Health and Care Bill

Lord Kamall Excerpts

Tuesday 18th January 2022 Lords Chamber

Moved by

[Lord Kamall]

That the instruction of 5 January be revoked and that it be an instruction to the Committee of the Whole House to which the Health and Care Bill has been committed that they consider the bill in the following order:

Clause 1, Schedule 1, Clauses 2 and 3, Clauses 5 to 14, Schedule 2, Clauses 15 to 17, Schedule 3, Clauses 18 to 27, Schedule 4, Clause 28, Schedule 5, Clauses 29 to 40, Schedule 6, Clauses 41 to 43, Schedule 7, Clauses 44 to 61, Schedule 8, Clauses 62 and 63, Schedule 9 ,Clauses 64 to 68, Schedule 10, Clause 69, Schedule 11, Clauses 70 to 74, Schedule 12, Clauses 75 to 80, Clause 4, Clauses 135 to 144, Schedule 17, Clauses 145 to 148, Clause 95, Schedule 13, Clauses 96 to 109, Schedule 14, Clauses 110 to 120, Schedule 15, Clause 121, Clauses 81 to 94, Clauses 122 to 134, Schedule 16, Clauses 149 to 154, Title.

Motion agreed.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 3 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I think it is fair to say that the debate today across your Lordships’ House has shown that it is impossible to understand how specialist palliative care can be regarded in any logical, practical or humane sense as something so different. I am sure that the Minister will do his very best to address that in his consideration of these important amendments.

I am grateful to noble Lords for making this debate possible by bringing forward these amendments and making sensitive, informed and often personal contributions to underline the need to ensure that specialist palliative care features in the Bill. I am particularly grateful to the noble Baroness, Lady Finlay, for setting out the fact that if we are to say that the NHS is cradle-to-grave, that must absolutely shape how we approach such services. The noble Baroness and others, including the right reverend Prelate, talked about inequality and the fact that, when we speak of specialist palliative care, inequalities are not just in the course of someone’s life but actually to the very moment they leave this world. That really had an impact on me, because that surely is an unfairness too far for us to just stand by.

Taking action could not be more pressing a need. We know that the UK’s population is ageing rapidly. The Office for National Statistics predicts that, in 20 years’ time, there will be twice as many people over the age of 85, while Marie Curie’s analysis for Cardiff University has concluded that the number of people needing palliative care will rise by 42% by 2040. This is a challenge to our society which will not go away. As the noble Lord, Lord Patel, said, we should be able to live our lives in anticipation of a good death. The right reverend Prelate spoke of the difference of witnessing a good death, as opposed to a death that is less than what it should be.

It is important to say that, even before the pandemic, experts at the Royal College of Physicians, the Care Quality Commission, the health service ombudsman and Compassion in Dying were all sounding the alarm on how those approaching the end of their life, and their loved ones, did not, in so many circumstances, feel supported to make the decisions that faced them and that it was impossible to turn away from. They did not know what choices were available, and, sadly, were not given an honest prognosis.

The amendments in this group offer dignity to the greatly increasing numbers who will need this care, and would bring in moral and well-evidenced measures essential to providing the tailored care that is needed in the final stages of one’s life. This includes sharing information about a person’s care across the different professionals and organisations involved in that care, and providing patients and their loved ones with specialist advice, 24 hours a day, every day of the week—which expert practitioners, including those at Cicely Saunders International, have been crying out for.

My noble friends Lord Hunt and Lord Howarth, the noble Baroness, Lady Finlay, the noble Lord, Lord Patel, and others underlined the work, role and contribution of the hospice movement, and also spoke about their incredulity at the reliance on charitable funding. Who in this Committee can be surprised at that feeling? I hope the Minister will be able to speak to that absolutely crucial point because, even before the pandemic, many hospices were suffering from poor decisions from clinical commissioning groups, poor practice, and a lack of support and recognition of the vital role that they play. That impacts on the individuals who so sorely need their services.

Marie Curie reported that 76% of carers who lost a loved one during the pandemic felt that they did not get the appropriate care that they needed. This is an opportunity to fix the problem. Every day, pandemic or none, the quality and personalisation of specialist palliative care will dictate how dignified and comfortable —or not—the end of a life will be, and how much of a burden will be borne by the carers and loved ones: whether, as the noble Baroness, Lady Hollins, reminded us, those left behind are adults or children. These amendments seek to get it right, and the feeling of this Committee could not be clearer. I look forward to the Minister’s response.

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

My Lords, as we reach the closing minutes of today’s debate and reflect on the wonderful contributions from across the Committee, perhaps it is fitting that we also talk about the final chapter of life, as the right reverend Prelate the Bishop of Carlisle said.

I thank all noble Lords who spoke very movingly today, particularly the noble Baronesses, Lady Meacher, Lady Hollins and Lady Walmsley, the noble Lord, Lord Patel, and my noble friends Lady Hodgson and Lady Fraser, who spoke about their own experiences. I also thank the noble Baroness, Lady Merron, for pointing out the 42% figure, which is very important to recognise. I thank the noble Baroness, Lady Finlay, for the engagement we had prior to this debate and for her helpful engagement with our officials and the Bill team. I hope that will continue.

What is interesting about this is that when I was younger, we as a society found it very difficult to talk about death. I was once told by my parents that the British find it very difficult to talk about death, except in faith groups. It is interesting that, over time, as we have become an ageing society, we are talking, as a matter of fact, about death. We talk about our wills, financial planning, and planning for care at the end of our life. It is appropriate that we recognise this. The fact is that, nowadays, when we look at the hospice movement, we do not think of it as a quaint little service or a charity; we think that it provides an essential service to help someone at the end of their life, and we recognise the difference between palliative care and end-of-life care.

I hope that I can reassure the Committee that the Government are committed to ensuring that people of all ages have the opportunity to benefit from high-quality, personalised palliative and end-of-life care, if and when they need it. I also pay tribute to the noble Lords, Lord Howarth and Lord Scriven, for their contributions. The noble Lord, Lord Howarth, talked about the role that the arts play in helping those at the end of their life, which he has talked about in a number of discussions we have had on this issue. Like the noble Lord, Lord Scriven, he made the point that while you want to see the state do more, you do not want to push or squeeze out the hospice movement, as we need the right balance.

Eating Disorders

Lord Kamall Excerpts

Monday 17th January 2022 Lords Chamber

[Baroness Bull (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a vice-chair of the APPG on Eating Disorders.

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

We are working to ensure that people of all ages with an eating disorder, or who are at risk of developing one, have access to the right support in the right place and at the right time. We are delivering on the ambitious transformation plans outlined in the NHS Long Term Plan and children and young people’s mental health Green Paper and provided additional investment this year to address pressures arising during the pandemic.

[Baroness Bull (CB)]

Does the Minister agree that improving support for eating disorders depends on improving understanding of their causes, prevention and treatment? Eating disorders account for 9% of mental health conditions in the UK but receive only 1% of mental health research funding. This leads not only to major evidence gaps but to fewer researchers, less research and the ongoing stigmatisation of the illnesses as a niche concern. Will the Minister’s department consider working with the NIHR on a long-term eating disorder research strategy to break this underfunding cycle, as it has for other health challenges, so that more effective support can be targeted on their prevention and treatment?

--- Later in debate ---

[Lord Kamall (Con)]

First, I pay tribute to the noble Baroness for all the work she has done in this area, making sure that we are all aware of this issue and keeping it on the agenda. In answer to her specific question, the department has invested nearly £110 million in mental health research, including research on eating disorders through the NIHR, as she mentioned. This includes the Eating Disorders Genetics Initiative and a systemic review led by the Evidence for Policy and Practice Information and Co-ordinating Centre. UKRI has announced funding for a £3.8 million study on eating disorders to inform prevention and early prevention in young people. This research is being led by King’s College London and the University of Edinburgh.

[Baroness Parminter (LD)]

My Lords, the latest NHS data shows a continuing increase in the number of people being hospitalised for eating disorders, mainly in the 18 to 39 age group, yet there is still no adult waiting time standard for people with eating disorders. This is despite knowing that access to quality community care can reduce the number of hospitalisations and unnecessary deaths. When are this Government going to introduce an adult waiting time standard for people accessing treatment for serious eating disorders?

[Lord Kamall (Con)]

As noble Lords can imagine, because of the pandemic, sadly, waiting times have gone up, but we are making sure that we are doing as much as we can to address that. Longer term, we are focusing on prevention, not only cure. We are also making sure that we are able to understand the various forms of eating disorder better. It is very simple to lump them all together, but there are different elements and you can distinguish between them. Then we will, I hope, be able to tackle that as much as possible.

[Baroness Janke (LD)]

My Lords, given that many young people with eating disorders find it very difficult to seek help and identify themselves, what specific additional resources have been provided for schools to help and support young people with this actually life- threatening illness?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about how we identify children and young people who are suffering from these disorders or may be a few steps away from it. We know that there are programmes from the Department for Education and our department to tackle mental health issues in schools, identifying pupils and encouraging them to come forward, to talk to a counsellor in the school, and making sure that there is signposting in the right place to ensure that we can tackle their issues.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister mentioned that eating disorders do not always present in the same way. He will be aware that some fluctuate, moving from chronic to acute over a period and back again. When people seek treatment for eating disorders, at the moment those who can afford it are not even able to access treatment in the private sector. If they were able to, however, would they then be able to access NHS treatments at a later date, for example, should they not be able to afford to continue with private treatment?

[Lord Kamall (Con)]

The noble Baroness raises a really important point. It is an issue that was raised over the weekend, in an individual case. I know that we are always advised as Ministers not to get involved in individual clinical decisions, but in this this case a child had not yet got a bed and the parents wanted to take them out for private treatment until a bed became available. They were told that if they went to use the private sector they would be put at the back of the list. I am trying to get more details on this but it seems a lack of common sense. I want to understand why it is happening, but I have not had an answer yet.

[Baroness Manzoor (Con)]

My Lords, what are the Government doing with regard to working with industry, particularly the fashion industry? At the moment, there is great emphasis on size-zero models, which cannot really be helpful when linking it to the question that the noble Baroness asked previously. It is not a good image, or setting the right image for people—that is, for boys and girls.

[Lord Kamall (Con)]

The issue of poor body image that my noble friend raises is very important. The Government are addressing known risk factors through both universal and targeted interventions. At the top level, that means looking at the Better Health and Every Mind Matters content, which focuses on support for mental health and well-being. Poor body image and low self-esteem are topics addressed there. It is also about looking at what pupils expect and at the prevention concordat for better mental health programmes, as well as working as part of the anti-obesity strategy to make sure that we get the right balance. Sometimes when you focus on information on packets, for example, it can have unintended consequences for those with eating disorders. Every time we look at labelling, we have to make sure that we have addressed those unintended consequences on people with eating disorders, so that they do not react negatively to it and perhaps indulge in behaviour that we do not want to see them indulging in.

[Baroness Merron (Lab)]

My Lords, the Royal College of Psychiatrists has warned that the hidden epidemic of eating disorders has surged during the pandemic, with many community services overstretched and unable to treat the number of people who need help. Will the Minister publish data about the number of people waiting for eating disorder treatment better to understand and meet the scale of the demand? Will he deliver a workforce plan to tackle staff shortages in eating disorder services so that it may be possible to treat everyone who desperately needs this help?

