St George’s Hospital: Patient Deaths
Lord Kamall Excerpts(2 years, 6 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and in so doing declare an interest as a member of the GMC.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
NHS England and Improvement will review the coroner’s prevention of future death reports and respond within the agreed timescales. The coroner’s investigations are ongoing. The Government are committed to improving the standard of investigations into serious patient safety incidents in the NHS to create a culture of learning from mistakes and to improve patient safety.
Lord Hunt of Kings Heath (Lab)
I am grateful to the Minister. This is a serious issue. An independent review into cardiac surgery at St George’s Hospital found evidence of shortcomings and a number of avoidable deaths. This finding has been totally contradicted by the senior coroner for inner west London, who found the methodology used in the review completely flawed and said of a particular case that the coroner was dealing with that the doctor’s approach had been without reproach. Given the review that will now be undertaken, does the Minister accept that, if the coroner is right, the whole method used by the NHS for these reviews will come under question?
Lord Kamall (Con)
I understand the premise behind the assertion and the Question but, as I explained to the noble Lord yesterday, a number of issues are ongoing—the coroner’s inquest, an employment tribunal and a number of other reviews—which, sadly, I am not allowed to comment on. However, I can say at the moment that we are committed to improving the standard of patient safety investigations. We have set up the independent patient safety investigation service and HSSIB to look at this, as the noble Lord will know from the Bill, and we have a number of independent investigations guidance for standard operating procedures by NHS England and Improvement for teams to use.
Baroness Finlay of Llandaff (CB)
In the light of the criticisms levelled by the coroner over the structured judgment review in particular, will the Government undertake to require the royal colleges and the new bodies set up to look at the procedure used? Although it looked at case notes, it included neither full oversight of previous medical history nor direct observation of clinical procedures, surgical technique—including anaesthesia—and post-operative nursing, all of which have an impact on outcomes. We all know that clinical opinion varies; the point at which a procedure is judged as high risk versus futile varies from centre to centre and can vary within them from one surgeon to another.
Lord Kamall (Con)
The noble Baroness clearly draws on her own experience of this. First, we have to wait for all the coroners’ inquests to finish; I think 36 have been completed at the moment. There will then be reviews, to which there is a statutory guideline on when they have to be responded to. However, it is also important to recognise the differences between the coroners’ inquests and the work of the independent mortality review, which was not undertaken to determine the cause of death in individual cases or attribute blame to individual clinicians—it was looking at a number of procedures.
Lord Suri (Con)
My Lords, it is nice of the noble Lord, Lord Hunt, to put this Question to the House. It is a very serious matter that patient deaths at St George’s Hospital were unnecessary. Having digested the comments, we must take the appropriate steps so that such negligence is not repeated. Hospitals are meant to save the lives of patients, not end them. Human life is very important.
Lord Kamall (Con)
My noble friend makes very important points which I am sure many noble Lords will agree with. It is about understanding what went wrong in places and learning from that. NHS England and Improvement is committed to improving the standard of patient safety investigations. It set up a new patient safety investigations team; as many noble Lords will know, HSSIB and a number of other panels and investigations are also looking to learn. In addition, NHS England and Improvement will have to respond to the coroners’ reports.
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 coroner noted that the NHSI investigation had not used expert investigators and in some cases used only desktop research, looking at case papers, failing to interview key staff witnesses and take a longer view. Given that HSIB uses independent specialist teams and provides a safe space for staff and whistleblowers to talk, is there not a case for asking HSIB now to do its own investigation into this?
Lord Kamall (Con)
The noble Baroness raises a very important question, and it was one of the questions I asked when I was being briefed on this. Unfortunately, when HSIB was established, it did not investigate to historical cases. The future HSSIB will also not be able to investigate such cases; it will undertake only cases that are brought to it in the future.
Lord Kakkar (CB)
My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identifies that the NHS, and indeed all healthcare systems, must be committed to ensuring the best clinical outcomes and securing patient safety. Clinical failings are subjected currently to a number of different potential investigations, such as local employer investigation, professional regulatory investigation, systems regulator investigation, civil litigation and potential criminal prosecution and interrogation. How do Her Majesty’s Government ensure that these multiple routes for investigating a clinical failing are properly co-ordinated to ensure that immediate learnings from such failings are applied to drive system improvement?
Lord Kamall (Con)
The noble Lord raises a very important point about the complexity of having a number of investigating bodies. When I was being briefed yesterday, I was surprised by the number of ongoing investigations. We acknowledge that there needs to be a consistent approach to establishing and running investigations and inquiries. We are currently looking to develop an effective and user-friendly guide to handling inquiries and involving DHSC policy procurement IT colleagues in the development of a framework. We are working also with the Cabinet Office to ensure consistency across government, so that whatever we do in health is consistent with other investigations.
Lord Sentamu (CB)
My Lords, the murder of Stephen Lawrence really caused a lot of trouble. The Met had a review and another review—and another review. The last person to do an apparently thorough review, Sir William Macpherson, turned up at the inquiry and said, “Your evidence is so awful we cannot listen to it any more.” Kent Constabulary carried out a review, but it did not uncover all the stuff that the Stephen Lawrence inquiry found. It was therefore suggested that there must be an independent police inquiry body so that the police are not marking their own homework. I wonder whether the same thing is happening here and whether this new independent review will uncover all that is required.
Lord Kamall (Con)
The noble and right reverend Lord raises a number of important points about consistency and the number of investigations. Their remits are often different, which can confuse the picture, and sometimes some of the investigating bodies are seen to extend beyond their remit, causing further confusion. In this case it is important to recognise the difference between the coroner’s inquest and the work of the independent mortality review. Coroners’ inquests are different, and an independent mortality review was not undertaken to determine the cause of death in individual cases or to attribute blame. It was all about processes, procedures and culture.
Baroness Merron (Lab)
My Lords, it is hard to imagine the trauma and pain that bereaved families have suffered, and the terrible impact on surgeons, the staff team and patients. It is concerning to read reports that junior doctors have been prevented from returning to work at the unit to keep them out of a toxic culture of inappropriate behaviour. Can the Minister tell your Lordships’ House what is being done to stamp out toxicity, not just in these tragic circumstances but in NHS workplaces more generally, and what assessment has been made of the problem?
Lord Kamall (Con)
Let me begin by agreeing with the noble Baroness on how important it is to recognise the impact that this has had on the bereaved families, and the uncertainty they have experienced. They thought it was going in one direction; clearly that was addressed by the coroner and now the coroner may apologise. When I was looking at this in more detail, I was sadly told not to discuss the culture because of ongoing investigations, but I commit to write to the noble Baroness, to make sure that I am not breaking any legal principles and that I give her a proper response rather than an inappropriate one now.
NHS Mental Health Patients in Private Hospitals
Lord Kamall Excerpts(2 years, 7 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what plans they have, if any, to address the reported £2 billion per year the NHS is paying to private hospitals to take on its mental health patients as a result of bed shortages.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Non-NHS providers have always played a role in delivering NHS services for patients since the founding of the NHS. The CQC regulates both NHS and independent providers to deliver care to the highest quality. The Government and the NHS have an ambitious transformation programme to increase investment in community mental health services and to introduce new models of care so that more people are cared for in their communities, reducing reliance on inappropriate in-patient admissions.
Baroness Thornton (Lab)
I thank the Minister. I beg the indulgence of the House to record that this is my last outing as opposition health spokesperson—although I shall be taking up other Front-Bench duties so your Lordships have not escaped completely. I wish to record a huge thank you to colleagues across the House with whom I have worked over many years; my especial thanks to the small but perfectly-formed Labour health team, my noble friends Lady Wheeler and Lady Merron and indeed the Back-Benchers; and my thanks to the many Ministers whose well-being I may not always have enhanced over the years.
On this Question, the issue is not whether it is a good use of NHS funding to spend £2 billion a year on privately provided mental health beds. It is about whether, given the parity of esteem for mental health recently reinforced in the brand new Health and Care Act, the Government have a plan to invest in reversing the decline of mental health beds and increasing the number of NHS mental health beds available at community level, as the Minister mentioned, where they are needed, and over what period.
Lord Kamall (Con)
I begin, if noble Lords will allow me, by paying tribute to the noble Baroness for her doughty and robust opposition, but also for the advice when I was a new Minister suddenly thrown in at the deep end. It was very comforting to have one of the Opposition help me and give advice—I make no comments about the quality of the advice but I was incredibly grateful. I also pay tribute, to requote her words, to the perfectly formed shadow team. I thank them very much for all their holding us to account.
On the issue, when I was looking at the future of mental health, one thing we have to look at its granularity. There are different types of mental health; someone suffering from eating disorders, for example, will have a very different need from someone who is schizophrenic. It is really important that we do not just assume that everyone needs to be in a bed. Where appropriate, we should move people out to the community but make sure that they are supported there, not just kicked out the door and left to fend for themselves. We are looking at a massive programme of investment and at how we can have more targeted interventions for those suffering from different mental health issues.
Baroness Watkins of Tavistock (CB)
My Lords, I declare my interest as the recent chair of a major HEE review, recommending ways to improve and deliver the mental health nursing workforce, which was released on 20 April. Can the Minister really drill down on the extent to which the new ILATs will be accountable for both local provision of mental health in-patient beds—services are not enough and some people need admission and care in hospital—and the consideration of workforce needs, not only locally but for the services they purchase in the independent and not-for-profit sector?
Lord Kamall (Con)
The noble Baroness makes an important point about how we ensure that those who require services in their community receive them, while ensuring that we have the appropriate workforce. She will know that throughout debate on the Health and Care Bill, we have discussed the fact that Health Education England, as well as NHS England, is developing workforce strategies—as are local trusts at their level, which know their needs and requirements at the same time. In terms of the specific question, I shall have to write to the noble Baroness.
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, I too congratulate the noble Baroness, Lady Thornton, on her outstanding contribution in her health Front-Bench role. From these Benches, it is always a pleasure to work with her and we look forward to continuing with her in her new role. Yesterday, the CQC served the Norfolk and Suffolk mental health trust with an improvement notice, reporting that staffing levels remain unsafe, waiting lists were long and, on average, 49 people per month died within six months of contact with that trust. There are staff shortages across NHS mental health services, so can the Minister say what the Government will do to ensure that there are enough qualified mental health professionals in the NHS?
Lord Kamall (Con)
I thank the noble Baroness for the question and for repeating the fact that you can find problems in the independent sector and in NHS providers. What is really important is that we are looking at the HEE workforce plan as well as the NHS workforce plan, while working with trusts at the local level and other providers of care to ensure that we have the most appropriate staff levels to meet local conditions.
Lord Young of Cookham (Con)
My Lords, if the £2 billion which the NHS is paying to the private sector is enabling vulnerable mental health patients to get high-quality care, is this not to be welcomed as it takes pressure off the NHS?
Lord Kamall (Con)
I should remind noble Lords that the noble Baroness said that she was not against private provision out of principle. Private provision can be very helpful and has always worked with the NHS, ever since it was founded. If we think about responders—for example, the impact of lockdown on many people—we have seen an increase in mental health needs. What do you do to increase the provision of mental health services? Do you wait for a new NHS hospital to be built? No—if there is a private provider out there, or an independent provider that can provide those services, you engage them. That is why the NHS and the independent sector, working together, is a really important partnership.
Lord Turnberg (Lab)
My Lords, is the noble Lord aware of the Migration Advisory Committee’s report, which pointed out what we all know: poor pay is driving social care workers, including mental health workers, out of the service and into the private sector? For example, they are losing more through inflation than they can keep up with and their pay certainly runs behind private sector pay. I understand that a social care worker can earn more in an Amazon distribution centre than they can in the social care sector. Can the Minister bring to the notice of the Treasury the damage that this policy is doing?
Lord Kamall (Con)
The noble Lord clearly discusses an important point: we have to have the appropriate workforce. The Government have begun a register of social care to work out who is in the workforce, what qualifications they have and what improvements we have to make to social care. We should also remember that social care providers are a mixture of private homes and state provision. At the same time, we have to make sure that we have the right people, locally trained. For example, the visa system encourages people to come and work in our social care system as well.
Lord Kakkar (CB)
My Lords, I draw noble Lords’ attention to my declared interests. In view of recent press reports about a young patient who absconded from a private sector mental health unit and subsequently died, and the subsequent coroner’s inquest findings, is the Minister able to confirm that the Department of Health and Social Care will be able to provide guidance on the safety and security arrangements that should attend outside areas at mental health units and subsequently might be used as the basis for CQC inspection?
Lord Kamall (Con)
Can I begin by—if my information is correct—wishing the noble Lord a happy birthday? If it is not his birthday, I have made a fool of myself. I am sure all the House joins me.
Wherever there is a tragedy, we have to learn the lessons. We spoke about this during the Bill, for example with HSSIB and making sure we have a safe space to understand what went wrong and ensure it does not happen again. We have to make sure that, as we move towards different models of care for people suffering from mental health conditions, it is appropriate to their condition. Not all mental health conditions are the same. Some will need in-patient provision and others will need care in the community, but we should make sure they are actually supported in the community.
Baroness Parminter (LD)
My Lords, I declare an interest in that I have a daughter currently in a private eating disorder facility out-of-area, which the NHS is paying for—for which I am extremely grateful. Given the increasing numbers of people suffering from eating disorders, both children and young people and adults, what hope can the Minister give families like mine that in future their young people and family members will not be sent far away, when we want to see them? They might be in hospital for four, six or nine months at a time. What hope can the Minister give people that—yes, there are brilliant community services for eating disorders and we need more of them—we will open up more beds in local areas to help families and sufferers of these appalling diseases?
