Diabetic Prevention Programme

Lord Kamall Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what was the business case for not recording the percentage of patients who joined the Diabetic Prevention Programme between 2018 and 2019 but failed to complete the course; and whether this information is now recorded.

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

Data on completion rates is collected for specific reference periods. Rather than looking just at a yearly comparison, completion is analysed to understand the impact of changes to the programme, such as providing a digital option for consumers. Data collected at specific reference points, such as from January 2017 to March 2019, shows a completion rate of 53%.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that. He may not know it, but I have been on the diabetes prevention courses, as I am on the cusp of diabetes. I was amazed by the rate of drop-out on the course that I was on. It ran for nine months. I wondered about the cost and so asked a Written Question on the details, which the Minister has now given me. With a nearly 50% drop-out rate, surely there is something wrong with the course. I want to see more courses but they should be run properly. Can we get the NAO to look at this to see if we can have some improvements and get better returns?

[Lord Kamall (Con)]

I thank the noble Lord for the question and pay tribute to him for his work in this area over many years. He is absolutely right. One of the challenges of this programme is that it is a nine-month course. Clearly, like many things, it was impacted by Covid, with a lack of in-person consultations and appointments. However, the silver lining to the cloud was the digital service. The course was able to move some patients on to digital services and to self-referring. One impact of that has been more people signing up to this programme.

[Lord Hamilton of Epsom (Con)]

My Lords, is it possible that it is not the course that is at fault but the people who go on it? Has the department not considered charging people a refundable attendance fee to ensure that they roll up?

[Lord Kamall (Con)]

I thank the noble Lord for his question but what is more important is that we get people who have diabetes on to the programme in the first place. As we adjust the programme to take account of the pandemic, for example, and digital offers, we are also looking at different ways to work with different communities. For example, I was talking to a young girl of Bengali origin in my department the other day. I said, “What do we do about getting to the heart of the communities, given that we are in Westminster and Whitehall?” She said that one of the problems in her community is that, “We love ghee—we love clarified butter, in our curries and our rotis.” We are looking at alternative recipes and menus so that people can still have the same food but it can be healthier.

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, the observational study by academics of the 2018-19 wave of the NHS diabetes prevention programme, published by BMC Health Services Research, observed disengagement within sessions when patients reported that information was difficult to understand, and when there were very large group sizes and problems with session scheduling. This is all before Covid. Problems with the course will inevitably make patients more likely to drop out but 50% is shocking. Now that this diabetes prevention programme has been rolled out across England, have these specific problems been addressed?

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Lord Grocott (Lab)]

My Lords, further to my noble friend Lord Brooke’s Question about the drop-out rate and his suggestion of an independent review, what mechanism is there for assessing courses that clearly are not as successful as they might be if there is such a high drop-out rate?

[Lord Kamall (Con)]

The point is about what we learn. For example, some noble Lords will have seen stories about the impact of minimum alcohol pricing in Scotland. Clearly, it did not turn out as intended because the review found that people from poor communities were spending more on alcohol, rather than the alcoholism rate being affected. In this case, we have learned that the nine-month programme and some of the other processes behind it clearly lead to a drop-out rate. We are looking at other programmes. One of the great stories we have seen is the use of digital and other forms of access. If we can roll that out as well with community programmes, it might be a better way of doing things.

[Lord McNicol of West Kilbride (Lab)]

My Lords, following my noble friend Lady Merron’s question regarding children, could the Minister say a little more about schools and what work the Government are doing to raise these issues there? We all know that the earlier we can prevent onset the better. Schools are a great place for this to be done.

[Lord Kamall (Con)]

The noble Lord makes an important point. When I speak to experts, policy officials and people working on diabetes, one of the things they say is that the Government cannot reduce obesity alone; efforts also have to include businesses, health professionals, schools, local authorities, families, individuals, community groups and civil society. We all have to come together collectively. There clearly are programmes in schools to encourage people to eat more healthily, but I am sure the noble Lord would recognise that, when we were children, we had programmes about not smoking, sex education and people not drinking alcohol. We would come out of them and say, “I’m never going to drink alcohol or smoke cigarettes again.” Two years later, we were all at parties and what were we doing? We have to make sure that it is impactful all the way through life, not just at that time.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree with the recently published scientific evidence that fasting is actually good for you and that missing an occasional meal would be a good thing, especially for preventing diabetes?

[Lord Kamall (Con)]

As my noble friend will be aware, there are always debates in scientific circles on this. There are different types of fasting regime as well. For example, during Ramadan lots of mosques expounded it as a great example of something that is not only spiritual but good for your physical health. It does depend. Other studies show that it depends on who is doing it and their other circumstances.

[Lord Scriven (LD)]

My Lords, could the Minister say what is being done regarding the latest statistics, which showed that just 34% of people in the north of England who have diabetes have access to the eight health checks that they should have?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord makes an important point. The Office for Health Improvement and Disparities is looking at a number of these areas and where the health service or the ICS locally has to target more resources. Clearly, one of the big concerns is disparities. The noble Lord has given the example of the north-east; as he rightly said, there will be parts of the country where those checks are not happening. It is vital that we tackle those disparities.

[Lord Brooke of Alverthorpe (Lab)]

I am sorry to be so persistent, but we are spending millions on these programmes. Since some work is being done to try to improve them, could the Minister give the House a report in six months’ time to tell us what progress is being made and give us some targets that are being delivered?

[Lord Kamall (Con)]

I am not entirely sure that I can give the noble Lord what he asks for, but I suggest that he asks me a Question about progress in six months’ time. Given that the noble Lord asked this Question, I will go back to the department and see what answers we can give.

[Lord Hain (Lab)]

My Lords, is there any link between patients with diabetes and other ailments and the drop-out rate? Can the Minister give any evidence for that?

[Lord Kamall (Con)]

I apologise, I did not hear what the link was: between diabetes and what, sorry?

[Lord Hain (Lab)]

Patients with other ailments or conditions and the drop-out rate.

[Lord Kamall (Con)]

I am not entirely sure of the answer to that. I will check and write to the noble Lord.

Social Care: Adults

Lord Kamall Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the survey by the Association of Directors of Adult Social Services, published on 13 May, which found that more than 500,000 people in England were waiting (1) for a social care assessment, (2) for their care package to begin, or (3) for a review of their care.

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

Local authorities are responsible for meeting the needs of those who require care and support under the Care Act. The ADASS survey highlights that their waiting lists are increasing, which is why we are investing to support improved outcomes and experiences of care for people and their families, including through an additional £5.4 billion over three years to begin a comprehensive programme of reform.

[Baroness Wheeler (Lab)]

My Lords, both the ADASS survey on social care waiting lists of 500,000 and Age UK’s estimate of 1.6 million people with unmet care needs are a stark wake-up call for the Government’s mantra of having fixed social care. The Minister knows that the official figures that he always quotes and quotes today are nowhere near enough to meet current and future demands, as key stakeholders and the expert think tanks routinely remind him. What are the Government doing to prioritise care and support in people’s homes and local communities? Does the Minister not recognise that the situation is getting worse, not better?

[Lord Kamall (Con)]

Many noble Lords recognise the challenges faced by not just this sector but all sectors, during Covid. One issue we have been looking at for many years, over subsequent Governments—we discussed this during the Health and Care Bill—is that social care was seen as a Cinderella service for many years. For the first time, thanks to noble Lords’ support, we managed to get the Health and Care Bill through to have a properly integrated health and care system. We are also looking at how we can make sure that we properly understand the health and care landscape, with the register and the hub, and that it is a vocation that more people find attractive.

[Baroness Altmann (Con)]

My Lords, I urge my noble friend, in light of the extraordinary number of vacancies in the social care sector—more and more staff are leaving to join other sectors—to urge the Government to revisit the Immigration Rules that do not allow overseas care workers, who could fill those gaps, to come in. We have a special system for agricultural workers; surely my noble friend agrees that we must not put picking fruit and vegetables above the needs of the most vulnerable in our society.

[Lord Kamall (Con)]

I thank my noble friend for the question, but make the point that it is important that we look not only to our domestic workforce but to recruit people from far and wide to fill those gaps. We have always done that. As I often say from this place, we must remember that public services in this country were saved by people from the Commonwealth after the war. They played a very important role in making sure that this country and its public services recovered after the war. On recruitment from overseas, on 15 February, we added care workers to the health and care visa and shortage occupation list, allowing these roles to be recruited from overseas. We hope that will enable us to fill thousands of eligible vacancies.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, is participating remotely.

[Baroness Brinton (LD) [V]]

My Lords, I go back to the previous question: this ADASS survey shows that almost 170,000 hours of homecare a week could not be delivered for the first three months of this year, because of a shortage of care workers. This is a sevenfold increase on the previous year. The changes proposed to the social care system will not increase the rates of pay for social care workers, at the moment, to make it attractive to others, who can work in hospitality. But there is a dire need for people now. What will the Government do right now to help solve this crisis?

[Lord Kamall (Con)]

As the noble Baroness will acknowledge, some of the problems have been in evidence for a long time. Sometimes, we are tackling the legacy of this neglect of the social care system. At the same time, we have to remember that many social care providers are not run by the state; they are private providers. Following the People at the Heart of Care White Paper, we want to make sure that, first, we encourage better conditions for workers. We also want to make sure that local authorities determine a fair rate of pay based on local market conditions. We have seen an increase in the national living wage, which means care workers will get an increase. But we are looking at all this as part of the overview of the social care landscape.

[Baroness Bull (CB)]

My Lords, could the Minister comment on the March 2022 progress report on the Out of Sight – Who Cares? report, which came out in October 2020? It found that of the 17 recommendations, none had been fully achieved and only four had been partially achieved. Can the Minister say when Government will address these recommendations and end the excessive use of the dehumanising isolation, segregation and seclusion within adult social care?

[Lord Kamall (Con)]

On that specific question, I will have to go back to the department and get an answer. I will commit to write to the noble Baroness.

[Baroness Uddin (Non-Afl)]

My Lords, 500,000 is a staggering number, but the number experiencing the deepest emotional and physical impact on families may be in the millions. Is the noble Lord and his department aware of the costs associated with neglecting these people and how many may have lost their lives while waiting for these services?