[Lord Kamall (Con)]

I thank the noble Baroness for raising the issue of the backlog as a result of the pandemic. We have seen eating disorder services continue to face increasing demand, especially as a result of lockdown and its mental health impact. The number of young people entering urgent treatment has increased by 73% between 2019-20 and 2021, and the numbers waiting for treatment have also increased from 561 to 2,083. To make sure that we meet the standard and get those waiting times down, we have invested an extra £79 million this financial year, and we are working with systems across the country to see how we can make sure that we address young people and adults who need access to this treatment.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that it is a very serious condition that 71% of the British people over the age of 30 are obese or overweight? The problem with this is that it interferes with the immune system, which makes them much more vulnerable to all kinds of diseases, not least infections. If we want to deal with the next pandemic now, we have to get people to reduce their weight so that obesity does not interfere with their immune systems.

[Lord Kamall (Con)]

The question from my noble friend highlights the difficulty of dealing with such a sensitive area. You have to be very careful how you address the issue of obesity. For example, it is quite right that we want to get the rates of obesity down, because it does lead to a number of other conditions that we have discussed many times here. One thing that you have to look at, however, is the unintended consequence of any laws. One possible unintended consequence is that some of the measures to tackle obesity, such as looking at food labelling, might affect people who have eating disorders. Every time we look at the obesity strategy, therefore, we make sure that we consult charities that look after people with eating disorders to ensure that we have the right balance. We will not always get it perfectly right, but we will try our best.

[Baroness Wheatcroft (CB)]

My Lords, anorexia nervosa is one of the most pervasive of mental health disorders. It can sometimes be successfully treated only in specialist in-patient units. What plans are there to grow the number of specialist in-patient beds? In 2019, the Government promised that people would not be sent to out-of-area beds after 2021, but I do not believe that that is currently the case.

[Lord Kamall (Con)]

I am sure that the noble Baroness will appreciate that we had a strategy to tackle obesity, but some of it has been knocked back a bit by Covid and having to tackle the backlog. However, we are looking at ways to ensure that the strategy gets back on track as we emerge from lockdown and there is, we hope, less pressure on the NHS.

Covid-19: Vaccinations for School Pupils

Lord Kamall Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Watson of Invergowrie]

To ask Her Majesty’s Government what progress they have made on delivering vaccinations for Covid-19 to school pupils since the Christmas holidays.

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

The Covid-19 vaccination programme continues rapidly, with nearly 52% of 12 to 15 year-olds vaccinated as of 15 January 2022. We vaccinated over 372,000 12 to 15 year-olds in England between 17 December 2021 and 15 January 2022—that is nearly 400,000 in a month, which included the Christmas break. Vaccinations for children aged 12 to 15 can be booked in out-of-school settings through the national booking service, alongside the ongoing school-based offer. We currently have 314 sites offering appointments that can be booked via the national booking service.

[Lord Watson of Invergowrie (Lab)]

I thank the Minister for that very full response but the figures he has quoted are at odds with those issued just last week by the Department for Education on the vaccination of 12 to 17 year-olds. The number of pupils absent from school with a confirmed contraction of coronavirus was up by nearly 50% over the figure for December. It cannot be a coincidence that only 40% of 12 to 17 year- olds, in the DfE’s own figures, have been vaccinated. This shows, whether it is the Department of Health or the Department for Education, that the Government have really failed to get a grip on the measures necessary to keep children learning—whether it is the supply of testing kits or classroom ventilation. I ask the Minister: what urgent action will the Government take to increase the level of vaccination among school pupils?

[Lord Kamall (Con)]

I think the noble Lord is being slightly unfair in the sentiment of his question. We have to remember that, when it came to vaccinating children, there was a huge debate around, first, whether it was ethical to do so and, secondly, whether the vaccines used for adults were effective in children. We could not really do any of that until we had sufficient data. It would have been irresponsible just to have pushed ahead without the data. Once we got the data, we started the vaccination programme for 16 and 17 year-olds and then for 12 to 15 year-olds, and we are pushing through as much as possible. Parents can book for their children on a national booking service. We expect many more parents to do so.

[Earl Howe (Con)]

My Lords, the noble Baroness, Lady Brinton, has indicated her wish to speak virtually, and I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, many parents are still saying that they have not heard when their clinically extremely vulnerable five to 11 year-olds will get their vaccinations, despite the JCVI saying that they should. Last week’s update to the GP green book now includes severely CEV children as eligible for the third primary dose, which is progress. However, there is no news for CEV young children not classed as severe, so can the Minister please say what he will do to ensure that GPs will call all these children for their vaccinations as soon as possible?

[Lord Kamall (Con)]

As the noble Baroness says, the JCVI advised on 22 December that children aged five to 11 in a clinical risk group, or who are a household contact of someone who is immunosuppressed, should be vaccinated. GPs and hospital consultants are now urgently identifying the children eligible, and we expect rollout to have started by the end of this month, with children and parents starting to be called up for appointments by the NHS locally. The message here is that there is no need for parents to contact the NHS; the NHS will make contact with the parents or carers of those eligible. Just to further reassure parents, we will be using a paediatric Pfizer vaccine authorised by the MHRA for use in this age group.

[Baroness Stuart of Edgbaston (CB)]

My Lords, given that it is safest to administer the vaccinations in a school setting, and unlikely that this round of vaccinations is the last one, has the Minister given any consideration to expanding the specialist community health nurses, commonly known as school nurses? Their numbers have been decreasing over the last 10 years. They could play a role in the future administration of vaccines in school settings.

[Lord Kamall (Con)]

I recall well being sent to the school nurse—sometimes we have fond memories, and sometimes less fond memories, of being sent to the school nurse. The noble Baroness makes a really important point. I will make inquiries and get back to her.

[Lord Udny-Lister (Con)]

My Lords, can my noble friend the Minister update the House on what actions the Government have taken to protect school pupils and teaching staff from the reckless behaviour and damaging misinformation being propagated by anti-vax protesters?

[Lord Kamall (Con)]

My noble friend raises a very important point, which I know a number of other noble Lords have also raised. In a free society, we have to get the balance right between freedom of speech and ensuring that people have a right to say even those things with which we may disagree fundamentally, while ensuring that misinformation is not spread. The department has now provided information and guidance to schools on how to handle any misinformation, and who to contact if there are protests which step beyond the line of acceptability and contravene the law. The police now have comprehensive power to deal with the activities, especially those which spread hate or deliberately raise tensions through violence or public disorder. I am sure many people will be aware of the attacks on vaccination centres in Truro in October and in north Wales and at the Bromley Civic Centre earlier this month. That was going way too far on freedom of speech, and we want to make sure that we deal with the people who take part in these acts.

[Lord Boateng (Lab)]

My Lords, does the Minister agree with the World Health Organization that the vaccination of children in the wealthy world should not be at the expense of the vaccination of health workers and vulnerable adults in the developing world? If so, what more can the UK do to ensure that the developing world has access to vaccines and the capacity to manufacture them?

[Lord Kamall (Con)]

I once again pay tribute to the noble Lord, Lord Boateng, for raising this issue and for the number of times he has raised similar issues about the developing world over the years. Since I became a junior Minister of Health, I have been involved in many meetings with the G7 and G20, and in bilateral meetings with other Health Ministers. This item always comes up on the agenda and is something that the British Government have pushed. We are leading donors to the international COVAX programme and are working across the world, with other countries and with manufacturers, to make sure that we get the vaccines to those who really need them. While we here in this country complain about third and fourth doses, for example, there are still many people in many countries who have not even had their first vaccine. In the longer term, that is not right for anyone.

[Lord Addington (LD)]

My Lords, would the Minister give us a little bit more of an insight into the general policy for vaccination of children at schools? Although we have problems here, we have a history of people resisting and giving bad information. Is there a coherent strategy that will come out for school-age vaccination that we can refer back to as a model for the future?

[Lord Kamall (Con)]

One of the important things we all have to learn, from what we have been through and are still going through, are lessons for the future—not only for future Covid vaccines there may need to be but for all vaccination programmes and, perhaps, future pandemics. One of the really important things about this is making sure we get the right information. We are working with schools to make sure teachers and parents have the right information and also know the risks. Many people will know that, over the weekend, 16 and 17-year-olds were called for their booster if there was a sufficient space since their last dose, and we are now looking at how we vaccinate 12 to 15 year- olds. We are looking in more detail at whether it is safe for five to 11-year-olds, but at the moment the advice is not there.

[Lord Blackwell (Con)]

My Lords, as my noble friend has said, this country is behind some other countries in rolling out vaccinations to five to 11 year-olds. He will also be aware that the extent of Covid in that age group is a major source of infection for parents and, therefore, society as a whole. Have the Government taken account, or will they take account, of the wider social and economic benefits of vaccinating that age group and weigh them up alongside the medical evidence?

[Lord Kamall (Con)]

The JCVI will continue to look at the new data as it emerges and recommend whether we boost 12 to 15 year-olds. But when we look at the vaccination strategy, we look not only at the tackling of the specific coronavirus or variant but also at the wider implications. For example, many noble Lords have spoken eloquently about the unintended consequences for mental health issues of lockdown. Beyond that, we have to look at societal and social issues and the way people, businesses, charities, et cetera are affected in doing their work. We always make sure we take a balanced approach, looking at the science, the wider medical issues and the unintended consequences.

[Viscount Stansgate (Lab)]

My Lords, the House is united on the importance of children’s education continuing, but it is the lack of vaccinations not just among children but among the teaching workforce that may interrupt their education. Do the Government have any estimate of the proportion of the teaching workforce that has not yet been vaccinated or is off work for Covid-related reasons?

[Lord Kamall (Con)]

The noble Viscount raises an important point. As we are expecting our children to be vaccinated, it is important that teachers are also vaccinated. It is one of the reasons we are looking at VCOD—vaccination as a condition of deployment—in the health service. In answer to the noble Viscount’s specific question, I am afraid I do not have the information with me, but I will try to speak to the Department for Education and write to him.

Ambulance Queues: Health Outcomes

Lord Kamall Excerpts

Thursday 13th January 2022 Lords Chamber

[Lord Scriven (LD)]

My Lords, I beg leave to ask the Question standing in my name and draw the House’s attention to my interests in the register.

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

We recognise that waiting times can impact outcomes, so patients in queues remain under constant clinical supervision and care and are prioritised according to need. Delays tend to be concentrated in a small number of hospitals, with 29 acute trusts across 35 sites responsible for 57% of the 60-minute handover delays nationally so far this winter. These trusts are receiving intensive support to improve, including through placement of hospital ambulance liaison officers and the safe cohorting of patients.

[Lord Scriven (LD)]

My Lords, half a million acute bed days each year are lost due to delays in discharge directly attributable to non-availability of social care, which leads to bottlenecks in emergency departments and ambulances being unable to unload patients. Does the Minister agree that the split of money raised by the health and social care levy over the next three years therefore needs to be more generous to social care, so people stop having to wait up to seven hours in the back of ambulances?

[Lord Kamall (Con)]

As the noble Lord will be aware, when the charge was initially announced it was intended to help with social care, which has been neglected for a number of years under successive Governments. Given the pressures of the backlog, the NHS has decided to divert some of those resources to help tackle it. We have invested money in social care in the short-term winter plan, and in the longer term we have announced extra investment to ensure that social care is an attractive career and offers real prospects.

[Baroness Finlay of Llandaff (CB)]

My Lords, does the Minister recognise that his response, saying that this involves a small number of trusts, does not address the data from NHS England for the seven days to January 2, which showed that 23% of all arrivals by ambulance had delays of half an hour or more—that is over 19,000—and that some 10% of patients waited more than an hour to be handed over? This meant that those ambulances were also unable to deliver first aid and first implementation of treatment to people who were waiting. Therefore, when patients arrived at emergency departments, they were even sicker than necessary, and it may be that some lives were lost.

[Lord Kamall (Con)]

The noble Baroness makes an important point. In anticipation of the winter crisis, last year we published the Urgent and Emergency Care Recovery 10 Point Action Plan to look at the direct pressures on not only A&E but the call centres, and at some of the wider system issues. For example, when people cannot get access to their doctor, they tend to go to A&E. At other times, they cannot get the replacement medication they want and have to call an ambulance to go to A&E and get it. We are looking at some of the wider system problems to make sure we address the backlog.