Lord Kamall (Con)
I thank the noble Baroness for sharing her very personal story. It is important that we understand it is more than stats and figures, which are provided to me by the department. In the community, we understand it is important to make sure that provision is as close to the patient and family as possible. We have to remember that care is not just for the patient; it impacts friends, family and others. We are looking at ways to ensure that care is delivered close to families and those suffering from these conditions.
Health and Care Bill
Lord Kamall ExcerptsTuesday 26th April 2022
(2 years, 7 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 150-I Marshalled list for Consideration of Commons Amendments and Reasons - (26 Apr 2022)
Lord Kamall
That this House do not insist on its Amendment 29B, to which the Commons have disagreed for their Reason 29C.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, with the leave of the House, in moving Motion A, I will also speak to Motions B, C and D. The amendments being considered today relate to the NHS workforce, reconfigurations, modern slavery risks in NHS supply chains and the adult social care cap.
I turn first to Amendment 29D. The unamended Clause 35 places a duty on the Secretary of State to report on workforce systems. Our report will increase transparency and enhance accountability by describing the workforce planning and supply system for healthcare workers, including those working in the NHS and public health alongside regulated healthcare professions working in social care and public health in England. The existing clause therefore already delivers, by and large, what Amendment 29D seeks to do.
I can confirm that we will be asking Health Education England and NHS England to assist in the preparation of the report. In addition, while the report will be published at a minimum of every five years, it can be published more frequently than that, if required. I can also confirm that, in the preparation of the initial report, we will also seek the views of key stakeholders. The report is in addition to the rest of our expansive work to improve workforce supply and planning, including the Health Education England strategic framework, which will be published in the coming weeks, and the NHS England long-term workforce strategy.
Moving to reconfigurations, I am very grateful for the constructive debates on these issues across both Houses, and in this place particularly to the noble Lord, Lord Stevens, and my noble friend Lady Cumberlege for their insightful and wise feedback on this power. The first set of changes we have proposed would mean that the NHS had to notify the Secretary of State only about the reconfiguration proposals deemed notifiable, which we will define through regulations. But we intend to align that definition with the existing duty on NHS commissioners to consult local authorities in the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. Similarly, our amendment removes the requirement for commissioners and providers to inform Ministers of
“circumstances that are likely to result in the need for the reconfiguration of NHS services”.—[Official Report, Commons, 25/4/22; col. 522.]
Throughout the Bill’s passage, we have been clear that our intention is to use these powers only in respect of substantial reconfigurations. The vast majority of reconfigurations will be managed without any ministerial intervention. These amendments and our planned regulations reinforce that principle.
Under the Town and Country Planning Act 1990, the Secretary of State for Levelling Up, Housing and Communities has powers to call in any planning application. However, the stated policy for many years has been to be very selective about doing so, and Ministers will, in general, consider the use of call-in powers only if planning issues of more than local importance are involved. I should like to put formally on the record that our intention is that the same principle applies here.
On the Secretary of State’s call-in power, concerns have been raised about patient safety. I want to be clear that these powers should never, and will never, prevent providers making urgent temporary changes where there is a clear and acute risk to the safety of patients or staff.
Secondly, our amendments give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate, a right to make representations to the Secretary of State where he or she has called for a proposal for consideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of representations he or she receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged. In addition, we also want the CQC’s expertise to be taken into account where it is appropriate for relevant reconfigurations. We will therefore look to make clear, in guidance, where information provided by the CQC should be taken into account.
Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the public interest. We are therefore requiring the Secretary of State to provide the reasons for his or her decisions and directions when he or she makes them.
Finally, we have heard throughout these debates that reconfiguration decisions must be made quickly to improve the quality of services received by patients. Our amendment requires that, once he or she has called in a reconfiguration proposal, the Secretary of State must make any decisions within six months. We believe that this set of changes answers many of the key concerns raised in Parliament and I therefore urge noble Lords to consider supporting these amendments.
I now turn to Amendment 48C, particularly on the issue of modern slavery. We clearly share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked to slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong that creates a duty on the Secretary of State to undertake a thorough review of NHS supply chains. Today, I can announce that we will go further than this. The Government’s further amendment in lieu will require the Secretary of State to make regulations with a view to eradicating the use in the NHS in England of goods or services that are tainted by slavery or human trafficking. The regulations can set out steps that the NHS should be taking to assess the level of risk associated with individual suppliers; the basis on which the NHS should exclude them from a tendering process; and what measures should be included in contracts. I am particularly grateful to my noble friend Lord Blencathra and also the noble Lord, Lord Alton of Liverpool, for their campaigning—in fact, their persistence—on this issue, and I welcome their support for the amendment. I will also continue, with other Ministers, to work closely with others across government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.
We must now turn to the issue of the adult social care cap. The Government have announced their plan for a sustainable social care system. It is fair and affordable, and designed to end the pain of unpredictable care costs by capping the amount anyone would need to pay at £86,000. The elected House has once again voted overwhelmingly in favour of our proposals, which are financially privileged—and I would remind the House of its proper role in considering matters that are financially privileged. On the issue of substance, this House will be aware that Governments of all parties, for many years, have considered social care but not implemented reforms due to concerns about the affordability of introducing a cap. I have said previously that reports have gathered dust on shelves but never actually been implemented. Now we have a real opportunity to grasp the nettle. If there are issues or unintended consequences, these will likely be found by the trailblazers, and we can then tweak the system to address any shortcomings. I ask noble Lords to not allow this opportunity once again to slip away.
The existing system is simply not good enough, and our reforms are a vast improvement. Our reforms ensure that more people are eligible for support with the costs of their care; that the amount they spend each week is reduced; and that they can retain more of their savings. At the moment, people get support with the costs of their care only once they have depleted their assets to under £23,250. We are increasing this fourfold, so that people with up to £100,000 in savings, who are currently paying all the costs of their care, will now be eligible for funding support from the state. Under the current system, only once you have depleted your assets to £14,250 do you no longer need to contribute from your assets. We are increasing this to £20,000. Most crucially, at the moment there is no cap. Our reforms mean that people will have more certainty and more peace of mind, and will be able to plan ahead, whatever part of the country they are in.
Baroness Wheeler (Lab)
My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.
I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.
As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?
For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.
Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.
The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?
The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?
Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,
“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]
is the fairest system. Is that not also the opposite of how levelling up should work?
The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.
On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.
Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.
Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.
I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.
I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.
Lord Kamall (Con)
I thank all noble Lords who have spoken in this debate. I will turn to the issues as briefly and succinctly as I can.
On workforce planning, I hope I can assure noble Lords that we will engage with stakeholders on the preparation of the report, which will include the regulated workforce in health, social care and public health. I hope your Lordships also understand the work being undertaken by the Government, NHS England and Health Education England to improve workforce planning and to lead the improvements we all seek. This is why we think the amendment is unnecessary. I also remind noble Lords that at local level there is an incredible amount of local planning going on much closer to the ground.
Lord Kamall
That this House do not insist on its Amendments 30B and 108B, to which the Commons have disagreed; and do agree with the Commons in their Amendments 30C to 30K in lieu.
Lord Kamall
That this House do not insist on its Amendment 48B, to which the Commons have disagreed; and do agree with the Commons in their Amendment 48C in lieu.
“Eradicating slavery and human trafficking in supply chains
(1) The National Health Service Act 2006 is amended as follows.
(2) After section 12ZB insert—
“12ZC Eradicating slavery and human trafficking in supply chains
(1) The Secretary of State must by regulations make such provision as the Secretary of State thinks appropriate with a view to eradicating the use in the health service in England of goods or services that are tainted by slavery and human trafficking.
(2) The regulations may, in particular, include—
(a) provision in connection with the processes to be followed by public bodies in the procurement of goods or services for the purposes of the health service in England (including provision as to circumstances in which a supplier is excluded from consideration for the award of a contract);
(b) provision as to steps that must be taken by public bodies for assessing and addressing the risk of slavery and human trafficking taking place in relation to people involved in health service supply chains;
(c) provision as to matters for which provision must be made in contracts for goods or services entered into by public bodies for the purposes of the health service in England.
(3) In this section—
“health service supply chains” means supply chains for providing goods or services for the purposes of the health service in England;
“public body” means a body exercising functions of a public nature;
“slavery and human trafficking” has the meaning given by section 54(12) of the Modern Slavery Act 2015;
“tainted”: goods or services are “tainted” by slavery and human trafficking if slavery and human trafficking takes place in relation to anyone involved in the supply chain for providing those goods or services.”
(3) In section 272 (orders, regulations, rules and directions), in subsection (6), after paragraph (zze), insert—
“(zzf) regulations under section 12ZC,”.”
Lord Kamall
That this House do not insist on Lords Amendment 80 in respect of which the Commons have insisted on their disagreement; do not insist on its disagreement with the Commons in their Amendments 80A to 80N in lieu; and do not insist on its Amendments 80P and 80Q instead of the words so left out of the Bill to which the Commons have disagreed for their Reason 80R.
Lord Kamall (Con)
I have already spoken to Motion D. I beg to move.
Motion D1 (as an amendment to Motion D)
Folic Acid Fortification
Lord Kamall Excerpts(2 years, 7 months ago)
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Lord Rooker
To ask Her Majesty’s Government when they intend to introduce draft legislation to replace the Bread and Flour Regulations, following their decision to implement folic acid fortification announced in September 2021.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I pay tribute to the noble Lord for his tireless advocacy of this important policy. Substantial progress has been made since September 2021, including working with the devolved Administrations to establish a cross-industry Bread and Flour Technical Working Group engaging stakeholders to move forward to the regulatory review. Proposed changes are being finalised and impacts assessed by a whole-UK working group for a consultation once the Northern Ireland Assembly elections have concluded.
Lord Rooker (Lab)
I thank the Minister. This is taking a long time. I have only one question for him. Given that it is now more than 30 years since the medical research councils connected up the difficulties of neural tube defects and that more than 80 countries have operated the policy, will he commit to using the best possible science? People have spent decades on this, and scientists tell me this can prevent up to 80% of neural tube defects. It has advanced since the original science 30 years ago.
Lord Kamall (Con)
The noble Lord is absolutely right: our scientific knowledge increases as scientists challenge each other and come to other conclusions. We have to be aware that there is no off-the-shelf solution. For example, I am sure the noble Lord will be aware that in Australia they can divide the flour and fortify only flour used to make bread. That cannot be done in this country, which is why we are working with stakeholders including heritage millers, for example, to make sure that we have the right solution. It has all been delayed due to a number of elections.
Lord Patel (CB)
My Lords, the United Kingdom has a high incidence of babies born with neural tube defects. What evidence have the Government collected as to the decrease in the incidence of neural tube defects in babies that would occur if an appropriate daily amount of folic acid was available in the nutrition of United Kingdom citizens?
Lord Kamall (Con)
I think the noble Lord will be aware that pregnant women are advised to take 400 micrograms of folic acid. That high level cannot be put into other foods because there are some unintended consequences. For example, it disguises some other traits and conditions in the older population. Therefore, one needs to get the right balance and proportion for the wider population.
Lord Cunningham of Felling (Lab)
My Lords, why did the Minister not say—or give some indication—as to when this working group will report, first to the Government and secondly to this House? It has had long enough since my noble friend succeeded in moving this policy change. When does the Minister expect the report, and when can we see some action?
Lord Kamall (Con)
I understand the complete frustration with the delays. When I asked the departmental officials about them, they said, “Funnily enough, usually we are people who support democracy, but democratic elections have got in the way.” Delays are due, for example, to the 2019 general election, the Scottish and Welsh parliamentary elections and the Northern Ireland elections.
Lord Kamall (Con)
It is not fair to have a go at officials over this. Once the Northern Ireland Assembly election period is out of the way, they can get on with it.
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, I too commend the noble Lord, Lord Rooker, for his tireless campaign. The continuing consequences of Ministers not introducing the new legislation are that around 430 children in the UK will be born with spina bifida each year until folic acid is added to bread flour. What will the Minister—not his officials—say to the families of these babies to explain why this was just not urgent enough to put into legislation, despite the Government’s decision to do so and despite elections? Officials are not always side-tracked by elections. What will the Minister say given that those children will need continuing health support for life?
Lord Kamall (Con)
I think the noble Baroness is being a little unfair. It is quite clear that some of the delay has been due to elections, particularly when it has been necessary to consult across the devolved Administrations. Let there be no doubt. The Government are not against this; we are in favour of it. We are having to cover a number of issues—for example, the level of folic acid fortification to ensure that we add an appropriate amount without the side-effects that have been found in older people. We need to standardise the minimum levels of the existing four fortifications—calcium, iron, niacin and thiamine—and to consider exemptions from fortification for products that have minimal amounts of flour. Provisions have to be made for flour used to manufacture ingredients. We have to consider potential exemptions, for example, for micro-businesses and heritage millers. This consultation will start in earnest once the Northern Ireland elections are out of the way.
Baroness Finlay of Llandaff (CB)
My Lords, do the Government recognise that the early MRC trial and all subsequent trials have shown that folic acid must be taken before a woman becomes pregnant? Giving supplementation once someone is pregnant is too late because of the formation of the neural tube. Now, with modern haematological techniques, the problem of pernicious anaemia and the confusion with B12 deficiency does not apply nearly as much, because it is easy to measure the levels.