[Lord Kamall (Con)]

When we look at the 500,000 number, we are talking about an assessment of any kind. These are not people who are outside the system; sometimes they may be in the system but waiting for another assessment within the system. For example, they could be waiting for Care Act deprivation of liberty safeguards, occupational therapy assessments, the beginning of direct payments or a review of their care. It means they are in the system but just waiting for another part of the system to work. The other thing about the report was that there was a 61% response rate, and it was extrapolated from that. Anyone who has read behavioural economists Daniel Ariely or Daniel Kahneman will know that people are more likely to focus on losses rather than gains and, similarly, in surveys people are more likely to report bad things than things that are going well.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend accept that what these figures show is that local authorities with insufficient resources are introducing rationing of services to some of the most vulnerable people in the country? Why did we pay more in national insurance if the money was not to be made available to social care until three years down the line and the crisis is now?

[Lord Kamall (Con)]

I wonder if I could correct my noble friend. The Government implemented a comprehensive review of the programme on adult social care with a £5.4 billion investment over three years from April 2022, of which £1.7 billion will be used to begin major improvements across adult social care in England, including but not limited to £500 million investment in the workforce and £150 million to improve technology. As many noble Lords recognise, for too long this sector has been neglected. In some cases, there is a lack of understanding about the breadth of the sector. We are trying to understand it and get people to register, and then we can improve it.

[Lord Scriven (LD)]

My Lords, I declare my interests as set out in the register. Some hospital NHS trusts have a third to a quarter of their beds bed-blocked by people who are clinically ready for discharge but cannot leave because of no social package being available. What are the Government doing now to deal with this problem? It undermines the NHS waiting list backlog as well.

[Lord Kamall (Con)]

The noble Lord makes an important point, and the fact is that if some patients do stay in hospital too long, they can lose control of certain faculties and see muscular deterioration. So it is our priority to ensure that people discharge safely, as quickly as possible, to the most appropriate place. Local areas should work together to plan and deliver hospital discharge, and the department is working with NHS England, NHS Improvement, local government and social care providers to monitor and understand the underlying causes and do something about them.

[Lord Watts (Lab)]

My Lords, the Government say this is a long-term problem, but they have been in power now for 10 years. What have the Government been doing to address this issue, bearing in mind that Andy Burnham identified this as a problem and was attacked by the Front Benches when he put forward some suggestions on how they could deal with it? This is a crisis made by this Government.

[Lord Kamall (Con)]

I am afraid I will have to humbly disagree with the noble Lord, because this has been a problem for subsequent Governments, as we discussed during the passage of the Health and Care Bill. In some cases we can see reports going back 50 years. What has happened over the years is that Labour, Conservative and coalition Governments have put those reports on shelves to gather dust. We were the first Government to introduce an integrated health and care system and to grasp the nettle.

[Baroness Manzoor (Con)]

My Lords, there is some anecdotal evidence that patients are being discharged from hospital without having a full care package in place. Could my noble friend say exactly what the Government’s policy is to ensure this does not happen? These are some of the most vulnerable people, such as individuals who have had a stroke. On occasions, they are sent home with no support mechanism at all.

[Lord Kamall (Con)]

I thank my noble friend for the question. It is a really important issue that we discussed many times not only during the passage of the Health and Care Bill but subsequently. We have to make sure that everyone in the system is working together to make sure that a hospital knows who it is discharging to and that the carer who will receive or help that person has not only the support but the facilities and capabilities at home, or wherever that person is being discharged to, to work with that person. There are gaps in the system; it is not perfect in all places. We are working with local authorities and others to make sure we improve the system.

[Viscount Waverley (CB)]

My Lords, would the Minister care to associate himself with today’s celebration of the arrival of the HMT “Empire Windrush” in 1948, whereby a statue has been unveiled at Waterloo station to remember that it was Caribbean citizens who, frankly, came to the rescue of the National Health Service? Are there lessons to be learned that the Minister might wish to apply to today’s situation?

[Lord Kamall (Con)]

I am so keen to answer that question because of my own Caribbean background. In fact, my father was part of that Windrush generation. He travelled from Guyana to Trinidad in 1952, and then from Trinidad to the United Kingdom, where he worked first on the railways and then as a bus driver. His brother worked in a post office and his sister was a nurse. That shows the vital contribution that people from the Caribbean made to this country post war.

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

Lord Kamall Excerpts

Monday 20th June 2022 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022.

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

My Lords, this statutory instrument seeks to ensure operational continuity as the changes under the Health and Care Act 2022 are implemented. It relates specifically to the transfer of functions from clinical commissioning groups, or CCGs, which were abolished by the 2022 Act, to newly established statutory integrated care boards, or ICBs.

Under the National Health Service Act 2006, amended by the 2022 Act, NHS England must set rules so that integrated care boards have “core responsibility” for every person who is provided with NHS primary medical services through registration with a GP practice in their area of England and every person usually resident in their area who is not registered with a GP practice. This means that, where a person is seeing a GP in an area, the relevant integrated care board is responsible for commissioning secondary health services that that person may need. This instrument provides an exception to this obligation for individuals who are usually resident in Scotland, Wales or Northern Ireland but are registered with a provider of NHS primary medical services in England.

This SI does not prevent those who are resident in Scotland, Wales and Northern Ireland accessing healthcare services in England. Instead, it simply makes clear where the commissioning responsibility sits for these patients. It promotes autonomy for devolved Governments to commission secondary care services for their residents, while still allowing these patients to continue to access secondary healthcare services in England. It is about which authority commissions and pays for a patient’s care, not the patient’s right to access care. This instrument is vital to ensure consistency and clarity between authorities in England and those in Scotland, Wales or Northern Ireland regarding who commissions and pays for a patient’s secondary care.

This statutory instrument allows for the continuation of the approach to devolved health policy introduced by the disapplication regulations 2013, which are being revoked as a consequence of the Health and Care Act 2022. Just to be clear, this instrument does not change existing cross-border commissioning arrangements; it simply transfers existing commissioning exceptions from CCGs to the new ICBs. We hope that these regulations will ensure operational continuity of services for patients as the English health system implements ICBs and are supported by the devolved Administrations, providing clarity on the role of integrated care boards within the existing cross-border arrangements.

I commend these regulations to the Committee.

[Lord Scriven (LD)]

I thank the Minister for his clear explanation. One can see from the number of noble Lords who wish to take part in this debate that this is not very controversial.

The instrument appears to tidy up the problems of people in different countries in the UK who may need to use NHS services in a neighbouring country and of who purchases those services. However, despite Ministers telling Parliament repeatedly that noble Lords could not vote on certain amendments because they had pre-agreed the legislation in the then Health and Care Bill 2022 with the Scottish Parliament, the Welsh Senedd and the Northern Ireland Assembly, it now appears that they had not made arrangements to continue the status quo—the very basic—of who commissions cross-border issues. These regulations enable that to happen. It would have been easier if such amendments had been allowed when the Bill was going through, rather than Ministers telling noble Lords from across the parties that such amendments around cross-border issues could not be voted on.

Many in the House along cross-party lines complained that, as the Health and Care Bill was progressing through the House, Ministers were taking considerable powers on themselves to create regulations. The Bill was enacted only two months ago yet we are already seeing their errors in the legislation being tidied up by this statutory instrument. How many more are still to come to ensure that all tidying-up arrangements are in place by 1 July? Would it not have been better for hard-working civil servants, both in the department and in Parliament, for the Bill not to have been brought out when there was still considerable focus on Covid and the omicron outbreak? Errors such as this are basic and waste civil servants’ and Parliament’s time.

--- Later in debate ---

[Baroness Merron (Lab)]

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

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

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

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

[Lord Kamall (Con)]

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

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

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

[Lord Scriven (LD)]

I hope that the Minister takes it in the spirit in which I asked the question, but this is an example of senior officials in the department—not for the first time—being involved with a commercial company and there being a revolving door going into that commercial company when specific multi-million-pound contracts are made. Do the Government feel comfortable that that is correct or do they feel that rules such as those for the Civil Service—where there are rules about revolving doors and taking this up—should also apply to NHS England employees? If not, does the Minister think that it should be looked at and that such rules should apply as they do for the Civil Service?

[Lord Kamall (Con)]

I thank the noble Lord for that clarification. My initial reaction was that I wanted to take this back to the NHS and ask. If the noble Lord will allow me, I will make that point directly, as the noble Lord made it so eloquently, to the NHS officials. Of course, as he rightly says, it is not just about the reality; we also have to address perception. We know that in a number of areas, for politicians but also officials, people are very concerned about revolving doors for those who have recently left and potential conflicts of interest. If the noble Lord will allow me, I will talk to NHS officials about this and get back to him.

On the particular issues, there will be more SIs. I am advised, but I will clarify it once again, that these regulations are made under the powers of the 2022 Act; it was previously done by regulation, and this will replace previous secondary legislation on disapplication from 2013. However, I take the point about whether this could have been done in the Health and Care Act. I will get a clear answer for noble Lords from my officials, if that is acceptable.

To conclude, I reassure the Committee that this instrument will not change how residents from devolved nations can access healthcare services in England. It is right that patients from Scotland, Wales and Northern Ireland continue to access secondary healthcare services in England as they do now, in a seamless way. Nor will there be any adverse financial consequences for devolved Governments or newly established ICBs, relative to the previous CCGs, in developing these regulations. This will continue the existing arrangements, which have been in place for several years and have the support of the devolved Administrations.

Given the outstanding questions, I hope that noble Lords will accept that I will write to everyone who took part in the debate—that should not be too difficult. I commend these regulations to the Committee.

Motion agreed.

Nursing: Staffing

Lord Kamall Excerpts

Thursday 16th June 2022 Lords Chamber

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

I thank the noble Baroness, Lady Tyler, for securing this important debate on the report published by the Royal College of Nursing on 6 June, regarding nurses’ experiences and thoughts about staffing levels. I also thank the noble Lords who contributed to the debate. I know that all noble Lords agree that nurses perform essential duties within our healthcare system and are an integral part of the NHS workforce. I think we all want to put on record our thanks for their considerable dedication and commitment to the NHS, particularly during the pandemic when they faced challenges never seen before. I would also like to thank nursing staff for sharing their personal experiences, and the RCN for its hard work and thorough approach in compiling this report. As my noble friend Lord Lilley said, nurses deserve our gratitude and our sympathy.

The Government have read closely the points raised in the report, and although there are some that we accept and are working hard to address, there may be other areas that we question. Overall, we welcome the publication of the RCN’s findings and the spirit in which the report was conducted. There is much common ground between the Government and the RCN, including our shared aim to have a well-supported nursing workforce.

