Cannabis: Medicinal Use

Baroness Walmsley Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

First, I thank the noble Baroness for meeting with my colleague, my noble friend Lady Penn, yesterday. When I became a Minister, the Permanent Sec recognised a potential conflict of interest, which I have been told means that I cannot meet with people about this particular issue, but I can answer this Question if I declare my interest. So I better quickly declare it: I used to work for a think tank that received some funding from the medicinal cannabis industry, and I shared a round table. That immediately ruled me out as having a conflict of interest. None the less, I am very happy to facilitate meetings with my ministerial colleagues. As the noble Baroness will be aware, there is a new ministerial colleague in place at the moment. The point remains that we have asked the industry, which makes lots of money in this area, to come forward and fund trials, but it has preferred not to do so.

[Baroness Walmsley (LD)]

My Lords, I understand that the MHRA is considering extending its compassionate access scheme, particularly regarding the import of Celixir20 from Israel. A number of children with rare forms of drug-resistant epilepsy rely on this medicine. Given the severity of the crisis of access to NHS prescriptions for medicinal cannabis, can the Minister ensure that there are no barriers to the MHRA acting now to extend this scheme?

[Lord Kamall (Con)]

The noble Baroness raises an important point about working with the importer of those medicines. The MHRA is exceptionally continuing to allow those medicines and is hoping to work with the importer and the Israeli company itself to see whether they will go through the MHRA approval process. In Israel, there are two ways of supplying the product: one is medicinal and the another is for non-medicinal cannabis uses. It has advised us that this is not a licensed medicine in Israel, and therefore we are asking the company to come forward. In the meantime, we are looking at an interim solution.

Health Improvement and Food Production

Baroness Walmsley Excerpts

Thursday 7th July 2022 Lords Chamber

Moved by

[Baroness Walmsley]

To move that this House takes note of the relationship between improving the overall health of the nation and food production.

[Baroness Walmsley (LD)]

My Lords, it is a pleasure to introduce this debate about three things very close to my heart: food, the health of our population and the planet. I do not need to explain the very strong link between these three.

We produce some excellent food in this country, but our farmers and fishermen have had a tough time over the last few years, especially if their markets are abroad and if they rely on foreign workers to harvest their crops. Therefore my first question to the Minister is: what are the Government planning to do about that?

Despite the quality of our food, our national food system is broken. We eat too much of the wrong things and it is making us ill, limiting our years of healthy life and costing the NHS millions. The Government are resisting some of the levers that could help put it right. As in other countries, the resilience of our food security is under pressure because of the illegal invasion of Ukraine, which is one of the world’s biggest wheat and vegetable oil producers; the cost of fertilisers for our domestic farmers is also badly affected. This is one of the factors causing the rise in the price of food. However, the recent national food plan published by Henry Dimbleby set out four objectives for improving our broken food system. They were:

“Make us well instead of sick … Be resilient enough to withstand global shocks … Help to restore nature and halt climate change … Meet the standards the public expect, on health, environment, and animal welfare”.


Those are four very good objectives.

The first questions are: what is a healthy diet and is it available to everyone? Experts agree that it must contain a balance of all the major nutrients, vitamins and minerals in adequate quantities for our age and other physical factors. However, the evidence of obesity in our country and the rise of diseases connected to it, such as diabetes, heart disease, cancer, musculoskeletal problems and stroke, shows that a healthy diet is not acceptable to many, particularly in the poorest demographic groups. Two out of five children are above a healthy weight by the time they leave primary school and a quarter are obese. Children in deprived areas are twice as likely to be overweight. Some 28% of adults are overweight and 36% obese; again, the risk is higher in the lower demographic groups and certain ethnic communities. This is not because these people are greedy, but mainly because they are poor and are eating the cheapest food they can get hold of. Many in fact do not have enough food and are forced to use food banks to feed the family. It is a disgrace that, in a rich country such as ours, some children would go hungry but for charities such as the Trussell Trust.

Sadly, the cheapest calories are often high in sugar, salt and fat and are the ones that contribute most to being overweight. Fruit and vegetables, and good-quality meat and fish cost more than fast food but highly processed food, manufactured in massive amounts, is sold cheaply on every high street. Henry Dimbleby explained it this way:

“Because there is a bigger market for unhealthy food, companies invest more into developing and marketing it. This in turn expands the market further still. The bigger the market, the greater the economies of scale. Highly processed foods—high in salt, refined carbohydrates, sugar and fats, and low in fibre—are on average three times cheaper per calorie than healthier foods.”


So, what can we do? Dimbleby suggested that we must escape this junk food cycle to protect the NHS and reduce diet-related inequality by reducing the consumption of HFSS foods by 25% and increasing fibre by 50% and fruit and veg by 30% to reach healthy levels. To reach the carbon budget, we need to reduce our meat consumption by 30%, because 85% of our farmland is used to grow feed or grass for farm animals. If we could make these changes, we could promote a healthy gut—one of the most important organs in the body—save the NHS millions and put some less productive farmland to other, desirable uses. There are various ways in which the Government could contribute.

I agree with Dimbleby’s conclusion that we must get healthy food directly to our children and at the same time save their parents money by expanding eligibility for healthy free school meals. This has now twice been recommended by Dimbleby but twice refused by the Government—can the Minister say why? The Government set up the Healthy Start scheme and the holiday food scheme, on which they should be congratulated, but have not accepted Dimbleby’s latest proposition to expand those schemes, despite their success. The Lords Committee report in 2020, Hungry for Change, also recommended this. Can the Minister explain why it is not being done?

I turn to food production. We are not self-sufficient and probably never will be, but 54% to 60% of our food is grown by our own domestic farmers. We must protect them, but that is not to say that they might not need to change what they do. Only last week the Climate Change Committee issued serious warnings about agricultural policy, but farmers are currently under pressure from many quarters. We ask them to grow more food and, at the same time, to reduce greenhouse gas emissions, use less fertiliser, stop polluting watercourses, increase biodiversity, plant more trees, improve their soil, protect carbon sinks such as peatlands, grow biofuels, site wind and solar farms, provide leisure opportunities—and on it goes. The pressure on land use is enormous, and they are not making it any more. I welcome the Government’s recent announcement that they will produce a land use strategy next year. Can the Minister give us any insights into how health and food production will be balanced with all the other pressures on land in the forthcoming strategy, and what levers the Government are considering using to achieve it?