Lord Kamall (Con)
In the brief which I received yesterday the recommendation is for a daily supplement of 400 micrograms of folic acid during the first 12 weeks of pregnancy. I am told that this advice will remain. Certain women with a higher risk of an NTD-affected pregnancy are advised to take a higher, 5-milligram supplement. This is why we have to get the right level. Increasing folic acid in flour alone will not solve the issue.
Lord Dodds of Duncairn (DUP)
My Lords, I commend the Government for reaching this position and for being the Government who have brought this matter to this stage. On a couple of occasions, the Minister mentioned the Northern Ireland elections. We know that there are some concerns about what might happen after those elections in terms of a Government being formed. This is a UK-wide matter. Can the Minister assure me that it will progress regardless of the state of devolution in Northern Ireland?
Lord Kamall (Con)
Call me old-fashioned, but I anticipated that there would be questions about further delays. When I asked the officials about this, I was advised that once the Northern Ireland elections were out of the way, they could get on with the consultation.
Lord Hunt of Kings Heath (Lab)
My Lords, I would like to come back to the level of fortification. There are rumours that the Government are going for a minimal level which will not be very effective. My understanding is that the most up-to-date research shows that folic acid is not at all harmful. Therefore, will he assure me that the technical working group that he is going to take forward at some point will look to implement a level that is going to be effective?
Lord Kamall (Con)
I understand the noble Lord’s question but the expert Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has advised on the level of fortification needed to prevent neural tube defects. It wants a level that is not considered to pose a risk to health. The advice it has at the moment is that supplementation of folic acid can mask underlying vitamin B12 deficiencies, particularly in older adults. If noble Lords with medical experience disagree, I will be very happy to facilitate a meeting with my officials.
Baroness Hayman (CB)
My Lords, I think the House would be grateful for such a meeting. Perhaps the noble Lord, Lord Patel, could take part. It is extremely depressing to hear the Minister today go backwards in time to the arguments, which have all—one by one—been disproved, against this policy. It would be much more helpful to hear of a timetable going forward for implementing it. Does the Minister accept that it is a matter of embarrassment, shame and distress to many of us that, more than 30 years after UK research did this and with 80 other countries that should be able to help us in getting levels and procedures right, there are still families facing distress and the termination of wanted pregnancies because we have not made progress?
Lord Kamall (Con)
I understand the frustration that noble Lords have expressed. The same frustration is shared by officials in the department. When I asked officials, “What are the issues that you really need to get to the bottom of?”, one was the appropriate level of fortification. It is interesting that noble Lords seem to disagree with the department’s advice. Therefore, I will facilitate a conversation. Another issue is how that appears compared to other additions and fortifications put into flour. We want to get the right balance. The Government are committed to doing this and we will start as soon as the Northern Ireland elections are over.
Baroness Merron (Lab)
My Lords, all the research on adding folic acid to flour, including that by the Government’s independent Scientific Advisory Committee on Nutrition, shows that it is a completely safe measure with no unintended health consequences. In preparation for going down this route to protect newborn babies—which I really would urge the Minister to progress as soon as possible—what plans do the Government have to communicate the benefits of these measures and to reassure those who may have concerns, including parents, and parents-to-be?
Lord Kamall (Con)
This will all be part of the consultation, but once the policy has been decided on and fortification starts, clearly, we will be communicating to parents, families and others. If there is a risk—which noble Lords in their expertise seem to disagree with—we will have to identify that. The history of good intentions is littered with unintended consequences. We must be aware of those in our pursuit of increased folic acid in flour.
Baroness Walmsley (LD)
My Lords, over the past two years, the Government have made urgent decisions about Covid-19 to save lives and save sickness. Why can they not, in light of the strength of the evidence we already have, make a similarly urgent decision on this issue to save harm to 400 babies a year?
Lord Kamall (Con)
We all want to save harm to 400 babies a year; indeed, we want to save harm to more babies. The issue is that we have to do it in a proper way. When I speak to the officials, they are quite clear that we all want this to happen—there have been delays, which I have mentioned—but we have to get the right level of folic acid. Noble Lords in their wisdom are saying that all the evidence that the department has been presented with is worthless. If they believe that, they should talk to my officials. I will be happy to facilitate that.
NHS: Abuse of Nurses
Lord Kamall Excerpts(2 years, 7 months ago)
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Lord Clark of Windermere
To ask Her Majesty’s Government what steps they are taking to reduce the abuse of nurses in the NHS.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Abuse directed towards nurses is unacceptable, and we are determined to tackle this. NHS England has established a violence reduction programme to address deliberate violence and aggression towards NHS staff and to ensure that offenders are punished quickly and effectively. This includes implementing the NHS violence prevention and reduction standard, which requires employers to implement plans to tackle violence in the workplace. In addition, the Government are legislating to double the sentences of those who are violent towards NHS staff.
Lord Clark of Windermere (Lab)
I thank the noble Lord for his Answer. He is clearly aware of the problem, which is indeed growing. Nurses and other NHS staff are abused daily and many are being reduced to tears. As the retention of nurses is at a critical stage, with abuse being a key contributing factor, what specific plans have the Government to tackle this problem as a matter of urgency in trying to build up the key respect in which the general public used to hold NHS workers?
Lord Kamall (Con)
The noble Lord is absolutely right that we have identified the issue, and the NHS is working on a number of plans. All of us abhor any abuse of nurses or indeed any other NHS staff. The NHS has looked into this and has seen that many cases of violence against NHS staff are committed by individuals who are in a mental health crisis, or suffering from dementia or other neurological conditions, rather than the classic perception of attacks on staff by the public. The NHS has not only the violence prevention and reduction programme but a number of other initiatives to try to tackle this unwarranted issue.
Baroness Watkins of Tavistock (CB)
My Lords, I declare my interests as outlined in the register. I particularly want to raise the issue of nurses on shifts who are having difficulty parking both near the hospital for a reasonable cost—that cost was removed during Covid, which made life much easier for them—and in the community, where we have reports of them being abused for parking near patients’ homes. What strategy will the Government achieve to reduce this stress and the associated verbal violence?
Lord Kamall (Con)
The NHS is looking at a number of different ways of tackling violence towards staff, as well as supporting them in how to handle difficult situations and giving them well-being support. On the specific issue that the noble Baroness raises, it is probably better if I commit to writing to her.
Lord Scriven (LD)
My Lords, the individuals who abuse healthcare staff should understand and then pay for the harm they cause and be helped to change their behaviour. To augment existing arrangements, will the Government therefore look at implementing an NHS restorative justice scheme?
Lord Kamall (Con)
We are looking at the way in which abusers are treated. On 13 November 2018, the Assaults on Emergency Workers (Offences) Act 2018 came into force, and since 2020 we have also been working with the Ministry of Justice in consulting on doubling the sentence for such assaults to two years. The Government are now legislating for this through the Police, Crime, Sentencing and Courts Bill. In addition, a Joint Agreement on Offences Against Emergency Workers was agreed between NHS England and NHS Improvement and the Crown Prosecution Service in January 2020.
Baroness Pitkeathley (Lab)
My Lords, will the Minister outline how the training of nurses is being adjusted or extended to take account of this regrettable violence towards them? Does he agree that when we are thinking about training, we must include all nurses—not just those who work in hospitals but, most especially, those who work in communities and therefore go individually into people’s homes?
Lord Kamall (Con)
As well as various programmes such as the NHS violence prevention and reduction standard, against which trusts are measured and held accountable, there are a number of different local initiatives to see what works and what does not in different places. There are a number of innovative ones, and I will give one example, rather than take up too much time. The No Force First initiative at Mersey Care NHS Foundation Trust has resulted in a 46% reduction in physical assaults against staff. There are a number of other examples that I could lay out in detail.
Lord Bird (CB)
There are many opportunities to stop the violence. My nephew is involved in security in a major hospital, and he says the pressure they are under is enormous. They have to work very long hours to make the necessary money. We must look at those kinds of policing operations within our major hospitals.
Lord Kamall (Con)
The noble Lord is absolutely right: it is not a simple issue, and people abuse for lots of different reasons. We are looking at different ways to deal with this, including training staff to deal with violence from patients with dementia or mental illness. We are also looking at various security measures. Money is being made available for trusts and primary care to take security measures, including the installation of cameras and screens for receptionists.
Lord Hamilton of Epsom (Con)
My Lords, does my noble friend have any idea who the people are who are abusing nurses, how many of them are drunk and how many of them are mentally ill?
Lord Kamall (Con)
I thank my noble friend for his question. When the NHS started investigating and digging deeper into this issue, the assumption was that it was often just members of the public. It is finding that it is individuals who have had a mental health crisis or are suffering from dementia or another neurological condition, rather than the classic perception of members of staff being abused by the public.
Baroness Merron (Lab)
My Lords, yesterday’s Health and Social Care Committee report emphasised that earlier diagnosis and prompt cancer treatment will not be possible without a plan to address gaps in the cancer workforce, including the need for nearly 3,500 additional specialist cancer nurses by 2030. Does the Minister accept that a workforce plan is essential to improving cancer diagnosis, research and treatment, and how will the Government attract new staff and improve staff retention by improving day-to-day working conditions, which must include preventing abuse and giving support where it does occur?
Lord Kamall (Con)
I hope the noble Baroness will appreciate that I have laid out some of the initiatives that are taking place, and which are not only trying to prevent abuses against members of staff and nursing staff but supporting staff to de-escalate them. On well-being and getting more nurses, the Government are committed to continuing to grow the NHS workforce. We are still committed to the figure of 50,000 more nurses and to putting the NHS on a trajectory towards a sustainable long-term supply in the future. We are working on a number of well-being schemes to ensure that nurses are supported and feel safer and more willing to stay in service.
Lord Laming (CB)
My Lords, does the Minister agree that sometimes, nurses find themselves in this difficult situation because, as the most junior staff, they are required to give unwelcome messages about the limitations of resources? There are a lot of managers in the health service, but they put nurses forward to give that unwelcome message to patients and their relatives. Can the Minister see whether there are better ways to protect the most junior staff in the organisation?
Lord Kamall (Con)
I must admit that I was not aware of that, but I will take it back to the department to investigate and will write to the noble Lord. We have been looking at how to train staff not only to deal with abusers but to handle different situations and to de-escalate. There are also a number of staff health and well-being support programmes, including website session support lines, certain apps, well-being seminars and coaching seminars.
Lord Mackenzie of Framwellgate (Non-Afl)
My Lords, abuse and violence is increasing towards not just nurses but others providing frontline services, such as shopworkers, teachers and police officers. The abusers are usually bullies and a minority in the community. I remember years ago as a rookie police officer being assaulted. The cavalry came to rescue me in the form of members of the public, led by a bus driver who turned out to be a special constable. This exemplifies the importance of voluntary public service. Does the Minister agree with this analysis, and what are the Government doing to encourage voluntary organisations such as the special constabulary to increase their numbers?
Lord Kamall (Con)
The noble Lord makes a very important point—it is not just about nurses but people right across the care sector, including doctors and receptionists, and public services. My father was a bus driver and he used to come home once or twice with a knife that he had taken off an attacker, having had to defend himself. This has been going on for years, and it is really important that we work in partnership with trade unions and others to ensure that we look after all our staff, particularly those in vital public services.
Health and Care Bill
Lord Kamall ExcerptsTuesday 5th April 2022
(2 years, 7 months ago)
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Lord Kamall
That this House do not insist on its Amendment 11 and do agree with the Commons in their Amendment 11A in lieu.
“(4) If the constitution includes provision under this paragraph allowing committees or sub-committees to exercise commissioning functions, the constitution must—
(a) provide for the members of any such committee or subcommittee to be approved or appointed by the chair of the integrated care board, and
(b) prohibit the chair from approving or appointing someone as a member of any such committee or sub-committee (“the candidate”) if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.
(5) In sub-paragraph (4) “commissioning functions” means the functions of an integrated care board in arranging for the provision of services as part of the health service.”.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I start with the amendments on ICB membership, children’s palliative care, hospital discharge and adult social care.
On integrated care boards, I hope noble Lords will recognise that the Government have listened to both this House and the other place. We have proposed some changes to the drafting of Amendment 105 in the name of the noble Lord, Lord Bradley, which I am aware that the noble Lord has seen. We hope that he recognises that our amendment in lieu meets the original intent of his amendment.
On Amendment 11, we hope that Amendment 11A in lieu, proposed in the other place, meets the expectations of your Lordships’ House. To avoid a number of unintended consequences or implications, we proposed an amendment in lieu that will ensure that those who pose a threat to the independence of the health service are excluded from the ICB and its committees. We have applied the same test to committees as we have to the main board, and the conflict of interest provisions and safeguards in the Bill also apply. We are grateful for the discussions on this question that we have had with noble Lords, including with the Front Bench opposite, and we hope that this amendment will be satisfactory.
Baroness Walmsley (LD)
My Lords, I shall make a few brief comments about Motions A, E, G1, L1 and Q. On Motion A, we very much welcome the Government’s amendments in lieu, to make it clear that no commissioning organisation within the ICS can have a member appointed to it who could reasonably be regarded as undermining the independence of the health service because of their involvement in the private sector. The Government have listened to the concern expressed by the noble Lord, Lord Hunt of Kings Heath, whom I congratulate for spotting the loophole, and that is very good and welcome.
