Health Care and Adult Social Care

Lord Kamall Excerpts

Wednesday 27th October 2021 Lords Chamber

[A noble Lord]

Round three!

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

I am on a hat trick. The department welcomes the report by the CQC and recognises the challenges that providers and local authorities are currently experiencing in recruiting and retaining staff, especially social care staff. While local government has a key role to play in tackling staff shortages, the department has been monitoring the situation closely. We have already put in place a range of measures, including funding to help local authorities and care providers address workforce capacity pressures.

[Baroness Wheeler (Lab)]

My Lords, the CQC’s concern about the desperate social care staff shortages this winter and warning about a tsunami of unmet need unless urgent action is taken is very worrying. It is clear that the health and social care levy will not provide any real means of dealing with chronic staff shortages for at least two years. The recent £162.5 million for the workforce retention and recruitment fund gives less than £100 per social care worker, according to this week’s analysis from the Homecare Association of care providers. The CQC has echoed the Commons Health and Social Care Committee’s call in May for an urgent total overhaul of workforce planning in light of workforce burnout after dealing with Covid; a people plan for social care; and an annual independent report with workforce projections. Can the Minister tell the House what progress is being made on this and when we can expect a fully costed and funded workforce plan for this key sector?

[Lord Kamall (Con)]

I thank the noble Baroness for her reference to the £162.5 million of funding for social care through the workforce retention and recruitment fund to help boost staff numbers and support existing care workers through the winter. This is on top of the third infection control and testing fund, introduced in October 2021, which is providing a further £388.3 million of adult social care Covid-19 support until March 2022. This means that, during the pandemic, we have made available more than £2.5 billion in funding specifically for adult social care. We are also taking action to support adult social care providers through a national recruitment campaign.

[Lord Bethell (Con)]

My Lords, this important report is challenging reading for all those who worked on the front line of the pandemic. Its most challenging section is undoubtedly the part on the recovery of services; in particular, as the noble Baroness, Lady Wheeler, said, the importance of

“investment in workforce development and formal changes in service specifications.”

Can the Minister give us some more precise details on how that budget will be spent?

[Lord Kamall (Con)]

I thank my noble friend for his question and for the advice he has given me to date. Even though I have size 11 feet, I am finding it rather difficult to fill his large shoes. On the funding announced, local authorities have a key role in supporting recruitment and retention in their local areas. We are working with them to make sure that they support local providers by identifying workforce shortages, developing workforce plans and encouraging joined-up services. We also continue to work closely with providers, councils and our partners to assess the situation and consider what further action may be necessary.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, the CQC’s annual report highlights the challenges faced by people with learning difficulties, their families and their informal carers. Does the Minister acknowledge this problem? The CQC accepts that its inspection procedures require more emphasis on the knowledge and experience of family and informal carers, following Professor Murphy’s report on the failures and abuse in Whorlton Hall. How can we hope that the CQC and other agencies in health and social care will give priority to the role of family and informal carers when the Government’s main policy statements and papers still virtually ignore their existence?

[Lord Kamall (Con)]

The Government recognise the valuable role that paid and unpaid carers play in social care. We are looking at how we can make sure that we recruit and retain staff. We understand the challenges that many care homes, quite often those in the private sector, face when trying to recruit and retain staff, given the competitive pressures around the jobs market. The Government certainly take seriously the role of unpaid and paid carers.

[Baroness Brinton (LD) [V]]

My Lords, in addition to the winter’s and next year’s workforce plan, the CQC reports that providers of residential care showed the vacancy rate rising month on month from 6% in April to 10.2% in September. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that already are at, or close to, capacity. In recent weeks, two homes in York have announced that they are closing. I appreciate the discussion about planning for the workforce but this is a current crisis. What is the Minister going to do as councils are overwhelmed trying to find beds for patients when there are none?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for the specific examples that she gave. The department is constantly monitoring the workforce capacity pressures. We are continuing to gather a range of qualitative and quantitative intelligence in order to have a strong and live picture of how the risk is developing and emerging. In more detail, this includes drawing on evidence gathered by a regional assurance team and regular engagement with key stakeholders, including the Association of Directors of Adult Social Services in England, local authorities and care provider representatives. We are also monitoring data from the capacity tracker, Skills for Care’s monthly workforce reporting and wider market data. To ensure that we are aware of any emerging workforce capacity pressures, we are strongly encouraging providers to continue sharing available capacity and completing the capacity tracker.

[Baroness Donaghy (Lab)]

My Lords, I conveyed my commiserations to the Minister last week. As he said, he is on a hat trick today, but he is no Salah just yet. The noble Lord is obviously not a Liverpool fan. As the report says, over the past year the pandemic has further exposed and exacerbated health inequalities. Case rates and mortality rates were higher in deprived areas—2.4 times higher than in the least deprived areas for mortality. The report stated that

“strategies to identify and tackle health inequalities were not yet well established.”

What is the Government’s strategy for this, given that deprived areas, such as those in London, are often next to the wealthiest?

[Lord Kamall (Con)]

The noble Baroness raises an important point but before I answer that specifically, I reassure her that I am a Liverpool fan, as well as an Enfield Town fan. It so happens that my middle name is Salah. I think that I can wear that name on the back of my shirt with pride. I assure noble Lords that I did not line that question up. One reason why the Office for Health Improvement and Disparities was set up in the first place was to look at disparities across a wide range of issues, not only in social care but in relation to gender inequalities, ethnic minority inequalities and some of the other inequalities and disparities between various areas. As the noble Baroness rightly says, sometimes one can find some of the poorest communities right next to the some of the wealthiest. We are hoping to address those issues through the work of the Office for Health Improvement and Disparities, by first identifying where disparities are and then addressing them.

[Lord Scriven (LD)]

My Lords, with more than 105,000 vacancies in social care, we have a bit of a crisis. Which job would the Minister advise a low-paid worker to take when offered one of these three full-time jobs, all advertised today: a delivery driver at £11 an hour, a supermarket shelf stacker at £10 an hour or a senior care assistant at £9.25 an hour?

[Lord Kamall (Con)]

I do not see myself as someone who is able to offer jobs advice or careers advice. But the points made by the noble Lord help to explain in many ways some of the pressures that care home providers are facing when recruiting in a competitive market. The Government have looked at funding and how we can work with care providers, particularly as many are in the private sector, as I said earlier. They are not directly controlled by the Government and we can therefore work with local authorities and care providers on how to make sure that they pay a competitive salary to attract care workers to work in the social care system, as opposed to some of the more competitive sectors that the noble Lord mentioned.

[Lord Hunt of Kings Heath (Lab)]

My Lords, one of the areas where there is most pressure has been that of unpaid carers. Not only are they having to take on a much greater load but for a long period they could not even visit their loved ones in care homes. In all the programmes that the Government are taking on, can the Minister say explicitly what is going to be done to support carers in their invaluable role?

[Lord Kamall (Con)]

I think that all noble Lords will agree with the point made by the noble Lord about the importance of unpaid carers and also paid carers. In relation to unpaid carers, we hope that as the social care reforms, in particular, come through, patients will be able to take advantage of social care. That will remove some of the burden from unpaid carers and free up their time. We are, however, looking closely at the implications and consequences of some of the proposed reforms.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, that concludes Oral Questions for today.

NHS England Funding: Announcement to Media

Lord Kamall Excerpts

Tuesday 26th October 2021 Lords Chamber

[Baroness Thornton (Lab)]

The Minister must by now be aware of the chronic staff shortages in the NHS. He will also be aware of the desperate state of some of our buildings in the NHS, and indeed the inadequate facilities for some of our mental health wards. This announcement mentions diagnostic staff, of which already one in 10 are missing. There is a 55% shortage of consultant oncologists, a shortage of radiologists, a shortage of specialist cancer nurses and, so far, no comprehensive NHS staff plan. Could the Minister tell the House who will run the proposed diagnostic centres? Will it be the NHS? Where will the staff for the diagnostic centres, surgical theatres and to operate the new equipment come from?

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

I thank the noble Baroness for her question. Since 2010, we have increased the clinical radiology workforce by 48%, from 3,239 to 4,797 full-time equivalent posts. Numbers of diagnostics radiographers are up by 33% since 2010 and therapeutic radiographers are up by 44%. We are offering those who want to join the radiographic workforce at least £5,000 as a non-repayable grant for each year of their training to be a radiographer. Since 2016, we have seen a 26% increase in those studying diagnostic radiography and a 10% increase in those studying therapeutic radiography.

[Baroness Brinton (LD) [V]]

My Lords, the £5.9 billion in the Chancellor’s early announcement is to pay for physical infrastructure and equipment, not for current services. The NHS Confederation says that next year’s NHS funding allocations are nowhere near enough either. Last week, the Royal Cornwall Hospital declared a critical incident in its A&E department when it had 100 patients in the 40-bed department and 25 ambulances queuing. Its ambulance service is also under intense pressure, reporting that 50 ambulances have queued at times—again, that is much larger than the actual department. This is echoed across the country. How will Ministers help A&E departments and ambulance services in crisis right now?

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[Lord Kamall (Con)]

The noble Baroness refers to what she sees as the workforce shortage. The Government are fully committed to supporting our health and care professionals and to making sure that we have the right number of people with the right skills to deliver excellent patient care and support the increased elective activity committed to under Build Back Better: Our Plan for Health and Social Care. The Chancellor will confirm to the House our three-year settlement for wider health budgets at the spending review on Wednesday, which will support the NHS to undertake long-term planning for the workforce and elective recovery. I will write to the noble Baroness on specific staff numbers for A&E.

[Lord Laming (CB)]

I wonder whether the Minister would agree that the NHS cannot succeed without adequate social care. In the last seven days we have had two reports that show just how vulnerable the social care system is. Can the Minister sign up to a new agreement to protect the NHS by supporting social care? That was absent in this statement.

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. We see social care as incredibly important, which is why we will soon have before the House a health and social care Bill to make sure that we look at both health and social care, from birth all the way through one’s life.

[Baroness Manzoor (Con)]

My Lords, I welcome the sum of £5.9 million, which comes on top of the additional commitments that were previously made by the Government. However, it remains the case that, with demographic changes, an ageing population and many more chronic diseases and illnesses, we will see a rise in cost. Can my noble friend say whether there is an active plan to look at a forward-thinking strategy as to how we will deal with this funding in the long term?

[Lord Kamall (Con)]

I thank my noble friend for that question. Last week we had a discussion on healthy ageing and making sure that the population of the UK is able to live healthy lives for longer. That is very much part of the overall thinking on health reform and we hope to have more details in due course.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister says that Ministers are dealing with workforce shortages. But surely he knows that, throughout the health service, there is a critical crisis. No one is in charge; it does not seem to be the responsibility of Ministers, Health Education England or NHS England. Who will sort this out and who will be held to account?

[Lord Kamall (Con)]

The noble Lord makes a valid point on workforce shortages. The Chancellor will confirm wider health budgets at the spending review, which is in only a few more days. We have already increased training places this year and will feed through into the available workforce. Ensuring that we have the workforce necessary to support this expansion will be driven by a combination of things, such as enforced workforce productivity, including from the spending review digital diagnostic investments, which are expected to deliver a 10% to 15% workforce productivity uplift. We are also looking at existing Health Education England funding, which will provide a pipeline for growth in training numbers.

[Lord Cormack (Con)]

I congratulate my noble friend on an auspicious beginning to his ministerial career. But I also draw his attention to the wording of this Urgent Question, which mentioned an “announcement to the media”. I give strong support to Speaker Sir Lindsay Hoyle in the other place for rebuking the Government for time and again bypassing Parliament. The Government are answerable to Parliament—that is fundamental to our constitution. It is an absolute disgrace that, time after time, Ministers blab to the press before making Statements in either House.

[Lord Kamall (Con)]

My noble friend makes a valuable point. It is important that we are accountable to Parliament, and we will continue to be so. I hope that the fact I am here today shows a willingness to be accountable to Parliament.