[Baroness Thornton (Lab)]

My Lords, NHS workers on the front line have been warning for months and months that the service is under strain due to a combination of waning workforce, Covid, respiratory infections, a backlog of patients and a build-up of health problems over lockdowns. The Royal College of Emergency Medicine has been calling for months for a response from Ministers to provide short-term and long-term solutions. We called on the Health Secretary last summer for urgent additional support to be put in place. Why are we still waiting for that leadership and necessary support to materialise?

[Lord Kamall (Con)]

I am sure the noble Baroness will acknowledge that a number of people have been calling for ways to address this. The Government announced the Urgent and Emergency Care Recovery 10 Point Action Plan last year, which includes supporting 999 and 111 services, looking at primary care and community health services, greater use of urgent treatment centres, increased support for children and young people, better communications and call handling, improving inflow and hospital discharge, looking at mental health needs and a number of other issues. In each of those 10 points we have drilled down on working with trusts and the ambulance service to make sure we can address the issues that are currently being raised.

[Lord Flight (Con)]

My Lords, could the Government look at how many lives have been lost as a result of delays? I suggest this might be more of an issue than the Government are aware of.

[Lord Kamall (Con)]

We regularly talk to the NHS—every day, in fact. We have, for example, daily omicron calls. Looking at some of the data, over 925,000 calls to 999 were answered by the ambulance service in December 2021, which is nearly 30,000 calls a day. That is 2% more than in November 2021, 22% more than in November 2020 and 9% more than in December 2019. We have invested in more people in the call rooms, working with BT to better handle the calls, and ensuring we have more staff where we need them to handle the whole system and ensure we can respond quicker.

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

[Baroness Brinton (LD) [V]]

My Lords, yesterday NHS England data showed that trolley waits of more than 12 hours in A&E rose in December to just under 11,000, which is three times higher than in December 2020. One hospital reported that it had a dozen patients waiting on a trolley for a bed for over 24 hours. The Minister has talked about extra money, but without staff and bed capacity in both hospitals and care homes, the crisis remains. Can he say what the Government are doing right now to help alleviate the current crisis?

[Lord Kamall (Con)]

I thank the noble Baroness for giving me the opportunity to say what the Government are doing right now. We are working closely with ambulance services, NHS England and the Association of Ambulance Chief Executives to reduce the handover delays. The 10-point plan I referred to earlier goes into detail about how we handle this, both in handling calls at call centres—some calls are not emergencies, for example, and patients are directed elsewhere—and in making sure that the wider system is available to make sure that patients are unloaded within the 15-minute target and that ambulances are turned around as quickly as possible. Where we have spotted disproportionate pressures in the system, as in the 29 hospital trusts across 35 sites, we have focused more resources there.

[Lord Forsyth of Drumlean (Con)]

My Lords, I appreciate that my noble friend has to read out what he has in his brief, but would he take time to read the report on social care published by the Economic Affairs Committee of this House, which received pretty well universal endorsement? Will he then discuss with his colleagues whether we really have fixed social care and whether the resources he is claiming are sufficient to meet the problem?

[Lord Kamall (Con)]

I thank my noble friend for drawing my attention to the report and the work of that committee. I will commit to reading the report and look forward to future discussions with my noble friend and many noble Lords across the House.

[Lord Bird (CB)]

Would it be possible at this time to talk also about preventing the next crisis and the crisis after that? Are we not always chasing something? The NHS, which does not spend a large amount of money on prevention, is now being hoist by its own petard,

[Lord Kamall (Con)]

The noble Lord raises a very important point. One of the things the NHS is looking at in more detail, and something we will discuss in forthcoming debates on the Health and Social Care Bill, is how we move a system culturally to not only treat patients once they are ill or need treatment, and work in terms of prevention and encouraging healthier lifestyles. When patients are kept too long in hospital, they can lose certain facilities such as muscle function, so we need to look at prevention as opposed to just treatment. Getting the right balance is something that the NHS and the Department of Health and Social Care are looking at closely.

[Baroness Jolly (LD)]

My Lords, as a result of Covid’s impact, many A&E departments have reconfigured their internal infrastructure and their working practices. Could the Minister tell the House how best practice is being disseminated to other NHS trusts? What support, financial and otherwise, have trusts received to do this?

[Lord Kamall (Con)]

Given that it was identified that there were particular pressures on 29 trusts across 35 sites, extra resources have been targeted and teams have made site visits to work out, for example, the flows in those hospitals, and to make sure that they deal not only with the immediate issues that those departments face but also with the wider system issues. For example, as I have mentioned, sometimes patients cannot get hold of doctors and go to A&E as a substitute because they want a face-to-face appointment. We are looking at a number of those wider issues. We announced £55 million of winter funding for all ambulance services and have boosted staff numbers by 700, including for the availability of the ambulance fleet, through a £4.2 million investment to improve times. We have also invested nearly £2 million to support the well-being of front-line staff during these pressures; they have experienced increased pressures, so we must make sure we look after them as well.

[Lord Lea of Crondall (Non-Afl)]

My Lords, is there a breakdown on the difference between physical resources in hospitals and the shortage of staff?

[Lord Kamall (Con)]

I am not sure whether there is a breakdown. As my noble friend said, sometimes I have to read out what is in the pack and sometimes I freelance, as I am sure many will appreciate—or maybe will not appreciate when I divert from the government line. But I will endeavour to find out whether those stats are available.

Vaccination Strategy

Lord Kamall Excerpts

Thursday 13th January 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I pay tribute to the staff of the NHS, volunteers and others, who have made extraordinary efforts during the vaccine rollout to save lives and build a world beyond Covid, while a particular debt of gratitude is owed to the Deputy Chief Medical Officer, Jonathan Van-Tam, who is standing down from his role.

To drive up vaccination rates, there is a growing need to tackle anti-vax propaganda and stop intimidation and abuse. Will the Minister commit to a communications campaign to tackle misinformation, particularly focusing on places and people with lower rates of take-up? Following the Labour amendment to the policing Bill that was agreed last night in your Lordships’ House, will the Government now take the opportunity to fast-track buffer zones around schools and vaccination centres?

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

I thank the noble Baroness for raising these issues. The first issue, that of anti-vaxxers, is really important. In a free society we always have to get the balance right between freedom of speech, making sure that people are free to go about their daily work, and making sure that those who want the vaccine get it as soon as possible. The Government are aware of this and are looking at it, but it is really important that we get the right balance. Whatever we think of the anti-vaxxers’ message, they have a right to say it, but we have to make sure that it does not impinge on the liberty of others to get their vaccine, especially since we are encouraging as many people as possible to get vaccinated.

I join the noble Baroness in paying tribute to the Chief Medical Officer, Jonathan Van-Tam. He appears on our daily omicron calls and I have had a number of conversations with him, and I know that there is incredible respect for JVT across the country. Indeed, I know that a number of people tuned in to his Christmas lectures on the virus; as the noble Baroness says, they were an excellent explanation of the virus and how to tackle it.

As for how we reach local communities, particularly those communities that have not come forward, I have had a number of conversations with noble Lords and Baronesses with their own experience of working with local communities in a bottom-up way. We have seen a number of local activities; indeed, my local masjid, or mosque, has a walk-in vaccination centre, and we have seen that in other faith places. A number of faith-based and interfaith networks have worked closely with the local community, because often some communities do not have the trust in authority that they have in priests, vicars, bishops—if I may say so—imams, et cetera. That is really important. We have also recorded promotional films in a number of languages, including Punjabi and Urdu in Birmingham, and got some celebrities to come up. I know I have gone on too long but I am very excited about what we are doing.

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I too echo the gratitude that this House and this country shows to Jonathan Van-Tam. Four months on, there are still severely clinically extremely vulnerable people eligible for a third primary dose and then a booster who cannot book their booster because the data system still cannot record this. Many CEV young children with underlying conditions are still waiting for their vaccines, as well as for guidance on how they, their families and their schools can keep them safe from Covid. This is important because there are now more children in hospital with Covid in the last three weeks than in the nine months of the first wave. Please can the Minister say how these people, who the Government say need the vaccines right now to keep them safe, can get them?

[Lord Kamall (Con)]

I thank the noble Baroness for making me aware of the issues. She will recall that we had a meeting on how we can address the concerns of the clinically extremely vulnerable, and I had hoped that a number of action points had flowed from that. If those have not been acted upon, I hope she will write to me and I can chase up the department and the NHS. I had assumed that that meeting, where we gave them some action points, was effective. I am sure she remembers that we requested a letter with action points, but if those have not been followed up, I will endeavour to chase that up.

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Masham of Ilton, is taking part remotely. I invite the noble Baroness to speak.

--- Later in debate ---

[Baroness Masham of Ilton (CB) [V]]

My Lords, how much research is being done on persons who may have developed Guillain Barré syndrome after the coronavirus vaccine booster? Is the noble Lord aware that there have been several cases of this serious condition recently?

[Lord Kamall (Con)]

I thank the noble Baroness for the question. I will have to write to her with the answer.

[The Lord Bishop of Gloucester]

Can the Minister update us on global statistics on vaccination? This is not only about justice, equality and dignity; it is also about the fact that new variants will arise unless we address the issue of international vaccination. What are the Government doing to ensure that everyone across our world is offered full vaccination? What focus is being given to the international situation, beyond ourselves?

[Lord Kamall (Con)]

I thank the right reverend Prelate for raising this incredibly important issue. I know a number of noble Lords across the House feel very strongly about this. Indeed, many of us are part of diaspora communities and understand that many communities across the world are very concerned. From the start of the pandemic, the UK has worked to support access to Covid-19 vaccines. We helped to establish the international joint procurement initiative, COVAX. At the end of 2021, the Government confirmed that they had delivered more than 30 million Covid-19 vaccines to other countries, benefiting more than 30 countries. We have invested £71 million to help COVAX secure early supply deals. The UK is one of the largest donors to the COVAX advance market commitment, which supports access to Covid-19 vaccines for up to 92 low and middle-income countries. I have a list of a number of other initiatives that we have taken part in. In addition, in bilateral, G7 and G10 discussions, we have put this issue on the agenda, making sure that we are working in a multilateral way across the world to help those countries.

[Lord Patel (CB)]

My Lords, first, in relation to the question asked by the noble Baroness, Lady Masham, very few cases of Guillain Barré syndrome have been reported following vaccination with Covid vaccines. That is not so surprising because it occurs with any vaccination, so it is not a reason at all for anybody to be denied vaccination. Secondly, and much more importantly, social media is full of worries that young women are particularly affected, because of the nonsense perpetrated that it will make them infertile. There is no scientific reason behind this. Does the Minister agree that all young women should take the vaccine? Thirdly, there are many pregnant women now in hospital because they were not vaccinated because of wrong advice that pregnant women should not be vaccinated. Again, there is no reason why pregnant women should not be vaccinated, and the recent data which suggests that mothers who breastfeed will transfer their antibodies to the newborn is good news too.

[Lord Kamall (Con)]

One of the wonderful things about your Lordships’ House is its range of expertise. I thank the noble Lord for enlightening us on the earlier question. However, as I committed to the noble Baroness, I will check the department’s reply and hope it corresponds with the noble Lord’s response; otherwise, I am sure we will have more discussions.