Farmers have to plan now, and they need help with the environmental land management scheme payments, which are to replace the former support system. It certainly makes sense that farmers should not be paid for how much land they have but for the public goods they provide. However, every farm, and every soil, is different, and there are many schemes to which farmers can apply for support. The large landscape section of ELMS has had 51 applicants for 15 initial schemes—some from large estates, but some from groups of farmers who want to work together to improve the landscape. That is encouraging, so I hope the Minister can assure me that some of the successful schemes will include small farms working together. I know he has received a note about this from Defra, because I asked the department to send it to him, so I hope it is not unfair to ask him these questions.

The local nature recovery scheme criteria will be available at the end of the year. This strikes me as rather slow, because farmers have to plan now how to respond to all these pressures. Can the Minister say how soon the funds for that part of the scheme will become available? The sustainable farming initiative applications opened last week. Farmers can apply online, and new software can help them identify what might be appropriate for them. However, we still have the overlapping countryside stewardship scheme, environmental stewardship scheme and others. I hope your Lordships see where I am coming from: we currently have maximum complexity of schemes—some beginning, some ending—and an alphabet soup of acronyms.

In its recent report on nature-based solutions to achieving net zero, the Science and Technology Select Committee recommended that an independent advisory service—human beings rather than software—should be provided to help farmers increase food production sustainably while also making a living. Can the Minister say what progress has been made in this respect? Many farmers will have to change their business model. That is risky, so they need good advice.

One of the problems we face is the large number of tenant farmers in the UK. Tenants might be reluctant to make improvements to the land if it is their landlord who will benefit in the long term. Soil improvement does not happen overnight—I know that from my own garden—so a farmer with a short tenancy might be reluctant to do it. I know that the noble Baroness, Lady Rock, is looking into this for the Government. I hope the Minister might be able to give us an insight into her interim recommendations; otherwise, I will have to ask her.

Our farmers have very high standards, so the last thing we must do is offshore our food production to countries that might produce higher emissions. We cannot police their standards of animal welfare or pesticide use. Then, of course, there are food miles. Since Brexit, there has been a reduced ability to check the quality of food coming in, according to a recent report by the Food Standards Agency. In addition, countries such as Australia and New Zealand have economies of scale in meat production with their enormous farms, which could put our livestock farmers at a great disadvantage. Can the Minister say how the Government will avoid putting farmers out of business or offshoring food production when negotiating trade deals? Will the Government set up a trade and agriculture commission, as proposed by Dimbleby?

The Government have indicated that they will provide more support for horticulture. This is good news, as we produce only 35% of our current supply of fruit and veg, but this will need to increase by nearly 90% if we are to increase our consumption, as advised by Dimbleby. Will the Minister say whether projects that make use of rainwater and renewable energy capture, technology and innovation will attract government support?

In north Wales a couple of years ago, a proposal to use the heat from a sewage works through heat exchangers to heat glasshouses to produce half the tomatoes and cucumbers needed by Wales was turned down by the local planning authority—all that locally produced food, all those jobs, all that energy and water saving lost because of a lack of vision. I hope the Minister can tell me that the Government have more vision than my local authority.

I turn to highly processed food. Not all our food comes straight out of the ground or the water; a great deal of it comes out of a factory. As we have heard, it is cheap and often contains too much salt, sugar and fat. There have been voluntary reductions, but they do not go far enough. Yet the Government resist mandatory measures, such as an extended sugar and salt tax. Can the Minister justify the claim that a small tax on sugar and salt in HFSS foods for manufacture and catering will increase the cost of food for poor people?

The advertising restrictions on HFSS foods before the watershed and online have been postponed. Can the Minister confirm that there will be no further postponement, despite today’s events?

Labelling can help people choose healthier food, but it can be difficult to identify what is really a healthy food. It is not hard for a piece of broccoli, an apple or a piece of fish, but it is a different matter for products with multiple ingredients. The Minister might remember our discussions, led by the noble Lord, Lord Moylan, during the passage of the Health and Care Bill about high-protein bars. The noble Lord, Lord Krebs, helpfully pointed out that the bar in question was high in salt and sugar and low in fibre, so not very healthy at all.

Since then, the noble Lord, Lord Krebs, and I have received material from a group of young people called Bite Back. Its report, Don’t Hide What’s Inside, explored the eating habits of 1,000 13 to 18 year-olds and examined the impact that packaging claims have on their perceptions of health. It found that three-quarters of young people think that their diet is healthy, despite the fact that their intake of sugar, fruit and veg, and fibre is nowhere near the Government’s daily recommendations. Almost nine in 10 think that smoothies are healthy, but 76% of juices and smoothies would get a red traffic light label for sugar. Eight in 10 believe that cereal bars are healthy, but 81% of those would get a red traffic light label for sugar. The report gives other examples.

Half of those surveyed agreed that health and nutrition messaging makes them more likely to buy a product. This makes the rules about labelling important but it is too often misleading. To demonstrate this, a fake snack bar was invented. It was made entirely from mud but branded as 100% natural, high in fibre, a great source of minerals and low in fat, which was true but also completely outrageous, since there was nothing in it but mud. It was done to call out big food brands on their manipulative marketing tactics and to make them step up with clear and honest packaging. The Government are being asked to introduce a clear, mandatory labelling policy, including declarations of free sugars, traffic-light labels, a review of where the thresholds should be lowered, regulation to end the use of health and nutrition claims on an unhealthy product and consistent portion sizes across categories. Will the Minister consider the young people’s proposals? If not, I suspect they might send him a mud bar.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I thank the Minister and everybody who has taken part in this small but perfectly formed debate. It has been cross-departmental, which is why I asked Defra to send the Minister some notes. If the Defra Minister had been responding, I think the noble Lord would have had to send him some notes, and vice versa. It was quite a difficult challenge for the Minister to have such a cross-departmental topic.

I am very grateful to noble Lords who elaborated things that I had time to mention only briefly in my initial remarks. In fact, some mentioned things that I did not have time to mention at all. I am grateful that the Minister mentioned the link between mental health and being overweight, and the noble Baroness, Lady Merron, mentioned the difficulties of the Procurement Bill and the possible contradiction between that Bill and the Health and Care Act. None of us had the chance to talk about the importance of teaching children to cook, for example, but I am so grateful that everybody mentioned food and health inequality, because it is a very big issue. Although the Government are doing some things to help address that, I think most contributors to today’s debate have suggested more things that we would like to have seen them do.

I want to take the Minister up on one point: he said that there appears to have been some sort of opposition to importing food. In fact, I think both the noble Baroness, Lady Merron, and I acknowledged the fact that we are not self-sufficient in food and are not going to be. What is important is that, first, we make sure that the standard of food that comes in is what the public expect and, secondly, as even the Government are now saying, in order for our food system to be resilient we need to produce as much as possible in this country in a sustainable way, while acknowledging all the other things that farmers have to do.