[Lord Scriven (LD)]

The Minister has just said in a previous answer that, to deal with the social care crisis, a Bill will be coming forward. The crisis is now. Care homes are not able to take people and are turning them away because of the lack of staff. You will not clear hospitals while social care cannot hope. What will the Government do now to deal with the social care crisis in this country?

[Lord Kamall (Con)]

The money that has been announced is for April 2022 onwards, for three years. In dealing with the specific issue now, believe me, we are having conversations within the department and elsewhere about how we address some of the issues that people are raising with us.

[Lord Patel (CB)]

Going back to the Question on the Order Paper, can the Minister state whether it is the Government’s intention to involve the private sector in delivering some of these diagnostics? If so, will they be paying the private sector tariff or the NHS tariff?

[Lord Kamall (Con)]

I thank the noble Lord for that question. It is important that we recognise that this is a public/private partnership and that we make sure that we can rely on expertise and investment from the private sector. On the specific question, I will write to the noble Lord.

[Lord Balfe (Con)]

My Lords, I point out that the NHS has an insatiable capacity to spend money. I put it to the Minister that political control must be re-exerted over the NHS. Nye Bevan did not found the NHS by asking civil servants to do it. I encourage the Minister to bring a Bill to this House PDQ to get political control back into the NHS and into running it.

[Lord Kamall (Con)]

I thank my noble friend for the very important point he has raised. A friend of mine with completely different politics from me—probably closer to that of noble Lords on the Benches opposite—once said to me, “The thing about working in the NHS is that we always want more money and we are always looking at how to balance that when we get more money”. I think it is important for the public, but also for workers, staff and patients, that we remember value for money and ensure that we spend as productively as possible.

[Baroness Barker (LD)]

My Lords, every NHS provider and professional group is telling the Government that the key shortage in the NHS is staff—and staff who are not exhausted. Can the Minister share with the House the evidence that led the Government to conclude that what the NHS needs above all else for the next three years is kit?

[Lord Kamall (Con)]

The noble Baroness makes a valuable point. We appreciate the hard work that the NHS workforce—doctors, nurses and other healthcare professionals—has put in. This announcement lays out how we will be spending on more kit but also how productivity will help take some of the pressures off the NHS workforce.

Coronavirus Act 2020

Lord Kamall Excerpts

Tuesday 26th October 2021 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee takes note of the temporary provisions of the Coronavirus Act 2020.

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

My Lords, we shall also consider the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021.

Moving to step 4 of the Government’s road map and easing the vast majority of restrictions in England was a major landmark in our fight against the virus. It is testament to the hard work and sacrifices of many people up and down the country. We are in a better position compared with this time last year and we are all conscious of how hard the pandemic has been for so many people.

On 14 September, we published the COVID-19 Response: Autumn and Winter Plan, which sets out how we will build on the progress made and prepare the country for future challenges, while ensuring that our system of healthcare does not come under unsustainable pressure. In recent weeks, we have seen an increase in the number of cases, hospitalisations and, very sadly, deaths. The pandemic is far from over. We must continue to stay vigilant and be ready for all eventualities.

The vaccination programme continues to provide a vital line of defence against the virus. We have vaccinated more than 86% of people over 12 years old in the UK with at least one dose. We are carrying out the largest-ever seasonal flu vaccination programme, alongside Covid-19 booster vaccines for priority groups. We have also secured 730,000 patient courses of antivirals for UK patients: 480,000 courses of Molnupiravir from Merck Sharp & Dohme; and 250,000 courses of PF-07321332 from Pfizer. I shall be testing noble Lords on these in future. These antivirals can be taken at home to target early Covid-19 infection. Should these antivirals receive MHRA approval, we will prioritise antivirals to protect the clinically vulnerable most at risk this winter.

As well as the vaccine and the booster programme, we are taking a number of measures to prepare for the months ahead. The NHS will receive an extra £5.4 billion over the next six months to support its response to Covid-19. This includes an extra £1billion to tackle the treatment backlog caused by Covid-19. These are just some of the actions we are taking to protect the public over the coming months, while trying to achieve the appropriate balance for any legislation and restrictions in place.

As part of the autumn and winter plan, the Government reviewed the remaining regulations and decided, subject to agreement from Parliament, to extend the No. 3 regulations and the self-isolation regulations. The Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021 extend these regulations to 24 March 2022. The test, trace and self-isolate system continues to be one of the key ways to control the virus and protect the nation. Under the self-isolation regulations, if you are notified that you have tested positive for Covid-19, or that you have been in close contact with someone who has tested positive, you must self-isolate unless exempt. Information about the legal requirements is available on GOV.UK.

The recently published Canna model concluded that, between August 2020 and April 2021, we saw a reduction of between 10% and 28% in virus transmission as a result of test, trace and self-isolation, and that, at key periods, self-isolation made a significant contribution to bringing down the reproduction number of the virus, also known as the R number. The Canna model estimates that test, trace and self-isolation has prevented 1.2 million to 2 million secondary coronavirus cases.

The technical amendments to the self-isolation regulations that we are debating today mean that, if you are a close contact of a positive case who has received doses of two different types of vaccine in the UK, you are not required to self-isolate. This ensures that those who have received doses of two different vaccines are treated in the same way as those who have received a full course of a single vaccine. The amendments also clarify that if someone in your household tests positive, you do not need to self-isolate if you received your second dose of the vaccine more than 14 days before the positive case in your household first experienced symptoms or tested positive.

In addition, the amendments clarify the requirements for those taking part in workplace daily contact testing schemes. These schemes offer daily lateral flow testing as an alternative to self-isolation for unvaccinated close contacts. If a person on one of those schemes tests positive with an assisted lateral flow test, but subsequently receives a negative result from a confirmatory PCR test, they must continue with daily testing, or self-isolate for the remainder of their original self-isolation period. These amendments, and extending the self-isolation requirements to March next year, are important to protect the public from this virus.

The No. 3 regulations, which we are also discussing today, are another important tool for managing the virus and protecting the public. The regulations equip local authorities with the powers to respond swiftly to local outbreaks. Local authorities have powers through these regulations to restrict, prohibit and close individual premises and outdoor public spaces and cancel events where there is a serious and imminent threat to public health. The powers have been used 330 times since the regulations came into force in July 2020. Local authorities play a critical role in public health protection, emergency response and infectious disease control. Covid-19 has been no different, with local authorities leading the responses in their communities. Extending the No 3 regulations will help ensure they have the tools to do their job.

We are all aware of the monumental challenge that Covid-19 has posed over the last 18 months and more. It was clear at the beginning of the pandemic that additional tools and powers were needed to enable a full-scale and wide-reaching response to save lives and livelihoods. We acted decisively to put in place the legislation needed to achieve this.

As noble Lords are aware, the Coronavirus Act 2020 came into force by Royal Assent in March 2020. It has been critical to our country’s response to this awful and devastating virus, giving the Government powers to take the appropriate action to respond to the challenge. I acknowledge the many concerns about how some of the powers in the Act have been used and assure the Committee that the Government have sought to use them in an appropriate and proportionate way, with arrangements to ensure accountability to Parliament. These include two-monthly reports to Parliament and six-monthly reviews, combined with confirmatory votes, without which the temporary provisions cannot continue. On each occasion, the House of Commons has confirmed that it is content for certain provisions to continue. The Government have also committed to expire provisions as soon as they are no longer needed. I will go into more detail on this shortly.

The Act has given us the temporary powers to ensure that the NHS and social care services have had the capacity to deal with the peak of the virus by allowing the temporary registration of over 28,000 nurses and other healthcare professionals and social workers. It has protected critical societal functions and ensured that they were able to continue—for example, enabling courts to use video technology in a wider range of circumstances. It has helped provide support packages for people and businesses; this includes the Coronavirus Job Retention Scheme, which has protected more than 11.7 million unique jobs—equivalent to over a third of the entire workforce—and the Self-employment Income Support Scheme grants, which have supported nearly 3 million self-employed people throughout the pandemic.

The Act has also shone a light on where public services can be improved in the longer term, such as allowing more virtual court hearings, and the Government will aim to secure these useful powers in alternative primary legislation.

The course of the pandemic continues to change, partly because of the strong defences we have built. It is right that we again reassess the legislative powers that are in place to deal with this pandemic and support the country. The third six-month review of the Coronavirus Act, which scrutinised its remaining 27 non-devolved temporary provisions, was published on 22 September 2021.

We have identified a further seven provisions in the Act as suitable for full expiry. Once that happens, Parliament will have been able to expire half of the original 40 temporary, non-devolved powers ahead of schedule. This includes removing some of the more controversial sections of the Coronavirus Act, such as powers to detain infectious people under Schedule 21 and issuing directions in relation to events, gatherings and premises under Schedule 22. These powers were taken at a time when the course and severity of the virus were unclear; we now recognise that they are no longer needed and should be expired.

We also propose suspending the remaining powers in Section 58, which cover provisions to ensure that, in the event of a very significant number of deaths, we can continue to deal with the deceased in a respectful and dignified way. Suspension rather than expiry of these powers is seen to be part of sensible contingency planning, since it allows them to be revived quickly if the public health situation requires it.

We will lay regulations as soon as possible to expire these provisions. Once expired, 20 temporary provisions will remain in the Act, three of which will be suspended. There are good reasons for retaining each of them. They continue to support the NHS, individuals and businesses throughout the potentially challenging winter months by allowing the temporary registration of healthcare professionals and statutory sick pay to be claimed on day 1 of self-isolation, but we hope they will help protect the progress we have made so far in beginning to recover from this awful pandemic. The legislation and regulations we are debating today help ensure that we have proportionate powers to help protect our public services, individuals and businesses.

This virus has presented the greatest public health threat to the United Kingdom in recent history, requiring a heroic response from everyone across the country, including our doctors, nurses, carers and other healthcare staff but also other key workers including transport, postal and delivery workers, who delivered much-needed food and items during lockdown.

We owe it to every person and organisation that has made sacrifices to protect themselves and others during this difficult time not to allow ourselves to fall at the final hurdle and to ensure that we emerge in the spring with the worst of the pandemic well and truly behind us.

Lastly, please allow me to repeat and highlight the simple things each and every one of us can to do to help limit the spread of Covid-19. First and foremost, get vaccinated. There are still around 4.7 million unvaccinated adults in England, and I welcome the advice I have been given by noble Lords across the House about how we can target some of the demographics that have not come forward for vaccines in line with the rest of the population. Let us all urge everyone who can have the vaccine to come forward.

If it has been more than six months and one week since your second jab and your GP has not contacted you, you can register at the NHS booking service online or call 119 to book your booster. Some noble Lords have told me about problems in this area. I am assured that these have been resolved but, if you come across anyone who is still experiencing issues getting through to either of those, please let me know and I will forward it to the appropriate person and make sure that we can target and tackle this.

Let us also urge people to take a flu jab when offered it. Please self-isolate and get tested if you have symptoms of Covid-19. Anyone who is told by NHS Test and Trace that they have tested positive or been in close contact with someone who has tested positive should follow the public health advice and self-isolate where required. Even if we are well, we can wear face coverings, meet outdoors or in well-ventilated rooms indoors, regularly wash our hands, and, where possible, makerapid tests part of our weekly routine.

I look forward to noble Lords’ continued scrutiny and valuable contributions to this debate.

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[Lord Kamall (Con)]

My Lords—apologies while I remove my mask—I thank all noble Lords for their valuable contributions to this important debate, and for the range of views expressed in the best tradition of our debates. The Government see extending the No. 3 and self-isolation regulations until 24 March next year as vital to allow local authorities to respond to serious and imminent threats from Covid-19, but also to ensure that the self-isolation system continues to protect the public during the challenging winter ahead. I have listened to and have taken on board—and will take on board—many of the concerns raised here today.