Let me begin by addressing some of the concerns raised in the report. The report was critical of the levels of safe staffing in hospitals in England. There is no single ratio or formula that can calculate the answer as to what represents safe staffing. It will differ within an organisation, and reaching the right mix requires the use of evidence-based tools, the exercising of professional judgment and a multi-professional approach. In England, the responsibility for staffing levels sits with clinical and other leaders at a local level. Providers should ensure that there are sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times. Staff should also receive the support, training, professional development, supervision and appraisals that are necessary for them to carry out their roles and responsibilities.

On domestic nursing recruitment, this Government are committed to increasing our nursing workforce, and one of our highest priorities is ensuring that we have a strong and steady supply of new nurses. As many noble Lords acknowledged, we have made the commitment to increase nursing numbers by 50,000 over the duration of the Parliament. We are well on our way to achieving this, with nursing figures now 30,000 higher than in 2019. This is a major level of growth in the nursing population, and to achieve it we need to look at every route that we can: domestic supply, international supply and improved retention. We have invested heavily in the domestic routes to nursing, broadening and diversifying the available routes, including apprenticeships, to offer opportunities to those who may not be able to go to university. This is in addition to the traditional university undergraduate and postgraduate routes into healthcare. We saw around 43,000 applicants to nursery and midwifery courses at the January application deadline, which is an increase of 25% compared to two years ago. This is supported by the introduction of a training grant of at least £5,000, given to nursing, midwifery and allied health professional students.

We have to acknowledge, as many noble Lords have said, that demand is outstripping supply. If we look at the bigger picture, we see that there are a number of reasons for this. We are living longer, and we are more aware of issues such as Alzheimer’s and dementias in those who live longer. We are also far more aware of mental health and its diversity. For example, when I was taking part in a debate on neurological conditions and I asked my policy team to list all the conditions, they said there were over 600. We were never aware of that before, to that level of detail, and it shows that supply will always struggle to keep up with demand.

To support long-term planning, the department commissioned Health Education England to work with partners and to review and renew the long-term strategic framework for the health and regulated social care workforce to ensure that we have the right skills, values and behaviours to deliver world-leading services and continue high standards of care. I mentioned this a number of times in the debates on the then Health and Care Bill. The work is nearing its final stages and will be published before the Summer Recess. Building on this, we have commissioned NHS England to develop a long-term workforce plan for the next 15 years, including long-term supply and demand projections, and we will share the key conclusions of this work. I am afraid that I am not able to give a date for that at the moment, but we will do it in due course.

On well-being and the retention of existing nurses, we must acknowledge that the last few years have been some of the most difficult that health and care staff have ever faced, and they have risen to the challenge admirably. Through the NHS people plan and people promise, we are taking action to improve staff experience and retention. This includes investing in staff health and well-being support, promoting flexible working opportunities to allow nurses to balance their working life, and strengthening leadership and organisational culture across the NHS. The NHS planning guidelines for both last year and this year emphasise the importance of supporting existing staff. Boards, leaders and managers across the NHS are being supported to adopt a compassionate, inclusive approach and to consider the health and well-being of all staff as a priority, so that is a consideration in every decision in the organisation.

I will turn now to some of the specific points raised. A number of noble Lords spoke about international recruitment. We should remind ourselves that immigrants from the Commonwealth, and across the world, who came here after the war, saved public services in this country. We should acknowledge that. Such people play a vital role in this country, but I understand concerns about international recruitment and whether it is ethical. We published a revised code of practice for international recruitment on 25 February 2021 in line with the latest advice from the World Health Organization. Through this code of practice, we are ensuring the fundamental principles of transparency, fairness and promotion.

Most of our recruitment internationally comes from countries which train more nurses than they have places for. They do this deliberately as a way of getting foreign earnings and remittances and having better qualified staff. For example, the Philippines, Kenya and states in India do this. It is really important to acknowledge that, so I should correct noble Lords who say that we are depriving these countries of their people. They also have the opportunity to develop their care in a world-class system. In addition, we have worked with the WHO on the red-list countries but, if an individual from one of those countries applies, we are not able to discriminate against them in the way that noble Lords want us to. We do not go out and recruit staff from countries on the red list, but individuals from them will apply.

People talk about a brain drain, but I will tell your Lordships a story about a friend of mine. I will not say which African country he is from, but he said to me, “You white people in the West talk about the brain drain and patronise us but, if I stay and try to work in my country, there are very limited opportunities for me—so my brain will be left in a drain. I want the best for my family, and that’s why I want to move to another country.” Further, if a person’s politics are different from that of the leadership of their country, it might sometimes hinder their promotion. While we adopt ethical guidelines in our explicit recruitment, we have to be aware that we cannot block individuals from countries on the red list from applying. That would simply be discrimination; we should be quite clear about that.

On top of that, I am concerned about a slight inconsistency. I hear people saying that we have lost people from the EU because we left it, but at the same time they complain about international recruitment. What is it about mostly white Europeans that they do not object to? Why do they then raise concerns about non-white non-Europeans from other countries? Therefore, we have to make sure that we are not inadvertently coming across as discriminatory against people who are not from white Europe. We have to make sure that we have a global view, not a little white European mentality.

It is also important that we retain existing staff, and a number of noble Lords spoke about that quite movingly. The NHS has a retention programme, and it is continuously seeking to understand why staff leave. There is an NHS health and well-being framework that helps NHS organisations to create a sustainable well-being culture. We are also looking at ideas, and “We work flexibly” is one element of the people promise. In February 2022, NHS England and NHS Improvement published a flexible working definition to help people balance all those various demands on life. Becoming a more flexible, modern employer will help us to recruit and retain people more effectively, and we see this as important.

My noble friend Lord Lilley asked about rationing university places. As with all degree subjects, unfortunately not every applicant is of the required standard to become a nurse and this means that there is sometimes a gap between applications and those accepted on to programmes. However, we had a record number of acceptances in 2021—a 28% increase versus 2019—achieved through offering non-repayable grants and investing £55 million in expanding capacity.

The right reverend Prelate raised the issue of staff raising concerns. The Government support the right of staff working in the NHS to speak up and raise concerns, and we take it very seriously. We have the National Guardian and the Speak Up direct helpline and website, and there are positive signs. The Freedom to Speak Up Index, the key measure of speaking up in the NHS, has improved every year since 2016 and the Government have enhanced the legal protections available to prohibit discrimination against job applicants.

I am afraid that I am running out of time, but I will try to answer as many points as possible. I will also go through Hansard and I commit to write to noble Lords.

The noble Baroness, Lady Bennett, mentioned staff morale. There is a comprehensive emotional and psychological support package which includes a health and care staff support service, including access to 40 mental health hubs around the country, which provide outreach and assessment services to help front-line staff. However, we know that a number of measures will be required—flexible working, mental health support and others—and it is really important that we look at this in its completeness when we look at these issues.

On the workforce, as I said, we have a number of different plans, including the Health Education England 15-year plan. On top of that, rather than a top-down system from Whitehall, sometimes you have to look at local services. ICBs, trusts and others will all have their own workforce goals and ambitions. We must make sure that it is not all top-down in a sort of Soviet way. We have to look at local discretion and the way we address this.

I hope I have answered many of the points raised but, on those I have not, I will write to noble Lords in the usual way. I thank the noble Baroness, Lady Tyler, for raising this debate. She is a fellow alumnus as we went to the same school, but at different times, as she likes to remind me. This is a hugely important area. I will close by reiterating the Government’s commitment to our workforce and to ensuring that staff feel well supported in their professions. I look forward to future debates on this subject and continuing to ensure that we have an NHS workforce that is fit for the future—and that is diverse. It is shocking, when you think about the contribution of many people who have come to this country from outside Europe and who are not white, that if you look at the top layers of NHS management you will see a distinct lack of diversity. That needs to be addressed, as well as all the other issues we have discussed today.

Defibrillators

Lord Kamall Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Aberdare]

To ask Her Majesty’s Government what plans they have to widen the availability of defibrillators in both public and private settings, including schools.

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

The Government encourage organisations across England to consider purchasing a defibrillator as part of their first-aid equipment. Many community defibrillators have been provided in public locations, including in shopping centres, through National Lottery funding, community fundraising schemes, workplace funding or by charities. There are now more than 43,000 registered AEDs in England, and from May 2020 the Government have required all contractors refurbishing schools or building new ones through centrally delivered programmes to provide at least one automated external defibrillator, or AED.

[Lord Aberdare (CB)]

My Lords, each year, some 60,000 people in the UK suffer out-of-hospital cardiac arrests. Fewer than one in 10 survive and every minute of delay in receiving defibrillation reduces their survival chances by 10%. I recently attended a drop-in event to introduce the world’s first personal defibrillator, which is around 1/10th of the size, weight and price of current models and actually fits in my jacket pocket. Have the Government considered how development such as this might affect their approach to widening access to defibrillators? Will the Minister agree to meet me and leading resuscitation organisations to discuss ways of increasing access to and awareness of defibrillators in schools, workplaces, sports locations and even homes?

[Lord Kamall (Con)]

I thank the noble for raising the issue of this particular defibrillator. I am personally not aware of it, but I would be very happy if the noble Lord would send me more information on it—it sounds just up my street when it comes to innovation, as it were. We are working across the UK, with different sectors. In some ways, it is almost like a channel marketing campaign. How do we get defibrillators out to as many locations as possible? There is the Circuit and the National Defibrillator Database, and there will be an app that will allow people to find their nearest defibrillator. We are working with schools, educational institutions, sports grounds, transport, the Health and Safety Executive, the British Heart Foundation, Resuscitation Council UK and other partners.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I welcome the fact that there is a rise in the number of defibrillators across the country, but one of the problems is that a lot of people do not realise where they are located, particularly the emergency services and indeed the general public. My noble friend mentioned the national defibrillator network, known as the Circuit, but a lot of people are not aware of this—this is where outlets can register where their defibrillator is and the general public can find out where a defibrillator is when they need them. Is there some way that the department can raise the awareness of the Circuit so that more people are able to use it?

[Lord Kamall (Con)]

My noble friend raises a very important point, in her usual assertive manner. The British Heart Foundation, in partnership with Resuscitation Council UK, the Association of Ambulance Chief Executives and the NHS, has set up the Circuit, which is now live in 13 to 14 ambulance services across England, Scotland, Wales and Northern Ireland. In January this year, the BHF launched a website that will assist members of the public to locate defibrillators; it is also looking at apps so that people can find out where defibrillators are. We recognise that in some places people themselves are putting in their own defibrillators and we are trying to make sure that they are aware that they should be feeding into the Circuit, so that more people are aware of where they are.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, if I may slightly broaden the Question, the Minister will be aware of the increasing difficulties caused by a lengthening of ambulance response times. This makes first aid at the point where the patient is located even more imperative. Could the Minister say what steps the Government are taking to increase training in first aid, and also whether introductory classes in first aid are given in schools?

