NHS National Health Inequalities Improvement Programme

Lord Kamall Excerpts

Thursday 25th May 2023 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, according to Henry Dimbleby, the Government’s public food procurement system is dominated by a few very large corporations, creating little incentive for innovation or improvement. Can the Minister give us an update on the trials in south-west England, in which small, local, high-quality food suppliers can get into public procurement—for example, to schools and hospitals? I understand that early evidence reports better quality and choice at no increased cost.

[Lord Kamall (Con)]

My Lords—

[Lord Markham (Con)]

Absolutely. Again, there are also very good grounds for locally sourcing in that way in terms of the environment and reducing the carbon footprint. I must admit to not being very familiar with some of the pilots mentioned, so I will find out and get back to the noble Baroness.

--- Later in debate ---

[Lord Markham (Con)]

I agree with the noble Baroness. It was said in answer to a Question not so long ago that the hypothesis about much of the reduction in increases in life expectancy in the G7 nations, apart from Japan, is that it is very much linked to obesity, and that starts early on in life. Education is a key part of that, but the things we are starting to do as regards the placement of foods in supermarkets are already having an impact, and the reaction of the industry to that has been the reformulation of some foods which has already taken out 14% of sugar and 20% of salt—but clearly there is a lot more to be done.

[Lord Kamall (Con)]

My Lords, I apologise to my noble friend the Minister and reassure him that I was not trying to answer the previous question. However, in answer to a previous question, my noble friend the Minister mentioned that the responsibility of school meals and nutrition lies with the Department for Education. Is he aware of any conversations and interaction between the Department for Education, the Office for Health Improvement and Disparities, and the Department of Health and Social Care?

[Lord Markham (Con)]

Absolutely. We work very closely together. The Healthy Start programme gives seven fruits a day to kids up to the age of seven to make sure that they get fruit and vegetables, and that is very much a joint initiative. Clearly, we need to be joined at the hip on some things, but as regards school meals, the DfE takes the lead.

Autism: Diagnosis Targets

Lord Kamall Excerpts

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

As we all know, it is a complex area, and there is no black and white diagnosis of autism. The noble Baroness’s point is absolutely correct: we need to make sure that the quality is there. The Bradford pilot has now been running in 100 locations. Every child has to get an early years profile score. If we can show the linkages and follow that up with the screening programme, that will be very promising; but, absolutely, we have to make sure that the right assessment is made.

[Lord Kamall (Con)]

My noble friend the Minister has rightly said that it is important to expand supply and work with the private sector. Can he tell me about the work that the department is doing with civil society organisations and charities in expanding supply?

[Lord Markham (Con)]

Yes, when I talk about supply, it is in all these fields. There are organisations of which I have personal experience, including the National Autistic Society, which does tireless work and has helped me out personally. So I know just how good they are in this situation. Absolutely, the whole strategy in this space is to expand supply by both the private sector and the independent and charity sectors.

Stroke Rehabilitation and Community Services

Lord Kamall Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. I believe that this is what the national integrated community stroke service is all about. It is the responsibility of each ICS to make sure that there is sufficient capacity in their area. At the same time, it is always good to make sure that that is happening, so I will follow up with the NHS to see what plans are in place to make sure that we really are getting that uniformity of service.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Bull, mentioned the importance of arts therapy for rehabilitation and for other issues. I add to her question by asking about the importance of musical therapy, not only for rehabilitation but to help people address mental health concerns. Could my noble friend the Minister add to his answer specifically with respect to musical therapy?

[Lord Markham (Con)]

As I say, I see social prescribing as taking in a whole range of arts, music and sport. Given that that is a particular interest of my noble friend, I am happy to follow up on both arts and music.

Social Care: Workforce Strategy

Lord Kamall Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend makes a very good point. I am aware that some homes have half the turnover rate of staff than others, clearly demonstrating much better levels of management and skills. I agree, and that will be part of the training.

[Lord Kamall (Con)]

Following the question from the noble Lord opposite about recruitment from overseas, I thank the Government for acknowledging that we will need immigration to fill some of the skills gaps. An issue that has been raised a number of times in this House is visas for social care personal assistants. Can my noble friend the Minister update us on whether visas are being issued for this category of workers?

[Lord Markham (Con)]

We recognise the contribution that overseas workers can make here, as demonstrated by the 57,000 visas. I will need to come back to my noble friend in writing with details on his precise point on personal assistants.

Plastics: Health Research

Lord Kamall Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I understand that this is part of the £500 million Blue Planet Fund that we put in place to help developing countries support the marine environment, and we are a contracting party to the OSPAR convention to participate in marine-limited monitoring programmes.