On the matter of carers and safe discharge in Motion E, we on these Benches were concerned that unpaid carers would not be sufficiently consulted and their own health and well-being might not be sufficiently taken into account. I am grateful to the Minister for spelling out, at my request, how the impact on carers will be assessed before a patient is discharged into her or his care. However, at the moment, when there is an outbreak of Covid-19 in a hospital ward, the carers are not allowed to visit the patient. Therefore, those conversations are not taking place. I should be very interested to know what the Minister will suggest about how those conversations can take place in that situation.
It is very important that appropriate action is taken to address the carer’s needs as well as those of the patient. Indeed, if those needs were not addressed, it would affect the ability of the carer to look after the patient, so both would suffer. I know this is a big responsibility for local authorities, which are strapped for cash, but it is vital that these needs are catered for, especially in light of the fact that those many thousands of unpaid carers save the public purse a massive amount of money, as well as looking after their loved ones with the loving care and attention that it would be very difficult for professionals, however dedicated, to give.
On Motions L and L1, I have listened carefully to the concerns of the noble Baroness, Lady Finlay, and she is quite justified. Governments have a habit of promising action but then moving on to something else, so we on these Benches, like the noble Baroness, will be looking out very carefully for the results of the review and the actions which we hope will follow.
We very much welcome Motion Q and congratulate the noble Lord, Lord Bradley, on achieving what he has. We particularly welcome the mention in the amendment in lieu of the word “prevention” of mental ill-health, as well as diagnosis and treatment.
Finally, as my noble friend Lady Brinton said, we support Motion G1 from the noble Baroness, Lady Wheeler. I want to add just two comments to those of my noble friend. We should support the amendment because the government savings will be paid by the poorest and most vulnerable, and 80% of those with dementia who have very long-term caring needs will be worse off under the Government’s proposals, and that is not right.
Lord Kamall (Con)
I thank all noble Lords who took part in this wide-ranging and interesting debate. Perhaps I can deal quickly with some of the issues. On mental health membership of the ICBs, I thank the noble Lord, Lord Bradley, for his persistence, but also for accepting the amendment that we produced in lieu.
On conflicts of interest, I thank all noble Lords for acknowledging the work that the Government have done, and I shall try to answer a couple of points. The noble Lord, Lord Hunt, asked about the chairs of the ICBs. They are appointed by NHS England, with the Secretary of State’s approval, which is the route by which the Department of Health and Social Care can ensure that the chair does not undermine the independence of the NHS. NHS England and the Secretary of State will want to appoint people who meet the highest standards and will not undermine the interests of the NHS. On the second question, ICBs will have to make arrangements to manage conflicts of interest to ensure that they do not affect, or appear to affect, the integrity of ICBs’ decision-making. This would implicitly include data sharing and access to information. I hope that that meets with the noble Lord’s approval and addresses his concerns.
On palliative care, I once again thank the noble Baroness, Lady Finlay, for all her work and for teaching me so much about the subject. Indeed, the officials in my department are very grateful for what they have learned about the whole palliative care process: the noble Baroness has definitely put it right on the agenda for consideration.
It is clear that the views of parents are very important, and it is essential that their voices are heard. That is why we expect the review to include evidence from both parents and clinicians who have been involved in disagreements in the care of critically ill children.
I also thank my noble friend Lord Balfe for the points that he made and I hope that we will have further conversations. I would be happy to put my noble friend in touch with officials in my department, so that they can benefit from his wisdom and many years’ experience of mediation.
There are already robust duties to involve parent carers in hospital discharge planning. Parent carers of a disabled child are covered by the right, under the Children and Families Act 2014, to request a carers assessment at any time. We will continue working closely with the Department for Education to ensure that, in guidance, we signpost to existing rights and protections for these individuals. The existing guidance stresses that discharge teams should ascertain whether the carer is willing and able to provide care and support post discharge, before an assessment of longer-term needs. No assumptions should be made about their willingness or ability—that includes all forms of ability—to care. This will be set out in the new statutory guidance. As the noble Baroness rightly knows, we will be working with Carers UK on the guidance.
I will finish on the adult social care cap. I understand the concerns that many noble Lords have expressed. In the current system, individuals with more than £23,500 face unlimited costs. The cap is not a target to work towards; it is a backstop to make sure that people are not liable for unlimited costs of care. There are a number of different issues and views on this, but we believe that our proposal is better than the current system. Although I understand the concerns of this House, I once again urge noble Lords to consider that the other place has considered this and rejected noble Lords’ amendments. The Government Benches will be opposing Motions G1 and G2.
I am also grateful to my noble friend Lord Lansley for the points he raised. We will look at all aspects of the trailblazer schemes; it would not be wise to limit what we look at. We want to get the best from that discovery and learning process, and perhaps spot with the trailblazing and piloting any unintended consequences. So we will look in a holistic way at how the trailblazer schemes are working before we roll them out nationally. We believe that that is wise and prudent.
I think that completes my points.
Lord Kamall
That this House do not insist on its Amendment 29, to which the Commons have disagreed for their Reason 29A.
Lord Kamall (Con)
My Lords, I have the notes just in time. I just hope I have impressed noble Lords with our lean operation—although sometimes the leaner the operation, the more brittle it is.
The amendments in this group all relate to questions of accountability. Amendment 29 addresses the question of workforce projections. I draw noble Lords’ attention to the sustained disagreement of the other place to this amendment. The Government are committed to improving workforce planning and we recognise the importance of having a properly trained workforce. Indeed, during my short time as Minister, noble Lords have asked a number of parliamentary Questions on workforce issues.
We are taking a number of steps to ensure that we have record numbers of staff working in the NHS and we are committed to continue to grow and invest in the workforce. This year, we have seen record numbers of staff in NHS trusts and CCGs, including doctors and nurses. The monthly workforce statistics for December show that there are more than 1.2 million full-time equivalents.
These workforce numbers come on the back of our record investment in the NHS, which is delivering on our manifesto commitment of 50,000 more nurses. We are on target with that, with nursing numbers a little over 27,000 higher in December 2021 than they were in September 2019. The spending review settlement will also underpin funding the training of some of the biggest undergraduate intakes of medical students and nurses ever. We recognise that doctors are liable to stay in the places they are trained, which is why we have opened up a number of new medical schools. That will take time to come through, but it is making sure that we are looking at the workforce in terms of longer timeframes.
Baroness Merron (Lab)
My Lords, I sense a deepening of support in your Lordships’ House for the issues contained within this group. I start by thanking the noble Baroness, Lady Cumberlege, for introducing Motion B1. I also put on record my thanks to the 100 organisations which have indicated their support and got involved to make this an even better Motion for us to consider.
Yesterday’s Health and Social Care Committee report said:
“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce”
through a workforce plan. The lack of staff, both currently and projected, is not restricted to the cancer workforce but extends to the total staff shortage of some 110,000 across the NHS as well as 105,000 vacancies in social care, while some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest number on record.
As we have heard, just last week your Lordships’ House debated the Ockenden review, which I believe has provided great focus on the issue of workforce planning. The review shockingly laid bare the reasons why hundreds of babies’ lives were avoidably cut short or damaged and mothers died; to their great credit, the Government have accepted every one of the recommendations. The clear finding here is that we must safely staff our maternity wards, yet midwives are leaving the NHS in greater numbers than it is possible to recruit them. If the Ockenden review does not illustrate why we need a workforce plan then I do not know what does.
It is worth reflecting on what Motion B1 is not about, in case that offers some late reassurance to the Minister. Despite needing all of these things, it does not commit the Government to hiring thousands more doctors and nurses, nor does it commit to new funding for the NHS. It does not even commit the Government to finally publishing the workforce strategy that the NHS is crying out for—even though the NHS has not had a comprehensive workforce strategy since the Government’s plan was published in 2003.
What Motion B1 talks about is an independent review of how many doctors, nurses and other staff are needed in health, social care and public health, both now and for the future, and that the report, which must be brought before Parliament, must be informed by integrated care boards, employers, trade unions and others—people with expertise and a great contribution to make. This is not just a question of recruitment, important though that is, but one of retention. There is absolutely no way out of planning and preparation; without them, it is just not possible to magic up the necessary staff. Motion B1 is about facing up to the scale of the workforce challenge so that we can see safe and efficient health and care. These Benches will certainly be supporting Motion B1 if the will of the House is tested.
I turn now to Motion C1 in the name of my noble friend Lady Thornton. The inclusion of a clause about changes to reconfiguration shows that not all of the Bill was what the NHS was asking for. The powers in this clause are unnecessary and introduce a very considerable new layer of bureaucracy. Just about every commentator and representative group has said that this approach of an interventionist Secretary of State is quite wrong. As many have pointed out, the power that any proposal can be taken over by the Secretary of State takes us down a road of politicisation and will deter some from even trying to pursue necessary but controversial changes. It matters not that we are told that this power will be used only sparingly; if it is there, that will influence behaviour.
Given where we are in the parliamentary process, outright rejection of this provision would, of course, be problematic. Our alternative in this Motion is to say that, if the power is only rarely to be used—in exceptional circumstances, when intervention is justified—then the way to deal with this is to make that case to Parliament, to put it up for proper scrutiny and to show the evidence. If we are potentially to deprive people of their right to be consulted, then at least let Parliament do a proper job of examining this.
I now turn very briefly to Motions D1 and K. I thank the noble Lord, Lord Blencathra, for presenting Motion D1 today. It seeks to ensure that health service procurement of all goods and services avoids modern slavery; in other words, it takes us further than Motion D. I thank the Minister for the move forward contained within that Motion; however, if the noble Lord, Lord Blencathra, wishes to test the will of the House, we on these Benches will certainly be in support.
I congratulate my noble friend Lord Hunt and other noble Lords for their persistence in ensuring that Motion K is before us today. Again, I thank the Minister for being so responsive on this point. I hope that, in the votes that follow, your Lordships’ House will swiftly take the opportunity to ask that we might further improve this Bill.
Lord Kamall (Con)
I thank all noble Lords for their contributions and their constructive debate and engagement, not only this evening but throughout the process of the Bill. I thank noble Lords also for their agreement to the measures we have drawn up on organ tourism. I thank the noble Lord, Lord Hunt, for the way he pushed the Government, making sure that we were able to find a constructive way of closing that gap.
Baroness Penn
That this House do not insist on its Amendments 30 and 108, to which the Commons have disagreed for their Reasons 30A and 108A.
Lord Kamall
Moved by
That this House do not insist on its Amendment 48 and do agree with the Commons in their Amendment 48A in lieu.
48A: Page 49, line 3, at end insert the following new Clause—
“Review into NHS supply chains
(1) The Secretary of State must carry out a review into the risk of slavery and human trafficking taking place in relation to people involved in NHS supply chains.
(2) The Secretary of State may determine which NHS supply chains to consider as part of the review or otherwise limit the scope of the review.
(3) But the review must at least consider a significant proportion of NHS supply chains for cotton-based products in relation to which companies formed under section 223 of the National Health Service Act 2006 (taken as a whole) exercise functions.
(4) The Secretary of State must publish and lay before Parliament a report on the outcome of the review before the end of the period of 18 months beginning with the day on which this section comes into force.
(5) The report must describe—
(a) the scope of the review, and
(b) the methodology used in carrying out the review.
(6) The report must include any views of the Secretary of State as to steps that should be taken to mitigate the risk mentioned in subsection (1).
(7) NHS England must assist in the carrying out of the review or the preparation of the report under this section, if requested to do so by the Secretary of State.
(8) In this section—
“health service in England” means the health service continued under section 1(1) of the National Health Service Act 2006;
“NHS supply chain” means the supply chain for providing goods or services for the purposes of the health service in England;
“slavery and human trafficking” has the meaning given by section 54(12) of the Modern Slavery Act 2015.”
Motion D1 (as an amendment to Motion D)
Lord Blencathra
Moved by
At end insert “and do propose Amendment 48B in lieu—
48B: After Clause 40, insert the following new Clause—
“Health service procurement and supply chains: modern slavery
The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England avoids modern slavery.””
Lord Kamall
That this House do not insist on its Amendment 51 and do agree with the Commons in their Amendment 51A in lieu.
“(a) for section 74 substitute—
“74 Discharge of hospital patients with care and support needs
(1) Where a relevant trust is responsible for an adult hospital patient and considers that the patient is likely to require care and support following discharge from hospital, the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve—
(a) the patient, and
(b) any carer of the patient.
(2) In performing the duty under subsection (1), a relevant trust must have regard to any guidance issued by NHS England.
(3) For the purposes of this section, a relevant trust is responsible for a hospital patient if the relevant trust manages the hospital.
(4) In this section—
“adult” means a person aged 18 or over;
“carer” means an individual who provides or intends to provide care for an adult, otherwise than by virtue of a contract or as voluntary work;
“relevant trust” means—
(a) an NHS trust established under section 25 of the National Health Service Act 2006, or
(b) an NHS foundation trust.”;
(b) omit”.
Lord Kamall
That this House do not insist on its Amendment 57, to which the Commons have disagreed for their Reason 57A.
Lord Kamall
That this House do not insist on its Amendment 80 and do agree with the Commons in their Amendments 80A to 80N in lieu.
“(a) in relation to eligible needs met by a local authority, to any amount the local authority charged the adult under section 14(1)(a) or 48(5) for meeting those needs;
(b) in relation to eligible needs met by a person other than a local authority, to what the cost of meeting those eligible needs would have been to the local authority that was the responsible local authority when the needs were met.”