[Lord Kamall (Con)]

Clearly, one thing is making sure the defibrillators are there and people know how to use them, but also, as the noble Lord rightly says, they should be educated in CPR and resuscitation. All state-funded schools in England are required to teach first aid, including CPR. Those requirements came in in 2020. To support schools further, the department’s teacher training modules cover all the teacher requirements in that. We are looking at how we roll that out further. As the noble Lord rightly acknowledges, it is all very well having defibrillators, but people have to use them and we also want to make sure we raise awareness of CPR.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, I call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, 12-year-old Oliver King died suddenly of sudden arrhythmic death syndrome, a condition that kills 12 young people under 35 every week. The Oliver King Foundation has been campaigning for a defibrillator in every school. Last September, the Secretary of State for Education said this should happen. The DfE has been working with the NHS to make this possible, but the NHS Supply Chain website says that, in December last year, only 3,200 were advantageously procured for schools to then purchase. Can I ask the Minister: is the NHS expanding its procurement to enable all 22,000 schools to be able to purchase defibrillators now and not just when the school is rebuilt?

[Lord Kamall (Con)]

The noble Baroness raises an important point: while we require defibrillators to be purchased when a school is refurbished or built, one of the things we are looking at is how we can retrofit this policy. We are talking to different charity partners about the most appropriate way to do this. What we have to recognise is that it is not just the state that can do this; there are many civil society organisations and local charities that are willing to step up and be partners with us, and we are talking to all of them.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am patron of CRY, a charity that looks at cardiac arrest in the young. Of the 270 children who die each year, 75% of them would still be alive if a defibrillator had been readily available. Do the Government recognise that, as well as having a defibrillator in a school, one must also be on the sports ground because many of the cardiac arrests occur during athletic activities? Therefore, having only one in a school is inadequate. Will the Government consider asking Ofsted to ensure that there is a defibrillator on every sports ground specifically as well as centrally in every school?

[Lord Kamall (Con)]

As the noble Baroness rightly says, it is important that we get these defibrillators out as widely as possible, including in sports grounds, for the reasons she mentioned. We are looking at how we work with partners in this area; for example, the Premier League announced that it will fund AEDs at thousands of football clubs and in grass-roots sports grounds. Also, Sport England is working with the Football Foundation on this. The defibrillator fund will see AEDs in a number of different sports grounds. We are also looking at other locations and working in conjunction with Sport England and the National Lottery fund. Not only do we have to put defibrillators in place, but people have to know where they are and how to use them.

[Lord Geddes (Con)]

My Lords, in days of old there were defibrillators in your Lordships’ House. Are they still there?

[Lord Kamall (Con)]

All I can say is that I hope so. I will try to find out and commit to write to my noble friend.

[Baroness Merron (Lab)]

My Lords, with Travelodge, Tesco and Royal Mail all announcing that they will participate in the British Heart Foundation use training pilot, will the Minister undertake to look at the potential impact of this training on saving lives and work with his ministerial colleagues across government to encourage such training on defibrillator use by other companies, the public sector and other organisations?

[Lord Kamall (Con)]

If noble Lords will excuse the pun, one of the heartening things in answering this is that, when I received briefing on this, it is really important and interesting how we are working across government. It is not only in the Department of Health; we are working with the Department for Transport on transport locations, DCMS on sports grounds, the Department for Education on education settings and other departments. This is really a cross-government initiative.

[Lord Polak (Con)]

My Lords, I was privileged to be at a meeting with Jamie Carragher and Mark King of the Oliver King Foundation and Secretary of State Nadhim Zahawi only a few weeks ago. At that meeting with some senior civil servants, he more than indicated that the Department for Education would be very keen to ensure that defibrillators will be in every single school and will not be waiting for the rebuild that has been mentioned. I urge the Minister to go back to the Department for Education and ensure that this happens. The Oliver King Foundation was founded because Mark King’s son, Oliver, passed away at 11 or 12 at a swimming baths in my old school in Liverpool because there was no defibrillator. The point about sports places is right. Can he go back to the Department for Education, get this commitment which I have heard with my own ears and make sure that every school has a defibrillator as soon as possible?

[Lord Kamall (Con)]

I thank my noble friend for his question. I know he has a long-term interest in this area. Of course I will go back to my department and talk about this. The important thing is making sure that we have more locations, that there is awareness and that people are educated in how to use defibrillators and in wider CPR.

Vaccinations

Lord Kamall Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, on behalf of the noble Baroness, Lady Greengross, I beg leave to ask the Question standing in my name on the Order Paper.

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

We have seen high levels of Covid-19 vaccine uptake by being flexible and innovative in how we get vaccinations into patients’ arms and being supported by strong national and targeted communications and community-led initiatives. We have sought to learn lessons from the rollout and the NHS is working collaboratively with partners to design future NHS vaccination services for Covid-19 vaccines and other vaccination and immunisation programmes, considering how we can better use data to improve access to information.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. One of lessons of the pandemic was that flu vaccines were given free to people aged between 50 and 64. The Government have said that from next autumn people will have to pay. The Minister will be aware that vaccination rates around the world, particularly in Australia, have increased dramatically. Will he reconsider this policy, given that we need to encourage that age group to have the vaccine?

[Lord Kamall (Con)]

The noble Lord is absolutely right; we have received advice on the flu vaccine and at the moment it is free to those aged 65 and over. The issue, frankly, is balancing resources. A number of people in the system are saying that if you keep mandating vaccines, it means they cannot get on with tackling the elective backlog. On balance, at the moment it seems better to focus on the elective backlog, but UKHSA and others are monitoring the situation very closely.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the whole House will know that the great success of the Covid vaccine’s development was not built during the pandemic but over many years of visionary research and investment. What steps are the Government taking to invest in a similar amount of research in next-generation vaccines for things such as cancer and universal flu?

[Lord Kamall (Con)]

My Lords, I thank my noble friend for that question. She will know that we are investing in a number of different areas via NIHR and other research bodies. Those research bodies also welcome applications for research funds in specific areas. We do not necessarily ring-fence that funding, but we ask for applications. One issue we learned about is that there is the potential for future vaccines to cure, or be used as therapeutics for, a wider range of issues. In addition, we are looking at blood tests which can identify far more conditions.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the shingles vaccine is available in the UK only to those aged between 70 and 79, whereas in the USA it is automatically available to everyone over 50. NICE data says that shingles is much more prevalent in those with a weakened immune system, yet they are not offered it until they are 70, resulting in severe cases of shingles, possible sight loss and other serious consequences which could have been mitigated by an early vaccine. Can the Minister say when Shingrix, the shingles vaccine suitable for the immunocompromised will be automatically offered to this group of patients?

[Lord Kamall (Con)]

I thank the noble Baroness for that question. I am afraid I will have to write to her with the details.

[Lord Clark of Windermere (Lab)]

My Lords, the country deserves credit for the high level of people coming forward to get vaccinated. As we move forward to the spring booster kicking in on 30 June, will the Government ensure that we maintain the high level of vaccinations? Will every individual who has received a vaccination then receive a letter informing them of their spring booster, either from their GP or the NHS?

[Lord Kamall (Con)]

The noble Lord makes a very important observation about the programme and it is very important that we learn from that. One of the difficult issues was that, quite often, when you publicise the fact that there is a vaccine, a certain number of people come forward but, after that, there is hesitancy in different communities. Sometimes we have to show a bit of humility in Westminster or Whitehall; we are not always the best people to connect with some of those communities—so we have worked with various local community and civil society organisations. There is also innovation: certain places have a jab cab, a bus goes around Merseyside encouraging people to get vaccinated and there is often encouragement to get vaccinated at music festivals, local community festivals, mosques, gurdwaras, temples et cetera.

[Lord Framlingham (Con)]

My Lords, there is wide- spread and growing concern that vaccinations against Covid-19 may be having a damaging effect on our natural immunity, leading to an increase in diseases such as shingles. Is the Minister aware of this? If he is not, perhaps he ought to make himself so. Could we have a government comment on this?

[Lord Kamall (Con)]

I am afraid I am not aware of the details to which my noble friend refers, but I would be happy if he wrote to me. I will then take that back to my department.

[Baroness Merron (Lab)]

My Lords, more than one in 10 children are not fully protected against measles by the time they start school, and research shows that many parents are unaware that it can lead to serious complications, such as pneumonia and brain inflammation —or, indeed, that it can be fatal. With the major focus on Covid vaccinations over recent years, what assessment has been made of the effect on the uptake of routine vaccinations, including MMR? What steps are being taken to restore any affected vaccination levels?

[Lord Kamall (Con)]

The noble Baroness raises a very important point. We have to recognise that the UK has one of the most comprehensive childhood and adolescent immunisation programmes in the world. We have seven national childhood immunisation programmes, three adolescent programmes and two elderly programmes. Vaccine uptake in the UK remains high overall, but there has been some decline in routine childhood vaccines—so we have been looking at school-based immunisation programmes, some of which were clearly interrupted due to Covid. At the same time, from October to December 2021, the coverage of childhood vaccination programmes actually increased.

[Lord Suri (Con)]

My Lords, it is vital that primary carers help increase the delivery of a structured mass vaccination programme to deal with conditions such as shingles and influenza. Are the Government going to act promptly, given that the fundamentals are in place since Covid-19 has been dealt with?

[Lord Kamall (Con)]

I thank my noble friend for that question. There is a lot of innovation in vaccines. Over the years, we have seen combined vaccinations, and some places have moved away from vaccinations to orals or to not necessarily needing vaccinations at all. I am aware of that, and I would be very happy to write to my noble friend with more details.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Masham of Ilton.

--- Later in debate ---

[Lord Kamall (Con)]

This year, what the officials call the “delivery model” is likely to be broadly similar to previous rollouts, with a similar mix of vaccination sites—mass vaccination centres, GP surgeries, pharmacies, hospital hubs, pop-ups et cetera—as well as NHS services. NHS England and NHS Improvement try to emphasise co-administration of Covid-19 vaccines with flu vaccines and other vaccines. At the same time, NHS England, NHS Improvement and MHRA are looking at current guidance to see how we can ensure that we encourage this more.