The Government believe that the Coronavirus Act continues to be a critical part of our country’s response to this awful virus, which has touched every corner of our society. In terms of parliamentary scrutiny, I understand the points that have been made by many civil libertarians here today. The Government believe that the Coronavirus Act has enabled them to provide help and support to people, businesses and our public services, and to boost the healthcare workforce at a critical time of need. I assure noble Lords that we will continue to review every aspect of coronavirus legislation, but we are now able to expire seven provisions and part of a further power in the Coronavirus Act. I hope this demonstrates the Government’s commitment to, and progress towards, winding down the emergency powers.

The Government see themselves as taking only those powers that are critical to our response and recovery—for example, powers that help make sure that the NHS is properly resourced and that statutory sick pay is available to those who are self-isolating. It is always a very difficult balance; we heard from the noble Baroness, Lady Merron, that she would have preferred us to keep some of the other emergency provisions. The Government’s autumn and winter plan sets out how we hope to sustain and bolster the progress that we have made thus far.

I turn to some of the specific points made by noble Lords; I hope I will have the time to respond to as many as possible. If I do not respond to every point, I will make sure that I write to noble Lords in answer to their specific questions. The noble Lord, Lord Hunt, asked when an SI would be laid. He also talked about unlawful convictions and incorrect charges, as many other noble Lords spoke eloquently about. I thank them for their contributions about the incorrect charging decisions under Schedule 21 to the Act. Of course it is regrettable that 295 incorrect charging decisions have been made under the Coronavirus Act. The primary issue that the Crown Prosecution Service has identified is that individuals were erroneously charged under Schedule 21 rather than under other legislation such as various health protection regulations. Since April 2020, the CPS has agreed to review all prosecutions made under the Coronavirus Act and it continues to do so. I hope, in some ways, that that reassures the noble Lord.

The noble Lords, Lord Hunt and Lord Scriven, my noble friend Lady Foster, and the noble Baronesses, Lady Fox and Lady Brinton, asked about parliamentary scrutiny. I know that this is an issue of concern to many noble Lords. The Government are confident that they have upheld their promise to allow for proper scrutiny and accountability of the powers in the Act. Many criticisms were levelled, which I understand, and I hope that noble Lords will continue to hold us to account on accountability. Maybe I can have some conversations offline with some noble Lords to make sure we do this as much as possible.

My noble friend Lord Balfe talked about living in the same street as former MEPs and doctors. He then went on to say that the doctors were his friends, but he did not say anything about whether the former MEPs were also his friends. I hope so, but I assure him that he still remains my noble friend.

On occasion, it has been necessary to introduce urgent measures to protect the NHS and save lives. The Government have committed to debates in advance of regulations coming into force wherever possible for measures of national significance. This included Parliament being recalled to debate the national lockdown in January, and debates and votes on regulations covering the tiers system; the steps regulations in March, which set the path for implementing the Government’s road map out of lockdown; and, in June, pausing the move to the next step of the road map.

The noble Baroness, Lady Fox, talked about impact assessments. On the evidence for decision-making, a full regulatory impact assessment was not prepared for many coronavirus regulations, as they fell under the civil contingencies exclusions of the better regulation framework. The Better Regulation Executive will not seek to enforce the current administrative requirement for validating impacts for temporary coronavirus legislation in advance of the wider reform of the better regulation framework.

The noble Baroness, Lady Brinton, and the noble Lords, Lord Hunt and Lord Scriven, accused us of ignoring the scientific advice by not implementing plan B now and asked who is advising us and what the trigger points are. Our approach has always been informed by scientific and medical evidence, and by the latest data. We take evidence from the Chief Scientific Adviser, the Chief Medical Officer, SAGE, of course, as part of that, the UK Health Security Agency, the NHS and others. They remain valuable when we balance the evidence of scientific opinion. Scientific experts have contributed directly to ministerial discussions.

As we have heard in this debate, many noble Lords have contested the science or referenced certain reports. It shows that, even around this area, science is contestable. That has been revealed in the way the Government assess all these trade-offs. What is also interesting is that many people in other parts of the health sector are concerned about some of the provisions, such as the impact on mental health and other unintended consequences. All these have to be balanced. The Government have benefited from the expertise of their science and medical advisers through the pandemic and remain deeply grateful for the role they have played in saving lives and protecting the NHS.

In our debate on Thursday last, I mentioned the work of Professor Mark Pennington, professor of political economy at King’s College London, who talked about the response to the pandemic via decision-making. He talked about the situation being almost a Hayekian, complex system, with many individuals having incomplete knowledge or, as Hayek said, the conceit of knowledge. That expresses and shows the difference of opinion. This is a case where we have to weigh up many different views, particularly among the scientific community, and, in addition, some of the papers referenced today by many noble Lords.

Noble Lords have asked what the set threshold is. The Government and our scientific advisers monitor a wide range of Covid-19 health data, including on cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infection, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. In assessing the risks to the NHS, the key metrics include: hospital occupancy for Covid-19 and non-Covid-19 patients; intensive care unit capacity; admissions of vaccinated individuals; and the rate of growth of admissions. The Government also track the economic and societal impacts of the virus to ensure that any response takes those wider effects—that is, socioeconomic effects as well as those in the medical and scientific professions—into account and assesses that range of views. It is not necessarily a binary decision but a range of views that must be considered and weighed up. Noble Lords have expressed eloquently in this debate the range of scientific views and papers on Covid.

A number of noble Lords, including the noble Lord, Lord Hunt, and the noble Baroness, Lady Brinton —forgive me if I do not remember the others—asked how regularly SAGE meets. Throughout the pandemic, SAGE has been a vital source of co-ordinated scientific advice and technical support to help guide the Government’s response. However, as I have said previously, we also consider other bits of scientific advice. Committee members utilise the latest scientific research, insight and analysis from across government, academia and industry. As new evidence or data emerges, SAGE updates its advice accordingly. As Covid-19 was completely unknown to us less than two years ago, this means that some of the guidance provided in the earlier stages of the pandemic has now been superseded or amended to reflect our ever-evolving understanding of the virus.

The noble Lord, Lord Scriven, asked about face coverings—

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister for explaining the Government’s approach to SAGE, but I have to say that it is rather confusing since SAGE clearly encompasses a wide range of scientific views. The Minister seems to be saying that it has been given a subordinated role, meeting only monthly, and, in essence, the Government are looking for other bits of scientific advice. I would like clarification on this because, for me at least, this is clearly a significant change in policy and practice.

[Lord Kamall (Con)]

I thank the noble Lord for that question. As I laid out earlier and have said formerly, the Government listen to a range of scientific advice, including from SAGE but also from the Chief Scientific Adviser, the Chief Medical Officer, the NHS and a range of other views.

[Lord Hunt of Kings Heath (Lab)]

I am sorry to pursue this but it seems to me that the Minister has made a very significant statement because all those people are on SAGE, as far as I am aware from looking at the minutes. I do not think that the Government can get away with simply saying, “We listen to a whole range of advice, including from SAGE”. Surely SAGE is the primary place from which the Government get advice.

[Lord Kamall (Con)]

I can only repeat what I have said previously but I will look at this in more detail and respond to the noble Lord if he is not satisfied with my response. I will try to make sure that I send a satisfactory response.

A number of noble Lords talked about the evidence around face coverings. Some noble Lords said that they definitely work. Others said, “No, there is no evidence that they work”. Others said, “Actually, they are useful as part of an overall package of other measures”. If the data suggests that the NHS is likely to come under unsustainable pressure, the Government will implement their prepared plan B. That is why we have explained it in advance: so that we cannot be accused of doing things at the last minute. Plan B would include legally mandating face coverings in certain settings, but we are not yet at that stage. The continued efforts of the public in practising safe behaviours and getting fully vaccinated will be critical to ensuring that the NHS does not come under unsustainable pressure.

[Lord Scriven (LD)]

This is an important issue that goes back to what the noble Lord, Lord Hunt, said. We keep hearing the phrase “when the time is right, we will implement plan B, if required”. Who will the Government take that advice from? Will it be SAGE, which, until now, has given the Government clear scientific advice that the Government have acted on—sometimes belatedly but they have done so? What are the criteria and who will give the advice on determining when the time is right within normal government business, if SAGE is no longer seen as having the primary role in advising, since its remit is during times of emergency?

[Lord Kamall (Con)]

Before I answer that in more detail, perhaps I may say that we are not putting SAGE into a subordinate role. It is independent and we rely on its advice. However, as I mentioned, we also rely on the Chief Scientific Adviser, the Chief Medical Officer, the UK Health Security Agency, the NHS and others, and balance up views within the scientific and medical professions. I hope I have also laid out the range of data that is examined. The decisions are data-led. We look at immunity, the ratio of cases to hospitalisations, proportional admissions and so on to see whether the data suggests that the NHS will be overwhelmed. That is what leads to the difficult decision-making and balancing up whether the time is right.

One noble Lord—I think my noble friend Lord Ridley —and many others referred to the research of the London School of Hygiene & Tropical Medicine showing the range of views. Some scientists are saying that the virus will grow while others are saying that if we keep doing what we are doing and rely on the booster vaccines, the numbers will drop off. As one can imagine, there is a range of views but I reassure the noble Lord, Lord Hunt, that we have not relegated SAGE. It is independent and we listen to its advice, as we listen to the advice of others.

On face coverings, the point made by my noble friend Lord Robathan was interesting regarding people who say they are in favour of face coverings but, as he sees when he travels on public transport, a smaller percentage wear them. That shows some of the difficulties in polling, whereby there are stated preferences but also revealed preferences. Although many people say that they will do things, one should judge them by their behaviour. I note that my noble friends Lady Foster and Lord Ridley also raised concerns about the efficacy of wearing face masks.

SAGE evidence states that face coverings, if they are worn correctly and of suitable quality, are likely to be most effective, at least in the short to medium term, in reducing transmission indoors where social distancing is not feasible. Reviews by the UK Health Security Agency in June 2020 and January 2021 found evidence that the use of face coverings in the community helped to reduce transmission. Once again, we have a range of views on the efficacy of face masks.

My noble friend Lord Robathan talked about schools, universities and transmission. In universities, there have been low case numbers among students since the end of the 2020-21 academic year, although there have been slight increases in recent weeks.

My noble friends Lady Foster and Lord Ridley asked why the Act was not being repealed. Correct me if I am wrong, but I believe the noble Baroness, Lady Fox, also asked that. Throughout the pandemic, the Government have been clear that the measures will not be in place any longer than absolutely necessary. That is why we are expiring a number of powers in the Act and intend to expire even more when, we hope, there will be a significant landmark in our progress. The two-year lifespan of the temporary provisions of the Act was chosen to ensure that powers remain available for an appropriate length of time and can be extended by the relevant national authority.

My noble friend Lord Balfe asked about test and trace, and the cost. We have released £280 million in funding thus far, which is broken down as follows: £114 million to cover the costs of the main test and trace support system, £116 million for discretionary payments, and £50 million for administrative costs.

My noble friend Lord Naseby asked about minority vaccine uptake. He asked what the Government were doing to drive uptake among ethnic minority communities. We are well aware of this issue and a lot of work is being done with a number of local community associations to work out the best way to reach them. Only yesterday, I asked the noble Baroness, Lady Benjamin, about how we could tackle particular demographics and got some very valuable advice from her on how we could focus. I fed that into the department, so hopefully that will be part of our strategy. What we have seen is pop-up temporary vaccination sites at many places of worship and community locations. One of the things we have been advised is to go to where the unvaccinated are and to see how we can pursue a targeted campaign.

The noble Baroness, Lady Brinton, asked whether there would be a charge for lateral flow tests. Anyone in England can continue to order free lateral flow tests. I am afraid that I am going to run out of time, so I will write to noble Lords.

[Baroness Foster of Oxton (Con)]

May I just make a point? My noble friend obviously spent a lot of time on certain aspects of this debate, but he tended to skip a little bit past the issue of whether plan B would be introduced. My question is—because I think it is very key—what exactly the benchmark would be to introduce something such as plan B. The NHS has been overwhelmed every year that I can remember during the winter for the last however many decades. At the moment, fewer than 5% of hospital beds are currently occupied by patients with Covid. I appreciate it is under pressure—we might have more flu cases, et cetera—but I would like a little bit of clarification on what the Government would see as that benchmark, because this is a big decision that I would not actually support.

