab)]

My Lords, I start by thanking the Minister for his extremely helpful introduction to these regulations. It is a pleasure to follow the noble Lord, Lord Scriven; I want to pick up some of the points he made. Let me say at the outset that we on these Benches support the regulations, which we accept are consequential and will not change services for people.

The words that have been used are that this is a “tidying-up exercise”. I want to dwell for a moment on the general point that there has been considerable time for this. The Health and Care Bill was introduced in July 2021 and we all know how long it spent in Committee, both in this House and in the other place. We also know how extensive the consideration of it was so it seems strange for us to find ourselves back discussing what are described as “consequentials”. This may be a simple tidying-up exercise—I accept that is what these regulations are—but calling it that ignores how we could have avoided the need to tidy up and, therefore, the amount of bureaucracy, time and effort that has been spent, not least in the department, in having to make these changes. Perhaps the Minister could address the general point that has been made in the course of this debate about why we find ourselves in this situation.

In the debate in the other place, the Minister talked about five more consequential statutory instruments that we should expect as part of this so-called tidying-up exercise. Perhaps the Minister can advise us on those. It is important that everybody, including system managers, knows what is coming down the track. I say that particularly given the record waiting lists and waiting times that the NHS is seeking to manage, yet we are talking about regulations that must be in place for 1 July so that everyone has certainty about what needs to be put in place and to be done. I accept the Minister’s assurance that this does not affect services to patients in a practical sense, but whenever we discuss regulations there is always an air of uncertainty around. Patients need to be assured that they will have a seamless service wherever they live or wherever they are. Therefore, knowing that we will be considering similar consequentials raises questions about certainty.

We hope that the regulations go through and that the Minister will respond to the points of concern that have been raised today. I hope that the regulations will ensure that the NHS can get on with the job that it is here to do.

[Lord Kamall (Con)]

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

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

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

Nursing: Staffing

Baroness Merron Excerpts

Thursday 16th June 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by thanking our nursing workforce and, indeed, the whole health and social care team. I congratulate the noble Baroness, Lady Tyler, on securing this important and very timely debate, and thank her for the way in which she set out the issues. It is important that we are considering them today, given this report. I also thank the Royal College of Nursing for this comprehensive report, which I believe shines a real light on the realities that are being experienced by the nursing team and patients. It produces a very loud red flag for the future, which I am sure the Minister will address. The Nursing and Midwifery Council also helpfully shared its annual registration data, cited in the report. I shall refer to that later.

The key message coming through from this debate, as has come through so many times, is the question of whether the Government have it right on workforce. I am sorry to say that, on this occasion as on previous occasions, the answer is no. This is about having the workforce to do the job. It has been debated numerous times in your Lordships’ House and in the other place. Your Lordships’ House made its view known very clearly that any organisation worth its salt—that certainly includes our National Health Service—would undoubtedly have in place a workforce plan for now and for planning ahead, looking at retention, recruitment and training, and all the many complexities involved. Yet within the Health and Care Act we did not have that commitment.

I will refer to the survey findings, which come in the context of record waiting lists and 50,000 registered nurse vacancies. The report refers to the fact that the UK’s exit from the EU and the Covid-19 pandemic have both highlighted and worsened long-term problems with workforce supply in health and social care. However, the report also says that this is nothing new. For many years, nursing staff have been shouting about the impact of growing staff shortages and the rising demand on their ability to deliver care that is safe and effective. The report argues that the impact of these pressures is now “beyond concerning”, with patient safety, care outcomes, staff retention and staff well-being affected.

On this point, I was glad to hear from the right reverend Prelate, who spoke of her experiences of talking to nurses and rightly reminded us of the positive side: nurses’ passion for improvement and service, and their commitment to delivering for patients. The right reverend Prelate also rightly spoke about the pressure on nurses. I wonder whether the kind of commitment shown to us by nursing teams means that their situation is constantly overlooked. I believe that there is a great tendency for them to be taken for granted because, as the right reverend Prelate said, they will always deliver.

From the report, we know that

“staffing levels are compromising care”

and

“that there are not enough registered nurses on shift”.

There is also a greater intensity of nursing care required by patients. This highlights that we have a worsening situation, not one that is static. This once again makes the case for proper workforce planning that can move with the times. I anticipate that the Minister will refer to the pandemic as being one of the greatest pressures. While that it is true, the report also said:

“Going into the … pandemic … 73% of nursing staff surveyed … said that staffing levels on their last shift were not sufficient to meet all the needs of the patients safely and effectively. In 2022, this has risen to 83%.”


This is not a new problem; it has been exacerbated but it would not be right to refer solely to the impact of the pandemic.

We have heard a number of the key findings, but the one that really strikes me is this:

“Only 25% of shifts had the full number of planned registered nurses on shift.”


Linked to that, 81% of those surveyed

“felt that patient care being compromised was due to not having enough registered nurses on the shift”,

and yet one in five said

“they felt unable to raise their concerns.”

This is a very dangerous cocktail to which I hope the Minister will have a response.

The report makes a number of recommendations, and we have had a number of proposals in the debate today. I am interested to hear the Minister’s response to the recommendations of the report and the points raised within this debate.

As we know, the Government have announced an increase in the number of nurses, and that can be tracked back to a 2019 manifesto pledge. In addition to providing us with an update on this situation, it is worth reiterating the point made by the noble Baroness, Lady Tyler, on the comments of the Chief Nursing Officer for England, Ruth May, who said that while she welcomed the pledge, it fell short of what was actually needed. This will be the case because recruitment on its own is not the point; it is also about the vacancy numbers, the shortfall and the numbers of nurses that are leaving.

On that point, I refer to the information from the Nursing and Midwifery Council. When asked why people had left, they said the main reasons were too much pressure, poor workplace culture, struggles with increased workloads and a lack of staff. Could the Minister give us more information on when he will be able to share the 15-year plan for the workforce? When will it materialise, and how will it take all of these matters into account?

The report calls for a “credible, costed long-term” health and care workforce strategy. A nursing team is at the heart of this. I hope that the Minister will hear the points made in today’s debate, but also the previous calls for a proper workforce plan, which will be the only way we can meet the demands upon us.