The noble Lord, Lord Kirkham, talked about happiness, and I could not agree with him more. My noble friend Lady Brinton talked about the socialisation of food, and somebody mentioned that the slower you eat, the less you probably eat, and that you relax while you do it and it does you good. I certainly agree on that point, but I do not agree with the noble Lord, Lord Kirkham, that anybody is trying to lecture people. What people are trying to do is to help and encourage others, to make recommendations and to make good food accessible to everybody in the country. Of course, that is what the Government are trying to do, but we would like to see more. Henry Dimbleby was certainly not lecturing anybody; he based his recommendations on the science and good advice from experts. We should all listen to what he had to say.

I was a bit concerned about what my noble friend Lady Brinton said about the danger of reducing the quality of school meals, and I hope the Minister will keep an eye on that as the price of food increases. We do not want to see that, because I know that the Government are trying to get good food directly to children.

With those few words, I thank everybody who has taken part. I know more people would have liked to speak, but the time of day and day of the week meant that some of the great experts on this topic in the House were not able to join us—and we miss them, of course.

Motion agreed.

Personal Protective Equipment: Waste

Baroness Walmsley Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

I think we should look at the context of this £9 billion or £12 billion figure. We must remember that, at the time, market prices were inflated. We could not have bought the equipment at the prices you can pay for it today. The Government at the time had to make an estimate. If they had bought too little equipment, they would rightly have been criticised. Given that you can never make absolutely accurate predictions, on balance it is better to procure more than less. I was speaking to a Democrat politician from United States the other day. He said, “I just made the decision to procure as much as possible, but I knew I would get the flak afterwards. Lives were more important.”

[Baroness Walmsley (LD)]

My Lords, at the beginning of the pandemic a great deal of PPE which was in store was already out of date and could not be used. Any homemaker knows that you look at the use-by date of the stuff in your fridge and try to use it before it goes out of date. Can the Minister say whether there is now a proper record-keeping system for the use-by dates of any PPE that is in store in anticipation of any future emergency need?

[Lord Kamall (Con)]

I think that the noble Baroness will recognise from when I was asked a previous Oral Question on this issue that where there was an official sell-by date, we had asked a couple of companies from which we had procured the equipment to look at whether that life could be extended. I am not sure of the details, so I commit to write to the noble Baroness.

Sugar Reduction Programme: Bread

Baroness Walmsley Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Kamall (Con)]

I pay tribute to the noble Lord. Since my first day at the Dispatch Box, he has challenged me on both sugar reduction and alcohol abuse. There comes a stage where it is diminishing returns. I know that the noble Lord and I are very keen on puns and dad jokes. When bread is being made, sugar is needed—kneaded; excuse the pun—because it extends shelf life by reducing the oxidation which causes food to deteriorate, it reduces the rate at which bread becomes stale, it activates yeast for fermentation, it adds the colour during the baking process, and it adds to the texture. The sugar contributes only about 2% of free sugars intakes in children. Therefore, it is much more worth while and targeted to focus on products that are higher in sugar.

[Baroness Walmsley (LD)]

My Lords, will the Minister join me in congratulating Tesco and Sainsbury’s? They have announced that, even though the Government are backtracking on the proposed ban on volume promotion offers of foods high in sugar, salt and fat, they will do it voluntarily anyway, and on time, to support the anti-obesity campaign. Will he encourage other retailers to join them and to work with their suppliers to reformulate and reduce sugar?

[Lord Kamall (Con)]

We should welcome moves by those in the industry, including retailers; if they can meet deadlines earlier, that is all to be welcomed. Perhaps I might correct the noble Baroness on one inaccuracy. The Government have not backtracked; we have delayed location measures until October 2022.

Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Baroness Walmsley Excerpts

Monday 23rd May 2022 Grand Committee

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

My Lords, the Pharmacy (Preparation and Dispensing Errors—Hospitals and Other Pharmacy Services) Order 2022 was laid before Parliament on 28 April. This draft order extends to the United Kingdom. I note that the noble Lord, Lord Hunt, has submitted a Motion to Regret in relation to the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022. This will now be subject to a separate debate.

The draft order before your Lordships has been in development for a long time under the auspices of the Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board, whose members include representatives from across the pharmacy sector and professional and regulatory bodies. The draft order is welcomed by pharmacy professionals working in hospitals and relevant pharmacy services, and has the support of the four Chief Pharmaceutical Officers of the UK.

I apologise for the parliamentary time taken to progress this order. The Government had to make some difficult decisions to deprioritise non-urgent legislation following the general election in 2019, EU exit and the Covid-19 pandemic. We are now returning to more business-as-usual matters.

The purpose of the order is to extend the defences already available to pharmacy workers in community pharmacy premises made under the Pharmacy (Preparation and Dispensing Errors—Registered Pharmacies) Order 2018 to ensure that registered pharmacy professionals working in hospitals and other settings, such as prisons and care homes, have access to the same defences. This would provide them with access to the defences to the criminal offences set out in Sections 63 and 64 of the Medicines Act 1968, which concern the adulteration of medicinal products in Section 63 and the sale of any medicinal product which is not of the nature or quality demanded by the purchaser in Section 64. The order makes these defences available in defined circumstances and, importantly, incentivises the reporting of errors where pharmacy professionals make genuine dispensing errors, improving learning to prevent such errors occurring.

In summary, the order will support improved patient safety by encouraging a culture of candid and fulsome contributions from those involved when things go wrong. This is a culture we want to see right across the NHS. Within this culture, pharmacy professionals can increase their learning from dispensing errors and identify mitigating action to make recurrence less likely in the future. I therefore commend the draft order to the Committee.

[Baroness Walmsley (LD)]

My Lords, I have always thought that the purpose of highlighting errors in the health service should be to learn and to avoid repeats, rather than to lay blame. That is why I supported the HSSIB, which was made mandatory in the recent Health and Care Act 2022. For that reason, I also support this order, which can contribute to patient safety by extending the removal of the threat of criminal sanctions for inadvertent dispensing errors beyond current community pharmacies and into other places where medicines are legitimately dispensed. These will include hospitals, care homes, prisons and detention centres. Anything which deters people shining a light on errors is a bad thing and should be addressed; anything which enables learning from them is welcome. However, although the order is welcome, I ask the Minister whether there has been evidence that staff have been deterred from exposing or informing patients about a mistake that has been made.