[Lord Kamall (Con)]

As the Department of Health and Social Care moves towards prevention, is my noble friend the Minister aware of initiatives within the National Health Service and across the health and care system to reduce the use of plastic across our system?

[Lord Markham (Con)]

I thank my noble friend. Yes, the NHS is committed to a 10% reduction in clinical single usage by 2045, and these plans are set out in the NHS long-term plan document, Delivering a “Net Zero” National Health Service.

Health Promotion Bill [HL]

Lord Kamall Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[Lord Kamall (Con)]

My Lords, I congratulate the noble Lord, Lord Addington, on securing time to debate the Private Member’s Bill. I approach this debate with three words in mind: apathy, sympathy and empathy.

Let us start with apathy. During the debate on the then Health and Care Bill, I reassured your Lordships of the Government’s commitment to a national plan for sport and physical activity, and that it would be published later this year. I also informed noble Lords that the Government were working across departments—and I referred to the health promotion task force, led by the Health Secretary, and pledged to keep your Lordships up to date on the progress. I believe that it was this commitment that convinced my noble friend Lord Moynihan to withdraw his amendment.

Unfortunately, in response to a recent Written Question, the Department of Health and Social Care explained that the health promotion task force was not a part of an updated Cabinet committee structure. To be fair, the Answer also explained that the Government’s Our Plan for Patients would address preventable ill health through collaboration across government and the National Health Service. However, it gives the impression that the Government’s approach to health promotion now appears to be one of apathy—or, perhaps more kindly, lethargy. One of the ironies is that part of encouraging physical activity is to overcome individuals’ apathy. Whatever the true picture, I am afraid that there is now a perception that the Government cannot be bothered to take health promotion seriously. I hope my noble friend the Minister will be able to address this perception head-on.

However, this is where I also feel sympathy—indeed, sympathy for my noble friend the Minister, since none of this is his fault. These decisions were made way above his pay grade. While noble Lords can attach no blame to him I hope that, by challenging the Government in this debate, they will empower him to raise your Lordships’ concerns with his department and across government.

My disappointment at the Government’s apparent apathy and my sympathy for my noble friend the Minister leads to my empathy, since I completely understand and share the concerns of the noble Lord, Lord Addington, in bringing forward this Private Member’s Bill. I share the noble Lord’s concerns about the lack of progress, but I am afraid that I will have to respectfully disagree with some of his Bill. One reason why I welcomed the establishment of OHID is because I hope that having the word “disparities” in the name of the organisation will force it to do what it says on the tin—that is, to identify and address health disparities, as the noble Baroness, Lady Uddin, said. This reminds me in some ways of the debate when many noble Lords asked for mental health to be explicitly on the face of the then Health and Care Bill, even though health is generally understood as both physical and mental health.

Whether we term it health improvement, health promotion or health creation, I know that noble Lords agree that it is important, but I hope that we can move on from the debate around health improvement, which seems sometimes to be reduced to the question of whether you burn off calories versus reducing calorie intake. It should not be a question of either one or the other. We can argue about the data and whether reducing calorie intake is more effective than physical activity, but surely the important thing is to encourage both. Indeed, some believe that physical activity may lead to less calorie consumption. A 2019 article in the International Journal of Obesity concluded that

“15-week exercise training appeared to motivate young adults to pursue healthier dietary preferences and to regulate their food intake.”

But everyone is different. There are also studies of people with eating disorders doing excessive exercise followed by binge eating, so we really need to understand it at the level of the individual.

I think that most noble Lords would agree that we should all do more to encourage physical activity. Fortunately, a lot has changed since my youth, when it was about selecting the best and forgetting about the rest. If you did not make the first or second team, you were more likely to be discouraged and give up. Unlike the noble Lord, Lord Addington, I am unable to refer noble Lords to the register of my interests, although I really wish I could for this debate. I was still playing five-a-side football into my 50s and playing with people 30 years younger, and my wife expressed some concerns. I needed allies, so I went to see my physiotherapist, hoping that she would be my ally, and she said, “I’m afraid I agree with your wife—you should give up playing football with people 30 years younger than you.” But that does not stop one from doing physical activities. Nowadays we see more clubs in local communities encouraging people to play sport, no matter their ability. We also see an emphasis on physical activity rather than just sport, encouraging individuals to find the physical activities that they enjoy the most—or perhaps dislike the least.