[Lord Kamall (Con)]

I thank my noble friend for that question. One of the difficult things about answering it—believe me, it frustrates me as much as it does the noble Baroness—is that there is no set indicator, no one silver bullet or trigger point. There is a range of indicators that we will balance up to measure how they will affect the NHS and whether the NHS will be overwhelmed.

I know it has been a difficult 18 months, and people across the UK have risen to the challenge of Covid-19. We hope that the Government’s support package has helped to safeguard jobs, businesses and public services. With continued perseverance during the autumn and winter months, supported by only those essential powers remaining in place, subject to the scrutiny of noble Lords, I hope that we will get through this. I thank noble Lords for their contributions to this debate and previous debates: their expertise and the range of views expressed are hugely appreciated. I also thank everyone across the UK for the sacrifices that they have made over the period.

I end by repeating my earlier plea to everyone to do their bit. As my right honourable friend the Secretary of State for Health and Social Care made clear, quite small changes can make a big difference. Both my noble friend Lord Naseby and the noble Baroness, Lady Merron, mentioned messaging. We all have a role to play in combating this virus, especially during winter, which we know will be a challenging period. We can all do our bit by washing our hands regularly, continuing to wear masks in crowds and on public transport, testing regularly where appropriate, staying at home when we feel unwell, and, most importantly, getting fully vaccinated against both coronavirus and flu—and urging friends and family to do so. By remaining vigilant together, we can help limit the spread of the virus in the months ahead. I commend the regulations to the Committee.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021

Lord Kamall Excerpts

Tuesday 26th October 2021 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021.

Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Men’s Health Strategy

Lord Kamall Excerpts

Monday 25th October 2021 Lords Chamber

[Lord Farmer]

To ask Her Majesty’s Government what plans they have to introduce a men’s health strategy.

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

Average male life expectancy is below female life expectancy in the UK, although women spend a greater proportion of their lives in ill health and disability. We are committed to taking action on the range of specific conditions that affect men particularly, including heart disease, liver disease and cancer. Tackling mental health, including suicide, and smoking—both of which are more prevalent in men—are also an important focus.

[Lord Farmer (Con)]

I thank my noble friend for that fairly comprehensive reply and I take this opportunity to welcome him to the Front Bench and give him every wish for good health during his tenure. The latest ONS estimates show that male life expectancy is falling. What analysis have the Government made of the social determinants of health that contribute to this decline, particularly many men’s lack of close relationships? How will they address the fact that, although loneliness is putting significant pressure on GPs, men are less likely than women to come forward?

[Lord Kamall (Con)]

I thank my noble friend for his warm welcome and hope that this continues for some time. To answer his question, the Government regularly consider the social determinants of health, especially how they contribute to our life and healthy life expectancy. We have seen growth in life expectancy slow in line with many countries, which is a challenge that has been exacerbated by the Covid-19 pandemic. We have not yet made a specific assessment of how social determinants drive male life expectancy. On the point about men’s loneliness, since the beginning of the pandemic we have invested £34 million in organisations supporting people who experience loneliness, including men.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am not sure from the first Answer whether the Minister was actually saying that there would be a strategy with resources and led by someone senior in the NHS. He will probably know that the All-Party Group on Issues Affecting Men and Boys has looked into some of the poor health outcomes for men. There is an acceptance in the NHS that this is almost a biological norm. This is a real problem that needs to be reversed and I hope that the Minister will agree that we need a firm strategy.

[Lord Kamall (Con)]

I thank the noble Lord for the advice that he has given me to date on many issues relating to this portfolio. In terms of a specific men’s health strategy, it was quite clear that we needed a women’s health strategy because for many years women’s health had not been given the consideration that it needed, including on a whole range of issues such as clinical trials and data, for example. On male life expectancy, the issues that men face are quite disparate, so we target particular issues such as systemic heart disease, cancers, particularly prostate cancer, the fact that more men than women die from suicide, alcohol-related deaths, drug-poisoning, smoking and obesity. We look at those and target them specifically, rather than putting them into an overall men’s strategy.

[Lord Scriven (LD)]

My Lords, we should not look at men as one homogenous blob. There is more than a nine-year life expectancy difference between men in the top income bracket and those in the bottom 10, which is more than the life expectancy difference between men and women in those brackets. What will the Government do to ensure equity and fairness to tackle this deep-rooted health inequality for some men?

[Lord Kamall (Con)]

The Government have launched the Office for Health Improvement and Disparities and part of its remit is to make sure that we look at inequalities within the health system, particularly gender inequalities or those to do with income strata, and at how people in different income brackets are affected differently. That is why the word “disparity” is in the name of the office.

[Baroness Greengross (CB)]

I declare my interest as co-chair of the APPG for Bladder and Bowel Continence Care. Will the Government consider making it a statutory requirement that in men’s public toilets there are appropriate bins for the disposal of stoma and other continence products, as well as personal care products? Currently, toilets used by women are usually provided with suitable means for the disposal of sanitary dressings, but why are there not similar requirements for male toilets?

--- Later in debate ---

[Lord Kamall (Con)]

I thank the noble Baroness for raising this important topic. I have to admit that I was not aware of this before it was raised. In looking into it further, I know that the noble Baroness was in contact with the previous Parliamentary Under-Secretary of State for Innovation on the issue. As the matter rests with the Department for Levelling Up, Housing and Communities, my predecessor, my noble friend Lord Bethell, had followed up with a letter in May this year, outlining the steps that the department is taking regarding toilet facilities, including looking at certain building regulations. The Department for Levelling Up, Housing and Communities has also launched a call for evidence on the provision of male and female toilets. As soon as we have more information, I will write and update the noble Baroness.

[Baroness Thornton (Lab)]

My Lords, suicide is the biggest killer of men under 50 in the UK. This figure, and the high rate among young men in particular, has not changed for decades. Research by the Samaritans shows that affluent middle-aged men seem particularly vulnerable—stigma and unwillingness to ask for support obviously play a part. What specific measures and investment are the Government building into their mental health strategy to address this serious matter?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this very important issue. We know that men are not a homogenous group, as the noble Lord, Lord Scriven, previously said, but some men are less likely than women to seek help or to talk about suicidal feelings. Others can be reluctant to engage with health and other support services. One of the things we have to do is tackle the stigma associated with this; that has been a key priority for years. That is why we funded the Time to Change campaign to 2020-21; it has played a key role. In addition, we have looked at resources on Every Mind Matters, the mental health hub on the NHS website. We have also issued guidance to local authorities and looked at how we can target the high-risk groups such as men.

[Baroness Uddin (Non-Afl)]

My Lords, I have closely witnessed the state of mental health provision for men recently, with a hugely significant presence of black and Asian men, particularly Muslims, for whom levels of services decry humanity and are far-fetched from the paper strategy. Given that men’s well-being is integral to our society’s well-being, many families and women remain vulnerable as a result. Will the Minister accept that we need not just strategy papers? Will he do everything he can to address this mental health pandemic, about which we have known for many decades?

[Lord Kamall (Con)]

The noble Baroness raises a very important point on how there might be a macho approach to seeking help in certain communities, and how we address those concerns on a community-by-community level. It is really important that we do that. It is part of the remit of the Office for Health Improvement and Disparities to look at how we target certain communities to make sure we address inequalities.

COVID-19: Type 2 Diabetes

Lord Kamall Excerpts

Thursday 21st October 2021 Lords Chamber

[Baroness Merron]

To ask Her Majesty’s Government what steps they are taking to support people at high risk of developing type 2 diabetes who have gained weight during the COVID-19 pandemic.

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

My Lords, helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, as I am sure many noble Lords agree. Our world-leading strategy to meet this challenge was published in July 2020 and reflects the significant work undertaken over recent years to halve childhood obesity and create a healthier environment to help people maintain a healthy weight.

[Baroness Merron (Lab)]

My Lords, new NHS research reveals that people seeking help to lose weight are significantly heavier now compared with those who sought help pre-pandemic. With type 2 diabetes closely linked to obesity and local public health services shown to be highly cost-effective in helping people to lose weight, what assessment has the Minister made of the link between the cuts in funding and the increasing levels of obesity and diabetes, and will the NHS evidence now drive the Government to commit to reversing public health grants and properly funding services that are essential to tackling obesity?

[Lord Kamall (Con)]

I am sure that noble Lords will agree that it is really important that we tackle these issues and respond to the weight increases over the Covid-19 lockdowns. In March, the Government announced £100 million of extra funding for healthy weight programmes to support children, adults and families to maintain a healthy weight. Additionally, more effort has been put into providing access to information.

[Baroness Jenkin of Kennington (Con)]

My Lords, currently one in 10 people in the UK are suffering from type 2 diabetes, a figure which has doubled in the past 15 years. It already gobbles up an unsustainable 10% of the NHS budget. As my noble friend said, it is preventable and treatable through maintaining a healthy weight, diet and exercise; there is no need for expensive medication. Can my noble friend continue to encourage systematic support so that people can achieve these objectives?

[Lord Kamall (Con)]

I thank my noble friend for that question and recognise the work she did with the Centre for Social Justice on this issue. The Government are keen to drive the NHS diabetes prevention programme, which plays a pivotal role in supporting those at risk of developing diabetes. During 2018-19, over 100,000 people took up the programme. In 2019-20, NHS England delivered the long-term-plan target, supporting around 120,000 people on the programme.

[Lord Patel (CB)]

My Lords, does the Minister agree that all those over the age of 40 who are obese, and those who record a high score on the diabetes type 2 assessment, should be offered a blood glucose and haemoglobin A1c test? If he does not agree, can he say why?

[Lord Kamall (Con)]

The Government, in conjunction with the Department of Health and Social Care and many other partners, including Diabetes UK, are looking at the most effective way to tackle diabetes but also to understand the trade-offs that must be made and the balance of considerations. I will write to the noble Lord on the detail of his question.

[Lord Jones of Cheltenham (LD) [V]]

In addition to the link between Covid and weight gain, some people can develop diabetes after an acute Covid-19 infection. The causes are not fully understood. What research into this connection are the Government encouraging?

[Lord Kamall (Con)]

The Government and the Department of Health and Social Care are reviewing the many impacts of Covid-19 that noble Lords will acknowledge. We are still trying to understand the various implications of lockdown. We have seen increases in weight leading to more type 2 diabetes. I will write to the noble Lord giving a detailed answer to his question.

[Lord McColl of Dulwich (Con)]

My Lords, as my noble friend Lady Jenkin has already mentioned, we have known for many years that reducing weight can reverse type 2 diabetes. With others, I was doing this successfully over 60 years ago. This draws attention to the urgent need for an even greater campaign to deal with the 71% of people in the UK over the age of 30 who are obese or overweight.

[Lord Kamall (Con)]

The Government have implemented weight-management services. Tier 2 behavioural weight-management services have been provided by 98% of local authorities thanks to the distribution of £30.5 million as part of the adult weight-management services grant. Additionally, £12.8 million was invested in an NHS digital weight-management programme for individuals with multiple long-term conditions, as well as NHS staff. There are a number of other programmes related to weight management which I may well go into in answering a later question.

[Baroness Boycott (CB)]

I am sure that the Minister is aware of the great social inequality in levels of obesity, as there has been with Covid levels. If you cannot afford a healthy diet you run a much higher risk of developing obesity. What measures will the Government explicitly put in place to support those on lower incomes to easily afford healthy diets—for example, factoring the costs of healthy diets into benefit levels, boosting healthy-start vouchers and introducing fruit and vegetable prescriptions? Right now, if you want to get a lot of calories to make you feel full, the cost differential is around a factor of 10.

[Lord Kamall (Con)]

In response to the increases in weight due to Covid-19, but also before, which led to more type 2 diabetes, the Government, the DHSC and the NHS have been looking in detail at how to respond. Further details will be made available.