Lord Kamall
That this House do not insist on its Amendments 85 to 88, to which the Commons have disagreed for their Reasons 85A to 88A.
Lord Kamall (Con)
My Lords, I beg to move Motion J and, with the leave of the House, I will speak to Motions M, N and P. This group of amendments relates to questions of patient safety, patient engagement, public health and building a learning culture in the NHS.
Last week in the other place we tabled amendments to ensure the full operability of Lords Amendment 91, in the name of the noble Baroness, Lady Hollins, on mandatory training on learning disabilities and autism. We have discussed and agreed these changes with the noble Baroness, and together these amendments will require all health and social care providers who carry out regulated activities to ensure their staff receive specific training on learning disabilities and autism.
At Report stage of this Bill the Government committed to accept in principle the amendment by the noble Lord, Lord Sharkey, on reciprocal healthcare and to change the process for regulations that give effect to international healthcare agreements so that they are subject to the affirmative resolution procedure. To ensure this Bill achieves the intended effect, the Government tabled Amendment 95A in lieu, which achieves the same objective but amends the international healthcare agreements clause, rather than the regulations clause. This will ensure that all regulations made under the soon to be named healthcare (international arrangements) Act 2019 are subject to the affirmative procedure, including any regulations made by the devolved Governments. I urge noble Lords to accept all these amendments.
I now turn to the issue of abortion at home pills. This group contains Lords Amendment 92 and related amendments. Both this House and the other place voted to make provision to permanently allow both pills for early medical abortions to be taken at home. These were, rightly, free votes of both Houses, but the Government brought forward this amendment in lieu to ensure that the legislation operates in the way that this House intended it to. I therefore ask noble Lords who agree with the intention of my noble friend Lady Sugg to instead support the Commons amendment in lieu.
I am also grateful to my noble friend Lady Eaton for bringing the important topic of safeguarding before the House. I reassure her that the well-being and safety of women and girls accessing abortion services has been, and will continue to be, our first and foremost priority. Safeguarding is an essential aspect of abortion care, and it has been long-established that a doctor or health professional is legally able to provide contraception, sexual and reproductive health advice, and treatment, including abortion, without parental knowledge or consent to a person aged under 16 years, provided that the doctor or healthcare professional is satisfied that certain conditions, including ability to consent, are met.
As a matter of best practice, every effort should be made to encourage those under age 16 to involve their parents, and if they cannot be persuaded to do so, they should be assisted to find another adult, such as another family member or specialist youth worker, to provide support. All abortion providers are already required to have effective arrangements in place to safeguard vulnerable children and to assure themselves, regulators and their commissioners that those are working. Having effective safeguarding arrangements in place will be essential for clinicians to make a robust assessment of whether a home abortion is suitable for anyone under age 16 and those under age 18.
I noted the statement from the Royal College of Paediatrics and Child Health, which stated that all young women aged under 18 and care leavers aged under 25 should be actively encouraged to attend an abortion service in person. With that in mind, we will work with the royal colleges, including the Royal College of Paediatrics and Child Health, and NHS safeguarding leads, to ensure that children and young people are actively encouraged to take up a face-to-face appointment and that anyone at risk of harm is identified and supported appropriately, including through referrals to other agencies.
The Government will continue to work closely with relevant professional bodies to ensure that the principles and duties of safeguarding children, young people and adults at risk are consistently and rigorously applied and that we continue to monitor all impacts of home use of both abortion pills. I hope that my noble friend will be reassured to hear that we will work with NHS England, the Care Quality Commission and abortion providers to ensure that they can safely offer telemedicine abortion services on a permanent basis and that all women are genuinely offered the choice of a face-to-face appointment.
On other issues, the Government cannot accept Amendment 88B, which has been put forward by the noble Lord, Lord Crisp, as an amendment in lieu of Lords Amendments 85 to 88, which were rejected by the other place. It would bind the Government in statute to consult, to a particular timeframe, on all recommendations within the Khan independent review which in the opinion of the Secretary of State require a consultation to implement. The review itself is not yet complete and is not scheduled for publication until May, when we will of course consider our next steps.
As the review is currently in the process of being drafted, the Government should not pre-empt what it will include. Importantly, the Government should not be put under a duty to consult on a range of proposals that they have not yet seen and may not support. Some proposals may require further development and agreement across government and across the UK before a consultation. We risk wasting government resource and time to consult, and stakeholders’ time to respond, by consulting on proposals that we may not intend to pursue.
The Government are firmly committed to Smokefree 2030 and we look forward to the outcome of the independent review. The review will inform both the health disparities White Paper and the Government’s new tobacco control plan, which will be published later this year. If any changes to tobacco legislation are proposed by the Government in that plan, I can commit that they will be consulted on. The need for additional spending to deliver our Smokefree 2030 ambition—and possible funding mechanisms—will be considered as part of the tobacco control plan and agreed with Her Majesty’s Treasury in the usual way.
I beg to move the Motion standing in my name and commend many of these amendments to the House.
Motion J1 (as an amendment to Motion J)
Baroness Thornton (Lab)
I shall be very brief, because it is time we draw this ping-pong session to an end. First, I congratulate the Minister on his introduction to the tele-abortion amendment, and on the reassurance that he gave to the House and the noble Baroness, Lady Eaton. The issue has been expressed very eloquently by the noble Baronesses, Lady Sugg and Lady Barker, and I have no intention of going into detail.
The only other matter before us right now on which we need to take a decision is that of the amendment put by the noble Lord, Lord Crisp. From these Benches, I need to say that we absolutely support the noble Lord in his amendment, and we will vote with him, if he divides the House.
Lord Kamall (Con)
I thank all noble Lords who have taken part in this debate and the debates throughout the day. We managed to stick to the point and tried to be as brief as possible. I am afraid I will not be as brief as the noble Baroness, Lady Thornton, but I will try to be briefer than I usually am.
I should just make some acknowledgements, looking at the whole group. First, on learning disabilities and autism, I thank the noble Baroness, Lady Hollins, in her absence, for her constructive engagement with the Government.
On tobacco, I once again urge noble Lords to reject Amendments 85 to 88 and 88B. The independent review is not scheduled for publication until May, when we will of course consider our next steps. I understand that the noble Lord told us to get on with it, but we do not want to pre-empt the independent review. As it is in the process of being drafted, we really want to make sure that we have proper consultation and agreement, both across government and across the UK with the devolved Administrations.
I hope the noble Lord is in no doubt that we are also committed to the tobacco plan and the reduction of smoking. We just do not feel that this is the right amendment, but the noble Lord may feel otherwise. Any changes to tobacco legislation proposed by the Khan review, a plan supported by the Government, will be consulted on. We firmly want to make sure we reach our smoke-free 2030 ambition or get as close to it as feasibly possible.
There is a debate about the polluter pays principle. I am sure the noble Lord, Lord Crisp, will recognise the debate about Pigouvian taxes, taxing negative externalities and who is responsible. Who is the polluter? In the car industry we tax the driver, as they put more petrol in. Should it be the smoker or the industry? There is a debate about this, but I hope these issues will be considered by the Khan review.
I also thank the noble Lord, Lord Sharkey, for his constructive engagement on reciprocal healthcare. I am pleased that we were able to narrow the gap and get to the same place.
I turn now to the telemedicine abortion issue. The Government felt that we should have gone back to pre-pandemic measures, but it was right that there was a free vote. We saw the results of the votes in your Lordships’ House and the other place, and we accept them. The democratic will of both Houses is quite clear. At the same time, we also accept that there were some concerns, as my noble friend Lady Eaton rightly said, about underage women being forced to have abortions and safeguarding. My noble friend Lady Verma also made a point about issues in certain communities; we know that these things go on in certain communities and that there are close relationships.
After the reassurances I gave at the beginning, my noble friend Lady Eaton said she was reassured enough not to push her amendment to a vote. I hope that remains the case and that my noble friend has not been persuaded otherwise. It is important that we consult, treat this sensitively and get the appropriate guidance, but the decision has been made by both Houses and we have to make sure that it works and that we address some of the legitimate concerns that noble Lords have raised in this debate.
Given that, I ask this House to accept the Motions in my name.
Lord Crisp (CB)
My Lords, let me first say how much I respect the Ministers and appreciate the time they have given to me and other noble Lords to discuss the “polluter pays” amendment. I really appreciate it and found it very useful. I think it was the noble Baroness—I cannot remember the name.
Lord Kamall
That this House do not insist on its Amendment 89 and do agree with the Commons in their Amendment 89A in lieu.
“Commercial dealings in organs for transplantation: extra-territorial offences
(1) After section 32 of the Human Tissue Act 2004 insert—
“32A Offences under section 32 committed outside UK
(1) If—
(a) a person who is habitually resident in England and Wales, or who is a UK national and not habitually resident in
Northern Ireland, does an act outside the United Kingdom,
(b) the act, if done in England and Wales, would constitute an offence under section 32(1), and
(c) the controlled material to which the act relates is controlled material consisting of or including a human organ,
the person is guilty in England and Wales of that offence.
(2) In this section “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.”
(2) After section 20 of the Human Tissue (Scotland) Act 2006 insert—
“20A Offences under section 20 committed outside UK
(1) If—
(a) a person who is habitually resident in Scotland, or who is a UK national and not habitually resident in Northern Ireland, does an act outside the United Kingdom, and
(b) the act, if done in Scotland, would constitute an offence under section 20(1), and
(c) the part of the human body to which the act relates consists of or includes a human organ,
the person is guilty in Scotland of that offence.
(2) In this section “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.
(3) Where a person outside the United Kingdom commits an offence under section 20(1) the person may be prosecuted, tried and punished for the offence—
(a) in a sheriff court district in which the person is apprehended or in custody, or
(b) in a sheriff court district determined by the Lord Advocate, as if the offence had been committed in that district.
(4) Where subsection (3) applies, the offence is, for all purposes incidental to or consequential on the trial and punishment, deemed to have been committed in that district.
(5) In this section “sheriff court district” is to be construed in accordance with section 307(1) of the Criminal Procedure (Scotland) Act 1995 (interpretation).”
Lord Kamall
That this House do not insist on its Amendment 90 and do agree with the Commons in their Amendment 90A in lieu.
“Review into disputes relating to treatment of critically ill children
(1) The Secretary of State must arrange for the carrying out of a review into the causes of disputes between (on the one hand) persons with parental responsibility for a critically ill child and (on the other) persons responsible for the provision of care or medical treatment for the child as part of the health service in England.
(2) The Secretary of State must publish and lay before Parliament a report on the outcome of the review, within one year beginning with the date on which this section comes into force.
(3) In this section—
“child” means a person aged under 18;
“health service in England” means the health service continued under section 1(1) of the National health Service Act 2006;
“parental responsibility” has the meaning given by section 3 of the Children Act 1989.”
Lord Kamall
That this House do agree with the Commons in their Amendment 91A as an amendment to Lords Amendment 91.
“(1) The Health and Social Care Act 2008 is amended in accordance with subsections (2) to (6).
(2) In section 20 (regulation of regulated activities), after subsection (5) insert—
“(5ZA) Regulations under this section must require service providers to ensure that each person working for the purpose of the regulated activities carried on by them receives training on learning disability and autism which is appropriate to the person’s role.”
(3) After subsection (5C) (as inserted by section 145) insert—
“(5D) In subsection (5ZA)—
“learning disability” has the meaning given by section 1(4) of the Mental Health Act 1983;
“service provider” means a person registered under this Chapter as a service provider in respect of a regulated activity.”
(4) After section 21 insert—
“21A Learning disability and autism training: code of practice
(1) The Secretary of State must issue a code of practice about compliance with requirements imposed by virtue of section 20(5ZA) (requirements relating to training on learning disability and autism).
(2) The code must make provision about—
(a) the content of training; (b) training appropriate to different roles;
(c) circumstances in which it is appropriate for training to be delivered in person;
(d) the involvement of people with learning disability, autistic people, or their carers, in the provision of training;
(e) accreditation of training;
(f) procurement of training;
(g) monitoring and evaluation of the impact of training;
(3) The code may make different provision for different cases or circumstances.
(4) The Secretary of State must, at least once every five years—
(a) review the code, and
(b) lay before Parliament a report setting out the findings of the review.”
(5) In section 22 (consultation in relation to code of practice under section 21)—
(a) for the heading substitute “Codes of practice: consultation and Parliamentary scrutiny”;
(b) in subsection (1), after “21” insert “or 21A”;
(c) in subsection (2), after “21” insert “or 21A”;
(d) in subsection (3), after “(2)” insert “in relation to a draft of a code or revised code under section 21”; (e) after subsection (5) insert—
“(5A) Where, following consultation under subsection (1) or (2) in relation to a draft of a code or revised code under section 21A, the Secretary of State decides to proceed with the draft (in its original form or with modifications), the Secretary of State must lay a copy of the draft before Parliament.
(5B) The Secretary of State may not issue the code or revised code if, within the 40-day period, either House of Parliament resolves not to approve it.
(5C) In this section “40-day period” means—
(a) the period of 40 days beginning with the day on which the draft is laid before Parliament, or
(b) if the draft is not laid before each House on the same day, the period of 40 days beginning with the later of the days on which it is laid before Parliament.