[Baroness Lister of Burtersett (Lab)]

My Lords, my understanding is that uptake of the Covid vaccine has been much lower among some of the most marginalised communities, reflecting that hesitancy to which the Minister referred. In part, it would appear that this is because of a lack of trust in state institutions. I very much welcome what he said about the deployment of other agencies, but what are the Government doing to build that trust for the future?

[Lord Kamall (Con)]

Indeed, this is a really important point: the essential issue must be trust. As politicians in Westminster or officials in Whitehall, we must all have enough humility to recognise that we may not be able to cut through that. We have been looking at working with a number of different people in those communities and working out what the best message and channels will be. For example, we have spoken to faith leaders in some places. Even though some people may not be of a certain faith—they may be agonistic or atheist—they still respect faith leaders. In other places, we are looking at where people who are vaccine-hesitant go, and whether we can get the message—or even the vaccines—across to them.

[Baroness Hayman (CB)]

My Lords, much of the success of our own vaccine development programme was based on investment in global health over many years. Is the Minister confident that, given the possibility of future pandemics, the research capacity in this country, and our contribution to international agencies such as the Global Fund, will not be prejudiced by the cut in our ODA spending?

[Lord Kamall (Con)]

How we work together globally, learn from each other and co-operate are really important. One of the bits in my portfolio is international relations and, particularly, co-operation on health issues. I have been in G7 and G20 meetings on this. One of the big issues we must all look at is AMR—antimicrobial resistance—and how we can, first, stop the use of antibiotics in both human and animal health and, at the same time, help those countries that use quite a lot to build capacity.

Personal Protective Equipment: Waste

Lord Kamall Excerpts

Tuesday 14th June 2022 Lords Chamber

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the expenditure on unusable and excess Personal Protective Equipment (PPE), and the reasons for the waste.

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

We have delivered over 19.8 billion items of PPE to keep front-line staff safe. Facing a dangerous virus, and against the background of no vaccine, as well as rising demand, market disruption and panic buying, we procured as much PPE as possible rather than too little. Only around 3% of PPE that the department purchased is unusable, and we are working with waste providers to dispose of unusable stock in the most environmentally friendly and energy-effective way.

[Baroness Merron (Lab)]

My Lords, £9 billion was wasted on PPE due to obscenely inflated prices, irregular payments to intermediaries and faulty kit which is now poised to go up in smoke, along with nearly one in four of the contracts in dispute around products which are not fit for purpose or where allegations of slavery have been made. We know that the Government were responding to an unfolding crisis, but how was this shameful episode allowed to go unchecked and why has the department been allowed to establish a track record for not following public spending rules?

[Lord Kamall (Con)]

We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.

[Baroness Meacher (CB)]

My Lords, I appreciate the very real time pressure at the beginning of the pandemic. However, a few days spent to ensure high-quality PPE through some form of competition would have saved lives. Will the Minister tell the House how many contracts were agreed through a personal contact, without any form of competition at all, in that first year?

[Lord Kamall (Con)]

The noble Baroness will recognise that I was not in post at the time, but I have been advised by officials in the department that they put feelers out to as many people as possible. Government officials, Members of the House of Lords and politicians from all parties were suggesting companies, and that was put through a process whereby the department made an assessment of whether it was able to award contracts.

[Lord Scriven (LD)]

My Lords, the National Audit Office found that the department is currently spending approximately £7 million a month on storing 3.9 billion PPE items that it does not now need. That is the equivalent of employing 2,400 extra nurses a year. Why are Ministers allowing this waste of taxpayers’ money to continue?

[Lord Kamall (Con)]

The noble Lord is absolutely right that we are paying storage costs, and over the last few months there has been a reduction in storage and the Government have been looking at more cost-effective ways. However, the overall strategy—and why we have two lead waste providers looking at the issue—is to ask how we can sell, donate, repurpose or recycle wherever we can. For equipment where complex chains of polymers cannot be broken down—chemists would understand this better—we are looking at how we can dispose of it in the most environmentally friendly way.

[Lord Winston (Lab)]

My Lords, does the Minister agree that it is not just a question of a knee-jerk response at the very last minute of a new pandemic? Various committees, including the Science and Technology Select Committee, had pointed out that a pandemic was almost inevitable and that exactly such preparations were needed some years before it actually occurred.

[Lord Kamall (Con)]

The noble Lord is absolutely right. If we think back to swine flu in 2009 and the pandemic preparedness for that, there were such suggestions at the time and in subsequent years—we should not blame the particular party that was in power at the time—and the Government were urged to buy more and more equipment. The fact is that, had we bought it, it would have been at lower prices, and the cumulative cost of storage over the years would not have been as much as we spent recently.

[The Lord Bishop of London]

My Lords, I recognise the considerable pressure that the Government, the NHS and Ministers were put under, but can the Minister tell us what is being done so that we can learn from this situation and not replicate it in the next pandemic?

[Lord Kamall (Con)]

The right reverend Prelate is absolutely right that we should learn lessons, and there are two things we can learn: one is the benefit of hindsight, and one is the fallacy of hindsight. The fallacy of hindsight is to say that, given the same pressures, I would have acted differently. We can never know whether that is true; that is counterfactual. If we look at the benefit of hindsight, one thing we can learn is that if we buy more than enough in the future, and it is the right thing to do so, we should buy equipment that is as environmentally friendly as possible so that if it needs to be disposed of it can be recycled into other items.

[Lord Young of Norwood Green (Lab)]

My Lords, does the Minister agree that the vast majority of hospitals are using single-use PPE garments which go straight to landfill after one use? There is available on the market a product with RFI tags, which enables it to be simply laundered for 70 different uses. Should we not be investigating that if we are serious about reducing carbon emissions?

[Lord Kamall (Con)]

I thank the noble Lord for that suggestion. I am not aware of the product to which he refers, but I should be grateful if he would write to me with more detail and I will pass it on to the department.

[Baroness Manzoor (Con)]

My Lords, it is important that lessons are learned from the PPE purchasing, but will my noble friend the Minister say what action the Government are taking to reduce people’s waiting times for surgery, diagnostic testing and clinical assessment, because that is the follow-on from the delays as a result of Covid-19?

[Lord Kamall (Con)]

My noble friend is absolutely right that there has been an elective backlog. In analysing the backlog across the system we have found that about 75% to 80% of those waiting are waiting not for surgery but for diagnosis. This is why we have rolled out community diagnosis centres and will continue to do so, not necessarily in NHS settings but also in sports grounds, shopping centres, et cetera. On top of that, about 75% to 80% of those who require surgery do not require an overnight stay. We are trying to work through the elective backlog as quickly and effectively as possible.

[Baroness Watkins of Tavistock (CB)]

My Lords, what investment is being made to ensure that we can make our own PPE in this country in future, because the chief problem was that we were competing in an international market in a crisis?

[Lord Kamall (Con)]

I am not aware of detailed proposals on that but I know that there are many British companies who sourced from abroad and others that tried to manufacture. If you look at the relative costs and skills in the value chain, you will find that for many of the entrepreneurs in this country it is not cost-effective to manufacture here.

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

Returning to the Question and putting it in some perspective, as my noble friend Lady Merron said, £9 billion has been wasted in this exercise. Is the Minister aware that that is half of the cost of Crossrail, the biggest and most complicated civil engineering project in the whole of Europe? Is this not a national scandal?

[Lord Kamall (Con)]

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

[Baroness Walmsley (LD)]

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

[Lord Kamall (Con)]

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

[Baroness Symons of Vernham Dean (Lab)]

My Lords, in answer to my noble friend Lord Winston, the Minister said that the storage costs would have been greater than the costs of buying the PPE at the time that we did. Can he substantiate this for the elucidation of the House in general and say what those costs would have been for storage relative to the costs that we paid in the end? Perhaps he can give us those figures. If he has not got the information readily available today, maybe he will give them within a week or so.

[Lord Kamall (Con)]

Had we bought the PPE when it was first suggested that we should be preparing, the initial purchase price would have been lower, probably about £2.4 billion, but there would have been additional costs such as storage, replenishment of expired stock, and disposal of items, because even then there would have been items which had gone beyond their shelf life. That would have pushed the total cost to £13.4 billion.

NHS: Respiratory Syncytial Virus Infections

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

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

My Lords, I thank the noble Baroness, Lady Ritchie, for raising this subject, not only today but a number of times via an OPQ and a number of Written Questions that I have received. The work she has done to raise awareness adds to the overall awareness, but it is really important that this forces the Government to respond and raise even more awareness.

I also thank the noble Baroness, Lady Ritchie, for sharing a very personal story, and the noble Baroness, Lady Brinton, for sharing her family’s story. Sharing these stories sometimes makes you realise that this is not about just words on a page; it really is about how it affects people’s lives on a day-to-day basis, which makes it real for us in seeking to understand it.

Before I answer all the detailed questions, perhaps I should begin by laying out the Government’s current understanding of RSV. The noble Baroness, Lady Ritchie, has already laid out some of the facts. We know that RSV is a common respiratory virus that usually causes mild, cold-like symptoms. It is widespread in humans, partly due to the lack of long-term immunity after infection. We know that children of under five are the most impacted by RSV. They are at risk of paediatric critical care admission, often linked to bronchiolitis. As has been said, every winter the NHS faces pressure from the increased prevalence of seasonal respiratory viruses. This includes Covid-19 and flu, where the rollout of our immunisation programme is critical in protecting individuals and lessening the burden on the system, but it also includes RSV.

In 2021, in response to the scenarios provided by the UK Health Security Agency, there was a cross-health system response to prepare for a more severe RSV epidemic—starting as early as mid-August—due to the almost complete suppression of the virus after measures were put in place to protect the public from Covid-19. As a result of increased disease activity in September 2021, NHS England and Improvement has estimated that the total cost of paediatric hospitalisations due to RSV was 24% higher in 2021-22 compared to 2019-20. The total estimated cost of paediatric hospital care due to RSV, based on the 2022-23 national tariff, was almost £20 million—£19.9 million in 2021-22.

Typically, the RSV season runs from October to February, with a peak in December. However, one recent complication arising is that, due to measures put in place for the Covid lockdowns, in some ways we now see an unseasonal activity of RSV. The NHS released an estimated £22 million centrally to support the paediatric respiratory surge response. This is focused on a number of issues: first, increasing the resilience of the paediatric transport services and, secondly, bringing forward the annual Palivizumab immunisation programme for at-risk infants from October to July. The cohort of at-risk infants eligible for immunisations was expanded and the doses administered increased in number from five to seven, to ensure protection for the duration of the longer-than-usual RSV season. Thirdly, we also allocated additional funding for the voluntary, community and social enterprise sector. This supported families but was also about that important question of raising awareness in our local communities, as noble Lords referred to, and how to manage respiratory infections.