It is vital that the duty of candour that applies to all health professionals is upheld. I welcome the news from the General Pharmaceutical Council that it plans to develop new learning resources to help pharmacists understand how to fulfil this duty and, crucially, why they should do so. Of course, the duty already appears in the Standards for Pharmacy Professionals. This is where actual offences come into the picture. It is right that pharmacists could still be prosecuted if they can be shown to have had deliberate disregard for patient safety, as such a person would not be acting in the course of his profession, so patient protection still applies.

Identifying such a situation would probably rely on whistleblowers, who need protection and confidence that they would not be penalised for revealing information. Will the Minister say who would be responsible for making this judgment? Would it be the General Pharmaceutical Council or a magistrate with professional advice?

National Institute for Health and Care Excellence

Baroness Walmsley Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure that the noble Baroness appreciates that this was a new process, because of the Orbis trial. In some ways, NICE was not exactly prepared for that. NICE has learned from that lesson and 100% of its guidelines are issued within 90 days of licensing. It has learned the lesson but, sadly, there was a confluence of factors: one was Orbis and the other was that the committee meeting regarding recommendations ran over because there were a number of other cancer drugs that it was trying to look at. It has put this on the agenda for the next meeting.

[Baroness Walmsley (LD)]

One of the ambitions in the life sciences vision is to enable early diagnosis and treatment, including immunotherapies such as cancer vaccines. However, last year, 20 treatment evaluations were paused because of lack of capacity at NICE. If successful R&D cannot be translated into treatments because of lack of NICE evaluations, how will that impact on commercial incentives and the ambitions set out in the life sciences vision?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how this fits into the life sciences vision, and NICE is very aware of it. In fact, only last week, I saw a draft business case for NICE for future years, and it takes on board the very point the noble Baroness refers to. NICE is looking at making sure that is has more timely advice and that it can respond quickly; it has also increased capacity, not only for conditions like this but for more digital devices.

Health and Care Bill

Baroness Walmsley Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

He says that, eight months after asking Hikvision to address shocking allegations, it has failed to answer his questions. There are more Bills coming: there will be a new modern slavery Bill and a procurement Bill. As my noble friend said, there will also be an opportunity for more amendments. However, it would be helpful to know this evening whether this excellent amendment will be used as a yardstick when it comes to framing other putative legislation.

[Baroness Walmsley (LD)]

My Lords, I begin by welcoming Motion B, which puts in place government Amendments 30C to 30K, laid in another place. They relate to the Secretary of State’s role in major NHS reconfigurations and are a credit to the Minister, his ministerial team and the Bill team. They have listened to the strong arguments from across this House, led so ably by the noble Lord, Lord Stevens of Birmingham, who is unable to be with us tonight. I thank the Minister for agreeing—eventually—that the powers originally proposed in the Bill were excessive, disruptive and unnecessary.

Unfortunately, we have not had such a fruitful consensus on the matter of workforce planning. We do not agree with the Commons that our workforce amendment, Amendment 29B, was unnecessary because appropriate measures already appear in the Bill. If that were so, and if the sector had had confidence in the Government’s track record in planning for adequate and safe staffing levels in health and care services, we would not have had more than 100 organisations backing our earlier attempts, led so well by the noble Baroness, Lady Cumberlege, to put in place a mandatory system for reviewing the available workforce and predicting what will be needed in future. However, here we are, with the Government having set their face firmly against any compromise on or serious discussion about the matter. One has to ask what the Government are afraid of.

Any effective workforce strategy must be based on reliable information, be regularly refreshed and have numbers in it. This House and the whole sector have no confidence that what the Government are proposing will do that. I understand that the Treasury has had a hand in the Secretary of State’s determination to just say no. Perhaps the Treasury is unwilling to foot the Bill, which will prove to be essential when all is revealed.

I put it to the Minister one last time that our proposal would be cost-effective. Staff shortages are a false economy. Missing staff are often replaced by very expensive locums and agency staff, and the stress of unsafe staffing levels causes valued staff to leave the service. Training and recruiting staff to replace them also costs money. High staff turnover is not an effective strategy for any business or service, and poor treatment for patients often has to be done again or leads to greater and more expensive needs further down the track. No efficient shopkeeper would fail to do a proper stocktake or take account of what people are buying and therefore what he needs to order to replenish his stock—but that is what the Government are doing if they fail to plan effectively for safe staffing. It is much more serious than empty shelves, because it is playing with people’s lives, as was recently demonstrated so clearly by the Ockenden report.

If the Government are determined not to carry out the reviews and consultations in Amendment 29D, I would like to ask the Minister whether they would be happy for some other organisation, such as NHS England, to do so and whether they will take note of the results of that investigation. Amendment 29D from the noble Baroness, Lady Merron, in Motion A1, is not a silver bullet; it will not solve the current staffing crisis in the NHS and care services. But it would provide a strong foundation for future safe and cost-effective staffing, which would be to the benefit of the whole population. It is our duty to ask the Government to think again—again.

[Baroness Wheeler (Lab)]

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]

is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

Folic Acid Fortification

Baroness Walmsley Excerpts

Wednesday 6th April 2022 Lords Chamber

[Lord Kamall (Con)]

This will all be part of the consultation, but once the policy has been decided on and fortification starts, clearly, we will be communicating to parents, families and others. If there is a risk—which noble Lords in their expertise seem to disagree with—we will have to identify that. The history of good intentions is littered with unintended consequences. We must be aware of those in our pursuit of increased folic acid in flour.

[Baroness Walmsley (LD)]

My Lords, over the past two years, the Government have made urgent decisions about Covid-19 to save lives and save sickness. Why can they not, in light of the strength of the evidence we already have, make a similarly urgent decision on this issue to save harm to 400 babies a year?

Health and Care Bill

Baroness Walmsley Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I wish to comment extremely briefly on Motion E, in relation to unpaid carers and hospital discharge, and to ask the Minister one question. I want first to pay tribute to the noble Baroness, Lady Pitkeathley, for her unstinting leadership on this issue. I very much welcome the amendment in lieu which the Government have brought forward to ensure that carers and patients are properly involved in discharge decisions.

My one point is that the cost of living crisis is a reality and life is getting tougher for many people. Involving carers at the point of discharge gives them the opportunity to say that they are unable to care, or unable to get the support they need for caring because they are juggling work and care—for example, if it is impossible for them to give up work fully because they need to feed the family or pay the bills. Can the Minister give me assurance that carers’ needs to juggle work and care will be both properly covered and explored in the guidance which I know that the Government are committed to producing, and which I am very much looking forward to seeing?

[Baroness Walmsley (LD)]

My Lords, I shall make a few brief comments about Motions A, E, G1, L1 and Q. On Motion A, we very much welcome the Government’s amendments in lieu, to make it clear that no commissioning organisation within the ICS can have a member appointed to it who could reasonably be regarded as undermining the independence of the health service because of their involvement in the private sector. The Government have listened to the concern expressed by the noble Lord, Lord Hunt of Kings Heath, whom I congratulate for spotting the loophole, and that is very good and welcome.