(5D) For the purposes of subsection (5C), no account is to be taken of any whole days that fall within a period during which—
(a) Parliament is dissolved or prorogued, or
(b) either House of Parliament is adjourned for more than four days.”
(6) In section 25 (effect of code under section 21 and guidance under section 23)—
(a) in the heading, after “s. 21” insert “or 21A”;
(b) in subsection (1), for “A code of practice under section 21” substitute “Codes of practice under sections 21 and 21A”;
(c) in subsection (2),
(i) for “A code of practice under section 21 or” substitute “Codes of practice under sections 21 and 21A and”;
(ii) for “is” substitute “are”;
(d) in subsection (3), after “21” insert “or 21A”.
(7) Until the first regulations made by virtue of section 20(5ZA) of the Health and Social Care Act 2008 (as inserted by subsection (2)) come into force—
(a) the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (S.I. 2014/2936) (“the 2014 regulations”), and
(b) the Health and Social Care Act 2008, are to be read as if regulation 18 of the 2014 regulations contained such requirements.”
Lord Kamall
That this House do not insist on its Amendment 92 and do agree with the Commons in their Amendment 92A in lieu.
“Early medical termination of pregnancy
(1) Section 1 of the Abortion Act 1967 is amended as follows.
(2) In subsection (3), for “subsection” substitute “subsections (3B) to”.
(3) In subsection (3A)—
(a) the words from “includes” to the end become paragraph (a);
(b) after that paragraph insert—
“(b) is not limited by subsections (3C) and (3D).”
(4) After subsection (3A) insert—
“(3B) Subsections (3C) and (3D) apply where—
(a) the treatment referred to in subsection (3) consists of the prescription and administration of medicine, and
(b) the registered medical practitioner terminating the pregnancy is of the opinion, formed in good faith, that, if the medicine is administered in accordance with their instructions, the pregnancy will not exceed ten weeks at the time when the medicine is administered (or in the case of a course of medicine, when the first medicine in the course is administered).
(3C) If the usual place of residence of the registered medical practitioner terminating the pregnancy is in England or Wales, the medicine may be prescribed from that place by the registered medical practitioner.
(3D) If the pregnant woman’s usual place of residence is in England or Wales and she has had a consultation (in person, by telephone or by electronic means) with a registered medical practitioner, registered nurse or registered midwife about the termination of the pregnancy, the medicine may be self-administered by the pregnant woman at that place.””
Lord Kamall
That this House do not insist on its Amendment 95 and do agree with the Commons in their Amendment 95A in lieu.
“(c) for subsection (4) substitute—
“(4) A statutory instrument containing regulations under this Act may not be made by the Secretary of State unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”;
(d) omit subsection (5);
(e) after subsection (5) insert—
“(5A) Regulations made by the Scottish Ministers under section 2A are subject to the affirmative procedure (see Part 2 of the Interpretation and Legislative Reform (Scotland) Act 2010 (asp 10)).
(5B) A statutory instrument containing regulations under section 2A may not be made by the Welsh Ministers unless a draft of the instrument has been laid before and approved by a resolution of Senedd Cymru.
(5C) Regulations may not be made by a Northern Ireland department under section 2A unless a draft of the regulations has been laid before and approved by a resolution of the Northern Ireland Assembly.””
Lord Kamall
That this House do not insist on its Amendment 105 and do agree with the Commons in their Amendment 105A in lieu.
“(5A) The chair must exercise the approval function mentioned in subparagraph (1)(b) with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”
Down Syndrome Bill
Lord Kamall ExcerptsFriday 1st April 2022
(2 years, 7 months ago)
Lords ChamberRead Full debate Down Syndrome Act 2022 View all Down Syndrome Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 26 January 2022 - (26 Jan 2022)
Baroness Brinton (LD) [V]
My Lords, I too want to join in congratulating the noble Baroness, Lady Hollins, on the Bill reaching the end of its legislative passage today. Her expertise and commitment to people with Down syndrome and other learning disabilities is well known and much respected—and not just in your Lordships’ House.
I rise to speak on behalf of some of the Peers who raised concerns about this Bill at Second Reading, particularly the noble Baroness, Lady Neville-Jones, and the noble Lord, Lord Farmer, who cannot be in their place today. I will start by saying what is good about this Bill. It has raised the profile of Down syndrome, which, speaking as someone with a nephew with Down syndrome, I say is a good thing and long overdue.
Your Lordships’ House will remember that eight of the 12 cross-party speakers noted that, if the Bill had the powers which its promoters suggest, there risks being a hierarchy of learning disability. This has already caused a split between families with learning disability, all of whom still need to fight for the limited resources to which the law says they are entitled. I am pleased to hear the noble Baroness, Lady Hollins, expressing her desire that the objectives of this Bill are extended to other people with genetic conditions and learning disabilities. I am sure that she and I—and others —will be looking to future government Bills to make a real difference to the lives of all people with learning disabilities.
I will not go through the details of the concerns we had before, because now is not the time. One of my great concerns is that the hopes of many families of people with Down syndrome have been raised beyond the powers in this Bill. I hope that the Minister will ensure that those aspirations are met, not just for people with Down syndrome but for the wider learning-disabled community. I wish this Bill well.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I begin by extending my congratulations to the noble Baroness, Lady Hollins. I am grateful to the noble Baroness for steering the Bill to this point. I also extend a warm welcome to those who were in favour of this Bill, some of whom are in the Public Gallery. I offer my thanks to the right honourable Member for North Somerset, Dr Liam Fox, who introduced this Bill in the other place. I also want to thank everyone else who has been involved in developing this important piece of legislation.
I know that a number of concerns have been raised, and I welcomed the scrutiny of the Bill two weeks ago at Second Reading. The Government recognised some of the points that were made. Noble Lords raised important matters about the risk of discrimination and widening inequalities, as well as how the proposed guidance could be developed, scrutinised and implemented in a fair and inclusive way. We have listened closely to these concerns, and I hope to reassure noble Lords on a few points so they can be confident in their support of the Bill and the impact it will have at this stage.
The guidance is about making clearer what steps could be taken by relevant authorities to meet the unique needs of people with Down syndrome. The Bill does not remove the duties under the Equality Act 2010 for relevant authorities to assess all the needs of people to whom they provide support. Our assessment is that, to prioritise funding and resources for people with Down syndrome above other groups without proper assessment of people’s needs would be considered unlawful.
The Government will consult with a broad set of stakeholders in developing the guidance, including those with other conditions. I want to be clear that people with lived experience will be at the heart of this at each phase of its development. We will strongly encourage and support people with other genetic conditions, disabilities and protected characteristics, and their advocates, to engage with this process. It is right that we support legislation that will improve life outcomes, reduce inequalities and build a fairer society.
Baroness Hollins (CB)
My Lords, I want to reassure noble Lords that I and others involved in this legislation, including seeing it through the parliamentary process, will do all we can to ensure that the process is as inclusive as possible. I know from experience that lived experience must be at the heart and soul of the creation of the guidance, and I welcome the reassurances given by the Minister here and the Minister in the other place on this. It has been a pleasure and an honour to sponsor this Down Syndrome Bill through your Lordships’ House.
Ockenden Report
Lord Kamall Excerpts(2 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, the Statement is as follows:
“Mr Speaker, with permission, I would like to make a statement on the Ockenden report. This independent review was set up in 2017 in response to concerns from bereaved families about maternity care at Shrewsbury and Telford Hospital NHS Trust. Its original scope was to cover the cases of 23 families but since it began, sadly, many more families have reported concerns. Due to this tragically high number of cases and the importance of this work to patient safety, early conclusions were published in an initial report in December 2020. We accepted all the recommendations from this first report and the NHS is now taking them forward. Today, the second and final report has been published. This is one of the largest inquiries relating to a single service in the history of the NHS, looking at the experiences of almost 1,500 families from 2000 to 2019. I would like to update the House on the findings of this report, and then turn to the actions that we are taking as a result.
The report paints a tragic and harrowing picture of repeated failures in care over two decades which led to unimaginable trauma for so many people. Rather than moments of joy and happiness for these families, their experience of maternity care was one of tragedy and distress, and the effects of these failures were felt across families, communities and generations. The cases in this report are stark and deeply upsetting.
In 12 cases where a mother had died, the report concludes that in three-quarters of those cases the care could have been ‘significantly improved’. It also examined 44 cases of HIE—a brain injury caused by oxygen deprivation. Two-thirds of these cases featured ‘significant and major concerns’ in the care provided to the mother.
The report says that of almost 500 cases of stillbirth, one in four was found to have major concerns in maternity care, which, if managed appropriately, ‘might or would’ have resulted in a different outcome. When I met Donna Ockenden last week, she told me about basic oversights at every level of patient care, including one case where important clinical information was kept on Post-it notes, which were then swept into the bin by cleaners, with tragic consequences for a newborn baby and her family. In addition, there were repeated cases where the trust failed to undertake serious incident investigations and, where investigations did take place, they did not follow the standards that would have been expected.
These persistent failings continued until as late as 2019 and multiple opportunities to address them were ignored, including by the trust board, which was accountable for these services. Reviews from external bodies failed to identify the substandard care that was taking place and some of the findings gave false reassurances about maternity services at the trust. The CQC rated maternity services inadequate for safety only in 2018, which is unacceptable given the huge deficiencies in care that are outlined in this report.
The report also highlights serious issues with the culture within the trust; for instance, two-thirds of staff who were surveyed reported that they had witnessed cases of bullying, and some staff members withdrew their co-operation within weeks of the publication of the report. The first report already concluded that
‘there was a culture within the … Trust to keep caesarean section rates low, because this was perceived as the essence of good maternity care’.
Today’s report adds that
‘many women thought any deviation from normality meant a Caesarean section was needed and this was then denied to them by the Trust’.
It is right that both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have said recently that they regret their campaign for so-called normal births. It is vital that across maternity services we focus on safe and personalised care, where the mother’s voice is heard throughout.
The report shows a systemic failure to listen to the families affected, many of whom had been doggedly persistent, raising issues over several years. One mother said that she felt like a
‘lone voice in the wind’.
Bereaved families told the review that they were treated in a way that lacked sensitivity and empathy and, appallingly, in some cases the trust blamed these mothers for the trauma that they had been through. In the words of Donna Ockenden, the trust
‘failed to investigate, failed to learn and failed to improve’.
We entrust the NHS with our care, often when we are at our most vulnerable. In return, we expect the highest standards. I have seen with my own family the brilliant care that NHS maternity services can offer. But when those standards are not met, we must act firmly, and the failures of care and compassion set out in this report have absolutely no place in the NHS.
To all the families who have suffered so greatly: I am sorry. The report clearly shows that you were failed by a service that was there to help you and your loved ones to bring life into this world. We will make the changes that the report says are needed, at both a local and national level.
I know that honourable Members and those families who have suffered would want reassurance that the individuals who are responsible for these serious and repeated failures will be held to account. I am sure the House will understand that it is not appropriate for me to name individuals at this stage. However, I reassure honourable Members that a number of people who were working at the trust at the time of the incidents have been suspended or struck off from their professional register and members of senior management have also been removed from their posts. There is also an active police investigation, Operation Lincoln, which is looking at around 600 cases. Given that this is a live police investigation, I am sure that honourable Members will recognise that I am unable to comment further at this point.
Today’s report acknowledges that since the initial report was published in 2020, we have taken important steps to improve maternity care. This includes £95 million for maternity services across England to boost the maternity workforce, and to fund programmes for training, development and leadership. The second report makes a series of further recommendations. It contains 66 for the local trust, 15 for the wider NHS and three for me as Secretary of State.
The local trust, NHS England and the Department of Health and Social Care, will be accepting all 84 recommendations. Earlier today, I spoke to the chief executive of the trust, who was not in post during the period examined in the report. I made it clear how seriously I take this report and the failures that were uncovered, and I reinforced that the recommendations must be acted on promptly.
However, as the report identifies, there are wider lessons that must also be learned, and it contains a series of actions that should be considered by all trusts that provide maternity services. I have asked NHS England to write to all these trusts, instructing them to assess themselves against these actions, and NHS England will be setting out a renewed delivery plan that reflects these recommendations.
I am also taking forward the specific recommendations that Donna Ockenden has asked me to put in place. The first is the need to further expand the maternity workforce. Just a few days ago, the NHS announced a £127 million funding boost for maternity services across England. This will bolster the maternity workforce even further and it will also fund programmes to strengthen leadership, retention and capital for neonatal maternity care. Secondly, we will take forward the recommendation to create a working group independent of the maternity transformation programme, with joint leadership from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. Finally, Donna Ockenden said that she endorses the proposals that I announced in January to create a special health authority to continue the maternity investigation programme currently run by the Healthcare Safety Investigation Branch. Again, we will take her proposals forward and the SHA will start its work from April next year.
I thank Donna Ockenden and her whole team for the forensic and compassionate approach they have taken throughout this distressing inquiry. This report has given a voice at last to those families who were ignored and so grievously wronged, and it provides a valuable blueprint for safe maternity care in this country for years to come.
Finally, I pay tribute to the families whose tireless advocacy was instrumental to this review being set up in the first place. I cannot imagine how difficult it must have been for them to come forward and tell their stories, and this report is testament to the courage and fortitude that they have shown in the most harrowing of circumstances.
The report is a devastating account of bedrooms empty, families bereft and loved ones taken before their time. We will act swiftly so that no family has to go through the same pain in future. I commend this Statement to the House.”