In addition, the system procured 4,000 specialist paediatric pulse oximeters to be distributed to GP practices to support primary care to help assess sick children. Finally, there has been a development of an online platform and digital skills passport. This has provided additional training to the paediatric and adult workforce to raise awareness, among the workforce and wider. It is important to note that the costs I have mentioned do not consider the cost of urgent care, NHS 111 or primary care presentations due to RSV. But it is clear that Covid-19 and RSV did have an impact on the system, for example the increased requirement for PPE which increased the NHS’s day-to-day running costs, making the delivery of frontline services more expensive.

Having laid that out, allow me to try to respond to some of the points made by noble Lords. One question raised was how the department will ensure that infants receive the right treatment without increasing antibiotic resistance. This is really important. One part of my job is that I do international health diplomacy for the DHSC. This is an issue—particularly AMR—that some people call the coming silent pandemic. How do we make sure we reduce our reliance on antibiotics, not only for humans but for animals and agriculture? Also, how do we make sure we do this globally? We may be able to do it in the richer, more developed countries, but there are other countries where it is the culture or they need to use antibiotics, so we need to make sure there are sufficient alternatives available.

We have committed to a vision where AMR is contained and controlled by 2040 and are halfway through delivery of our five-year national action plan. Optimal antibiotic prescribing is a key theme of this work, and we continue to take steps to better support clinicians to make appropriate prescribing choices. In relation to AMR, or to make sure we are aware of this, we are working globally with a number of countries. Also, RSV is a virus, and we should not—by my understanding—be using antibiotics on viruses.

A number of other questions included what considerations the department made on the treatment. The cross-systems exercise took place in June 2021 and I reassure noble Lords that it involved the devolved Administrations. It focused on resilience planning for the potential increased surge. After the exercise, regional NHS England teams finalised annual paediatric critical care winter surge planning to anticipate any increase in RSV cases, including for paediatric intensive care beds. NHS England and Improvement also signed off on regional plans which were submitted to the national team. This built on local exercises and included equipment requirements.

In June 2021, we saw the UK palivizumab prevention programme, with a central alerting system bulletin issued to inform NHS trusts to initiate the programme as soon as possible in line with updated policy of up to seven doses at monthly intervals, rather than the five previously. This was stood down at the end of January 2022, because palivizumab provides about a month of protection against RSV, with the aim of reducing the risk of hospitalisation.

In addition, the UK Health Security Agency and NHS England and NHS Improvement have led on public-facing communications, including press releases on RSV highlighting the likelihood of a rise in infections and encouraging parents to look out for symptoms of severe infection in at-risk children, which included advice on reducing transmission to others. That is in addition to the work we are doing with civil society and with clinicians at both primary and secondary level.

Noble Lords also asked what solutions we are looking to in future, and the noble Baroness, Lady Wheeler, mentioned a treatment that has potential. There is a key antiviral treatment under development by Enanta Pharmaceuticals, but there are also a number of developments in RSV immunisation innovation, and I shall go through a few of them.

First, there is the infant monoclonal antibody, called nirsevimab, by AstraZeneca and Sanofi, and that is progressing. GSK was looking at a maternal vaccine, but I understand that that is currently paused. Pfizer has a maternal vaccine, which is progressing, as is a Pfizer older-adult vaccine. Johnson & Johnson is also looking at an older adult vaccine, as is Moderna. Some vaccines are currently in phase 3 trials, such as those for older adults. The UK Health Security Agency and the JCVI will continue to monitor the development of those trials. The MHRA will ultimately be responsible for the approval of new vaccines, licensing and marking authorisation for new medicine in the UK.

As for our plans, there is currently an out-of-season rise in RSV cases and we have seen RSV swab positivity increasing to almost 4%, with the highest positivity in the under-fives, at 14%. A lessons learned exercise took place in February 2022 to identify and share learning to inform future responses and strengthen the resilience of paediatric services longer term. There is continued surveillance and the data continues to be monitored. Especially given the experience of the unseasonal paediatric programme, it is really important that we are aware of this all year round. Clearly, some lessons have been learned from Covid, such as the whole-system approach to support surge planning and how we rely on established relationships between and within regions, but also via local community organisations. That is, first, to ensure that all clinicians at all levels are aware of RSV and are looking out for it, as well as working with local voluntary and community organisations to raise awareness in parents, families and communities.

We have also been co-operating internationally to model data from other countries that have experienced it, in particular Australia, New Zealand and South Africa. UKHSA and others have been in contact with them to try to understand what lessons could be learned for the UK. NHS England and NHS Improvement also brought forward critical care planning.

I talked about community investments and some of the preparations. It is really important that we are aware at primary and all care levels. The children and young people’s transformation programme procured 4,000 specialist pulse oximeters from the NHS supply chain, which were used to supply primary care—I think I talked about that. In the workforce, Health Education England is working closely with specialised commissioning teams in the operational delivery network to support more awareness. I talked about the online platform. The numbers here may not mean much, but there are 437 resources uploaded, 3,400 users and 62,000 tailored resources. There is also practical guidance developed by the Royal College of Paediatrics and Child Health and NICE. They have reviewed and updated their guidelines with a focus on improving patient flow and recommendations for early safe discharge.

In addition, there is a children’s safer nurse staffing framework for in-patient care, which includes awareness and more support. I have a number of lines about non-paediatric action, but perhaps it would be better if I wrote to noble Lords after the debate summarising them and picking up any questions that I may not have answered in detail today.

In closing, I thank the noble Baroness, Lady Ritchie, for raising awareness, not only today but more generally—I know that she will, rightly, continue to hold the Government to account—and all noble Lords for their questions. I hope that, if I have not covered them, I shall do so in writing. Be reassured that the health system in England mobilised resources prepared for the surge in RSV cases and hospital admissions. This was essential to protect at-risk groups, including infants and the elderly, but also to work across the four devolved Administrations of the United Kingdom to make sure this action is UK-wide, not just in England. I am grateful to noble Lords for taking part in the debate today.

Health and Social Care Leadership Review

Lord Kamall Excerpts

Thursday 9th June 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we also thank all the staff in the NHS and social care sectors, and specific thanks go to General Sir Gordon Messenger and Dame Linda Pollard for this excellent report. We too support the recommendations in the report.

The Liberal Democrats believe our NHS is in desperate need of support. We need to remember that there are well over 100,000 NHS staff vacancies—and an equally worrying number in the social care sector—and we are concerned about the impact of these vacancies on patient safety.

With millions now waiting for treatment and waiting times increasing, it is more important than ever that the Government address the workforce crisis facing health and social care. We have just come this afternoon from debating two key issues in Grand Committee that the NHS faces: managing RSV and other respiratory infections, and managing neurological conditions.

The two sectors have serious staff shortages in clinical health and that is replicated right across the NHS. After a gruelling couple of years, many staff are considering leaving or retiring early. The Government need to get a grip on this workforce crisis and seriously start planning for the long term, giving the crisis the attention it deserves. I too echo the question from the noble Baroness, Lady Merron, about when the workforce planning draft will first be presented to Parliament. It is urgently needed.

This leadership report is blunt. It highlights the current absence of accepted standards and structures for the managerial cohort within the NHS and says that it has

“long been a profession that compares unfavourably to the clinical careers in the way it is trained, structured and perceived”.

And that is not just inside the NHS. Far too many people—even Ministers—slam managers as unseen, expensive bureaucrats. This report calls that out, as well as recognising that consistent standards and improvement are needed. That is welcome.

The recommendation for a new national entry-level induction for all who join health and social care, as well as national career programmes for managers right across the sector, is very welcome, but what plans do the Government have now for the interim? The crisis is with us—we see it every night on the television news—and the benefits of training and culture change will take some time to bear fruit.

The executive summary advocates a step change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff. It goes on to say that good practice is by no means rare but it is not consistent throughout the NHS, and it raises particular concerns about the experience of those with disabilities or race-protected characteristics. We agree with the report’s proposals that EDI should become a universal indicator of how the system is working.

The fourth recommendation in the report on the simplified standard appraisal system is also welcomed, alongside consistent management standards and consistent accredited training. The talent management recommendations are also excellent.

We welcome any measures that seek to improve the way the NHS works, such as the Government’s pledge to build more hospitals, but many of our senior NHS managers struggle with failing buildings that, rather like our Parliamentary Estate, need urgent repair or replacement—but until then they have to try to make them safe. My own local hospital, Watford General, is a case in point. With that in mind, will the Minister please tell us how he proposes to unblock the delays to meet his Government’s pledge of 40 new hospitals by 2030?

Yesterday, the Secretary of State likened the NHS to the now-defunct video store Blockbuster, saying that the country has a

“Blockbuster healthcare system in the age of Netflix”

and that things would change by 2030. To date, only six projects that predate the Prime Minister’s premiership have started construction, despite the Government’s 2019 election pledge that 40 would be built by 2030.

A core theme of the report is collaboration. It reports pockets of excellent practice but also pockets of stuck and poor practice. The report is clear that a real culture change is needed now. In some parts of the NHS there is still an “ignore if not invented here” approach that must be challenged and changed.

Leadership is indeed key to a well-functioning health service, but having enough staff to care for patients is critical to reducing waiting times and improving patient outcomes. Ministers seem keen only on tinkering with leadership programmes. They seem to be ignoring the huge number of vacancies in the NHS and recently refused to write workforce planning and projections into law. So what additional steps will they take to increase the number of doctors and GPs working in our health service in the next nine months? Workforce shortages across the health and social care sector are leading to long wait times and poor outcomes.

Our NHS leaders have done a sterling job steering the NHS through the pandemic and now they are trying to tackle record-breaking waiting times. Leadership is pivotal to the success of any organisation, and the example set by the head of the organisation plays a huge part in that success.

It is a shame that the report focuses only on the NHS and not on the department, because it is important that we remember that two areas over which the Secretary of State’s predecessor, Matt Hancock, had power were PPE and test and trace, both of which were extremely badly handled in leadership terms. Does the Minister agree that leadership starts with Ministers? In an exchange between the Secretary of State and General Sir Gordon Messenger published yesterday, the Secretary of State said, “Leadership is critical”.

Finally, the most welcome chapter of the report is the final one, chapter 4, on implementation. The authors set out a clear route map for making this happen through the establishment of the review implementation office. I note that, yesterday, the Secretary of State said that he accepted all the recommendations. From these Benches, we will hold him to account for the resources necessary for the review implementation office to deliver them.