[Lord Robathan (Con)]

My Lords, I am glad that the Government recognise that this is a huge problem, and the dangers that being overweight brings, especially during Covid. However, does my noble friend not recognise that the strategy, good as it may be, is not working? Is it not time to revert to the situation when I was young, when it was not socially acceptable to be grossly overweight, and to push individual responsibility? Government policy should tell people that they must not eat so much.

[Lord Kamall (Con)]

I am beginning to wish I had eaten a full breakfast. With any strategy or programme, we always have to be careful about unintended consequences. As we focus more on obesity and make more people aware of healthy living and healthy eating, it is important to have the right balance and to be aware of the impact this can have, so that we are not creating more problems, concerns and anxieties for those who suffer from eating disorders.

[Lord Rennard (LD)]

My Lords, one in three deaths during the first period of the pandemic were among people with diabetes. Obesity accounts for most of the risk of developing type 2 diabetes and, even without the problems of the pandemic, a type 2 diabetic, such as me, at my age, is expected to put on one or two kilos every year. Will the Minister now look to reverse what the King’s Fund says is, in real terms, a £1 billion cut in local authority public health budgets since 2015, and at providing even more support for programmes such as GP referral to fitness classes, which can help people manage their diabetes more effectively?

[Lord Kamall (Con)]

As well as looking at the important role that funding can play, it is important to do better with the money available. There are many things we can do to make sure that the programmes we have are more effective, but I repeat that we have to make sure that they work and we have to look at the evidence. When discussing the evidence internally in the department, I have been told that many of these programmes will be reviewed after five years to make sure that they are effective and do not lead to unintended consequences.

[Baroness Stuart of Edgbaston (CB)]

My Lords, the Minister made reference to the well-being strategy in his opening Answer. In the interest of joined-up government, I also urge him to take notice of another strategy, the Dimbleby review of the national food strategy. None of these problems will be resolved unless we go to their root, which is our attitude to food availability and the supply chain.

[Lord Kamall (Con)]

The Government will consider a number of inputs in looking at the most appropriate strategy to address type 2 diabetes and, as many noble Lords have referred to, the increase in weight of many in our population during lockdown. The Government will consider the evidence of the Dimbleby independent review throughout the development of our food strategy.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked, so we now move to the next Question.

Covid-19 Update

Lord Kamall Excerpts

Thursday 21st October 2021 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my honourable friend the Parliamentary Under-Secretary of State for Health and Social Care. The Statement is as follows:

“With permission, Mr Speaker, I would like to make a Statement on coronavirus. Even through the warm summer days, we drew up our autumn and winter plan. We used the time to plan and prepare, because we know that Covid-19 thrives in colder weather. With winter now around the corner, Covid-19 is re-emerging, as expected. It is clear that this pandemic is far from over: new cases of the virus are high; the pressure on our hospitals is steadily growing; and, sadly, we are seeing over 100 deaths a day. We must therefore be prompt and proportionate in how we enact the plan. We will not be implementing our plan B of contingency measures at this point, but we will stay vigilant and ready for all eventualities, even while pursuing plan A to its full extent.

Vaccines are our first line of defence. Eighty-six per cent of everyone in the UK over 12 has received at least one dose, and 79% of people have had at least two. Two steps naturally follow from this. The first is to plug any gaps in the wall by doing all we can to get vaccines into the unvaccinated. There are 4.7 million people over the age of 18 in England who have not accepted the vaccine, so we are working hard to encourage those who can take it to do so. It is never too late to come forward. We are also working with parents and schools to ensure that this life-saving protection is extended to over-12s.

Our vaccines continue to save countless lives, but early evidence shows that their protection can wane over time, especially in older and more vulnerable people. Our second step has therefore been to reinforce our wall of defence still further. That means third doses, not only for the immunosuppressed but booster shots for all those in phase 1 of our vaccination programme. We have given more than 4 million third doses and boosters in England so far. It is good, but it is not good enough. I want all those eligible to come forward. Over 85% of people have done it twice; there is no good reason not to do it again.

Those who are over 50 or in another priority group, and who had their second jab over six months ago, will be eligible for a booster. The NHS will send an invite once an individual is eligible. But if the invitation has not arrived despite a person becoming eligible, they should contact the national booking service. Boosters can be booked online or by calling 119, because there is zero room for complacency when it comes to this deadly disease and we all have our part to play.

Vaccines are not our only line of defence. Antivirals can stop a mild disease from becoming more serious. Our antivirals taskforce has been looking for the most promising new drugs, to speed up their development and manufacture. Yesterday, we signed a landmark deal for hundreds of thousands of doses of two new antivirals from Pfizer and Merck Sharp & Dohme. Should the MHRA approve their use, we will work with the NHS to make sure that they quickly get to those who need them.

There are, of course, further lines of defence: those that form plan B of our autumn and winter plan. We have always sought to maintain measures that are proportionate to the stage of the pandemic that we are in. We detailed plan B so that people and businesses would know what to expect. This includes face coverings in certain settings, encouragement to work at home where possible, and Covid certification. None of us wishes to implement these measures, but they are clearly preferable to having to close businesses or enforcing further lockdowns.

I recognise vaccine certification is of particular interest to my colleagues in this House. As we set out in our plan, we would seek to provide a vote in Parliament ahead of any regulations coming into force. However, at this time, we remain on Plan A and we will continue to monitor the situation carefully. We are identifying new variants all the time, including a new version of the Delta variant known as AY.4.2, which seems to be growing in prevalence.

Equally, we are monitoring the situation in our hospitals. I want to thank everyone in the NHS and social care for everything they are doing to keep us safe. Today, I can confirm to the House that we are making £162.5 million of additional funding available for social care through a workforce retention and recruitment fund to help local authorities work with providers to boost staffing and support existing care workers through the winter.

In closing, I want to underline just how many things remain within the control of each and every one of us. When we are offered vaccines for Covid-19, we can take up that offer. When we are offered a flu jab, we can take that too. When we have symptoms of Covid-19, we must isolate and get tested. Even if we are well, we can wear face coverings, meet outdoors, let the air in when we are indoors, regularly wash our hands and make rapid tests part of our weekly routine. Let me be clear: rapid tests are a vital tool. A quarter of the positive cases we are identifying at the moment come from lateral flow tests. They also help to give people peace of mind when they visit vulnerable people, such as grandparents.

Even before Covid, winter has always been a tough time for people across our country, for the NHS and for social care. We have another tough winter ahead. But we have a plan. We are prepared and, if things have to change, measures will be prompt and proportionate. We all have a part to play in protecting each other and the people we love.”

I commend this Statement to the House.

--- Later in debate ---

[Baroness Chisholm of Owlpen (Con)]

My Lords, it is the turn of the Front Bench.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord and noble Baroness for their questions, and I will try to clarify some of the issues. I also thank the noble Lord for his acknowledgement of my newness to the job and for giving me some bandwidth on it, if that is fair enough.

Let me be quite clear on the questions that were asked in terms of threshold. There is no pre-set threshold for considering plan B; we consider a range of evidence and data—as we have done throughout the pandemic—to avoid the risk of placing unsustainable pressure on the NHS. For example, while the number of Covid-19 patients in hospital is an important factor, the interaction with other indicators, such as the rate of increase in hospitalisations and the ratio of cases to hospitalisations, will also be vital. We will need to make a judgment on whether plan B is necessary based on the interaction of all those indicators, and informed by advice from the Government’s scientific and clinical experts—I will come to that question later. As I have said, we have an effective vaccine and much-improved treatments, so we are not where we were last winter.

The Government’s objective is to avoid a rise in Covid-19 hospitalisations that would put unsustainable pressure on the NHS. The Government will monitor all the relevant data on a regular basis to ensure that we can act if there is a substantial likelihood of this happening. The Government monitor a wide range of Covid-19 health data which, to give a taste, includes cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infections, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern.

In assessing the risk to the NHS, the key metrics include hospital occupancy for Covid-19 and non-Covid-19 patients, intensive care unit capacity, admissions in vaccinated individuals and the rate of growth of admissions. The Government also track the economic and societal impacts of the virus to ensure that any response takes into account these wider effects. We also monitor a range of metrics on other NHS pressures, including winter respiratory hospitalisation rates, influenza, urgent and emergency care pressures, elective activity and ambulance response times.

A number of noble Lords asked, “So what is the plan for autumn and winter?” The Government’s plan includes building our defences through pharmaceutical interventions, including vaccines, antivirals and disease-modifying therapeutics; identifying and isolating positive cases to limit transmission—test, trace and isolate; supporting the NHS and social care, including managing pressures and recovering services; advising people on how to protect themselves and others through clear guidance and communications; and pursuing an international approach, helping to vaccinate the world and managing risks at the border.

Of course, we have had to prepare contingency measures for if the various indicators and the range of scientific advice that we receive suggests that we have to move to plan B. The measures include: mandatory vaccine-only Covid status certification in certain riskier settings; legally mandating face coverings in various settings, such as public transport and shops; and communicating clearly and urgently to the public if the risk level increases. The Government may also consider asking people to work from home again, if necessary, but, once again, a final decision on this would be made at the time, dependent on the latest data and recognising the extra disruption this causes to individuals and businesses. The message is clear: we prefer not to go to plan B. We prefer to rely on informed choice, but we might have to go to plan B, if cases rise.

I was asked questions on some statistics. Some 49.5 million people had been given a first dose by the end of 19 October, and almost 45.5 million people had been given a second dose. More than 4 million boosters and third doses have been administered so far, including to one in three health and care workers who are eligible. But there is more to do: 5.5 million people have been invited for their booster so far, and another 1.9 million people will be invited this week, as they have become eligible over the last few days and weeks.

Looking at NHS pressures, we are working with NHS England, which is leading work with NHS providers, regions and stakeholders to ensure that robust operational plans are in place for the winter, including plans to meet potential increases in demand for emergency care driven by seasonal flu and Covid-19. To further protect the NHS this winter, we are also carrying out the largest ever seasonal flu vaccination, alongside Covid-19 booster vaccines for priority groups. The NHS will also receive an extra £5.4 billion over the next six months to support its response to Covid-19.

The noble Baroness asked about boosters in care homes. We are committed to ensuring that those who are most vulnerable receive their booster jab as soon as possible after they become eligible. That of course means that care homes are a priority. Vaccination teams have already visited over 40% of all care homes in England, and we expect thousands more to have either received a visit or have a date for a visit scheduled in the coming weeks. The latest figure I have, from a few days ago, is that 40% of care homes—in addition to the 40% where boosters have been received—have booked a visit. That leaves a 20% gap, which we are continuing to look at and work on. Some, for reasons of local outbreaks, cannot yet receive a visit, but we are very clear that 80% are on plan and we are looking at how to narrow that 20% gap.

The noble Lord referred to the NHS booking system. I was not aware of the problem, so I thank him for bringing it to my attention. I will investigate and get back to noble Lords, but I am afraid I do not have the answer at my fingertips. I am sure the noble Lord will appreciate that.

The noble Lord also asked about NHS capacity. The NHS can respond to local surges in demand in several ways, including through expanding surge capacity in existing NHS hospitals, mutual aid between hospitals, and making use of independent sector capacity and accelerated discharge schemes.

I apologise to noble Lords that I am over time. All I will say to finish off, in answer to the question about our scientific advice, is that we have confidence in SAGE. I was also asked who we listen to. Our approach has always been informed by scientific and medical advice, using the latest data. We take advice from the Chief Scientific Adviser, the Chief Medical Officer, the UK Health Security Agency, the NHS and others, which remains valuable. As always, scientific experts have contributed directly to ministerial discussions.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I declare my interest as chair of Genomics England. Does the Minister agree that, as well as testing, sequencing is critical to tracing the pandemic as cases rise? In addition to delta, we are now observing the delta subtype, AY42, and we need to be constantly on our guard for vaccine escape. Can he say what steps are being taken to ensure that our so far really very good pathogen sequencing programme will be as responsive as it needs to be to the winter surge?