Baroness Walmsley (LD)
My Lords, I too thank the Minister for repeating the Statement. We must acknowledge that the vast majority of midwives, nurses and clinicians providing maternity services do their very best to provide good care for their patients. It must have been with great sadness that they read—as we read with great sadness—today’s Ockenden report and the previous interim report, which have shone a light on a shocking range of shortcomings in maternity services, leadership and inspections at Shrewsbury and Telford Hospital NHS Trust. I hope that this report will lead, in future, to mothers and babies being as safe as we can possibly make them in our NHS.
The report has been made possible only by the bravery and persistence of all those families who were prepared to go through their trauma all over again when they gave evidence of what happened to them and the awful consequences and pain that followed. From these Benches we offer our thanks and sympathies to all those suffering bereavement and ongoing health issues. The report is also a tribute to the fine work of Donna Ockenden and her team, who used both their professional knowledge and their human qualities to conduct the review with dedication, empathy and attention to detail.
I also commend those members of staff who were prepared to give very candid evidence to the investigators. Such people are sometimes referred to as whistleblowers; I call them courageous, public-spirited professionals. However, their actions were not without risk to themselves and their future, as with many whistleblowers in the health and care services. I therefore ask the Minister: will the special health authority, which is being set up to continue the maternity investigation programme currently run by the Healthcare Safety Investigation Branch, have the same safe-space confidentiality for those giving evidence in the future as the HSSIB, which is currently being legislated for in the Health and Care Bill? The Minister will know how strongly both Houses of Parliament feel about the importance of giving staff absolute confidence that the material they disclose remains confidential in the interests only of learning and improving patient safety rather than laying blame.
The report stated that:
“There were not enough staff, there was a lack of ongoing training, there was a lack of effective investigation and governance at the Trust and a culture of not listening to the families involved.”
I therefore first acknowledge last week’s funding announcement of £127 million by NHS England for maternity services, although this is still significantly short of the £200 million to £350 million recommended by the Health and Social Care Select Committee in June 2021. However, it is surprising to me, in the light of Donna Ockenden’s clear finding that staff shortages risk lives, that the Government, in the other place, continue to resist the amendment of the noble Baroness, Lady Cumberlege, voted for by your Lordships, on assessing, reporting and planning for safe levels of staffing in the NHS and social care. Proper planning cannot take place without an accurate and independent assessment of current supply and future need. In light of the Ockenden report, will the Government change their position on this?
There are currently 2,000 midwife vacancies in the NHS, according to NHS England figures published last month, and the number of midwives in post has fallen since last year. This is going in the wrong direction.
In the debate on the interim report in your Lordships’ House on 14 December 2020, the noble Lord, Lord Bethell, denied that the issues in Shrewsbury and Telford maternity services were linked to understaffing. Does the noble Lord, Lord Kamall, now accept that staffing is an issue? Can he say what will be done about it? As Ms Ockenden rightly says, we need to create a situation where midwives, nurses and clinicians want to remain in the NHS. We will not do that if they are constantly having to battle against staff shortages.
The report also highlights the need for women to be listened to when engaging with maternity services, rather than experiencing a culture of services based around targets for a particular kind of birth. I need hardly say that giving birth is a very personal matter and women’s preferences must be listened to and provided where clinically appropriate. Ockenden emphasised that listening to women and empowering them in their care will lead to improved outcomes. I therefore remind the Minister of the parallel between this situation and telemedicine abortion treatment, where the Government are failing to listen to women’s clinically safe preferences. I was pleased to hear recently that Members of the House of Commons have been listening to women, rather than to the Government.
The report pointed out that what happened in Shrewsbury and Telford was not an isolated incident. In July 2021, 41% of maternity services in England were rated as inadequate or requiring improvement. That is why the report made 15 recommendations aimed at all maternity services across the country, and I understand that the Government have accepted them all. Can the Minister therefore say how implementation of these country-wide recommendations will be monitored and reported on? Will that duty be given to the CQC or will there be a special system?
I finally turn to training. In the debate on the interim report in December 2020, my noble friend Lord Scriven pointed out that:
“In 2017, the £8.1 million national maternity training fund was withdrawn. Does the Minister now, in hindsight, regret this, and will he seek to re-establish this fund urgently?”—[Official Report, 14/12/20; col. 1522.]
I echo his question today. Will the money for training be ring-fenced and will midwives going for training always be covered by similarly experienced staff?
Despite earlier events, similar although smaller in scale to what happened at Shrewsbury and Telford, there has not been systematic integrated change. Can the Minister therefore assure us that this will happen now, especially under the new regime of integrated care systems? Who will be responsible at the level of NHS England, ICSs and individual trusts, as well as politically, for ensuring that, this time, the changes highlighted by Donna Ockenden are implemented in a timely way, so that no more families will be avoidably deprived of their precious child, mother or wife?
Lord Kamall (Con)
I begin by thanking both noble Baronesses for their questions and resisting the temptation to bring too much politics into it. This is an issue that we all feel very strongly about. I will try to answer as many questions as I can; I apologise in advance if I do not answer all the questions today. I have quite a big briefing pack, which I have been through a number of times. I commit to writing to noble Lords and the noble Baronesses to fill the gaps.
As the noble Baronesses said, we accept all the actions outlined in the report. The Secretary of State has asked NHS England and NHS Improvement to write to all the trusts across England about the final Ockenden report, and will ask all maternity services across England to assess their services against the 15 immediate and essential actions outlined in the report —and take action where they fall short. As the noble Baronesses acknowledged, NHS England and NHS Improvement have announced that they will invest £127 million in maternity care; that money will go towards the NHS maternity workforce and improving neonatal care.
We have also seen work under way to tackle some of the key issues in the report, such as the £5 million for the Avoiding Brain Injury in Childbirth collaboration project, the establishment of a special health authority to continue the work, which I shall go into later, and the development of 17 new maternal medicine networks. We will update the House as appropriate on the monitoring.
We have to look at the culture; I completely understand the points made. Strong leadership will now be established across the system, with the appointment of named regional and local maternity safety champions led by two national maternity safety champions, Matthew Jolly and Jacqueline Dunkley-Bent. In every trust, front-line maternity safety champions—one obstetrician, one midwife and one neonatologist—will work closely with a board maternity safety champion to promote unfettered floor-to-board communication. We have also tried to make progress in shifting away from a defensive blame culture in healthcare towards a culture in which we recognise and accept when things go wrong and look to learn.
I thank noble Lords for their engagement, particularly over the HSSIB, during the passage of the Bill. I think we all agreed that it was important that we kept as many people as possible out of the “safe space” to encourage people to come forward. However, as we have seen in these cases, people were bullied and disincentivised from coming forward; some even withdrew their names.
Last year, there was a £500,000 fund to provide maternity leadership training for NHS maternity and neonatal leaders. We looked at addressing the issues raised in the first Ockenden report—to use that phrase again, “between ward and board”—to make sure that there was proper accountability and training.
On workforce, as I said, NHS England and NHS Improvement have the investment. In addition, there is £95 million in new funding to support the recruitment of 1,200 more midwives and 100 more obstetricians, and to support multidisciplinary team training. The department has also commissioned the Royal College of Obstetricians and Gynaecologists to develop a new workforce planning tool to improve how maternity units calculate their medical staffing requirements. The tool will calculate the number of obstetricians at all grades required locally and nationally to provide a safe, personalised maternity service within the context of the wider workforce. Health Education England has also been working with stakeholders towards a targeted increase of 3,650 midwifery student training places by the end of 2022-23.
One concern that was raised when I spoke to officials and asked for briefings before this evening was whether reports such as this one would disincentivise people from coming forward to work in midwifery. We have to be very careful that we are as open as possible and that we make sure that the system learns where there are problems. People are human, and they will be concerned about coming forward. So we have to get the right balance and have safety, training and awareness all the way through, making sure that it is patient-centred.
I shall try to answer as many questions as I can; I know that other noble Lords want to come in. In terms of deterring midwives from leaving—I know that there is a real concern here—the NHS people plan focused on improvement and retention. There is a well-being guardian role focused on: healthy work environments and safe spaces; empowering line managers to hold meaningful conversations; emotional and psychological support; a dedicated health and care staff support service; a bereavement helpline; free access to a range of mental health apps; a range of counselling and talking therapies; and online resources. Money has also been invested in 14 mental health hubs across the country, and £6 million has been set aside for a national support service for critical care staff.
We have to tackle bullying and harassment in the service. The people plan deals with a number of issues on that; there is also a visibility and respect framework and a toolkit. A number of projects and pilots are under way across the NHS to support organisations to see what works and where we can learn from that.
There were some questions about the special health authority, which we see as a key part of work to improve the investigation and learning culture. The investigators will carry out timely and independent individualised investigations into maternal and neonatal deaths and incidents across England. The SHA’s investigation will be family-centred and mother-centred, but it will also provide families with answers to questions about why an incident occurred or why their baby died, rather than just sweeping this away. The learning from these investigations will be shared at a local level and across the wider system. As an independent body, the special health authority will continue the work of the HSIB from 2023, and maternity investigations will continue during this time, without interruption, until the SHA is fully operational—this is specifically for maternity.
As for what the Government are doing to make sure that women’s voices are heard, we have the women’s health strategy—I know that noble Lords have heard that before—and we are looking at multidisciplinary training in the maternity workforce. There is a debate within the training community about whether you train someone to be a midwife first or whether they should start as a nurse and have nursing skills first. I will stop there to allow other noble Lords to ask questions.
Baroness Bottomley of Nettlestone (Con)
My Lords, this is a deeply shocking report, and I applaud the Minister for the way in which he has responded. Above all, I of course applaud Donna Ockenden for the formidable clarity of the way in which she has taken the evidence and, without emotion but with great empathy, set out the 84 recommendations and the 15 “Immediate and Essential Actions”. Of course, some of this is about resources, and the Minister has made some statements about this and the fact that, however much we have, we will always want more, but I welcome the resources invested in this.
More important to me is the issue that the Minister touched on about multidisciplinary training. Midwifery has often been an area where there is almost tribal warfare between the midwives and the obstetricians and gynaecologists. Passing a patient on to a gynaecologist has almost been seen as an act of failure. Time and again, we see delays and this ludicrous target of a low caesarean rate. There has been a phenomenal fall in maternal and perinatal mortality over 100 years, but, at the same time, women now have babies when they are older, and babies are larger. There surely must be the interdisciplinary training that the Minister has referred to and that is so important—and the working group with the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.
Lastly, I come to this deplorable culture where doctors bury their mistakes. It has always been the case in the medical profession that there has been a reluctance to acknowledge failures and problems, saying, “There’s been a problem. Let’s put it aside. Don’t trouble the families with the truth; it’ll upset them more”. This culture of concealment is totally destructive. There are many other professions where mistakes and errors—goodness knows, much of this happens in the heat of the moment—are used as examples from which others can learn, not with a blame culture but with a culture of learning and progress.
I very much congratulate the Government on their approach. This has been a terrible example of groupthink and lack of action, and all of us must be vigilant over whatever institutions we are working with in whatever part of the health service.
Lord Kamall (Con)
I thank my noble friend for her points. I will take this opportunity to elaborate a bit on multidisciplinary training in the maternity workforce. Some £26.5 million of the £95 million invested in maternity services last year will allow training aimed at how multidisciplinary teams work together. There is a new core curriculum for professionals working in maternity and neonatal services—this is being developed by the maternity transformation programme, in partnership with professional organisations, clinicians and service users, to address variations in safety training and competence assurance across England. A single core curriculum will enable the workforce to bring a consistent set of updated safety skills and continue to learn. It is important that we have collaboration and close working relationships between midwives and obstetricians because that obviously benefits the mothers and babies within their collective care. The noble Baroness has already said that this has to be mother-centred and patient-centred.
I also thank my noble friend for highlighting the fact that the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have been clear that the professions must work together collaboratively. We expect all maternity services to act on the recommendations.
We also have to make sure that staff feel able to and confident about speaking up, as my noble friend said. The Government have taken this issue seriously. In response to a recommendation from Sir Robert Francis’s Freedom to Speak Up review, we established the independent national guardian, to help drive positive cultural change across the NHS and, in addition, to provide support to a network of local freedom speak-up guardians. We will have to see how that works, what can be done better and how we can improve it. Putting in one measure will not solve all these problems. There is no silver bullet, but one of the reasons to put this in at local level is to see where it works and where it does not, and what we can learn from that.
Baroness Finlay of Llandaff (CB)
My Lords, I also thank the Minister for the very sensitive way in which he has dealt with this Statement and, like others, commend those parents who have fought for years to be heard. I also commend Donna Ockenden for an outstanding report that makes really harrowing reading.
To follow up on the question asked by the noble Baroness, Lady Bottomley, about training, it has struck me for many years that the competition between midwives and obstetricians is extremely damaging. It was there when I was a medical student and it has not changed. The bullying culture on the wards has I think been almost endemic and right across the system. I hope that the colleges will look at training jointly from day one, not just after qualification, because that team building needs to happen very early. The way the midwifery tutors and the obstetric tutors deal with their trainees must be integrated from day one and then follow on into continuous professional learning. So my first request is that that message goes back very clearly to the schools of midwifery and to the obstetric training courses.