On the matter of carers and safe discharge in Motion E, we on these Benches were concerned that unpaid carers would not be sufficiently consulted and their own health and well-being might not be sufficiently taken into account. I am grateful to the Minister for spelling out, at my request, how the impact on carers will be assessed before a patient is discharged into her or his care. However, at the moment, when there is an outbreak of Covid-19 in a hospital ward, the carers are not allowed to visit the patient. Therefore, those conversations are not taking place. I should be very interested to know what the Minister will suggest about how those conversations can take place in that situation.

It is very important that appropriate action is taken to address the carer’s needs as well as those of the patient. Indeed, if those needs were not addressed, it would affect the ability of the carer to look after the patient, so both would suffer. I know this is a big responsibility for local authorities, which are strapped for cash, but it is vital that these needs are catered for, especially in light of the fact that those many thousands of unpaid carers save the public purse a massive amount of money, as well as looking after their loved ones with the loving care and attention that it would be very difficult for professionals, however dedicated, to give.

On Motions L and L1, I have listened carefully to the concerns of the noble Baroness, Lady Finlay, and she is quite justified. Governments have a habit of promising action but then moving on to something else, so we on these Benches, like the noble Baroness, will be looking out very carefully for the results of the review and the actions which we hope will follow.

We very much welcome Motion Q and congratulate the noble Lord, Lord Bradley, on achieving what he has. We particularly welcome the mention in the amendment in lieu of the word “prevention” of mental ill-health, as well as diagnosis and treatment.

Finally, as my noble friend Lady Brinton said, we support Motion G1 from the noble Baroness, Lady Wheeler. I want to add just two comments to those of my noble friend. We should support the amendment because the government savings will be paid by the poorest and most vulnerable, and 80% of those with dementia who have very long-term caring needs will be worse off under the Government’s proposals, and that is not right.

[Lord Kamall (Con)]

I thank all noble Lords who took part in this wide-ranging and interesting debate. Perhaps I can deal quickly with some of the issues. On mental health membership of the ICBs, I thank the noble Lord, Lord Bradley, for his persistence, but also for accepting the amendment that we produced in lieu.

On conflicts of interest, I thank all noble Lords for acknowledging the work that the Government have done, and I shall try to answer a couple of points. The noble Lord, Lord Hunt, asked about the chairs of the ICBs. They are appointed by NHS England, with the Secretary of State’s approval, which is the route by which the Department of Health and Social Care can ensure that the chair does not undermine the independence of the NHS. NHS England and the Secretary of State will want to appoint people who meet the highest standards and will not undermine the interests of the NHS. On the second question, ICBs will have to make arrangements to manage conflicts of interest to ensure that they do not affect, or appear to affect, the integrity of ICBs’ decision-making. This would implicitly include data sharing and access to information. I hope that that meets with the noble Lord’s approval and addresses his concerns.

On palliative care, I once again thank the noble Baroness, Lady Finlay, for all her work and for teaching me so much about the subject. Indeed, the officials in my department are very grateful for what they have learned about the whole palliative care process: the noble Baroness has definitely put it right on the agenda for consideration.

It is clear that the views of parents are very important, and it is essential that their voices are heard. That is why we expect the review to include evidence from both parents and clinicians who have been involved in disagreements in the care of critically ill children.

I also thank my noble friend Lord Balfe for the points that he made and I hope that we will have further conversations. I would be happy to put my noble friend in touch with officials in my department, so that they can benefit from his wisdom and many years’ experience of mediation.

There are already robust duties to involve parent carers in hospital discharge planning. Parent carers of a disabled child are covered by the right, under the Children and Families Act 2014, to request a carers assessment at any time. We will continue working closely with the Department for Education to ensure that, in guidance, we signpost to existing rights and protections for these individuals. The existing guidance stresses that discharge teams should ascertain whether the carer is willing and able to provide care and support post discharge, before an assessment of longer-term needs. No assumptions should be made about their willingness or ability—that includes all forms of ability—to care. This will be set out in the new statutory guidance. As the noble Baroness rightly knows, we will be working with Carers UK on the guidance.

I will finish on the adult social care cap. I understand the concerns that many noble Lords have expressed. In the current system, individuals with more than £23,500 face unlimited costs. The cap is not a target to work towards; it is a backstop to make sure that people are not liable for unlimited costs of care. There are a number of different issues and views on this, but we believe that our proposal is better than the current system. Although I understand the concerns of this House, I once again urge noble Lords to consider that the other place has considered this and rejected noble Lords’ amendments. The Government Benches will be opposing Motions G1 and G2.

I am also grateful to my noble friend Lord Lansley for the points he raised. We will look at all aspects of the trailblazer schemes; it would not be wise to limit what we look at. We want to get the best from that discovery and learning process, and perhaps spot with the trailblazing and piloting any unintended consequences. So we will look in a holistic way at how the trailblazer schemes are working before we roll them out nationally. We believe that that is wise and prudent.

I think that completes my points.

--- Later in debate ---

[Lord Clement-Jones (LD)]

My Lords, briefly, I support the remarks of the noble Lord, Lord Hunt, regarding Motions F and F1. He, assisted by my noble friend Lady Brinton and I, has pursued the question of the future of data governance in the NHS with great determination and persistence. I pay tribute to him and to medConfidential in that respect. I know that the Minister, the noble Lord, Lord Kamall, is equally determined to make sure that data governance in the new structures is designed to secure public trust. I very much hope that he will give the assurances sought by the noble Lord, Lord Hunt.

The key problem we identified early on was the conflict of interest referred to by the noble Lord, Lord Hunt, with NHS England in effect marking its own homework, and those who have data governance responsibility reporting directly to senior managers within the digital transformation directorate. I hope that the assurances to be given by the Minister will set out a clear set of governance duties on transparency of oversight, particularly where NHS England is exercising its own statutory powers internally. I look forward to what the Minister has to say.

[Baroness Walmsley (LD)]

My Lords, I plan to address matters in the group that have not been addressed by my noble friends. They are workforce planning, reconfiguration and organ tourism.

First, on Motion K, on organ tourism, I congratulate the noble Lord, Lord Hunt of Kings Heath, my noble friend Lady Northover and others on their success in convincing the Government that something must be done about this dreadful trade. I also thank the Minister for listening.