[Lord Kamall (Con)]

I thank my noble friend for that question. The UK is world leading in genomics, and it is something that we can all be proud of. COVID-19 Genomics UK has now sequenced 1 million genomes, and the UK is working with global partners to fill global sequencing capability gaps. This includes building the new variant assessment platform, which will offer UK expertise to assess and detect new Covid variants emerging globally.

[The Lord Bishop of Manchester]

My Lords, I apologise for having stood up too early a moment or two ago; I am still very much learning my trade in this House, but I follow the dictum of Martin Luther, that if you must sin, sin boldly.

I am grateful for the Statement, and assure the Minister that the faith communities, which did a lot last year to get health messages to some of the harder-to-reach groups in our society, stand ready to do the same again this winter, but I wonder whether the Government have made a rod for their own back in having plan A versus plan B. It seems a very polar way to deal with things when, actually, we need a more graduated method. Perhaps I might encourage the Government not to be the prisoner of their own rhetoric and for the Minister to share with his colleagues in another place that perhaps we could have steps between a plan A and a plan B: we need gradual, incremental stages as the virus levels rise. I encourage him to try that.

[Lord Kamall (Con)]

I thank the right reverend Prelate for his advice, and for pointing out the very important role that faith communities paid played helping many people get through the lockdowns. They play an important role in this country; many people often assume that it is down to the state, but faith communities play a really important role and complement many of the things we do.

In answer to the right reverend Prelate’s specific question, it should not be seen as plan A or plan B; it is sequential. The Government would prefer that plan A works and that we vaccinate more and make sure that we reach those who have not yet been vaccinated. But if the figures, and the various factors we are looking at—scientific, but also socio-economic—suggest that we have to go to plan B, then we will. At the moment, we are hoping that plan A will work, but we are reliant on the advice that we get from the various scientific advisers that I outlined, but also the other stakeholders, to ensure that we test plan A. Hopefully, it will work, but if it does not, we will move to Plan B.

[Baroness Hollins (CB)]

My Lords, I have recently returned from Germany, where medical masks are worn indoors in settings such as shops, restaurants, theatres, conferences, churches and, of course, on public transport. To enter, you have to show a Covid green vaccination pass—the QR code is checked—or, alternatively, a same-day antigen test performed and certified in a pharmacy. It is easy, it is acceptable, it is working and people feel safe. The death rate is much lower. Will plan B provide the same security and reassurance to British citizens as I experienced in Germany by mandating face masks and green passes, and will this happen soon enough to prevent more deaths? We started the pandemic with a first lockdown that was too late; plan B may be too late.

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her experiences from Germany. We are relying very much on a range of scientific advisers to tell us whether we need to move to plan B but at the moment, because we are not where we were last winter and because we have broken the link between cases, hospitalisation and deaths, we would prefer to try plan A. If we have to move to plan B, we will—on the advice of our range of scientific advisers—but there are also some concerns, as the House can imagine. I think it was Professor Mark Pennington of King’s College London who said, when assessing Covid-19 and the response to it, that you have to look at it as a complex system. When one thing happens, there might be a reaction elsewhere but also unintended consequences.

One concern we have heard about mandating face masks at the moment is: who enforces that? Do we suddenly have more police enforcing it and become a police state? Transport workers are also concerned about having to approach certain people and ask them to put their mask on in the proper place, for fear of abuse, so we have to get the balance right. We will try to stick to plan A, given that we have broken that link between cases, hospitalisations and deaths, and encourage more people to get vaccinated while reaching out to those hard-to-reach groups. But if the numbers and the various indicators are there and the scientific advice tells us to move to plan B, we will do so.

[Viscount Stansgate (Lab)]

My Lords, I too thank the Minister for repeating the Statement. It is such a pleasure to follow the noble Baroness, Lady Blackwood, to whom I had the pleasure of referring by name a week ago today in my maiden speech. SAGE is so crucial to the advice given to the Government. So far as I understand it, in the first half of this year SAGE met on at least a dozen occasions. Yet since July it appears to have met only three times. Is it true that SAGE has not met since 9 September and, if so, why? On 9 September, SAGE’s official advice was that the epidemic was

“entering a period of uncertainty”

because of waning immunity and “changes in contact patterns”—which meant people going back to work and children going back to school. SAGE then

“reiterated the importance of acting early to slow a growing epidemic.”

When SAGE advises the Government, as it did on 9 September, that

“Late action is likely to require harder measures”,


does the Minister agree?

[Lord Kamall (Con)]

I thank the noble Viscount for his question and welcome him to the House. The Government are taking a range of advice, including from SAGE, but also from the Chief Scientific Adviser, the Chief Medical Officer, the UK Health Security Agency and the NHS. We have to balance a number of different views. We want many scientific experts to contribute directly to ministerial discussions and believe that we have benefited from that wide range. I know that SAGE has met regularly; I do not have the latest date for when it did so but I can forward that information to him.

Covid-19: Plan B

Lord Kamall Excerpts

Wednesday 20th October 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government, further to the rising number of Covid-19 cases and comments made by the NHS Confederation regarding the reintroduction of certain restrictions, what criteria they have put in place as the triggers to implement their Covid-19 “Plan B”.

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

I thank the noble Lord for the very important Question. As set out in the Government’s comprehensive Covid-19 Response: Autumn and Winter Plan 2021, if the data suggests that the NHS is likely to come under unsustainable pressure, the Government have prepared plan B contingency measures. We monitor a wide range of Covid-19 data closely, so we can act if there is a substantial likelihood of this happening. We also track the economic and societal impacts of coronavirus to ensure that any response takes into account those wider effects in a balanced way.

[Lord Scriven (LD)]

My Lords, Professor Stephen Reicher, a member of SAGE’s sub-committee, said yesterday:

“I don’t want lockdown … The danger is if you do nothing … in terms of infections, in terms of long Covid, in terms of hospitalisations … they will be left with no alternative.”


Based on what the Minister has just said, what evidence do the Government have of why scientists such as Professor Reicher are wrong in seeking mitigation measures now to deal with the worrying number of viral transmissions as a way of stopping future lockdowns?

--- Later in debate ---

[Lord Kamall (Con)]

In order to judge what the next action should be, the Government have laid out plan A. Plan A is focused, for winter 2021-22, on building defences through vaccines, antivirals and disease-modified therapeutics, identifying and isolating cases of transmission through test and trace, and supporting the NHS and social care, but also advising people on how to protect themselves and offering clear guidance and communications.

[Baroness Thornton (Lab)]

My Lords, it is quite clear that those things are not working. When I saw the Secretary of State for BEIS doing the media rounds this morning denying that plan B was coming down the track, I thought we might open a book on how soon the Government will actually launch plan B. I would like to ask the Minister whether plan B becomes necessary because the Government have made such a mess of plan A, with very late vaccinations for 12 to 15 year-olds and a worryingly low uptake of booster jabs. Is it too late to prevent an NHS winter crisis, with the knock-on effects that will have for our backlog?

[Lord Kamall (Con)]

I thank the noble Baroness for her question and, while I have the opportunity, for all her advice, as a new boy in the role. We will continue to look at a number of different factors, including both economic and health indicators, before we judge whether it is necessary to move to plan B. Plan B does not actually involve complete lockdown. It involves introducing mandatory vaccine-only Covid status certification in certain riskier settings; legally mandating face coverings in certain settings, such as public transport; and communicating clearly and urgently to the public if the risk level increases.

[Lord Robathan (Con)]

My Lords, could my noble friend tell us, following the amazing success of the vaccine rollout, what proportion of hospital beds are occupied by Covid patients? Because it seems to me that some people—some doomsayers—are trying to create panic where there is no need for it.

[Lord Kamall (Con)]

I thank my noble friend for his question. I do not have the detailed data and I will write to him. But in terms of the link between cases, hospitalisations and deaths, it is quite clear that the vaccine has been working to break the link between the number of cases, hospitalisations and deaths.

[Lord Rooker (Lab)]

Would the Minister accept that one of the unfair criticisms, in some ways, over the last 18 months, has been “too little, too late”? That cannot happen again. We need to set good examples. At Prime Minister’s Questions today, there was not a single Conservative MP wearing a mask in a crowded Chamber. What on earth is that as an example to the people on the Tube and everywhere else? Clearly, some small measures now will save the big measures later.

[Lord Kamall (Con)]

I agree with the noble Lord that it is important that we take as many measures as possible to make sure that we do not have to move to plan B. I assure the noble Lord that I do wear my mask to, hopefully, set an example, and I hope others will too—but it is really important that we understand what factors are driving this rise in numbers and the most effective way of tackling it.

[Baroness Manzoor (Con)]

My Lords, can the Minister say what action the Government are taking to ensure that the inequalities that have been experienced by black and ethnic minority people in relation to Covid-19 are being addressed now?

[Lord Kamall (Con)]

I thank my noble friend for that question, particularly in the light of this being Black History Month, an important month to be celebrated in terms of the contribution that the Afro-Caribbean community has made to this country over many years. However, on the specific issue, sadly there are some demographics in communities that have a lower uptake of vaccines. The Government are discussing with a number of stakeholders how we can improve information, but also encourage and exhort people from these communities to take the vaccines.

[Baroness Hussein-Ece (LD)]

My Lords, we know there are government advisers who are advising the Government to implement plan B. Can the Minister say which ones are advising the Government not to implement plan B?

[Lord Kamall (Con)]

I am sure the noble Baroness will appreciate that all these issues are not necessarily binary, and that there are often a number of trade-offs, not only between economic and health factors but also within the health community itself. For example, there have been warnings that if we go down the route of more restrictive measures, we will see an increase both in patients who are unable to have the surgery that they had planned and in mental health cases.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, taking the Minister back to the answer he gave to my noble friend Lord Rooker, on the issue of mask wearing, the evidence seems to be that wearing a mask does have an impact on whether viruses are transmitted, and in this case there is efficacy in respect not only of Covid-19 but of other viruses which could be circulating at this time of year and themselves putting pressure on the NHS. What is it that the Government cannot bear about asking people to wear masks? It has no economic cost, costs very little in terms of inconvenience and has a very significant impact.

[Lord Kamall (Con)]

I assure the noble Baroness that plan B does involve legally mandating face coverings in certain settings, such as public transport and shops. I am sure many noble Lords will have recognised, when they are travelling in by public transport, the number of people wearing masks on public transport, even though advice by the transport companies has dropped.

[The Lord Bishop of Durham]

My Lords, I have a daughter who works in A&E in a London hospital who simply says, “Please will you make people act responsibly once again?” It costs us absolutely nothing. We acted too slowly previously. We have seen 10% increases in the last week; please just get on with plan B.

--- Later in debate ---

[Lord Kamall (Con)]

I thank the right reverend Prelate for his question. It is important. Personally, I do believe that many people should be wearing masks and that there is evidence for this. But the fact is, we have to look at a number of indicators and balance those up.

[Lord Cormack (Con)]

My Lords, could my noble friend tell us how many of us who are eligible for the third jab have had it? I have had mine. Could he also tell us what forward planning we have? Is this going to be an annual event? Are the resources available to ensure that it can be continued indefinitely?

[Lord Kamall (Con)]

I thank my noble friend for that very important question. Some of the data suggests that there has been a slower uptake for the booster. I do not have the exact information and data available on the uptake of the booster, but I will make sure I write to my noble friend.

[Lord Harris of Haringey (Lab)]

My Lords, the Minister keeps referring to plan B, but he has not answered the fundamental question that my noble friend Lord Rooker raised. This Government have too often in the past been slow to respond, and as a result has had to introduce far harsher measures as a consequence. Does he accept that that has been the case in the past, and what assurances can he give us, as we go forward, that that will not happen later this year?

[Lord Kamall (Con)]

I am afraid I disagree with the noble Lord on that particular question. In fact, the UK is seen as a leader in the speed and efficiency with which it adopted vaccines. Countries that criticised the UK were, only a year later, saying “How did you do it? How did you manage to roll out your vaccines so quickly?” Of course, things change, and it is very important that we balance all the factors when considering whether to move to plan B.