During my brief time in the Department of Health and Social Care, I became interested in the idea of social prescribing, helping people with physical and mental health conditions through the power of music, the environment, arts and physical activity. I recognise that there is scepticism from some clinicians, but I have heard of so many positive stories of people for whom it worked. But with an ageing population and increased pressures on the state, we should also remember that the state cannot do this all or alone. We need to encourage more local neighbourhood civil society groups, which better understand the people in their local communities. By asking the Government to be more involved, we should be wary that they do not squeeze out civil society but better co-operate and co-ordinate cross-government initiatives in partnership with it.

To sum up, I am disappointed by the Government’s apparent apathy in promoting better health. I sympathise with my noble friend the Minister, since none of this is his fault, and I empathise with the noble Lord, Lord Addington, and his frustration at the lack of progress, even though I disagree with renaming OHID. I end with a question to my noble friend the Minister. Now that the health promotion task force no longer exists, how will the Department of Health and Social Care drive cross-government action to improve health outcomes?

NHS Waiting Times

Lord Kamall Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. There are a number of areas where we can do this. I point to the possibility for home testing a lot more. Covid was a perfect example, whereby it became commonplace. Rather than samples being sent away to a laboratory, we came up with lateral flow devices and were able to do it cheaply and pretty accurately, although not quite as accurately. That is a perfect example of using technology to do more home-type diagnosis.

[Lord Kamall (Con)]

My Lords, in learning from best practice in other countries, are my noble friend, the department or the NHS aware of the pioneering work of Dr Shetty in Bangalore, who has pioneered production-line surgery for certain procedures? Are the Government considering that at the moment? If not, why not?

[Lord Markham (Con)]

I thank my noble friend for that. While I am not familiar with that exact case, I saw a very good, probably quite similar, example in Chase Farm Hospital, which has four operating theatres in a sort of barn. It has a complete production line for elective hip replacements and so on to get that capacity and efficiency.

Health: Pancreatic Cancer

Lord Kamall Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

My understanding is that we do have the capacity for these research trials. Also, on workforce in the cancer space, we have invested £50 million, so we are actually 200 people over our target on that. This is part of the Chancellor’s announcement about the long-term workforce study, which I know will be welcomed by many in this House, where we will be looking, area by area, at exactly what workforce needs we have—and we have a recruitment plan against that.

[Lord Kamall (Con)]

My Lords, in response to an earlier question, my noble friend the Minister talked about the need for more awareness in advance of identifying appropriate screening methods. Given that it is now Pancreatic Cancer Awareness Month, what else are the Government and the NHS doing outside that to ensure there is more awareness for patients to come forward for potential pancreatic cancer?

[Lord Markham (Con)]

I thank my noble friend. Key to this is the Help Us to Help You campaign, which reaches out to lots of different communities, including a number of minority communities. At the same time, we have rolled out the early cancer diagnosis service to GPs, where they are looking out for some of those warning signs, even when people are there for a regular appointment. Clearly, as has been said by other speakers today, a lot more needs to be done; it is a journey, but awareness is the vital first part of that journey. On that point, I thank the Pancreatic Cancer UK charity, which has been excellent in this field.

GPs: Anti-depressants and Alcohol

Lord Kamall Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

On this occasion, that is probably a question about which I need to write back to the noble Lord to give him the detail on it.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Wheatcroft, alluded to the fact that sometimes patients would be more effectively treated through social prescribing, or cultural and arts prescribing. What advice is given to GPs to make them aware of cultural, art and music therapy in solving or tackling depression?

[Lord Markham (Con)]

I agree that we have to make sure that GPs are equipped with the full range of tools for the job and the full range of knowledge. We are probably all aware of some instances of GPs who are very aware and progressive in this space, and others where they do not have that same level of information. We are putting a £2.3 billion increase in 2023-24 into the mental health space to treat an extra 2 million people. We need to make sure that we have a range of help that we can put in place for these people.

NHS: Backlogs

Lord Kamall Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

[Lord Kamall (Con)]

My Lords, in response to an earlier question about the hospital building programme, my noble friend the Minister mentioned the modern construction techniques of hospitals. I wonder whether he could enlighten the House on some of the leading technology methods we are looking at when it comes to the new hospital programme.

[Lord Markham (Con)]

Absolutely; I look forward to sharing this with the House in a lot more detail shortly. This is a real opportunity to create a world-leadership position. The idea behind it is to have a standardised approach to building hospitals—hospitals 2.0, as I like to call them—where we look as much as possible to have standard processes, procedures and components, so that we can build them quicker, cheaper and more efficiently, and get economies of scale from doing that. I believe that it will not only pioneer the way we build hospitals in this country but give us an opportunity to be a pioneer worldwide and create a major export industry.