On Motions B and B1, we support the noble Baroness, Lady Cumberlege, and will be right behind her when she leads us into the electronic Content Lobby on her Motion B1. It was made clear during earlier stages of the Bill that Peers across the House believe proper planning for training and providing a safe health and care workforce is essential. We also hear that almost 90% of trust leaders do not think the NHS has robust plans in place to deal with the workforce shortage. We are asking a lot of the NHS and care workforce at the moment; they are badly understaffed but, at the same time, are being asked to reduce the backlog of treatments that built up during the pandemic, while Covid-19 is still rampant in the population and thousands of patients are still in hospital with that as the primary cause.

In these circumstances, we have a desperate need for a reliable system to plan for and provide the staff we need, but nobody has confidence in the current system—if you can call it that. However, it seems that the Treasury has stuck its oar in. I find that rather odd, since neither the Bill as drafted nor the various amendments of the noble Baroness, Lady Cumberlege, have mandated the Treasury to fund the numbers of workers at every level who may be identified as necessary to deliver the health and care we need.

I accept that, when the yawning gap becomes clear between the numbers we have and the numbers we need for safe care, there would indeed be pressure on the Treasury to provide the money. However, it has been pointed out many times—including this afternoon, by the noble Baroness, Lady Cumberlege—that the NHS spends £6.2 billion every year on expensive agency staff, whose roles could be provided much more cheaply, and with better continuity for patients, by permanent employed staff. Considerable savings could be made to offset this.

It is significant that the Government are resisting the noble Baroness’s amendment. They know very well that the reviews she recommends would shine a light on the fact that the NHS and care systems do not know what they have got or need, and are badly short-staffed. The Government would be pressured to do something about it.

Since the Ockenden report, something else which is rather crazy has emerged. The Government have agreed to comply with all Ockenden’s recommendations, including on planning for and providing adequate staff in obstetrics and gynaecology. Hopefully, all maternity units will be safer in future, but it would be ridiculous to have a maternity unit adequately staffed in the same hospital as a cancer or stroke unit that was not. In voting for the amendment from the noble Baroness, Lady Cumberlege, we will attempt to save the Government from making such a dreadful and unnecessary mistake. We will be voting for safe health and care services in the future, in the interests of patients and staff alike.

On Motions C and C1, we support the amendment in the name of the noble Baroness, Lady Thornton, which she will no doubt speak to in a moment. In voting for this amendment, we will again be attempting to save the Secretary of State for Health and Care from getting himself into an awful pickle. There may be far too much temptation for a Secretary of State to use the powers in the Bill as it stands to meddle in matters far better decided by the professionals and local authorities on the ground. A clear process, which is rooted in local accountability, already exists for reviewing proposals for NHS reconfiguration—there is no call for the Secretary of State to be further involved except now and then if an election is in the offing. The Government have emphasised accountability throughout this Bill, but that accountability must be at the right level. Many of the decisions that might be made under the power that we are attempting to curtail today should be accountable to local people through those operating the local integrated care systems. By interfering, the Secretary of State may well corrode the very accountability that the Government say they want. We will be voting with the noble Baroness, Lady Thornton.

[Baroness Merron (Lab)]

My Lords, I sense a deepening of support in your Lordships’ House for the issues contained within this group. I start by thanking the noble Baroness, Lady Cumberlege, for introducing Motion B1. I also put on record my thanks to the 100 organisations which have indicated their support and got involved to make this an even better Motion for us to consider.

Yesterday’s Health and Social Care Committee report said:

“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce”


through a workforce plan. The lack of staff, both currently and projected, is not restricted to the cancer workforce but extends to the total staff shortage of some 110,000 across the NHS as well as 105,000 vacancies in social care, while some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest number on record.

As we have heard, just last week your Lordships’ House debated the Ockenden review, which I believe has provided great focus on the issue of workforce planning. The review shockingly laid bare the reasons why hundreds of babies’ lives were avoidably cut short or damaged and mothers died; to their great credit, the Government have accepted every one of the recommendations. The clear finding here is that we must safely staff our maternity wards, yet midwives are leaving the NHS in greater numbers than it is possible to recruit them. If the Ockenden review does not illustrate why we need a workforce plan then I do not know what does.

It is worth reflecting on what Motion B1 is not about, in case that offers some late reassurance to the Minister. Despite needing all of these things, it does not commit the Government to hiring thousands more doctors and nurses, nor does it commit to new funding for the NHS. It does not even commit the Government to finally publishing the workforce strategy that the NHS is crying out for—even though the NHS has not had a comprehensive workforce strategy since the Government’s plan was published in 2003.

What Motion B1 talks about is an independent review of how many doctors, nurses and other staff are needed in health, social care and public health, both now and for the future, and that the report, which must be brought before Parliament, must be informed by integrated care boards, employers, trade unions and others—people with expertise and a great contribution to make. This is not just a question of recruitment, important though that is, but one of retention. There is absolutely no way out of planning and preparation; without them, it is just not possible to magic up the necessary staff. Motion B1 is about facing up to the scale of the workforce challenge so that we can see safe and efficient health and care. These Benches will certainly be supporting Motion B1 if the will of the House is tested.

I turn now to Motion C1 in the name of my noble friend Lady Thornton. The inclusion of a clause about changes to reconfiguration shows that not all of the Bill was what the NHS was asking for. The powers in this clause are unnecessary and introduce a very considerable new layer of bureaucracy. Just about every commentator and representative group has said that this approach of an interventionist Secretary of State is quite wrong. As many have pointed out, the power that any proposal can be taken over by the Secretary of State takes us down a road of politicisation and will deter some from even trying to pursue necessary but controversial changes. It matters not that we are told that this power will be used only sparingly; if it is there, that will influence behaviour.

Given where we are in the parliamentary process, outright rejection of this provision would, of course, be problematic. Our alternative in this Motion is to say that, if the power is only rarely to be used—in exceptional circumstances, when intervention is justified—then the way to deal with this is to make that case to Parliament, to put it up for proper scrutiny and to show the evidence. If we are potentially to deprive people of their right to be consulted, then at least let Parliament do a proper job of examining this.

I now turn very briefly to Motions D1 and K. I thank the noble Lord, Lord Blencathra, for presenting Motion D1 today. It seeks to ensure that health service procurement of all goods and services avoids modern slavery; in other words, it takes us further than Motion D. I thank the Minister for the move forward contained within that Motion; however, if the noble Lord, Lord Blencathra, wishes to test the will of the House, we on these Benches will certainly be in support.

I congratulate my noble friend Lord Hunt and other noble Lords for their persistence in ensuring that Motion K is before us today. Again, I thank the Minister for being so responsive on this point. I hope that, in the votes that follow, your Lordships’ House will swiftly take the opportunity to ask that we might further improve this Bill.