[Baroness Fox of Buckley (Non-Afl)]

One of the reasons why there is a health crisis at the moment seems to be that it is a non-Covid crisis. Would the Minister comment on the fact that the backlog, the collateral damage of lockdowns, has created a terrible situation? It is non-Covid related, so we should not overreact. Quickly, on plan B, which experts will he take advice from? Will it be Professor Reicher, a behavioural and social psychologist, or the NHS Confederation, run by someone who was on “Moral Maze” with me? Not all experts are experts, or should be listened to.

[Lord Kamall (Con)]

I thank the noble Baroness for pointing out the important issue that there is a trade-off. There are some who continue to argue against moving to plan B, and it is important that we assess the balance of arguments. There are trade-offs within health itself. There will be some patients who will be concerned about plan B because of how it will affect their access to healthcare, and there are other, wider societal factors.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, will the Minister ensure that before any change in government policy, whether it be plan B or any other changes, there will be proper consultation with the devolved Administrations?

--- Later in debate ---

[Lord Kamall (Con)]

The Government have co-ordinated action and been in constant conversation with the devolved Administrations—or, as one noble Lord said, the devolved Governments—to co-ordinate and to learn from each other in terms of a UK-wide response.

[Baroness Uddin (Non-Afl)]

My Lords, the Minister will be aware that not only have ethnic minority communities seen tremendous disparities in their experience of Covid, but so have people with disabilities where long-term care is needed. Is his department in consultation with them at the moment, in preparation for plan B?

[Lord Kamall (Con)]

The new office OHID, the Office for Health Improvement and Disparities, clearly assesses a number of factors and government policy to help those from more deprived communities and in more deprived areas. If the noble Baroness has specific examples and wishes to write to me, I will answer.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, would my noble friend tell me whether the Government are still happy with the composition, mathematical modelling and advice from SAGE?

[Lord Kamall (Con)]

May I write to my noble friend on that?

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, can the Minister explain now—and not write to me—how and by whom these decisions are made? Are they made by the chief executive of the NHS or by the Secretary of State for Health and Social Care, or do they have to wait for a decision from the Prime Minister and wait until he returns from his beach holiday?

[Lord Kamall (Con)]

The Government are consulting widely on the measures to be taken, balancing and looking at the trade-offs not only in health but with wider societal factors.

[Baroness Pinnock (LD)]

My Lords, nearly 1,000 people are dying every week from Covid. What is the trigger in deaths before plan B comes into effect?

[Lord Kamall (Con)]

I am not sure I agree with the noble Baroness on the figure she cites; I will double-check and write to her. On the triggers, it is clear that we have to look at a range of factors before deciding whether to move to plan B.

[Baroness Altmann (Con)]

My Lords, clearly these are very difficult issues, but can my noble friend help the House—if not today then in writing—by explaining some of the statistics being used to judge what is happening with Covid right now? For example, the use of a Covid-positive test within 28 days of death is not necessarily indicative of what is happening, and the vaccine programme seems to have ensured that those who are seriously ill or sadly dying of Covid are those who are not vaccinated or have serious underlying other conditions—in which case, the statistics may be misleading us somewhat.

--- Later in debate ---

[Lord Kamall (Con)]

I thank my noble friend for making that valuable point. When one looks at the broken-down data, one sees that there are some demographics that have not taken up the vaccine as much as they should have, including a number who have not received the booster. We want to make sure that as many people as possible are vaccinated so that we do not have to move to plan B and can continue with plan A. Plan A includes provisions for ensuring that we increase the number of people vaccinated.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, the time allowed for this Private Notice Question has now elapsed.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Kamall Excerpts

Wednesday 20th October 2021 Grand Committee

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

My Lords, this has been an excellent and fascinating debate. I thank the noble Lord, Lord Patel, for his chairmanship of the Science and Technology Committee. I have heard the challenges that he faced. I also thank those noble Lords who sit on the committee and all those who contributed to the report. It was in-depth and covered a range of issues, in the fine tradition of reports from the House of Lords. I remember that when I was a Member of the European Parliament a number of reports from this place were read there. The expertise available here was widely acknowledged.

The report covered a number of issues: the trends and challenges, the science of ageing, lifestyle and environmental factors on ageing, the better use of technology and digital services, and the ageing society grand challenge mission. I will come back to those in more detail.

I also thank all those noble Lords who have spoken today for their knowledgeable and insightful contributions, particularly building on their expertise. I have admired many of them from afar for many years. It is a real privilege to be here in the same debate as them.

Promoting good health, enabling people to live long and healthy lives, and improving the health of the whole population are all something we want, but they are also fundamental aims of this Government. We can do this most effectively by harnessing the incredible opportunities provided through innovation, science and technology, as the noble Baroness, Lady Greengross, and other noble Lords mentioned.

Before I respond to the specific points made today, I will return to one of the points that noble Lords rightfully acknowledged: the impact of the Covid-19 pandemic and the subsequent lockdowns on life expectancy. A number of noble Lords quoted the Office for National Statistics, as well as some interesting pages and websites that we could read to learn more about this. They also highlighted that life expectancy at birth in the UK between 2018 and 2020 was 79 years for men and 82.9 years for women, but this saw a decrease of seven weeks for men with almost no change for women compared with 2015-17. However, the committee report mentions that there has been a decrease for females over the past decade.

One of the Government’s current priorities is to clear the backlog resulting from the pandemic. This report rightly acknowledges the devastating impact of the Covid-19 pandemic and its response on people’s lives in this country, but also how the pandemic has exposed existing health inequalities, which the Government will tackle as part of our levelling-up agenda—as many noble Lords have referred to today.

The Office for Health Improvement and Disparities has been tasked with helping more people to live longer lives in good health and reducing health disparities by breaking the link between someone’s background and their chance of living a healthy long life. As noble Lords are aware—indeed, some have mentioned this—while people are living longer, many suffer poor health towards the end of their lives. A notable statistic is that people in the least deprived areas live in good health for almost two decades longer than those in the most deprived areas. The noble Lord, Lord Patel, and others referred to this statistic.

The Medical Research Council is leading a cross-government programme of research to understand the ageing process better and promote health in later life, but also on how to motivate healthier lifestyles to improve healthy life expectancy. Like many noble Lords, I want to see the MRC rely more on evidence-based research to ensure that targeted interventions work and avoid unintended consequences.

Many noble Lords have shown an interest in the ageing society grand challenge mission for additional healthy, independent years of life while narrowing the gap. The noble Baronesses, Lady Young and Lady Greengross, mentioned this challenge in particular; I assure noble Lords that the Government remain committed to it. One of the most effective ways to increase life expectancy and healthy life expectancy is to prevent people getting ill in the first place. The report rightly lists risk factors, including the impact of smoking and excessive alcohol consumption. The noble Viscount, Lord Hanworth, pointed to the impact of alcohol, when interventions are often focused on other substances, such as tobacco. From looking at the statistics, alcohol not only leads to cirrhosis of the liver but is often responsible for other deaths—drownings, murders, et cetera—so it is important to look at the wider impact of alcohol consumption. We should also look at poor diets, nutrition, obesity, physical inactivity and the environmental factors that affect physical, cognitive and mental health as humans age.

The Office for Health Improvement and Disparities will drive this cross-government effort to reduce ill health. As many noble Lords know, part of the title of this office is about health disparities. It will continue to publish the productive healthy ageing profile, which provides data at national, regional and local levels on a range of indicators, including healthy life expectancy, health behaviours, NHS health checks, employment and housing.

As the Minister for Technology, Innovation and Life Sciences, I am hugely excited by the role that all three will play in our economic recovery from the pandemic, as well as in our long-term prosperity and in improving the health of the nation. The Government’s new innovation strategy, announced in July, sets out our vision to make the UK a global hub for innovation by 2035, not only in digital technology but in the exciting area of life sciences.

The Government’s commitment to innovation also applies to social care. In the September announcement on social care reform, the Government were clear that innovation would play an important part. Therefore, we continue to work with care users, providers and other partners to codevelop the reform plans, and will publish further detail in the forthcoming White Paper.

GPs’ surgeries are the first point of contact for many patients. The pandemic rapidly changed how services are provided, moving to telephone and online to complement face-to-face appointments where necessary. We continue to look at ways to improve the experience, as many noble Lords will remember from the discussion yesterday when face-to-face appointments were raised. The Government are clear that you have to leave it between the patient and clinician but, when a patient requests a face-to-face appointment, there has to be a good medical reason for the clinician to turn it down.

Many noble Lords alluded to technology. I will continue to work with NHSX and NHS Digital to drive digitisation and the sharing of appropriate data across our system of healthcare, from GP practices to hospitals, and to the social care sector to complement the proposed reforms in the Health and Care Bill. The noble Lord, Lord Desai, mentioned the issue of data sharing and making sure it is all there, but there are some challenges, as I am sure the noble Lord will acknowledge. Many civil liberties organisations have expressed concerns, and I have been in contact with a few to pledge that I will discuss how we can make sure that data is safe, and appropriate data is digitised and shared in the most appropriate way, so that patients have trust. We are looking at the development of things such as trusted research environments to make sure that patients are reassured.

I will work across government with the Office for Life Sciences, BEIS, the Department for International Trade and No. 10 to make the UK a location of choice and hub for life sciences, not only in the Cambridge-Oxford-London golden triangle but across the UK as part of the levelling-up agenda.

I will try to address some of the specific points made by noble Lords. The noble Lord, Lord Patel, asked a number of specific questions and I will try to respond to some of them. The noble Baroness, Lady Manningham-Buller, talked about overprescribing. There was an overprescribing review published on 22 September, and I thank Dr Ridge and all those who participated for their diligent work, which produced such a thought-provoking document. It sets out a series of practical and cultural changes, including the better use of technology. I hope that this report will be a call to action for everyone, whether a patient, clinician or healthcare leader, to think about what we can do to take forward this vital agenda.

The Government remain committed to extending healthy life expectancy by five years and I repeat that pledge. To deliver on this commitment we will work with the Office for Health Improvement and Disparities, as I have mentioned previously. The office—I will use its acronym OHID, as I know many in healthcare like their acronyms—will set out its future plans for extending healthy life expectancy, including how these plans will be delivered and, crucially, monitored in due course. In addition, the new health promotion taskforce will drive and support the whole of government to go further in improving health and reducing disparities to tackle many of the factors that are critical to good physical and mental health.

The Government are strongly committed to supporting research into dementia, which a number of noble Lords referred to. UK researchers are at the forefront of global efforts to find a cure or disease-modifying treatment by 2025. Sadly, the response to the prevention Green Paper has been delayed by the need to focus on the pandemic response, but we will bring forward a response to the consultation in due course.

Many noble Lords asked about the levelling-up White Paper, which will be published later this year. It will set out policy interventions to improve livelihoods and opportunity in all parts of the UK, especially to improve health outcomes and reduce the gap in healthy life expectancy. Given the very technical nature of some of the remarks made by the noble Lord, Lord Patel, on the biology of ageing, I hope he will not mind if I respond to these points in writing.

A number of noble Lords raised the issue of technology, including the noble Baroness, Lady Young, and the noble Lord, Lord Mair. Once again, the issue of data sharing came up. We welcome the report’s recognition of the role that technology can play and it is really important to drive this. Part of it is data sharing, and part is making sure that the different parts of our system of healthcare work together and that we can learn from best international practice.

Before I entered this House, I used to do a lot of work analysing technology. One of the things I looked at is how the Japanese decided to respond to the changing demographics of their country. Some countries respond by immigration, but others do not want to respond like that and Japan is one of those that is very sceptical of immigration. Therefore, it is focusing on technology and how to improve the lives of people getting older, whether through some of the technologies that other noble Lords mentioned, such as touch-sensitive items and data communicating with clinicians, or through robots and extraskeletal equipment to allow older people to live a more meaningful life.

The NHS is also supporting many people to stay at home for their healthcare with digital tools and remote monitoring, partly helped by the fact that more and more of the population are buying mobile phones, Fitbits and various digital devices, and are able to provide that data. Once again, we have to be very careful and make sure that the public is onside as that data is shared.