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

My Lords, I thank the noble Baronesses for their questions and for their general welcome for the tone of the Messenger report. I also pay tribute, as did the noble Baronesses, to Sir Gordon Messenger and Dame Linda Pollard for their combination of leadership skills as well as clinical and medical knowledge. I pay tribute too to the number of people who were consulted across the system who fed into the report.

I shall try to address some of the questions that were asked. The Messenger report looked at both health and social care. It was interesting that reference was made to reports being published but nothing being acted on. I think we can be proud that, for the first time, we are now aiming, as is set in law following the passing of the Health and Care Act, for a properly integrated health and care system. We can now work to that properly across the system.

In December 2021, the Government published their strategy for the adult social care workforce in the People at the Heart of Care: Adult Social Care Reform White Paper. Our strategy aims to create a well-trained and developed workforce, a healthy and supported workforce, and a sustainable and recognised workforce. Work that has already started includes the review of the existing workforce and the voluntary register to look at the workforce landscape and the various qualifications. We also want to look at how we make sure that the workforce is professionalised and that people feel attracted to it as a career. The strategy is backed up by an historic investment of at least £500 million for new measures over three years—noble Lords will be aware of that.

Both noble Baronesses raised workforce planning. During the debates on the Health and Care Bill, I made it quite clear that where we disagreed with some of the amendments was on the frequency of the reports that was called for. Let me be quite clear about what we are doing in terms of workforce. First, we have the Health Education England strategic framework to support long-term planning. The department commissioned HEE to review and renew the long-term strategic framework for the health and regulated social care workforce—the right skills and the right values and behaviours to deliver world-leading services. The work is nearing its final stages and will be published before the Summer Recess.

Building on this, we have also commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. We will share the key conclusions of this work as soon as it is ready. Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at a minimum of every five years describing the NHS workforce planning and supply system. The report provided for in that section will increase the transparency and accountability of the workforce planning process. On top of this, rather than everything simply being top down—the person in Whitehall or Westminster telling local services what to do—there is also the bottom-up planning, at trust level and ICS level, looking at the right workforce and skills mixes required on the boards and in the services to deliver the right services to patients.

The noble Baroness referred to the North East Ambulance Service. This highlights why this report was so badly needed. My right honourable friend the Secretary of State for Health and Social Care said yesterday in the other place that he was very concerned by what he has heard about the ambulance service and that he is not satisfied with the review that has already been done. He said that we need a much broader and more powerful review; he will have more to say about this very shortly.

We welcome the report. We have rightly said, as both noble Baronesses have said, that we welcome all the recommendations. To ensure that these are delivered as quickly as possible and with the right impact, an implementation plan co-created across the whole health and social sector is required. This report will therefore be followed by a plan with clear timelines and deadlines for delivery.

I am grateful to both noble Baronesses for raising the issue of discrimination and lack of diversity. It is interesting that our public services post war were rescued by immigrants from Commonwealth countries—from Africa, Asia and the Caribbean—yet, amazingly, we do not see them at the top of these organisations. Why is that? Frankly, we must move away from this position of white people stopping black and Asian people from being promoted and fobbing them off as “diversity officers”. They do not want to be diversity officers. We are good enough to be leaders and we must ensure that this is instilled right through our health and social care system, not just at the bottom level but all the way up. That will be the test of true diversity and true openness to equality.

There has been some positive movement towards tackling discrimination. The NHS people plan established a set of robust and comprehensive initiatives thought to imbed equality, diversity and inclusion. The recruitment and promotion practices have been overhauled and there will be named equality champions, but we must ensure that this is not just fobbing off. We need to see more diversity right at the top of our health and care system.

If I have not answered the noble Baronesses, I will write to them.

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Masham of Ilton, wishes to take part remotely, and this seems a convenient moment to call her.

--- Later in debate ---

[Baroness Masham of Ilton (CB)]

It is tragic that so many babies and mothers have died when they should have been safe in hospital. What happened to the standards of care which were required? Fresh young enthusiastic people joining the NHS and those in care should be safe from bullying, harassment and discrimination. If something goes wrong with patients’ treatment and care, should there not be a duty of candour, with openness and honesty? Surely this should be incorporated in leadership education. I hope that it will be.

[Lord Kamall (Con)]

The noble Baroness is absolutely right that there should be a duty of candour. Noble Lords will remember that during the Health and Care Bill debates there was the debate around the openness of HSIB process. Here we have a difficult balance. On one hand, if someone has acted inappropriately or caused damage, you would want them to be brought to justice but, on the other hand, we know that the NHS has a culture of cover-up when things go wrong. It is great that we praise the NHS when things go well but I have heard too many stories of when things go wrong and clinicians close ranks and cover up.

Sometimes, they gaslight. I was talking about this the other day to a young official in the department and she told me about her friend, a young Afro-Caribbean female, whose baby died during birth. When she complained, the papers suddenly, magically disappeared. How can that happen? We have to make sure that there is real justice, but we have to get the right balance. HSIB makes sure that there is a safe space so people can feel free to come forward, so that we learn from that. Sometimes there may not be justice for the individual, but we can make sure that we avoid a repeat of these incidents. The Ockenden report clearly showed the role that the culture of the organisation played. We must be careful: there should not always be a focus just on numbers; we do not want to train people within the wrong culture and do more damage. We have to tackle all these issues at the same time.

[Lord Lilley (Con)]

My Lords, I would congratulate the Secretary of State Sajid Javid on presenting this report if it called for fewer full-time equality, diversity and inclusion officers and devoting resources, intention and focus to patients. Sadly, on reading the report, it does not; quite the reverse. It is totally obsessed with EDI. EDI is mentioned three times as frequently as patients. There is no mention of waiting lists, whistleblowers, cover-ups or value for money, and only one reference to efficiency. There is nothing about the lessons of Staffordshire or the failures in the health service—nothing at all. It is about EDI only. Worst of all, it states that demonstrating a commitment to EDI is more important than just technical skills.

It is important that we eliminate discrimination from the health service, but when I am treated, it is the technical skills of the medical staff I am worried about, as it is when those whom I love are being treated. The report sets goals for increasing the representation of underrepresented groups, but no goals for improving outcomes for patients. Worst of all, it proposes using the everyday discrimination scale as an objective tool of management, yet it is entirely subjective and all the academic literature I have found suggests it is completely worthless. Will my noble friend commission another report that will deal with people’s real concerns about the NHS?

[Lord Kamall (Con)]

I thank my noble friend for the question. It is important that we recognise that not only do we have more doctors and nurses than ever before, but we need staff to be good leaders. That includes understanding diverse workforces and, as I said earlier, making sure that we have good leaders at the top. Why do we have a diverse workforce? In fact, that diversity is not represented right at the top, in the leadership. Sometimes, when you want to change an organisation—I am sorry, but I did an PhD in organisational change—there are a number of aspects and one of them is the culture and the leadership. Sometimes a new leadership comes in that can drive that change in the organisation. It is not just about structures but about making sure that we improve the standard of care we give to people. This issue came up in the report, because we have to have the right leadership and focus on patient care and on making sure that we have a proper integrated health and social care system for patients all the way through their lives.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the report, and particular work needs to be done in the area the Minister has just described. The NHS is very diverse, more than most public sector groupings. Therefore, if there is a problem there, it needs addressing and it should be given high priority.

First, the real issue that worries the public at the moment concerns the little statement sneaked out by the Secretary of State that he has now agreed to a 15-year work strategy being prepared. The public are worried about the great number of unfilled vacancies in the National Health Service. That number continues to rise, and we now have more than 100,000 vacancies. The public expect the Government to move in a number of ways to try to fill those vacancies, rather than simply waiting for a long-term strategy. Will the Minister tell the House what new ideas the Government have to fill the vacancies? I know that is not an easy question to answer.

Secondly, I suggest that the Government have conversations with the agencies, which supply staff to so many different places in the NHS at such high costs, to see whether some accommodation could not be reached with them. Thirdly, I have personally had experience recently of being treated in the private sector. I spent some time talking to the staff, many of whom were ex-NHS and said they would never return to it. I would like to know what work has been done by the Government in exploring the views held by those people who have left NHS service to establish why they have gone, and what they would need to see change in the NHS to encourage them to return to it.

[Lord Kamall (Con)]

I thank the noble Lord for that question. We should look at the context of the different environment and the challenges that our health service and health and social care system is facing compared to in earlier years. A number of different factors have come together. One is that we have an ageing population and people are living longer but not necessarily living longer well, and therefore, where before the focus was mainly on physical treatments, we are now far more aware of issues like dementia and the challenges presented by ageing populations. On top of that, we are simply aware of more conditions. I have just come out of a debate on neurological conditions, of which I was told that there are probably 600. When I was a child, that probably would have been dismissed—no one would have thought that there were such a number—so there is more awareness of the issues to be treated.

Mental health is now treated more seriously. It was never taken seriously before; it was always about “pull yourself together” or the stiff upper lip, but now we understand that people have mental health conditions. We need to make sure that we have a health and care system, including private and independent, that can meet those needs.

One of the challenges is that we need more doctors and nurses. The funny thing is that we actually have more NHS doctors and nurses than ever before, but we recognise that on top of that we still need more. Investing in the workforce is therefore a key priority.

There is the 15-year plan, as I have said. The NHS also has the people recovery task force to make sure that all NHS staff are not only kept safe but retained. There are a number of initiatives, which I am happy to write to the noble Lord about, about helping staff who feel burned out, as well as retention programmes.

On top of that, we have increased the number of medical school places. We have found that students are sometimes more likely to stay close to areas where they have studied, so new medical schools have opened in some of those places which have found it hard to recruit. We also have more new nurses coming through the system but, despite that, there is still demand for more. We are looking at various ways to improve retention but also attract new staff.

--- Later in debate ---

[Lord Young of Norwood Green (Lab)]

I have posed one question, and I will pose a couple more. I will move to further questions and my criticism of the report. First, I agree with a lot that the noble Lord, Lord Lilley, said. On diversity, we recently had a situation, on which I would welcome a comment from the Minister, where the NHS could not bring itself to define a woman in gynaecological circumstances—I find that somewhat unbelievable.