On young women, the noble Lord is absolutely right that we should be encouraging as many people as possible to take the vaccine, even—I know this is being broadcast publicly—those who have not had their first or second vaccine. It is not too late. We urge everyone to have their first and second vaccine, but also to have the booster. It is the best protection, even for those who have previously had Covid. We know that almost all pregnant women who are hospitalised or admitted to intensive care with Covid-19 are unvaccinated. The latest data from the UK Health Security Agency shows that Covid-19 vaccinations provide strong protection for pregnant women against the virus. It shows that the vaccines are safe for pregnant women, with similar birth outcomes for those who have had the vaccine and those who have not. We have launched a new campaign that urges pregnant women not to wait to take the vaccine; it highlights the risks of Covid-19 to mother and baby and the benefits of vaccination.

[Baroness Blackstone (Ind Lab)]

My Lords, I declare my interests as set out in the register. Following on from the question of the noble Lord, Lord Patel, I want to pick up the issue of pregnant women. The Government have belatedly—very belatedly—announced a campaign to persuade pregnant women to get vaccinated. Had they done it earlier, some deaths would have been avoided. Is the Minister aware of the particularly low levels of vaccination among pregnant women from ethnic minorities? What are the Government doing to reach out to them in particular, to persuade them to get vaccinated and save their own lives and those of their unborn children?

[Lord Kamall (Con)]

The noble Baroness makes an incredibly important point that I am sure we all agree with. This is a combination of two issues. One is reaching those communities that generally, pregnant or otherwise, are not being vaccinated. The other is making sure that pregnant women are receiving the message that it is safe to have the vaccine. We are doing this through a number of channels, including through medical staff and the NHS, but we also have a number of targeted campaigns, looking at those communities to make sure we build trust, break those gaps down and give them the confidence to come forward and be vaccinated.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I shall speak more briefly than I had intended, because this has been a very long debate, absolutely full of expertise, about a suite of amendments all of which have considerable merit. I know that both Ministers on the Front Bench have been listening very carefully and have noted the consensus across the Committee that this Bill will not succeed unless it addresses very clearly the disgraceful health inequalities in this country at the moment.

Health inequality affects quality of life, life expectancy and, in particular, healthy life expectancy, which has now stalled across certain demographic groups. As we have heard, it has been analysed brilliantly by Professor Sir Michael Marmot. It affects the well-being of the patient and their family. The really sad thing is that much of it is preventable. These things are particularly rife in the poorer parts of the country, because that is where the social determinants of health such as housing, referred to by my noble friend Lord Shipley and others, have most effect. We have heard a number of statistics about health inequalities, but I shall give your Lordships just one. People living in the most deprived areas of the UK spend almost a third of their lives in poor health, compared to only about a sixth of those living in the least deprived areas. That says it all.

Unfortunately, inequalities were not at the forefront of the Government’s response to the pandemic. They suspended equality impact assessments for legislation, resisted publication of evidence of the impact of the virus on BAME individuals—as pointed out to them eloquently by the noble Baroness, Lady Lawrence—and failed to provide adequate isolation support for those on low incomes, forcing them to go to work. The Covid pandemic has therefore seen the biggest shift in life expectancy in the UK since World War 2: a fall of 1.2 years in males and 0.9 years in females. It is therefore essential to heed Sir Michael Marmot’s words and “build back fairer” and not just “better”.

The noble Baroness, Lady Greengross, kindly mentioned the report of the Science and Technology Committee on healthy ageing. I was a member of that committee under the capable chairmanship of the noble Lord, Lord Patel. It became very clear from our witnesses that unhealthy ageing happens years before the person is old and depends enormously on their demographic and their lifestyle. For their sake and for the sake of the future of the NHS, for which no Government will ever be able to provide enough funding unless something is done on prevention, we must do something to level up the health outcomes of the nation. This Bill is a very good place to start all over again on that agenda.

I have added my name to Amendment 11, so ably introduced by the noble Baroness, Lady Thornton, whom I must congratulate on the way she analysed these issues at the beginning of this debate. I thank her for that. Also crucial is Amendment 14, so ably promoted by the noble Lord, Lord Patel, and my noble friend Lady Tyler. Amendment 11 is an attempt to ensure that NHS England produces guidance about the collection, analysis, reporting and publication of the data which makes transparent the performance of various NHS bodies on health inequalities. Without collecting that, we cannot judge the performance of those organisations. If it is not done consistently, we cannot assess an organisation’s performance in comparison to other similar bodies. That is why such guidance must come from the top. I know that the Government want each ICS to do its own thing in a way which it considers most appropriate for its area. However, for the important objective of levelling up health outcomes across the population, judgment of performance can be made only if the data is comparable between one ICS and another or one trust and another, so we cannot leave it to them to collect the data in any way they like.

Of course, there are big issues about the resources available for the collection and analysis of data, but such information is essential if improvements are to be made. Therefore, a duty to “have regard” to guidance published by NHSE would put pressure on the organisations to so arrange their finances as to ensure adequate resources for this, and, of course, it would be cost-effective.

I also have Amendments 61 and 63 in this group. They would insert “assess and” into new Section 14Z35 inserted by Clause 20, which covers the duty of an integrated care board to reduce inequalities in access to health services across its population and in the health outcomes achieved. Although it is well known that, in general, the lower the demographic the greater the health inequalities, this is by no means uniform, even across a single local authority, let alone across a large ICS area. Indeed, even within a single local government ward, which may be fairly affluent in general, there are often pockets of deprivation. Every local councillor knows where they are. In order to devise policies and deploy services geographically in a way that improves access and outcomes for those deprived communities, the ICS needs to drill down and do the detailed work to identify where they are and what factors are damaging health. It may be poor or overcrowded housing. It may be lack of access to shops selling healthy food. It may be lack of access to leisure and sports facilities in which to take exercise. It may be poorly performing schools or overstretched primary care services. It may simply be poverty, preventing people heating their homes adequately or buying nutritious food. In rural areas, it may be lack of access to pretty well everything, as the right reverend Prelate reminded us. Whatever it is, you cannot fix it until you know what and where it is.

That is one of the reasons why we reject the new power of the Secretary of State to meddle in the reconfiguration of health services locally, but that is a debate for another time. In cases such as this, an overview will not do, and local knowledge is key. That is why we believe it is essential to mandate an ICB to do the detailed research on which to base its commissioning decisions, so that it can fulfil the duty to reduce health inequality put on it by this Bill—once it has been amended by a lot of these amendments.

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

My Lords—

[Noble Lords]

Hear, hear.

[Lord Kamall (Con)]

You have not heard what I am going to say yet.

I thank all noble Lords who have taken part in this debate; it has been fascinating. It has touched on a number of things that I feel strongly about personally. Before we go further, and given my background and that of my right honourable friend the Secretary of State, I want to assure noble Lords that we both feel very strongly about inequalities. I say that as someone who grew up in a working-class immigrant community. I was born at Whittington Hospital; I also accessed North Middlesex hospital and Chase Farm Hospital, with which I know the noble Baroness, Lady Tyler, is associated, though I am not sure I will get any more points for that, to be honest.

One thing I feel strongly about, and saw in many areas when I was an MEP for London, is where the state has failed, whichever Government was in power. I have worked with non-state, local community, bottom-up projects which understood the issues in their communities far better than any national or local politician—there was sometimes even a distance between them and their local ward councillor, as the noble Lord, Lord Mawson, and I were discussing the other day.

I thank the noble Baroness, Lady Thornton, not only for the thoughtful way in which she opened the debate and introduced the amendments but for pointing out some of the people who are often forgotten; for example, the homeless. I have worked with a number of local community homeless projects, such as the Hope Foundation in Acton and Vision Care for Homeless People. Perhaps I may also do a quick advert for the Take One, Leave One project, which is based outside Vauxhall station on Fridays, between 12 pm and 3 pm —people can leave excess clothes and homeless people can pick them up. I urge any noble Lords passing through Vauxhall station on a Friday to support this.

Sex workers, the Traveller community and drug users have been mentioned. Sometimes we think that these issues are remote from us and will not affect us—but everyone is only one of two steps away from homelessness. A broken family, mental health issues, your friends saying, after a while, “Actually, you can’t stay on my sofa any more”—where do you go? When I have met homeless people, they have quite often come from a very different place, not the stereotype that we often hear. They have come from quite a stable family, a good relationship, a good job: but two or three things have gone wrong in their life and suddenly they are homeless. It happens to many people who resort to such desperate measures.

Another thing I am slightly concerned about, if I am honest, is that when I was a young child growing up in immigrant communities, there was a distrust of authority. We see the difficulty, for example with the vaccine schemes, in trying to reach some of those communities. It was not only authority that we were quite suspicious of and concerned about but—I hope noble Lords will forgive me for using this phrase—white, middle-class do-gooders who thought they knew best what was best for us as working-class immigrant people and could tell us what was best for us, rather than listening to us and our real concerns. Quite often we felt that they had captured the agenda, and that was why the money and resources which were supposed to be helping us did not reach the people who needed help: it got captured by the white, middle-class do-gooders.

I pay tribute to the noble Lord, Lord Howarth, and the noble Baronesses, Lady Greengross and Lady McIntosh of Hudnall, for the emphasis on the arts and creative industries. Sometimes, music and the arts are a way of overcoming this distrust, learning about the culture of those communities and also aligning the culture and the issues with some of the very real problems and tensions we face. The noble Lord, Lord Desai, talked about prevention being better than cure. It is an issue we talk about constantly in the department, and the NHS also talks about it. The noble Lord, Lord Desai, as an economist, will acknowledge that economics is often simply about the allocation of scarce resources and finding the most efficient way of achieving that.

My late father once told me, “Never forget where you came from and what you were”, and this is one of the reasons I feel very strongly, as do many noble Lords across the Committee, about the issue of inequalities. How do we tackle this, what is the best way to do it? Will putting it in the Bill solve all the problems? Actually, it will not, but we can discuss how we can make it more effective, and not just feel, “Great, we’ve got it in the Bill, job done”. It has to be more than that. As the noble Lord, Lord Scriven, said, it cannot just be an institutionalised Gladys; it has to be more than that. So, I am deeply grateful that we gave this issue the time it deserves. It is really important for me personally. We want to tackle health inequalities and ensure that everyone has the same opportunity to enjoy a long and healthy life, whoever they are, wherever they live and whatever their background or social circumstances.

I hope I can assure the noble Baroness, Lady Greengross, with whom I have had a number of conversations about music and dementia. I have volunteered, perhaps rather rashly, to organise a fundraiser with my band and other bands for that. I hope that does not give me an excuse to lay the YouTube link to my band in the Library: I shall try to avoid that temptation.

However, to deliver on the commitment on 1 October, we launched the Office of Health Improvement and Disparities within the Department of Health and Social Care—the noble Lord, Lord Scriven, anticipated that I would say this—and we also set up a cross-government ministerial group to identify and tackle the wider determinants of poor health and health disparities. It is important that this cannot be top-down; we have to go to some of the social enterprises and local communities, but also we must not prejudge, prevent or duplicate the work of the integrated care systems in this. NHS England is already tackling health disparities through the NHS long-term plan. That sets out a clear intention to set measurable goals and to make differential allocations targeted at reducing health inequalities and disparities. This has resulted in funding increases to some of the most deprived parts of the country.

As we know, making sure that these deprived areas get the most funding does not mean it will trickle down to those who really need it; it could well be captured by some of the do-gooders I mentioned earlier. The noble Lord, Lord Howarth, talked about those targeted interventions. NHS England and NHS Improvement is also taking forward the Core20PLUS5 initiative as an approach to addressing health inequalities. This will focus on improving outcomes in the poorest 20% of the population, along with inclusion health groups and five priority clinical focus areas.

Health and Care Bill

Lord Kamall Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I congratulate the four noble Lords who have produced this excellent suite of amendments across the Bill to ensure that ICBs procuring or commissioning goods and services on behalf of the NHS are firmly focused on their responsibility for NHS England’s commitment to reaching net zero by 2040. It has been an excellent and informed debate, and one with much enthusiasm to reassure the noble Baroness, Lady Hayman.