Ockenden Report

Baroness Walmsley Excerpts

Wednesday 30th March 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the Minister for bringing this Statement to your Lordships’ House and for the reassurances he has given and the actions that have been, and will be, taken. I listened to this Statement in great sadness and shock, as I know that so many others have as they heard the news unfold. I will start by expressing heartfelt gratitude to the families who came forward. We would not be here today had it not been for their persistence and the resilience they have shown across over 20 years in their fight for justice. I also thank Donna Ockenden and her team for this landmark report. I utterly regret the appalling circumstances in which it has come before us.

Today marks an important milestone for hundreds of bereaved families who are seeking justice. As the Minister said, it is not the end, because West Mercia Police are investigating some 600 cases. This report lays bare the disturbing truth of what families have had to face and why their fight for justice has been so fierce. The inquiry examined cases involving nearly 1,500 families in instances crossing over decades. It concluded that hundreds of babies were stillborn, died shortly after birth or were left severely brain damaged, and that mothers died giving birth while others were made to have natural births despite the fact that they should have been offered a caesarean. This must have been cruel. The report says that over 200 babies and nine mothers might have survived if they had received the right care.

In addition to what we have read about the actual circumstances, the report also has huge implications for the future of maternity care. The report, of course, makes for harrowing reading—cries for help going unheard; parents having to try to resuscitate their own children because there was no one there to help; and women and babies dying needlessly because the mothers were not listened to. That women were silenced and ignored at their most vulnerable, when they were relying on the NHS to keep them and their babies safe, is shameful. In addition to the NHS, the CQC also failed in its duties as it missed opportunities to stop the poor maternity care.

No woman should ever have to face going into hospital to give birth not knowing whether she and her baby will come out alive. However, these were not just one-offs or isolated incidents of negligence. There was an institutional failing in a system riddled with a toxic culture of bullying, ignoring mothers and deliberating keeping caesarean rates low, even though that was not the right thing for the mother. The entire culture failed to take up the many opportunities to realise that there was a serious problem and to act. We are where we are today because of the persistence and resilience of the families who have suffered, and continue to suffer, and because of their refusal to give up the fight to expose these failings.

The only comfort we can offer them is that their voices have been heard, and that we commit today, in your Lordships’ House, to ensure that these failings are never repeated. For too long, patient safety issues and the voices of women have been an afterthought, leading to the kind of crisis we saw in this NHS trust—and this must change. There can be no compromise on patient safety, which has to be a priority for both health professionals and Ministers.

With this in mind, I will put some points to the Minister. I certainly welcome the acceptance of all 84 recommendations, but how will the Minister monitor the progress that is being demanded through these recommendations, and when and how will this be reported to Parliament?

The report makes it clear that safe services cannot be run unless there is a culture of transparency and accountability. Can the Minister therefore explain how he intends to ensure an open culture within the NHS, with a willingness to learn, particularly within maternity services, and for future failures to be identified and corrected quickly?

Underpinning issues in maternity care, as is the case across so much of our NHS, is the workforce, which is why we have been pushing so hard on this matter in the Health and Care Bill. The NHS is now losing midwives faster than it can recruit them. A recent CQC survey shows that almost a quarter of women were unable to get help when they needed it during labour. Hundreds of pregnant women were turned away from maternity wards last year because there were not the staff available to care for them. What is being done to ensure that the NHS can recruit the midwives that it needs? What is being done to keep the midwives we have in post?

It is only with the necessary workforce that the NHS will be able to ensure that women receive the care that meets their needs and prioritises their safety. That security and respect is all that the families who suffered so much at Shrewsbury want, and it is all that the women who put their and their babies’ lives in the hands of the NHS want. This has to be reasonable, and it has to be done.

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for repeating the Statement. We must acknowledge that the vast majority of midwives, nurses and clinicians providing maternity services do their very best to provide good care for their patients. It must have been with great sadness that they read—as we read with great sadness—today’s Ockenden report and the previous interim report, which have shone a light on a shocking range of shortcomings in maternity services, leadership and inspections at Shrewsbury and Telford Hospital NHS Trust. I hope that this report will lead, in future, to mothers and babies being as safe as we can possibly make them in our NHS.

The report has been made possible only by the bravery and persistence of all those families who were prepared to go through their trauma all over again when they gave evidence of what happened to them and the awful consequences and pain that followed. From these Benches we offer our thanks and sympathies to all those suffering bereavement and ongoing health issues. The report is also a tribute to the fine work of Donna Ockenden and her team, who used both their professional knowledge and their human qualities to conduct the review with dedication, empathy and attention to detail.

I also commend those members of staff who were prepared to give very candid evidence to the investigators. Such people are sometimes referred to as whistleblowers; I call them courageous, public-spirited professionals. However, their actions were not without risk to themselves and their future, as with many whistleblowers in the health and care services. I therefore ask the Minister: will the special health authority, which is being set up to continue the maternity investigation programme currently run by the Healthcare Safety Investigation Branch, have the same safe-space confidentiality for those giving evidence in the future as the HSSIB, which is currently being legislated for in the Health and Care Bill? The Minister will know how strongly both Houses of Parliament feel about the importance of giving staff absolute confidence that the material they disclose remains confidential in the interests only of learning and improving patient safety rather than laying blame.

The report stated that:

“There were not enough staff, there was a lack of ongoing training, there was a lack of effective investigation and governance at the Trust and a culture of not listening to the families involved.”


I therefore first acknowledge last week’s funding announcement of £127 million by NHS England for maternity services, although this is still significantly short of the £200 million to £350 million recommended by the Health and Social Care Select Committee in June 2021. However, it is surprising to me, in the light of Donna Ockenden’s clear finding that staff shortages risk lives, that the Government, in the other place, continue to resist the amendment of the noble Baroness, Lady Cumberlege, voted for by your Lordships, on assessing, reporting and planning for safe levels of staffing in the NHS and social care. Proper planning cannot take place without an accurate and independent assessment of current supply and future need. In light of the Ockenden report, will the Government change their position on this?

There are currently 2,000 midwife vacancies in the NHS, according to NHS England figures published last month, and the number of midwives in post has fallen since last year. This is going in the wrong direction.

In the debate on the interim report in your Lordships’ House on 14 December 2020, the noble Lord, Lord Bethell, denied that the issues in Shrewsbury and Telford maternity services were linked to understaffing. Does the noble Lord, Lord Kamall, now accept that staffing is an issue? Can he say what will be done about it? As Ms Ockenden rightly says, we need to create a situation where midwives, nurses and clinicians want to remain in the NHS. We will not do that if they are constantly having to battle against staff shortages.