The noble Lord, Lord Mair, also talked about AI and robots. The Government are taking action in this area. In August 2019, the Prime Minister announced a £250 million-boost to AI in the healthcare sector. I have been in very interesting conversations with the NHS AI Skunkworks. It is fascinating to see some of the technology that has been looked at there.

A number of noble Lords also mentioned how we make sure that an ageing population is digitally aware. I worked with a number of local civil society projects in a previous life. One of the interesting projects was where we got younger people to come in and teach older people to use technology. Not only did it give a more meaningful life in many ways to the older people learning technology but it was interesting that quite often some of the young people were from deprived backgrounds—sometimes single-parent families—and they were able to connect with the older person they were teaching. In many cases they found a new mentor or a new role model in their life. It was one of those interventions that helped the elderly people and some of the young people from broken families. We have to look in a more joined-up way at how we can make sure that we help more people that way.

The noble Lords, Lord Mair and Lord Sikka, also talked about the internet. There is something about the essential digital certificates that are being funded for digital entitlement and based on new standards. The Government and Ofcom have agreed a set of commitments with the UK’s major broadband and mobile operators to support vulnerable consumers, not only during the pandemic but as we go forward to make sure there is no real digital divide.

The noble Baroness, Lady Young, and the noble Lord, Lord Browne, spoke about inequalities, as did the noble Viscount, Lord Hanworth, the noble Lord, Lord Davies, and my noble friend Lord Balfe. The Office for Health Improvement and Disparities has said that it is time to shift the centre of gravity for the department and the health system from treating disease to building good health. As many noble Lords have said, we should start this at a young age as effectively as possible.

One of the issues that my noble friend Lord Ridley mentioned is that it is all very well having these health education programmes at a young age, but will people listen then? When I was at school we had programmes about smoking, alcohol and other things. I remember my friends saying that they were never going to drink or smoke, but a couple of years later we were all out partying. When is public education effective? Do you just assume it is at childhood and not again? How do we make sure that it continues throughout one’s life? That is why it is important that public health messages are built on evidence and communicated in a way that appeals to those we are trying to reach.

The noble Baroness, Lady Young, also spoke on various other things about public health. I assure her that regional directors of public health will sit within the Office for Health Improvement and Disparities and will join up at the national and local level.

The noble Baroness, Lady Young, and the noble Lord, Lord Davies, spoke about levelling up. The White Paper will look at how we set out bold policy interventions to tackle a number of different inequalities. As many noble Lords will know, there are multidimensional inequalities and many ways of people identifying, if you like.

A number of noble Lords also spoke about obesity. Many noble Lords will be aware that we published our current obesity strategy in July 2020. This sets out an overarching campaign to reduce obesity by taking forward actions from previous chapters of the childhood obesity plan and setting out measures to get the nation fit and healthy.

This will involve a number of interventions; some of them have been controversial. Some, such as the restrictions on advertising of food high in fat, sugar and salt, both on TV and online, will be progressed as part of the Health and Care Bill. We should be aware of the controversy around some of this and make sure that, when we make these interventions, they are based on evidence, and we are able to review the evidence and bring it back to show what difference it has actually made, rather than just make the intervention, hope for the best and feel good that we have made it. Evidence-based research is very important as we make these interventions.

The noble Baroness, Lady Sheehan, mentioned ethnic-minority inequality, and the Better Health campaign that the Government launched will look at how we focus on those most at risk, including those from specific ethnic-minority communities, those living with long-term health conditions and people over the age of 40 from lower socioeconomic groups, looking at particularly targeted interventions for each of those different minority groups. On long Covid, which she also mentioned, OHID will be looking at a range of factors that impact life expectancy as we look to reduce health inequalities, and that includes some of the issues on long Covid.

A number of noble Lords talked about dementia, and we have been implementing the 2020 challenge on dementia, published in February 2015, to make sure that dementia care, support and awareness of research are transformed. We will be setting out our plans for dementia for England for future years in due course. The noble Baronesses, Lady Young and Lady Greenfield, mentioned dementia research and statistics, and I commit to write to them with more details on the questions they asked, given the time.

I already mentioned that the noble Viscount, Lord Ridley, talked about some of his scepticism of the public health agenda, and I mentioned my experience and that of many friends, but one issue that he mentioned was diagnosis. The work of Genomics England is interesting. As it goes forward, it will be able to identify potential diseases that individuals will face in their life. This is not as easy as it sounds, because it also raises a number of ethical issues. At what point do you notify people that they will suffer from particular diseases? Do you intervene early, or do you wait until a particular age? A number of these issues are incredibly difficult, but we will try to get the right balance.

We talked about research and funding, and the National Institute for Health Research is welcoming funding applications for research in a number of different areas, including those who want to look at the issue of healthy ageing. I hope I have talked in detail about the data strategy, but it will be important that we get there.

I apologise to noble Lords for not being able to cover all the points raised. To finish, I say just that it is an insightful and wide-ranging report, and that the Government remained committed to ensuring that as many people as possible enjoy a long and healthy life, whoever they are, wherever they live and whatever their background.

GPs: In-person Appointments

Lord Kamall Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what steps they are taking to ensure all patients can choose to have a telephone or in-person appointment with their GP; and what assessment they have made of the impact of appointments not being in person on the late diagnosis of conditions.

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

We have published a comprehensive new plan to support GPs and make it easier for patients to see or speak to GPs and their teams, based on their choice. The plan is backed up by a new £250 million winter access fund, which will help patients with urgent care needs. As part of this, practices should ensure that they are providing the right proportion of appointments for their registered population that is clinically warranted and takes account of patient preferences.

[Lord Balfe (Con)]

I thank the Minister for his reply but point out that one of the fundamentals of the NHS has been that the patient has decided when they wish to see the doctor. Under Covid, that has been breached many times, with doctors having far more power not to see patients. Can he assure me that the aim of the department will be to get back to a system where the patient decides whether they need to see the doctor?

[Lord Kamall (Con)]

My Lords, I am happy to agree with the sentiment in the question from my noble friend, but it is important to make sure that we are not overly prescriptive. Patients sometimes want face-to-face consultation, but they may also be happy with a telephone call or an online consultation. At the heart of this should be patient choice.

[Baroness Pitkeathley (Lab)]

My Lords, has the Minister heard GPs say, as I have, that the most important question a patient asks is the one as they are leaving—the one as they are walking out of the door? Will the training of GPs be amended to cover the different listening techniques that may be required for online consultations, so that these important questions are not missed?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her expertise in this area, and absolutely agree with the question she asked. I do not have the details of the training of GPs to make sure that they are best prepared for online consultations, but I will write to her.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, does the Minister agree that we are in danger of looking at this issue the wrong way around? Given that there is much ongoing research into clinician and patient experience of virtual appointments, that primary care consists of many more people than just GPs, and that complex diagnoses are usually given by specialist consultants, there are multiple reasons from both the clinical and patient viewpoint for what medium to choose. Can the Minister reassure the House that there will be no blanket targets imposed on professionals for the percentage of appointments that need to be face to face, virtual or by telephone, and that GPs, patients and other clinicians are able to assess between themselves what is the most efficient medium to ensure the best possible outcome for the patient?

[Lord Kamall (Con)]

What is important here is that we leave it to the relationship between the GP and the patient to decide the best form of consultation. Sometimes that will be face to face and, if the patient wants a face-to-face consultation but the GP is unable to provide one, they have to give a good medical reason why not. However, we can balance that with online and telephone appointments.

[Baroness Brinton (LD) [V]]

Many GPs are feeling as if they have been completely thrown to the wolves by Ministers, and even Jeremy Hunt has said that the proposed plan and the £250 million winter access fund to support GPs and reduce the pressures they face is little more than a sticking plaster and will not help, given that the real problem is the shortage of qualified GPs. There are not even locums in many places and no longer applicants for many GP jobs. Has the Minister talked to GPs about their current extensive workload, and will he reconsider the assistance needed to support our exhausted GPs?

[Lord Kamall (Con)]

It is important that we listen to GPs and understand their needs and how we can support them. We have committed to growing and diversifying the workforce and boosting GP recruitment. We have also committed to recruiting an additional 26,000 primary care staff to be embedded in multidisciplinary teams. The details of the training will be left to the trainers themselves.

[Lord Flight (Con)]

My Lords, it was appropriate for GPs to avoid physical contact with their patients when the Covid risk was significant. As this abates, it is surely equally correct for GPs to agree to returning to seeing patients when they so request and where their symptoms invite further investigation. Also, rewarding GPs at a lower rate for telephone appointments and for working three rather than five days a week might serve as an effective incentive to restoring physical appointments.

[Lord Kamall (Con)]

At the centre of what the department requires and expects is that GPs work with their patients to decide the most appropriate form of consultation. In some cases that will be telephone, in some cases that will be online, and in some cases it will be face to face. When the patient requests face to face and the GP refuses, they have to give a good medical reason why.

[Baroness Stuart of Edgbaston (CB)]

My Lords, healthcare depends crucially on the relationship between patient and professional. A recent study of Norwegian records found that the longer the relationship between an individual GP and a patient, the more you reduce the need for out-of-hours care and the likelihood of being admitted to hospital. Face-to-face consultation is important but even more important is the case manager function of the general practitioner. Can the Government make a similar study in England in terms of individual GP and patient relationships and medical outcomes, and encourage the devolved Administrations to do similar work so we can compare data?

[Lord Kamall (Con)]

The relationship between the patient and the GP is important, so we have made sure that choice is at its centre. As they develop the relationship, they can decide on the most appropriate way to be consulted and to give advice.

[Baroness Thornton (Lab)]

The Government have consistently promised and failed to increase the number of GPs. Instead of the 5,000 additional ones promised in 2015, this year we have 1,300 fewer GPs. When the Health Secretary announced the £250 million winter access fund to enable GP practices to improve the availability of services to patients, where did he think those GPs would come from? Where is the magic locum tree? It is a seven-year pipeline to produce a GP. Does the Minister agree that rubbishing and attacking GPs is not going to attract medics to take up this profession?

[Lord Kamall (Con)]

I think we all agree that we should appreciate the work that GPs did during Covid; they were often the front line. It is important that we continue to make sure that we recruit more GPs. Some 3,793 doctors—the highest ever number—accepted a place on GP training in 2020, so I do not recognise the criticism.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, I take this opportunity to welcome the noble Lord to his new position; it is the first chance I have had to do that. Does he agree that virtual appointments increase the number of patients dealt with but not the quality of the consultation? Now that we are coming out of extreme measures, what are the Government doing to level up the worst GP practices to the standards of those undeniably excellent ones in some areas? Will he now encourage GPs to have more face-to-face appointments?

[Lord Kamall (Con)]

I thank the noble Lord for his warm welcome to me in my new role. As other noble Lords have expressed, it is really important to make sure that the relationship between patient and doctor or GP is respected. That will not always mean being seen face to face, but when a patient asks for this there has to be a good medical reason if the appointment is not. Speaking from personal experience, I have found online consultations as good as, if not sometimes better than, face-to-face appointments.

[Baroness Smith of Newnham (LD)]

My Lords, I declare an interest. Last November, my father turned yellow. He rang to get a doctor’s appointment and was given a telephone consultation. He does not have a smartphone. The GP said, “It’s jaundice, but it might be pancreatic cancer.” No other suggestion was made and there was no suggestion that he could go in to see the GP. He did not know that he had a choice. He is still with us 11 months later; it clearly was not pancreatic cancer. The idea that people have choice does not work if they are not strong and vocal enough to be able to tell the GP practice, “I need a face-to-face appointment.” What will the Minister do to make patients aware that this is possible?

[Lord Kamall (Con)]

I sympathise with the case that the noble Baroness communicated. It is important that GPs and patients work that relationship out between themselves. If a patient asks for a face-to-face appointment and the GP refuses to give one, the GP has to have a good medical reason.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.