We fully support the amendments and have little to add from these Benches following the expert contributions of those proposing the amendments and the other noble Lords who have spoken. I am sorry my noble friend Lady Young, who put her name to the amendments, cannot be here. She was a key member of our team during the recent passage of the Environment Bill, and her expertise and wisdom always guides and reflects our approach. The House is clearly interested in this vital matter, as we saw this week in an important Oral Question on the Prime Minister’s promise for a new, overarching net-zero test for new policies. Assuming the Government fully support the key commitment from NHS England, I hope that, in his response, the Minister will accept the need for the amendments and will not argue that the proposed new clause is unnecessary as NHS England already has a commitment that will percolate down to ICBs.

As we have heard, the power of public sector procurement is a massive issue and there is no bigger part of the public sector than the NHS. The NHS has such an important impact on other environment issues, such as waste, pollution and resource consumption, especially for plastics, paper and water. We should ensure we are on the front foot in using that impact to deliver the net-zero commitment.

The NHS has made a start, but there is much more to do. These amendments would reinforce the importance of action in these areas for the new bodies and processes that the Bill creates. The NHS is a big player and, as noble Lords have stressed, it can play a big role in tackling all of these climate change and environmental challenges. Procurement is a strong lever that the NHS can utilise in key markets, particularly in those areas where it is the sole purchaser. The noble Lord, Lord Stevens, was very eloquent on this issue and I look forward to the Minister’s response in the light of his contribution.

Like other speakers today, my noble friend Lady Young wanted to stress that action so far is only the beginning. In the light of the importance of climate change and other environmental challenges, we strongly support such a duty being in place for all the public and private bodies with significant impacts when future legislation comes through Parliament. We did that when inserting a sustainable development duty into the remit of every possible public body from the late 1990s onwards, but this time it has to be not only enacted but managed, delivered, tracked and reported.

As the Minister, the noble Lord, Lord Callanan, told the House this week, every sector of government needs to do its bit, and we need to hold them to that. These amendments are vital, since every public body will have to take further action this decade if we are to restrain temperature rises to two degrees—far less, 1.5 degrees.

Finally, I too thank Peers for the Planet both for its work and, especially for me, its excellent briefing. As noble Lords have stressed, the NHS has committed to net zero and aims to be the world’s first net-zero national health service. It is responsible for around 5% of the UK’s carbon emissions. That is why the NHS’s role and contribution to net-zero targets should be fully integrated into the Bill. I look forward to the Minister’s response and his detailing of how the NHS is to achieve its ambitions. I hope that he will acknowledge that its commitment must be in the Bill. These amendments present a vital opportunity to enshrine in law a commitment that I think most, if not all, would want to see delivered.

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

I thank the noble Lord, Lord Stevens, for the amendments and the noble Baroness, Lady Hayman, for her opening remarks. I also thank the noble Baroness for her suggestion yesterday that it might make my life a lot easier if I just accepted amendments. I understand that advice, having just gone through a two-hour debate on the previous group.

A number of noble Lords referred to how these amendments relate to our previous debate on inequalities. I point out that that is sometimes not quite in the way that we would expect. We might think there is a direct connection, but sometimes the green agenda can be seen to be for those who can afford it—as I explained before, for the white, middle-class, patronising people who tell immigrant working-class communities what to do and push up their costs. Anti-car policies push up costs for those in rural areas, and there are higher fuel costs as we replace gas boilers with potentially more expensive heat pumps. We have to be aware of those issues. In the long term, I am optimistic. I look forward to the day when we have solar power and wind power, with storage capacity, which will reduce costs.

[Baroness Northover (LD)]

Will the Minister look at this globally and recognise that the poorest are affected the worst? When he talks about those in poverty, he should think globally.

[Lord Kamall (Con)]

I accept that point, but I also accept that, sometimes, one can be patronised, and I do not accept being patronised as I was in the earlier debate. One day, there will be cheaper fuel, and we can look forward to it, but we have to make sure that the transition along the way is not seen to push up costs for working people, because we all feel passionately about this green agenda.

[Baroness Bennett of Manor Castle (GP)]

The Minister was talking about the impact of policies on the poor. Does he agree that many of the products—the fabrics, the chemicals—are manufactured in the poorest areas of the world, producing pollution that has disastrous impacts on some of the poorest people?

[Lord Kamall (Con)]

I was going to come to the noble Baroness’s points, and I am grateful to her for raising these issues directly with me previously.

Turning to the amendments, I thank the noble Baronesses, Lady Hayman and Lady Young of Old Scone, and the noble Lords, Lord Stevens and Lord Prior, for bringing this debate before the Committee. There is no doubt that the NHS has a significant carbon footprint. There is no doubt that a poor environment has direct and immediate consequence for our patients, the public and the NHS. There is no doubt that it has an impact on the health of the nation. As the noble Baroness, Lady Hayman, pointed out, the NHS accounts for around 4% to 5% of UK emissions. If we go further, as the noble Baroness, Lady Bennett, said, that is 40% of public service emissions. Noble Lords are right to highlight the critical role that the NHS has to play in achieving net zero.

To support that work, NHS England—thanks in part to work already started by the noble Lord, Lord Stevens, who I know has had conversations with my right honourable friend the Secretary of State for Health and Social Care—is leading the way through a dedicated programme of work, as many noble Lords acknowledged. This includes ambitious targets for achieving net zero for the NHS carbon footprint by 2045 and for its direct emissions by 2040. This is ahead of the target set by Section 1 of the Climate Change Act 2008; we welcome that ambition and will continue to support the NHS in that.

--- Later in debate ---

[Lord Mawson (CB)]

I thank the Minister. Can I just give an illustration about the local on this issue? I am certainly not an expert on climate change, but I am a practical person who worries a lot about granularity and the gap between a lot of talk I have heard over many years on all sides of this Chamber—with very large amounts of money cited, et cetera—and the realities in this building.

I am trying to buy an electric car at the moment, as a responsible citizen. When I went to have a look at the multi-storey car park below this building—the local—and wondered where I am going to plug it in when it arrives here, I ended up talking to one of the facilities managers, who was a very nice man. I asked him how many plug-in points there were underneath this building—again, the local. He said, “I don’t know, Lord Mawson, but I will look into this”.

He was diligent and came back to me. We started to have a conversation about it, and he began to suggest that I need to carry a cable in my car with a three-pin plug. I pointed out that my office is across St Margaret Street, in Old Palace Yard, on the third floor, so maybe I should run it across there with a carpet over it and up to the third floor to plug it in there. We had this amusing conversation. I said, “Well, go on then, tell me: how many are there in this building, where all this chatter and talk is taking place?” His answer was that there are two. I suggest that the gap between reality and rhetoric is very large indeed. If we are really going to deal with these issues—as we must—we must now become intensely interested in the NHS and in all the systems of government about practicality and the procurement machinery, which I suggest is not working.

I talked to one of the facilities people yesterday about my office, which has a light switch with a notice over the top of it telling you how to use it. It is completely ludicrous. She told me that that system is going to be different to all the systems here in the Palace of Westminster; none of it is joined up.

I think the Minister is right. The clue is in the local, but all our systems and our civil servants must now become interested in practicality and the local if we are really going to get serious about these matters. It is absolutely crucial to get procurement right, because without that, we will never deliver this.

[Lord Kamall (Con)]

I thank the noble Lord, Lord Mawson, for that intervention, and I completely agree. There are some incredibly inspirational projects going on in our local communities, tackling and addressing the green agenda, and sometimes, top-down, we may feel good about it in this place, but it really affects working people and those who face higher costs and we have to be very careful.

On the specific question of procurement, the NHS is already publicly committed to purchasing only from suppliers which are aligned with its net-zero ambitions by 2030, and last year, NHS England set out its roadmap giving further details to suppliers to 2030. This is supported by a broad range of further action on NHS net zero and we hope that by pushing this through at NHS England level, but also with ICSs, we can see some of that local innovation as local trusts and local care systems and even health and well-being boards respond to those local challenges—others could learn nationally. To respond to the question of the noble Baroness, Lady Walmsley, NHS England will publish the world’s first net-zero healthcare building standard; this will apply to all projects being taken forward through the Government’s new hospital programme, which will see 48 new hospital facilities built across England by 2030.

There is political consensus on green issues. and we should pay tribute to the noble Baroness, Lady Bennett, and the Green Party for making sure, over the years, that the green agenda has been put at the centre of British politics. We find green policies in all the election manifestos of the mainstream parties: that is in no small part due to the noble Baroness’s party and to the noble Baroness herself. So, even while we may disagree on how to achieve some of these things, there is no doubt that we are not going to reverse on our commitment. Whatever Governments are elected in future, all are committed to a carbon net-zero strategy and a cleaner environment. So, I must gently disagree with her that these amendments are necessary.

I would like to have further conversations with the noble Lord, Lord Stevens, given his experience, on why he feels that, despite all the great work that the NHS has been doing, these amendments are still necessary. I would like to have further conversations with him and others, but at this stage, I ask the noble Baroness to withdraw the amendment. Across the political spectrum, we must make sure that we are pushing the NHS to deliver, not only at the national level but at the ICS level and even lower, at the place level that the noble Lord, Lord Mawson, speaks so eloquently about.

[Baroness Bennett of Manor Castle (GP)]

Before the noble Lord sits down, will he respond to the question, of which I gave him prior notice, about the document?

[Lord Kamall (Con)]

I apologise to the noble Baroness—I am so sorry, but I am trying to juggle 300 devices. That is a slight exaggeration, if I am honest. We recognise the importance of ensuring that all chemicals in the NHS supply chain are appropriate and properly managed as part of the net-zero strategy. I think the noble Lord, Lord Stevens, even touched upon some of the chemicals that were used and some of the issues he looked at during his time at the NHS when it comes to chemicals. The NHS must also comply fully with the Control of Substances Hazardous to Health Regulations, the CoSHH regulations.

More broadly, although Defra is the lead department for harmful chemicals, the UK Health Security Agency feeds in its expertise in relation to restricting and banning chemicals, and we are grateful to it for that work. The UKHSA is also looking at each of those chemicals, which we hope in future can be replaced by less harmful materials and chemicals. I undertake to write to the noble Baroness in more detail than the short answer I have given her at this stage.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, like the noble Baroness, Lady Thornton, I shall start with those who I think should not be on the board before I turn to those who I think should. To a great extent I support the noble Baroness’s Amendment 29, but with a small caveat that, if she wished to press it, might require a bit of redrafting. I will explain.

Additional provider medical services are very useful in many areas to fill gaps in primary care capacity. They may provide additional services from which other NHS primary care services have opted out, such as out-of-hours services or enhanced services beyond the capacity of local NHS GPs to deliver. In some areas they have taken over primary care services where NHS GP practices have become too small to be viable or all the partners have retired.

Some APMS services are commercial businesses with a responsibility to their shareholders to make a profit, and I do not think these should be on the board. However, some APMS contracts go to NHS entities, and I would not want to exclude those. Of course, we must remember that for many years GP practices have also been small businesses, sort of, operating within the umbrella and ethos of the NHS. They too need to clear their costs or they will close down.

That is all well and good. However, if the Government are serious that they want to exclude private sector interests from ICBs, they must surely agree to include in that ban non-NHS entities that hold APMS contracts. A failure to accept the amendment of the noble Baroness, Lady Thornton, must surely make us a little suspicious about the Government’s claim that their amendment inserted in another place would successfully exclude private interests from the board.