What are we doing about fixing the situation in A&Es where paramedics stand by trolleys for hours on end while people are dying of strokes outside? I have raised this question with the noble Lord a number of times. It can be fixed, but you have to be determined. If the noble Lord wants an example of best practice, I recommend that he look at Wolverhampton, where he will find an example. There is no mention of best practice in this report, which I find astonishing. I also note the importance of new technology being adopted in a coherent way. I look forward to the Minister’s answers to those questions.

[Lord Kamall (Con)]

I thank the noble Lord for his questions. I say up front that I am not a fan of Twitter, even though I am still on it. Frankly, I do not like social media and I try not to look at it too much—but I welcome that the noble Lord shared some of his concerns.

The noble Lord is absolutely right on bullying and harassment; they are not acceptable in any form and should not be tolerated—this is part of the NHS people plan. This goes to the heart of the review: it is about leadership and culture. We have to make sure that there is a culture where bullying and discrimination are not tolerated. Frankly, it is about not diversity officers but greater diversity, which are not always the same. As I said, we have a diverse workforce, but why do we not see more diversity in the upper echelons of our health service? It is important that bullying is tackled and that we have that culture—but this also comes from local leadership.

I am grateful to the noble Lord for the number of times that he has suggested thinking outside the box on A&E. We have looked at various pressures on it; sometimes people go to it because they cannot get a GP—how do we address that? Sometimes, people do not want to go to A&E and try other routes but end up there—so how do we make sure that those other routes are available? We are looking at how to triage better and how people can use 111 instead. There are a number of issues and, as the noble Lord rightly said, technology can play a role.

House adjourned at 5.59 pm.

Neurological Conditions

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

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

My Lords, I thank all noble Lords who took part in this debate, especially the noble Lord, Lord Dubs, for raising this issue. I also thank him and the noble Lord, Lord Monks, for sharing their personal experiences. As the noble Baroness, Lady Wheeler, rightly said, hearing people’s personal experiences, rather than simply reading words on a page, really does bring it home. I also thank the noble Baroness, Lady Murphy, for sharing her experience from the other side, as it were; that was a very valuable contribution for us all.

I should start by talking about the overall plan. I will then focus on some of the conditions discussed today. We have to acknowledge that the pandemic affected health and care services, which is why we must have a recovery service. The priority of that recovery is to address the pressures caused by the pandemic. Noble Lords will be aware of the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care, published in February 2022, which sets out a long-term plan to look at bringing that down. It also looks at creating extra capacity, including through partnerships with the independent sector and in the NHS, to undertake more complex work, such as neurosurgery, with improvements for the most clinically urgent patients.

To support the ambitions in the delivery plan, the department has committed more than £8 billion over the next three years, from 2022 to 2025. This investment is in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to the health and care system to push the recovery forward.

We know that there can be significant variation in the services provided for people with neurological conditions. I can confirm that NHS England is currently recruiting for a national clinical director for neurology to tackle this variation and provide national leadership and specialist clinical advice. This will complement existing work to improve neurology services—particularly the work of the neuroscience transformation programme, which will support services to deliver the right service at the right time for neurology patients closer to home. The noble Baroness, Lady Brinton, and others made this point.

NHS England also continues to work closely with the National Neurosciences Advisory Group to ensure continued service improvement and support neurosurgery networks with transformation and implementing changes that could have the highest impact. The National Neurosciences Advisory Group has developed a series of best practice optimal pathways for neurosurgery and neurology. They are being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology. This work is anticipated to be completed during this financial year.

We also know we cannot increase health service capacity and access to treatment without expanding our workforce capacity. As was made clear in many debates during the passage of the Health and Care Act, the Government commissioned Health Education England to come up with a strategy. The Act mandates the Government to publish a workforce strategy and plan every five years, on not only a national level but a bottom-up local level. We want to avoid Soviet Union-style planning which does not understand local communities, local trusts and areas. Bottom-up planning will happen at primary and secondary care level, trust level and ICS level. I will make some more comments about that.

We have made some progress so far with nearly 29,000 more hospital and community health service staff in March 2022 compared to the previous year, which includes nearly 11,000 more nurses and 4,300 more doctors. Working with the NHS, we will continue to identify and address these gaps across key types of staff. To support long-term planning, as I said, we have commissioned Health Education England.

On the social care workforce specifically, we know that many people living with neurological conditions rely on support from care workers. We recognise the challenges the sector faces in recruiting and retaining staff. Noble Lords will be aware that we launched the national register. It was voluntary at first, as some concerns were raised in the initial consultation about people not wanting to register. We want to build that confidence so we can understand the existing landscape and the myriad qualifications. How can we ensure we rationalise it so that it is a more professional service which people will feel attracted to, and what issues will we have to address so that we recruit more? To support local authorities and providers to address workforce pressures, there is the health and care visa and shortage occupation list, alongside work with DWP. We hope to boost recruitment in these areas.

Let me go into some more specific issues. It might be handy for me to discuss how the NHS generally, and the department, look at neurological conditions. When I was being briefed on this, I asked if I could be sent a list of all the neurological conditions. I now realise that was a naive question; apparently there are over 600 types. That shows that awareness is one of the big issues and barriers. If you want change, you have to realise what the issue is. If you think of how we as a society have developed, things that we now consider neurological conditions are things where, in the old days, people were told to pull themselves together. There were quite offensive names for some conditions that people had. We are now far more aware of them, which is really important. They can be broadly categorised into sudden onset conditions, intermittent and unpredictable conditions, progressive conditions and stable neurological conditions.

The noble Lord, Lord Dubs, and the noble Baroness, Lady Wheeler, rightly raised the issue of unpaid carers. During the debate there was consensus on the work that unpaid carers do, often with little reward, and what support should be available. As a result of the pressure rightfully put by noble Lords on the Government, the department and NHS have been interacting with Carers UK. I also put on record our thanks to the noble Baroness, Lady Pitkeathley, for all her work in this area and for pushing the Government to make sure that we first understand what support is needed. Sometimes it can be as simple as respite; at other times, far more support is needed. It is also about awareness and training, and we have the reform funding programme. We want to make sure that we not only recruit more motivated carers, giving them a proper career path, but do not forget the unpaid carers—recognising who is an unpaid carer and what support can be available, working from national government level and at local level.

The noble Lord, Lord Dubs, and my noble friend Lady Fraser also raised the issue of mental health. In addition to managing neurological conditions, we recognise that patients quite often do not get enough mental health support. We are committed to expanding mental health services. We also have the long-term physical health pathway. We are integrating improving access to psychological therapies—IAPT services—and have launched a public call for evidence in developing a new cross-government 10-year plan for mental health. I hope I can encourage all noble Lords to highlight that.

The noble Lords, Lord Dubs and Lord Monks, rightly raised the issue of multiple sclerosis and spoke about their own experiences of it. NICE has updated its guidance on management, diagnosis, treatment, care and support of people with MS. Following diagnosis, and with a management strategy in place, we aim for most people with MS to be cared for through routine access to primary and secondary care. NHS England has commissioned the specialised elements of MS care through the 25 specialised neurological treatment centres across England. The various parts of the NHS systems have also started to implement the guidance set out in the progressive neurological conditions RightCare toolkit, which includes a specific section on MS and was developed in collaboration with key stakeholders, such as the MS Trust and the MS Society. The RightCare toolkit provides the opportunity to assess and benchmark current systems to find out how we can improve. But it also has to be a continuous learning system, not just one set of guidelines that are followed for ages until someone tells you they are out of date.

Another important aspect of this is the research, as my noble friend Lady Fraser rightly raised. The Department of Health and Social Care funds research into neurological conditions through the National Institute for Health and Care Research. In 2019-20 the NIHR spent about £54 million on research through the Medical Research Council and is open to more bids, but it does not assign for particular conditions. Quite often, why NIHR does not assign a pot for certain conditions comes up in debates. It is open to research bids in all areas, including neurological conditions and so far it has given £54 million, but it welcomes more applications. Other areas are really important as well, such as motor neurone disease and others. That is why we urge the research community to come forward.

We also want to make sure that there is more awareness throughout the workforce, as noble Lords rightly said. As a speciality, neurology is popular and generally sees a 100% fill rate for training places. There has been an expansion in neurology posts across England and postgraduate trainees will start in August 2022. The National School of Healthcare Science is recruiting more trainee scientists to its three-year, work-based training programme, which leads to a master’s degree in neurosensory sciences. But the point is taken that it is not only these specialists we need; we also need to make sure that staff across the system are aware of these conditions and how we deal with them.

The noble Lord, Lord Dubs, raised the issue of cannabis. In November 2018 the UK Government legalised cannabis for medical use but imposed strict criteria. Specialist doctors are allowed to prescribe medicinal cannabis but there are still concerns about this not being enough people. I take the point that the noble Lord, Lord Dubs, made: if the patients feel that it benefits them, then it benefits them. That is important. I can offer to write to the noble Lord, Lord Dubs, or to have a further discussion.

We have seen increases in the number of full-time doctors working in this specialty, in neurology, including consultants, but as I have said, it is important that they are not just specialists.

Turning to strategies, there are two at the moment, one for dementia and the other for acquired brain injury. Once again, I am open to suggestions and happy to listen if people want to raise issues about this.

I should just touch on the neurosciences transformation programme. The NSTP itself came up with a new definition for specialised neurology and a model for new neurology services. The clinical pathways and the optimal pathways have been developed and indicators are being designed in partnership with stakeholders to support services delivering the right service at the right time for all neurology patients and, critically, closer to home or in the home. What we hope to see is that this approach will be built in as part of the integrated pathways, through the ICSs being set up.

On some questions that I am unable to give specific answers to—for example, on housing and a number of other issues—I offer to write to noble Lords. I think the noble Lord, Lord Dubs, asked whether I am prepared to have a meeting. Usually I say yes—I am sure noble Lords recognise that I met frequently during the passage of the Health and Care Act—but I just want to make sure I am the relevant Minister. If the relevant Minister is not available, I am very happy to meet, or to meet with the relevant Minister. I would really like to learn more and, either on my own or in partnership with the relevant Minister, to meet with the noble Lord, Lord Dubs—

[Lord Dubs (Lab)]

The task force.

[Lord Kamall (Con)]

The task force, yes—I thank the noble Lord for the prompt.

That is all I will say for now. I apologise if I have not covered all the questions; I will endeavour to write. I will diligently read Hansard and offer to write to noble Lords on those questions I have not answered. I thank the noble Lord, Lord Dubs, for raising this issue and all noble Lords for taking part in the debate and for their questions. It means I have to go back to the department and not only learn more myself but make sure we have some meaningful answers to the questions that noble Lords asked.

Committee adjourned at 4.56 pm.