The report also highlights the need for women to be listened to when engaging with maternity services, rather than experiencing a culture of services based around targets for a particular kind of birth. I need hardly say that giving birth is a very personal matter and women’s preferences must be listened to and provided where clinically appropriate. Ockenden emphasised that listening to women and empowering them in their care will lead to improved outcomes. I therefore remind the Minister of the parallel between this situation and telemedicine abortion treatment, where the Government are failing to listen to women’s clinically safe preferences. I was pleased to hear recently that Members of the House of Commons have been listening to women, rather than to the Government.

The report pointed out that what happened in Shrewsbury and Telford was not an isolated incident. In July 2021, 41% of maternity services in England were rated as inadequate or requiring improvement. That is why the report made 15 recommendations aimed at all maternity services across the country, and I understand that the Government have accepted them all. Can the Minister therefore say how implementation of these country-wide recommendations will be monitored and reported on? Will that duty be given to the CQC or will there be a special system?

I finally turn to training. In the debate on the interim report in December 2020, my noble friend Lord Scriven pointed out that:

“In 2017, the £8.1 million national maternity training fund was withdrawn. Does the Minister now, in hindsight, regret this, and will he seek to re-establish this fund urgently?”—[Official Report, 14/12/20; col. 1522.]


I echo his question today. Will the money for training be ring-fenced and will midwives going for training always be covered by similarly experienced staff?

Despite earlier events, similar although smaller in scale to what happened at Shrewsbury and Telford, there has not been systematic integrated change. Can the Minister therefore assure us that this will happen now, especially under the new regime of integrated care systems? Who will be responsible at the level of NHS England, ICSs and individual trusts, as well as politically, for ensuring that, this time, the changes highlighted by Donna Ockenden are implemented in a timely way, so that no more families will be avoidably deprived of their precious child, mother or wife?

[Lord Kamall (Con)]

I begin by thanking both noble Baronesses for their questions and resisting the temptation to bring too much politics into it. This is an issue that we all feel very strongly about. I will try to answer as many questions as I can; I apologise in advance if I do not answer all the questions today. I have quite a big briefing pack, which I have been through a number of times. I commit to writing to noble Lords and the noble Baronesses to fill the gaps.

As the noble Baronesses said, we accept all the actions outlined in the report. The Secretary of State has asked NHS England and NHS Improvement to write to all the trusts across England about the final Ockenden report, and will ask all maternity services across England to assess their services against the 15 immediate and essential actions outlined in the report —and take action where they fall short. As the noble Baronesses acknowledged, NHS England and NHS Improvement have announced that they will invest £127 million in maternity care; that money will go towards the NHS maternity workforce and improving neonatal care.

We have also seen work under way to tackle some of the key issues in the report, such as the £5 million for the Avoiding Brain Injury in Childbirth collaboration project, the establishment of a special health authority to continue the work, which I shall go into later, and the development of 17 new maternal medicine networks. We will update the House as appropriate on the monitoring.

We have to look at the culture; I completely understand the points made. Strong leadership will now be established across the system, with the appointment of named regional and local maternity safety champions led by two national maternity safety champions, Matthew Jolly and Jacqueline Dunkley-Bent. In every trust, front-line maternity safety champions—one obstetrician, one midwife and one neonatologist—will work closely with a board maternity safety champion to promote unfettered floor-to-board communication. We have also tried to make progress in shifting away from a defensive blame culture in healthcare towards a culture in which we recognise and accept when things go wrong and look to learn.

I thank noble Lords for their engagement, particularly over the HSSIB, during the passage of the Bill. I think we all agreed that it was important that we kept as many people as possible out of the “safe space” to encourage people to come forward. However, as we have seen in these cases, people were bullied and disincentivised from coming forward; some even withdrew their names.

Last year, there was a £500,000 fund to provide maternity leadership training for NHS maternity and neonatal leaders. We looked at addressing the issues raised in the first Ockenden report—to use that phrase again, “between ward and board”—to make sure that there was proper accountability and training.

On workforce, as I said, NHS England and NHS Improvement have the investment. In addition, there is £95 million in new funding to support the recruitment of 1,200 more midwives and 100 more obstetricians, and to support multidisciplinary team training. The department has also commissioned the Royal College of Obstetricians and Gynaecologists to develop a new workforce planning tool to improve how maternity units calculate their medical staffing requirements. The tool will calculate the number of obstetricians at all grades required locally and nationally to provide a safe, personalised maternity service within the context of the wider workforce. Health Education England has also been working with stakeholders towards a targeted increase of 3,650 midwifery student training places by the end of 2022-23.

One concern that was raised when I spoke to officials and asked for briefings before this evening was whether reports such as this one would disincentivise people from coming forward to work in midwifery. We have to be very careful that we are as open as possible and that we make sure that the system learns where there are problems. People are human, and they will be concerned about coming forward. So we have to get the right balance and have safety, training and awareness all the way through, making sure that it is patient-centred.

I shall try to answer as many questions as I can; I know that other noble Lords want to come in. In terms of deterring midwives from leaving—I know that there is a real concern here—the NHS people plan focused on improvement and retention. There is a well-being guardian role focused on: healthy work environments and safe spaces; empowering line managers to hold meaningful conversations; emotional and psychological support; a dedicated health and care staff support service; a bereavement helpline; free access to a range of mental health apps; a range of counselling and talking therapies; and online resources. Money has also been invested in 14 mental health hubs across the country, and £6 million has been set aside for a national support service for critical care staff.

We have to tackle bullying and harassment in the service. The people plan deals with a number of issues on that; there is also a visibility and respect framework and a toolkit. A number of projects and pilots are under way across the NHS to support organisations to see what works and where we can learn from that.

There were some questions about the special health authority, which we see as a key part of work to improve the investigation and learning culture. The investigators will carry out timely and independent individualised investigations into maternal and neonatal deaths and incidents across England. The SHA’s investigation will be family-centred and mother-centred, but it will also provide families with answers to questions about why an incident occurred or why their baby died, rather than just sweeping this away. The learning from these investigations will be shared at a local level and across the wider system. As an independent body, the special health authority will continue the work of the HSIB from 2023, and maternity investigations will continue during this time, without interruption, until the SHA is fully operational—this is specifically for maternity.

As for what the Government are doing to make sure that women’s voices are heard, we have the women’s health strategy—I know that noble Lords have heard that before—and we are looking at multidisciplinary training in the maternity workforce. There is a debate within the training community about whether you train someone to be a midwife first or whether they should start as a nurse and have nursing skills first. I will stop there to allow other noble Lords to ask questions.