Amendment 29 would extend the range of those involved in commercial enterprises from being members of the board of an ICS beyond those that we have just discussed in relation to the noble Baroness’s Amendment 28. Amendment 29 would specifically exclude NHS GP practices and voluntary or not-for-profit organisations from the ban. There are many types of organisations that would be included in the ban, although they could be heard on the board of the integrated care partnerships. Those include: pharmaceutical companies; providers of medical devices, equipment or premises; people who own care homes; and many other essential services without which our NHS could not survive. However, their importance should not entitle them to influence the constitution, strategy or commissioning principles of the board of the ICS. They are important providers that will be appropriately involved in planning at other levels, but they should not be able to steer fundamental decisions without the suspicion that they might have a commercial interest in such decisions. Indeed, the ban proposed in the amendment would protect such companies from such a suspicion, so perhaps it would be welcomed by them.

Turning to those who should be on the board, I will not repeat what the noble Baroness, Lady Hollins, said in introducing her amendments, because she has done it extremely well, particularly emphasising the impact of integrated services on people with learning difficulties and people with autism and how they could benefit from better integrated services if we got it right. So, I support her amendments.

I turn to Amendment 37, to which I have added my name to those of the noble Baroness, Lady Thornton, and the noble Lord, Lord Patel, for the following reasons. According to the Explanatory Notes, each ICB and its partner local authorities will be required to establish an integrated care partnership, bringing together health, social care and public health. The constitution of the ICB as it stands in the Bill specifies that the board must include only a minimum of three types of people who the Government clearly believe are essential to the effective operation of the board. They are someone from NHS health trusts or foundation trusts, someone from primary care, and someone from one of the local authorities in the area. If it is okay to prescribe these members, would it not also be wise to prescribe a few other key people with appropriate knowledge in order to achieve the ICB’s objectives of bringing together health, social care and public health? This amendment therefore suggests five other nominees—not 15, bearing in mind the Government’s wish to keep the ICB to a manageable size. But given the powers of the board, I would think it essential to have people nominated from mental health, public health, social care, health trade unions, patients and carers to bring their knowledge to strategic decisions.

If the board is to comply with the ambition of parity of esteem for physical and mental health—which we talked about two days ago—it will be important to have someone with the knowledge of how mental health services are working, as my noble friend Lady Tyler emphasised. Public health is a very particular discipline, the importance of which has been amply shown during the pandemic, which also has a vital role to play if we are to improve the health of local people and level up inequalities. Social care provision should never be separate from or subsidiary to health, as it is intrinsic to the functioning of health services in every area, so it is inconceivable that any ICB should ever be without someone from that sector.

The NHS is a people business, which is why those who deliver the services and the patients who are on the receiving end should have a voice at the top. Similarly, those thousands of unpaid carers, without whom vulnerable people would use up more of the NHS’s scarce resources than they currently do, should be represented at the very top of these new organisations. Their contribution to the efficient use of the board’s financial resources is crucial.

If the objective is to encourage more integration and collaboration, how could it be right not to have these additional five or six groups of people helping to make the strategic decisions? If that is not the case, as has been said by other noble Lords, the board could be dominated by the large acute hospitals and primary care, and the integration objective of the Government, which I endorse, would fail. I look forward to the Minister’s reply.

[Lord Kamall (Con)]

My Lords, this has been an excellent and wide-ranging debate, and I really am grateful to all noble Lords who tabled amendments today.

With your Lordships’ leave, I turn first to Amendment 18 in the name of the noble Baroness, Lady Thornton. This amendment would mean that the relevant ICB and ICP would need to be consulted before NHS England is able to provide support and assistance to bodies other than NHS bodies. The NHS has, under successive Governments of all political colours—indeed, since its foundation in 1948—commissioned care from various sectors to help it be more responsive to patients’ needs, and particularly to help deliver the commitments set out in the NHS constitution.

The vast majority of NHS care has been—and will rightly continue to be—provided by taxpayer-funded public sector organisations. But experience before and during the pandemic has demonstrated how important it is for NHS England to have the power, as the Trust Development Authority currently does, to provide support and assistance to any providers of services on behalf of the NHS. This will ensure that independent providers can, if necessary, be commissioned to provide important additional capacity where needed.

[Baroness Thornton (Lab)]

I really rather hoped the Minister would not go into whether or not I was suggesting that we should or should not be using private services. This is about who commissions services; this is not about who provides services. In my opening remarks, I said that a variety of providers is exactly what we have and will continue to have.

[Lord Kamall (Con)]

I thank the noble Baroness for that clarification.

The amendment seeks to exclude individuals whose GP practices hold an alternative provider of medical services, or APMS, contract from being a member of an integrated care board. While APMS contracts may not be appropriate for all GPs, they offer the ICBs, as commissioners, greater flexibility than other general practice contract types. As the noble Baroness, Lady Walmsley, acknowledged, the APMS framework allows commissioners to contract specific primary medical care services to meet local needs. APMS contractors include some private and third sector social enterprises and GP partnerships, which provide outreach health services for homeless people, asylum seekers and others. It is quite clear that none of this diminishes the commitment to ensure that care is provided free at the point of use, paid for by taxpayers.

All contract holders providing NHS core primary medical services are subject to the same requirements, regulations and standards, regardless of the type of contract. The Care Quality Commission, as the independent regulator, ensures that all contracts meet these standards.

Some GP partnerships concurrently hold a general medical services contract for core medical provision, as well as an APMS contract. Some individual GPs provide services for a range of practices. The concern is that this amendment would exclude GPs working for one or multiple practices which operate under APMS contracts from being members of the ICB.

NHS England’s draft guidance states that nominated members of an ICB will be full members of the unitary board, bringing knowledge and a perspective from their sectors, but not acting as delegates of those sectors.

This amendment would prevent some individuals being on integrated care boards, based on what type of NHS GP contract their practice holds. This could limit the ability of primary medical service providers to appoint an ICB member who understands the health requirements of the local population. This could reduce the diversity of GPs who could be appointed, based on their contract type. If we think of the unintended consequences, this may inadvertently exclude representatives with much-needed expertise in serving specific local populations and addressing their health needs.

Earlier, we talked about tackling inequalities. I feel very strongly that there are sometimes unintended consequences, where people think that they know better what is best for their communities. It would be unfortunate to exclude APMS contracts, or anyone who had an APMS contract and who had the expertise needed for those communities that are not receiving an adequate service, or for poor, immigrant communities. This could go against the goal that we all want to see of tackling inequalities.

I now turn to Amendments 29 and 30. I am grateful to the noble Baroness, Lady Merron, and the noble Lord, Lord Davies, for bringing this issue before the Committee. I understand the interest in the role of independent providers in the integrated care boards. I also understand the concern across the Committee to ensure that independent providers, including companies seeking to produce health and care products, should not be appointed to the board of ICBs. We agree. Integrated care boards will be NHS bodies whose board membership consists of a minimum of individuals nominated by NHS providers, GP services and local authorities whose areas coincide with that of the ICB.

Although, as has been acknowledged, service provision by the independent and voluntary sectors has been an important and valuable feature of the system under successive Governments, it has never been the intention for independent providers as corporate entities to sit on integrated care boards, nor for an individual appointed to be there as a representative of an individual provider, in any capacity. People must therefore be assured that the work of ICBs will be driven by health outcomes, not profit. However, we recognise that this is a matter of concern to many noble Lords, as well as to the other place. We have been keen to put this beyond doubt, which is why we brought forward the amendment on this very point at Report stage in the other place. This amendment makes clear that no one may be appointed to an ICB who would undermine the independence of the NHS as a result of their interests in the private healthcare sector, social enterprise or elsewhere, including the public sector.

--- Later in debate ---

[Baroness Walmsley (LD)]

I apologise for interrupting the Minister, but I want to ask him a question going back to Amendment 28 and the APMS contracts. If we were to bring forward an amendment that made it very clear that we had no objection to NHS entities or not-for-profit organisations with APMS contracts being on the ICB, would he take a more friendly approach? It would just eliminate those that take profit out of the NHS.

[Lord Kamall (Con)]

I thank the noble Baroness for that suggestion and for trying to narrow the gap that there clearly is. If an amendment were put forward, we would look at it very carefully and consider the unintended consequences from the way it is drafted. We will consider it but, as I am sure the noble Baroness appreciates, I can make no promises at this stage.

I turn to the point made by my noble friend Lord Hunt of Wirral about how provider input in the work of an ICB will be reconciled with assessing both the suitability and performance of providers. As my noble friend correctly noted, each ICB must make arrangements on managing the conflict of interest and potential conflicts of interest, such that they do not and do not appear to affect the integrity of the board’s decision-making processes. Furthermore, each appointee to the ICB is expected to act in the interests of the ICB. They are not delegates of their organisations, but are there to contribute their experience and expertise for the effective running of the ICB—a point made most eloquently by the noble Lord, Lord Mawson, my noble friend Lady Harding and the right reverend Prelate the Bishop of London. It is important that this is about expertise, not the trust or organisation that they are taken from, or their skills and knowledge, as the noble Lord, Lord Mawson, said.

We are also keen to allow ICBs to develop their own governance arrangements, which best take their local circumstances into account. We want to give them the flexibility to learn and develop as their best practice evolves, so that other ICBs could learn from that best practice where there are concerns.

To support ICBs, NHS England is working with them to issue guidance and to develop and make clear our expectations of ICB leaders—expectations that have been reflected in the discussions and fantastic contributions from many noble Lords. For these reasons, I regret that the Government cannot accept these amendments at this stage. However, I hope I have given noble Lords such reassurance that they feel able to withdraw their amendments.

Turning to the membership of integrated care boards, I will begin with Amendments 27, 37, 38, 39, 40 and 41. I am grateful to all noble Lords who have brought forward these amendments today. I understand the interest from all sides in this membership. Schedule 2 sets out the minimum membership of the integrated care board; it will need to include members nominated by NHS trusts and NHS foundation trusts, by persons who provide primary medical services and by local authorities of areas that coincide with or include the whole or any part of the ICB’s area.

I take the point of the noble Lord, Lord Bradley, about mental health. I am sure he recalls the debate on Tuesday, when noble Lords felt very strongly about this. I have offered to meet many noble Lords from across the Committee who indicated that they want to see this parity with mental health, which they do not believe is implicit at the moment, even if we believe that “health” refers to physical and mental health. Indeed, it refers to spiritual health in many ways. But we understand that we have to close that gap and I will make sure that the noble Lord, Lord Bradley, is invited to those meetings.

It is important for us that we are not overprescriptive, which is especially true of any membership requirement. Any extension beyond the proposed statutory minimum will risk undermining local flexibility to design a board, as my noble friends Lord Mawson and Lady Harding and others have said, in the most suitable way for each area’s unique needs, drawing on the best expertise, but not where they are from. It may also make the boards less nimble and less able to make important decisions rapidly if we overprescribe.

It is important to remind the Committee—I apologise if noble Lords do not appreciate the repetition—that we set a floor and not a ceiling. The ICB can appoint board members if it wishes. Local areas can, by agreement, go beyond the legislative minimum requirements. They will want to ensure they appoint individuals with the experience and expertise to address the needs and fulfil the functions. Areas are already doing this. For example, in south-east London the ICB is proposing to include three provider members—acute, community and mental health—and six place members, one for each borough. This approach is exactly how we want ICBs to use the flexibility available to them.

If, in time, some of the concerns expressed today by noble Lords become clear—such as issues being skated over, ignored or elbowed out by others with louder voices—we may need to add further requirements that relate to ICB membership, and there are regulation-making powers in place in Schedule 2 to allow the Secretary of State to do so. Furthermore, NHS England has the power to issue statutory guidance to ICBs. It could, for example, use this to recommend that each ICB should consider appointing a learning disability and autism senior responsible officer, as I know the noble Baroness, Lady Hollins, has asked for and has spoken about most eloquently many times, most recently in a debate a few weeks ago.

Taken together, our approach reflects our view and, I reiterate, the view of the NHS that we should not attempt to overlegislate for the composition of ICBs and instead let them evolve as effective local entities to reflect local need. Let us get the right balance between the top-down and bottom-up approach, and make sure that they are relevant to their local areas. I am afraid that these amendments are seen to take a different approach, by adding more people to the minimum requirements for the ICB, making them larger but not necessarily better. They also add additional complexity by introducing a significant number of members who are responsible for activity outside the NHS. We think these would be better represented on the integrated care partnerships, which have a broader remit. I come back to the point that it is about expertise, not which trust.

I will consider the comments made by noble Lords very carefully if some of the concerns have not been met, and will have future conversations, between this stage and the next, if they feel that we have not addressed their concerns completely. I regret that the Government cannot accept these amendments. I hope that I have given your Lordships some, if not complete, reassurance and that noble Lords will feel able at this stage to withdraw and not press their amendments.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for his detailed response. I was disappointed with the first remarks he made because he resorted to the mantra that the Government tend to go to when the question of private sector interests in delivering healthcare is raised by this side of the House. That is a shame, because the questions that we have raised are legitimate. In fact, his friends in the Commons accepted the conflicts of interest that could arise from private sector interests being represented on ICBs. We were seeking to make sure that that is watertight and there is no way of it changing. That is a legitimate question to ask.

I thank the noble Lord, Lord Patel, and the noble Baronesses, Lady Walmsley and Lady Meacher, for supporting Amendment 37, which is the key amendment in this group as to who may or may not be members of the board.

The noble Baroness, Lady Hollins, made a powerful case for the interests of people with learning disabilities and autism being represented. We know that where health systems make the health of people with learning disabilities a central priority, the whole health system benefits from it. That has happened in some places—for example, in Manchester—and it demonstrates how we improve the whole system. It is an important point.

My noble friend Lady Bakewell made the point about Centene and Operose, and that is partly why I put forward my amendment on APMS. The Minister may recall that we raised this matter in Questions a few weeks ago, when I asked him to write to me about what system had been used to give that contract to Centene, or Operose, in Camden, the area where I live. Having served on the CCG in Camden, I was aware of the importance of who runs primary care and of who the GPs in our surgeries are. Having right and proper people and organisations running our primary care was one of the criteria that you would use as a commissioner when you were looking at who was running, and who might wish to run, primary care and GP surgeries. I was involved in that process. As I learn about the history and background of this organisation now running primary care and GP surgeries in the UK, I do not think they are right and proper people to be doing that.

If this amendment does not serve the purpose of stopping that happening, I ask the Minister and the Bill team to reflect on what we might need to do to ensure that those from the private sector, social enterprises and charities whom we commission to run parts of our health service are right and proper people to do so. The remarks made in that regard by the noble Lord, Lord Hunt, were very interesting and useful, as they often are.

The noble Baroness, Lady Meacher, made the point about public health. That is the theme running through this Bill: the need for public health to be represented. She was also absolutely correct to bring us back to the idea that clinical leadership is very important. Of course it is. The right reverend Prelate the Bishop of London asked some pertinent questions.

My noble friend Lady Pitkeathley raised the issue of social enterprises, which is close to my heart. I am the honorary secretary of the All-Party Group for Social Enterprise, which I helped to found 20-odd years ago. The APPG has just completed an inquiry, chaired by the noble Earl, Lord Devon, about the impact of Covid on social enterprises, which absolutely illustrates the points made by my noble friend and which I will share with the Minister when it is available.

The noble Baroness, Lady Finlay, made relevant points about Allied Healthcare. I think that the noble Baroness, Lady Walmsley, and I agree that the problem with APMS is that there is a lack of clarity and it is a bit of a loophole, and we need to look at it again. This may not be the Bill to do it in, but it might be.

With those remarks, and hopeful that the issue of who the members of the ICBs will be will run through our discussions for the next few weeks, I beg leave to withdraw the amendment.

Respiratory Viruses

Lord Kamall Excerpts

Tuesday 11th January 2022 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the risks posed by respiratory viruses this winter to (1) children, (2) young people, and (3) the elderly; and what further medical protection measures they will put in place to tackle (a) respiratory syncytial virus, and (b) influenza.

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

Influenza remains a health threat, which is why the Government are offering flu vaccinations to more people this winter, including older people and, for the first time, all schoolchildren up to year 11. Reduced transmission of respiratory syncytial virus, or RSV, last winter led to a summer surge, particularly in child cases—there were few among elderly adults—which is now diminishing. Seasonal RSV preventive monoclonal antibodies for highly vulnerable children were authorised from June 2021.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, measures taken to combat Covid-19 over the last year have resulted in the epidemiology of seasonal viruses being out of sync with usual patterns. Last year, Public Health England reported concerns about rising rates of RSV infections in infants following the Covid-19 lockdowns, and reduced immunity levels combined with an already stretched health service. Given the continued pressures on the NHS, can the Minister outline what evaluation the Government have made of the NHS’s capacity to handle a potentially extended RSV season, and will they work with the devolved Administrations in that regard?

[Lord Kamall (Con)]

There was an unseasonal surge in RSV activity during the summer of 2021, which peaked in late July at about 15.7% swab positivity and a hospital admission rate of 2.5%. But, following the summer surge, RSV activity declined and positivity currently sits below seasonally expected levels. As a consequence, the RSV hospitalisation rate has declined since the summer surge.

[Lord Clark of Windermere (Lab)]

My Lords, thankfully, influenza is low again this winter, largely on account of the most effective way to counter flu: hand washing, covering one’s mouth and vaccination. The House will recognise that those are the identical solutions for fighting Covid. So I urge the Minister and his colleagues to keep hammering those three simple messages in their anti-Covid approach, because at the same time that will reduce many deaths by keeping flu down.

[Lord Kamall (Con)]

The noble Lord makes a very important point that we should acknowledge. The fact is that the preventive messages against Covid are equally valid against influenza. Indeed, the reduction in social contact since the pandemic has led to a reduction in seasonal flu, as we would expect, compared with previous years. I take the noble Lord’s point and will make sure that I repeat it when I can.

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. We have her on screen. This is a convenient point to call her.

[Baroness Brinton (LD) [V]]

My Lords, government data show that more children have been admitted to hospital with Covid in the last three weeks than in the whole of the nine months of the first wave. Many clinically extremely vulnerable children are still expected to go to school, even though they still await their vaccines and guidance on how to manage the risks they face, including RSV and influenza. Can the Minister say when these children and their families will get the vaccines and guidance they need? If he cannot, will he please write to me with the answer?

[Lord Kamall (Con)]

The Government have put in place a range of measures to protect children from RSV this winter, including expanding the passive immunisation programme for all at-risk infants, ensuring that the NHS has surge plans in place to respond to any increasing cases, raising awareness among parents and at schools of the symptoms of RSV and when to seek medical help, and increasing our out-of-season surveillance capacity.

[Baroness Altmann (Con)]

My Lords, given that the elderly are more susceptible to respiratory viruses in the cold, and given the number of excess winter deaths we have already seen in recent years, the reduction in the earnings link for the triple lock and the lack of availability of any increase in the cold weather support for older people, will my noble friend consider whether the Government might introduce any emergency measures to help pensioners keep warm through the winter?

[Lord Kamall (Con)]

My noble friend makes a very important point that during the winter people quite often need some help and assistance with winter fuel and other issues. For RSV and influenza, this winter we have had the continued offer of vaccination for 50 to 64 year-olds for the first time, and to additional cohorts. By 19 December, 82% of people aged 65 years and over and 48% of people under 65 years in risk groups had received a flu vaccine.

[Baroness Thornton (Lab)]

My Lords, in July last year my right honourable friend Jonathan Ashworth anticipated the risk of co-infection with both viruses—popularly known as “flurona”—being likely to compound the impact of Covid. He asked then whether the Prime Minister would invest now in testing capacity so that, alongside a Covid test, it would be possible to test for flu and RSV. Is there a plan to take up multipathogen testing for the future—it is obviously too late for this winter—as we learn to live with Covid?

[Lord Kamall (Con)]

There are a number of innovations when it comes to vaccines and testing for vaccines. Indeed, some of the companies and organisations we spoke to recently about future testing requirements, for example, have looked at multiple tests or tests where you can identify multiple conditions. It is one of the things that the department and the NHS are continuing to have conversations on with suppliers.

[Lord Naseby (Con)]

I congratulate my noble friend on the success of the flu jab and the way it has worked this year through general practice. In passing, I also reflect on the pre-testing of children going back to school and having a test just before school. There remains a concern, though, about the elderly who are housebound. There was a problem with ensuring extra Covid jabs for that category. Will my noble friend ensure that general practices check on a regular basis where appropriate that there are such jabs as are necessary for the housebound who are eligible?

[Lord Kamall (Con)]

I thank my noble friend for congratulating me, but I should not take any credit for this; it is thanks to the dedication of all the people who work in our health and social care system, and the innovation we have seen in the public and private sectors over many years to tackle many of these conditions. I will look into access for elderly people at home and commit to write to my noble friend.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, at the outset of this pandemic, the emphasis appeared to be on hands and touching for transmission of Covid. This appears to have changed to contamination by airborne particles and wearing masks, which makes more sense for a respiratory virus. Can the Minister tell your Lordships’ House whether this analysis is correct and publish the evidence showing the efficacy of face coverings?

[Lord Kamall (Con)]

As the noble Lord will know, there has been a debate on the efficacy of face coverings. The Government believe that they do contribute, along with a number of other measures. One of the things we have to be careful of, when we talk about one measure, is not to diminish the importance of other measures. As a noble Lord who spoke earlier said, all these measures are important—washing hands, opening windows and making sure you are socially distanced—as well as wearing masks. Rather than isolating one preventive measure, we think they all contribute together.

[Lord Pickles (Con)]

My Lords, can my noble friend tell the House what progress has been made on the provision for the visually impaired of lateral flow tests capable of being used without the help of a third party?

[Lord Kamall (Con)]

I thank my noble friend for that question. I am not aware of the answer, and I will commit to writing to him.

[Lord Patel (CB)]

My Lords, there is good evidence through a randomised trial of 300,000 people that shows the efficacy of mask wearing, but that is not my question. We should be pleased that RSV infections in children are lower this year—I am sorry, I should have taken my mask off; surgeons are used to speaking with masks on. We should be pleased that RSV infections and bronchiolitis in children are significantly lower this year, but there are lessons to be learned both for epidemiological studies and for research. Are the Government or the Department of Health engaging in that?

[Lord Kamall (Con)]

I thank the noble Lord for removing his face mask; I know it is supposed to be a preventive measure, but it prevented me hearing his question. We are following the epidemiological picture for RSV and are regularly updated, both in the NHS and in the department.

Health and Care Bill

Lord Kamall Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Lord Cormack (Con)]

My Lords, in the absence of the noble and learned Lord, Lord Judge, I take it upon myself to echo the trenchant observations of the noble Baroness, Lady Walmsley. What do the Government think Parliament is? What do they think it is for? Again and again, we have these Bills—skeleton Bills, Christmas tree Bills, call them what you like, but one thing is abundantly plain: Henry VIII is sitting firmly on his throne issuing his diktats.

This is no way for a democratic Government to treat Parliament, especially the elected House. However, if the elected House will not fully protect itself, we have a duty to speak up for it. There are many who, because of the circumstance of their election recently in Parliament, perhaps feel a bit diffident, but we have a duty not to be diffident. We in this House have a duty to say, “This is no way to treat Parliament”, because we are in effect creating executive departments with dictatorial powers. That is inimical to a parliamentary democracy. It is plain wrong. I do not know how often I shall intervene in the debate on this Bill, but what I do know is that I do not like what I see.

I have enormous and genuine respect for my noble friend the Minister. He has already, very rightly, earned himself a reputation in this House as somebody who is anxious to learn about parliamentary customs and practices, and to listen and reflect. I beg him, as I look at him now, to please talk to his colleagues in the other place who have greater power within the department and say to them that there is real concern in this House—I am delighted to see my noble friend Lady Cumberlege nodding at this point—which has within it many medical experts, such as my noble friend Lord Ribeiro, the noble Lord, Lord Winston, who does not seem to be here this afternoon, my noble friend Lord Kakkar and many others who know about medicine and how things should be organised and who do not see it as their prime purpose to help a Secretary of State hang his baubles on the Christmas tree.

We have a chance—we have done it before in other Bills—to try to improve on this skeleton, this Christmas tree, and to put Henry VIII back in his box, which is where he should be put. I hope that as this Bill goes through your Lordships’ House it will be probed, scrutinised and improved.

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

I start by thanking the noble Baroness, and indeed all noble Lords who have spoken thus far. I will make a general point in response to my noble friend Lord Cormack. I recognise that I am relatively new to this House and that I have much to learn. I hope to learn much, not only from noble Lords who have more experience of the procedures of this House and of holding the Government to account but from many noble Lords from across the House with medical expertise and management expertise in the health and social care sector.

I also thank the noble Baroness, Lady Thornton, for bringing this debate before the Committee. Amendment 1 would mean that we could not commence the change of legal name from the National Commissioning Board to NHS England until after an impact assessment for each of the clauses in Part 1 of the Bill is published, while Amendment 315 would mean that we could not commence Part 1 until after the publication of an impact assessment for each clause’s impact on the risks, costs and benefits to patients.

I hope I can reassure the noble Baroness that my department has published the impact assessments. She acknowledged this and I accept that they were not published in the most timely way. I will endeavour to do my best to make sure that we publish these assessments with as much notice as possible. They are available for noble Lords to review on GOV.UK. I am very happy for the noble Baroness to take credit for the first impact assessment. We will endeavour to do better. We will also commit to publishing further impact assessments for secondary legislation made under the powers contained in the Bill, where those regulations will have significant impact on the health and care system or private businesses, to provide transparency and clarity to the system.

The amendment would also delay the commencement of Part 1 until at least six months after commencement regulations were laid before your Lordships’ House. This would delay the implementation of the key provisions contained in Part 1.

The NHS put forward its recommendations for legislation in 2019. It is preparing, subject to parliamentary passage, to implement the ICB provisions of the Bill from July 2022. We know that ICBs in effect exist in many areas, in whatever form of development, and it is essential that we put these on a statutory footing as soon as possible. The development of ICBs builds on years of development work in local systems to improve partnership working. Delaying the implementation risks a loss of momentum in establishing statutory integrated care boards and the benefits that they are intended to deliver. For these reasons, I ask the noble Baroness to withdraw her amendment.

[Baroness Thornton (Lab)]

I thank the Minister for that very gracious answer and start to our deliberations. I also thank in particular the noble Baroness, Lady Walmsley, and the noble Lord, Lord Cormack. I really was rather hoping that the noble Lord, Lord Cormack, would come in, as this is absolutely what he knows about. He is quite right. I hope that noble Lords who are experts in this will look carefully at the Bill and at the two reports I referred to, because they will need to guide us in our deliberations over the next few weeks.

Let us see what the impact assessment says—whether it works or not—and see whether we need to review certain parts of the Bill with a view to looking at the Constitution Committee’s report, for example, which also was published only yesterday. With that, and with the warning that this is the beginning and not the end of the discussion, I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I feel that today’s debate on this important group of amendments should carry much weight because, at its core, this is about treating people as whole people and seeing them as physical, mental and social beings. Our welfare on each of those fronts is absolutely key to the others. It is not possible simply to treat one without regard to the others, and it is crucial that we enhance people’s well-being across our whole complexity as human beings.

I am glad to speak to this group of amendments because, as we have heard across all sides of the Committee throughout today’s debate, the reality is that, despite the best efforts encapsulated in the mandate, and many times in policy, we find that competing priorities, an avalanche of guidance and instructions, and events—the pandemic has been referred to several times, of course—mean that mental health services can be, and indeed have been, relatively left behind. As the Centre for Mental Health reports:

“Mental health problems account for 28% of the burden of disease but only 13% of NHS spending.”


In the debate today we have also asked ourselves: where is the accountability? For example, we know that in many clinical commissioning groups the actual spend on mental health was below what it was supposed to be, yet there have been no consequences. We need to address not just the finances but the mechanisms around it and the impact on individuals.

The founding National Health Service Act 1946 rightly spoke of a comprehensive health service that secured the improvement of both physical and mental health, and subsequent Acts, quite rightly, have confirmed this. In operational terms, the Government require NHS England to work for parity of esteem for mental and physical health through this NHS mandate, but we know, and have heard again today, that this requirement falls down when we go to a local level.

One way or another, we will all be familiar with a whole range of stories of people who have not been able to access treatment in a timely manner or who find that they are pushed around a system with very little effect and discharged from care before it is appropriate, with consequences that are all too clear to see. It is difficult to overestimate just how challenging this is, not just for the individuals but for local commissioners, because they face competing pressures in trying to deal with this.

As has been emphasised, this group of amendments is about not just getting on the road to financial parity, important though that is, but changing the culture and the whole means of monitoring and implementation, so that disparities can be addressed—indeed, if possible, so that difficulties can be headed off at the pass. It is a well-worn phrase, but it sometimes seems that mental health is a Cinderella service—the one that can be cut first, to the benefit of the more visible services. Some of the recent statistics show that one in four mental health beds has been cut in the last decade, while just last year 37% of children referred by a professional to mental health services were turned away. That is a shocking statistic that we need to move away from.

I thank noble Lords for promoting these amendments and for their contributions illustrating what they mean and the reason we need them today. The noble Lords, Lord Stevens and Lord Patel, made timely points about the impact of the pandemic. If this is not a moment for focusing more on mental health, I do not know what is. The challenge we have and the difficulty presented by the pandemic is that while there is a focus on cutting waits for operations—and we know that is important—this could be a reason for mental health services to get somewhat lost, when in fact the pandemic reminds us of the importance of mental health and the need for the NHS to meet the needs that there now are.

The amendment by the noble Lord, Lord Stevens, encourages and directs the actions necessary for transparency on expenditure. I recall that they were referred to in the debate as legislative levers, and that is indeed what they can be. For me, they encourage not just accountability and transparency but actual action and change—the change we need to see.

The noble Baroness, Lady Hollins, referred to parity of esteem having to be applied locally, not just at a higher level. That is the only way we will see a difference in mental health services and improve the mental health of people in this country.

The noble Lord, Lord Crisp, made reference to the fact that legislation is trying to catch up with where we are as a society, and the noble Lord, Lord Warner, referring back to the meeting he attended, said that the public are well ahead of the game. I believe that is true. Indeed, as the noble Baroness, Lady Watkins, said, we have to prepare for tomorrow. It is not satisfactory that we stay stuck in today, or indeed in the past.

In my view, these amendments move us on. They bring mental health services into real parity with physical health services, but they also connect mental and physical together. I hope they will find favour from the Minister.

[Lord Kamall (Con)]

I begin by thanking all your Lordships for the wide-ranging debate. I want to say how much more I learn, listening to the contributions in each of these debates, before I stand up to speak. I thank all noble Lords for their contributions. As the noble Baroness, Lady Merron, says, this debate carries some weight for our understanding that social, mental and physical well-being are equally important. We should not seek to suggest that one takes precedence over another. I also thank the noble Lord, Lord Stevens, for kicking off this debate with his encouraging and not critical amendments; I take them in that spirit.

Following on from that, and before I go to some of the specific amendments, I will just reflect on some of the contributions made thus far. I first thank the noble Lord, Lord Howarth, for raising social prescribing. I know we have discussed this a number of times since I became the Minister, with particular contributions from the noble Baroness, Lady Greengross, on the importance of art and music in helping to unlock the mind and touch the soul.

As has been made clear, social prescribing is a key component of the NHS’s universal personalised care, and I know that, crucially, this can work well for those who are socially isolated or whose well-being is impacted by non-medical issues. The NHS has mechanisms to ensure that social prescribing is embedded across England: for example, the primary care network directed at enhanced services specification outlines that all PCNs must provide access to a social prescribing service.

I also thank the noble Lord, Lord Patel, for raising the importance of the mental health of children and for making sure that we do not forget, even within mental health, that many sections of our society can quite easily be forgotten.

I agree with the right reverend Prelate the Bishop of London: we have come a long way. I remember as a child in the 1970s going to visit my uncle who was a psychiatric nurse at Claybury Hospital and looking at the patients, with the innocence of a child, and thinking, “These people don’t look ill to me.” We have come far since then. I remember the Rampton hospital scandal in the late 1970s, where the patients were treated appallingly, almost not as humans, and with a lack of dignity. The fact that today we are discussing the parity of mental with physical health shows how far we have come as a society.

We also spoke about loneliness and isolation. The noble Baroness, Lady Watkins, and I have had conversations about loneliness and some of the civil society projects that, for example, bring together lonely older people with children from broken homes so that both can benefit and learn from each other. I remember a story that I have mentioned in the past: in one of the projects I visited, a rather old man said, “I lost my wife five years ago and I had almost given up on life. The fact that I am now working with children from broken families and am almost being a mentor to them gives me a purpose to live—a reason to get up in the morning. I have no longer given up on life.” There are so many of these civil society projects, and no matter how we legislate, sometimes those local projects get to the nub of the problem in their local communities.

I have to pay attention when not only two former NHS chief executive officers but the former Chief Nursing Officer speak in the debate. The noble Lord, Lord Crisp, talked about the focus on outcomes, not inputs and how it is important to make sure that we are not gaming the system, mentioning mental illness and mental health but not doing anything effective about it.

Autism was mentioned by the noble Lord, Lord Warner, a former Health Minister. We are fully committed to improving access to and provision of health and care services for autistic people and people with a learning disability. I know that we have had at least one debate on the treatment of patients with autism and sometimes the terrible conditions they experience. That just shows how important this is.

I am trying to say that in many ways that the Government are absolutely committed to supporting everyone’s mental health and well-being and to ensuring that the right support is in place for all who need it. I therefore welcome the amendments which look to ensure parity of esteem across physical and mental health. I assure noble Lords that we support the sentiments behind these amendments and take mental health seriously.

Indeed, one of the considerations in weighing up the many arguments for further measures in response to Covid—from those who were asking for lockdown, for example—is that we also had to recognise that there was a mental health impact to lockdown. As a Government, we had to look not only at the societal and economic impacts but the mental health impacts within health considerations.

On the amendments, I will first address those tabled by the noble Baroness, Lady Hollins—I add my voice to those of the many noble Lords who have paid tribute to her work over many years in promoting this issue and ensuring that we take it seriously. I also pay tribute to the noble Baroness, Lady Walmsley, for making sure that we are informed about this. These amendments would explicitly reference both mental and physical health and illness in certain provisions of the Bill. I understand that the intention is to ensure that due attention is given to both “mental and physical health” and “mental and physical illness”. Indeed, you cannot separate mental and physical illness, as the noble Baroness, Lady Jones, said. We have moved way beyond “Pull yourself together, man” or a stiff upper lip attitude. We see how mental health plays a role, for example, in terrorism, with those who are recruited to be terrorists, or in those with eating disorders, or the number of people in prison who suffer from mental health issues. It is important that we fully recognise that.