My second point relates to the CQC, which has done a great deal to raise the quality of care across the NHS and is often to be admired. However, it is worrying that it took so long for it to realise that there was a problem. That would suggest that, internally, its benchmarking of what was normal was at a level that is actually unacceptable. I hope the Minister will be able to go back to the CQC and that the CQC itself will be supported to radically rethink the way that it looks at maternity services. I hope that it will be prepared to have some extremely difficult inspections, consultations and conversations with staff in some units that were previously thought to be doing well, but where it might discover that there is bullying and, particularly, this closed-ranks culture that was so evident in the way people responded to the report. But, overall, I think we are all grateful for the openness of this report and the openness with which the Minister has brought it to our notice.
Lord Kamall (Con)
I begin by thanking the noble Baroness, Lady Finlay, not only for her questions today but for the advice she has given me over a number of months since I started in this post. I have learned so much from the noble Baroness, especially from her courage to speak about her own professional experiences and admit where there are issues that need to be addressed. I am very grateful for that.
I completely take the point about working together from day one because, if you do that, you embed that culture of collaboration from day one, rather than just training people and then saying, “Oh, by the way, don’t forget to work collaboratively”. I think that has to be bred into the system and it is something we have to understand.
The other principle, which all noble Lords discussed in debates on the Bill, is the concept of a safe space. In an ideal world, we would find out who was responsible and they would be held to account, but what is really important is that we learn from that and the system learns from its failures. We have to encourage the ability to have a safe space where people feel confident about speaking up. We saw incidents where people felt bullied into not speaking up or where they withdrew their statements. If we can get this through the SHA and throughout the culture of the new HSSIB, this would be a really important first step. I thank noble Lords who, during the debate, pushed for the removal of certain bodies in order to make sure people felt comfortable coming forward.
On the CQC, there are real questions about the inspections in 2014 and 2016 and why it did not recognise safety concerns at the trust. Subsequently, the CQC did recognise the issues and place the trust in special measures. There was some progress made by the trust following this, and there were two subsequent visits. As a regulator, the CQC holds providers to account and makes clear where improvements must be made, but I think it recognises that there are lessons to be learned. There are lessons to be learned not only in government but across the health and care sector. It is important that we look systemically at how we work together and address some of those concerns.
Baroness Watkins of Tavistock (CB)
My Lords, I also thank the Minister for the sensitive way in which he has addressed this very difficult statement.
I was particularly moved by the fact that there are empty bedrooms. I have a daughter who is 31. I took a long time to get pregnant and, at the very end of my pregnancy, I woke up and said that I was ill. I went to hospital and my husband said to me, “I don’t think you’re ill, I just think you’ve never had a baby before”. But as the day went on, he came to see me, and apparently I said to him, “If anything happens to me, you will look after our child, won’t you?” He said it frightened him because I am not given to drama. He went to the midwife in charge of the ward and said, “I’m really worried about my wife”. It was taken seriously. I had a scan, and—the noble Baroness, Lady Finlay, will know that this is very rare—I had a rare form of pre-eclampsia in my liver, called HELLP syndrome. In 10 minutes, I had a caesarean section. I was ill for several months and my daughter was in ITU. She has a bedroom at home—she does not live in it except when she comes back—and it has really made me think, not just about the women who lost families but about how much we train healthcare professionals to listen to the significant other of the person. We have not said a lot about that today. That significant other may be a husband, it may be a man, it may be a same- sex partner, but I urge that training includes listening to the significant other.
I also want to raise that strengthening clinical reporting at board level is essential. I and others did research after the Francis report, where it was very clear that boards were not spending significant time looking at clinical issues but were looking at financial issues. That changed then, but I believe the Ockenden report reminds us that there should be further NHS guidance to boards about their responsibility for examining mortality and morbidity rates in order that that is kept closely under supervision at board level. Believe you me, as an ex-deputy chair of a trust, I know that that was one of the most important things I looked at. I chaired the clinical audit committee and I know that those are the things that can pick up recurring issues early and enable boards to look at what is actually going on in the system. We do not want to have another Ockenden report that may not be about midwifery but about something else.
My final issue is to re-emphasise that we must get workforce planning right for the whole of the NHS, not just midwifery—though I welcome everything the Minister has said in relation to midwives and obstetricians.
Lord Kamall (Con)
I thank the noble Baroness, Lady Watkins, for sharing a very personal story. It must have taken quite a bit of courage to share that with us so publicly.
The noble Baroness talked about the “significant other”. Sometimes we consider ourselves the insignificant other. I remember when I became a father about 20 years ago for the first time. When you watched the TV programmes, they quite often told the father, “Go and have a smoke and come back. We’ll let you know.” Clearly, nowadays, you would not advise anyone to go and have a smoke. I remember how involved I was allowed to be. I was in the room for 22 hours for the first birth. Pre-natal care was fantastic, but once the baby was born, my wife was ushered into a bathroom, and I was sent away somewhere else. I could hear her voice. She called me. When I went in, she was sinking into the bath; she was just too exhausted. She was terrified and did not have the strength, and I pulled her out. It might have been a tragedy—I do not know—but it shows that even little things like that could have made a huge difference.
We are all grateful when a wonderful new life comes into this world. Let us think about the preparation that families go through—they prepare a separate room; families buy baby clothes and toys for everyone, expecting that bundle of joy to come home. When that is cruelly snatched away from them due to incompetence, we have to make sure that it happens as little as possible in the future. We know that incidents will occur. It brings a lump to the throat.
Noble Lords will recognise that there has been a debate on workforce. There is a debate in government on it. We shall just have to see how that resolves itself. I have heard loud and clear from noble Lords that it is not only about the maternity workforce; it is also about the wider NHS workforce, as well as making sure that we learn from incidents like this and build in that culture of prevention but also openness when things go wrong.
Baroness Andrews (Lab)
My Lords, this has been a rather unusual Statement in many ways, not just because it raises such extraordinarily profound questions but because it calls up such deep experiences for everybody around the House and for everyone who has a child or grandchild who survived this still-dangerous procedure. We are indeed indebted to the Minister, to Donna Ockenden and to the parents. It must have taken huge courage to relive all that, because the trauma never fades when one has had that sort of experience. One lives with it.
It is an unusual Statement because of the quality of the experiences around the House. I cannot add to them, but I want to follow up the concern of my noble friend on the Front Bench about monitoring. It is extremely important that we have a clear idea of the trajectory of the implementation of the recommendations and the speed at which they are implemented, because “promptly” is used in the report and the Statement. It is important that we have an idea also of their impact on the ground in terms of the experience of the staff and the patients in that very hospital. That is the only way in which we will know whether these recommendations and the relationship between them are having an impact.
For example, I do want to lower the tone by talking about money, but the Statement makes reference to £127 million. Over what period are we talking about that as an investment? How will it be distributed? Where will the emphasis be placed? Some of things identified are fundamentally important but elusive. How will that be reflected in changes to the quality and quantity of leadership training available? We all know that this is a failure of leadership in so many ways. For a long time, the NHS has been struggling with ways of coming to terms with developing creative leadership which will not condone blame, evasion and avoidance but embrace the need for change and improvement, and transmit and cascade that. These are specific questions. This is such a serious point of inflection in maternity services that we need to know how this is going to come back to us from the department and the Minister, so that we will be able to understand and keep tabs on what is happening. I would be grateful if the Minister could address that.
Lord Kamall (Con)
The noble Baroness raises some important issues. Looking at the big picture, as I say, we have accepted the actions made in the report, and I have asked for a timeline for the implementation from the NHS. However, I commit to updating the House when I can. I will also go back to the department and ask some more questions and make sure that I will write to noble Lords who took part in the debate in order to fill in the gaps.
A number of different issues were raised with regard to the £127 million for next year. That is for next year and it is in addition to £95 million in 2021 to try to recruit 1,200 midwives and 100 consultant obstetricians. Work is also under way as part of the largest nursing, midwifery and allied professional recruitment drive in decades. Since September 2020, there are other initiatives, such as the new non-repayable training grant of at least £5,000 per academic year for eligible students. There is extra funding of up to £3,000 per academic year to eligible students for child dependents, and £2,000 per academic year for those studying specialist subjects. There is also a new grant of at least £5,000 in addition to maintenance and tuition fees provided by the Student Loans Company.
An extensive NHS England and Improvement support package is also being developed to allow NHS trusts to establish and expand ethical international midwifery recruitment—I know that noble Lords have raised many issues about that. Health Education England has also pledged money to fund additional clinical placements, including for nursing, midwifery and allied health professionals and healthcare science, and the Government have provided almost £450,000 to the Royal College of Obstetricians and Gynaecologists to develop a new workforce planning tool. It is very easy to talk about large sums, but these are specific examples of what we are doing. However, I will write to noble Lords with more details.
NHS: Pre-pandemic Facility Levels
Lord Kamall Excerpts(2 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Balfe
To ask Her Majesty’s Government when they expect the full range of NHS facilities, such as hospital visiting and booking GP appointments, to return to pre-pandemic levels.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, NHS services are open to patients and numbers of general practice appointments have returned, or are returning, to pre-pandemic levels. As before the pandemic, hospital visiting is currently at the discretion of NHS trusts. Hospitals are expected to accommodate at least one hour of visiting per day, and preferably more. The department is working closely with the NHS to tackle the Covid-19 backlog and restore pre-pandemic activity and performance as soon as possible.
Lord Balfe (Con)
I thank the Minister for that Answer, but in our local hospital there are very big signs saying that visiting is still not permitted, while it seems to be quite in order for staff who are unvaccinated to go in and out of the hospital at will. What steps are being taken to test unvaccinated staff to ensure that they are not carrying Covid, and can the Minister remind me whether we have repealed the bit of legislation that restricted the number of people who can be in a GP’s surgery?
Lord Kamall (Con)
I thank my noble friend for those questions and will try to answer as many of them as I can. We are aware that this idea of returning to normal is patchy in different parts of the country. Some people have told me that visiting their GP or a hospital is fine, while others have had real trouble. Therefore, when these issues come up, I hope that noble Lords and others make us aware, so that we can ask the NHS what is happening. It is clearly an issue of capacity, but also, some people are trying to get face-to-face appointments with their GPs, while some practices are trying to move towards a technology-based service offering. I am aware of that. GP appointments are up to 60% of what they were pre-pandemic, but we understand that there is progress to be made in other areas.
Lord Laming (CB)
My Lords, I wonder whether the Minister realises that he could make himself hugely popular in the country if he could persuade GP practice reception facilities to be more user-friendly and welcoming to the clients.
Lord Kamall (Con)
The noble Lord makes an important point, and I can see a lot of agreement, judging by noble Lords’ body language. However, we must always be careful about this issue because patients have had different experiences. I have been speaking to noble Lords about this. Some have told me that it is really good and has gone back to normal; others are having real trouble getting access to a GP or even getting someone to answer a phone in the first place. We must be careful, because if I say, “GPs should be doing more,” I will be criticised for being tough on GPs, but if I say that we must understand that GP practices are under a lot of pressure, I will then be criticised for not pushing hard enough to solve the problem. The pandemic accelerated pre-existing trends. We were already moving more towards the use of technology. Some people were quite happy to contact their GP by phone or online, and we will see some of that. We will never go back to 100% face-to-face, but certainly, patients should be able to have face-to-face appointments unless there are good clinical reasons why they cannot.
Lord Watts (Lab)
My Lords, is it not about time that the Government reformed GP services? Should we not have GP and diagnostic centres replacing traditional GP services? At the moment, many GPs are making thousands of pounds out of buildings that have been paid for by the NHS. When will the Government be getting value for money for taxpayers?
Lord Kamall (Con)
One of the advances we have seen with technology is the community diagnostic centre; these will no longer necessarily be at health centres or GP surgeries. We are looking at rolling them out in the community, in shopping centres and sports stadiums. About 80% of the people on the waiting lists are waiting for diagnostics, so we hope that will be a great way of tackling the waiting list.
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, surveys of parent carers during the pandemic by the Disabled Children’s Partnership reveal that more than 70% of disabled children were unable to access their pre-pandemic levels of therapies and health services, and many of their conditions regressed during the pandemic. How do the Government plan to use wider NHS recovery funding to meet the acute health needs of disabled children and young people?
Lord Kamall (Con)
I thank the noble Baroness for making me aware of this issue. We are aware of a number of front-line services where there is a backlog as a result of the pandemic and not being able to have face-to-face appointments. However, I will have to write to her on the specific case that she raised.
Lord Geddes (Con)
My Lords, on the other side of the question from the noble Lord, Lord Laming, I have it on very good second-hand authority that receptionists are getting an extraordinary amount of abuse from the public. That is one of the problems.
Lord Kamall (Con)
My noble friend raises an important point. No matter how frustrating we might find trying to get an appointment with a GP, there is no room for abuse of our NHS staff—whether GPs, doctors, nurses or other health and care workers. I completely support the point he made.
Lord Austin of Dudley (Non-Afl)
My Lords, for many patients, the service before the pandemic was not nearly good enough, so our ambition ought to be much higher in the future. Why can we not reform the system by empowering patients with choice and competition? With modern IT services, why can GPs not be paid by appointment and why can patients who choose to not be able to ring round to find a GP who can treat them when and where they want, instead of being restricted to one practice?
Lord Kamall (Con)
The noble Lord makes some really good suggestions. On technology, one of the things we are looking at is why, in this day and age, when you can book appointments online for most other meetings, you cannot for GP practices. We want to make sure that people can book online, by telephone, and in advance—rather than having to phone at 8 am —and also let them choose between different places. We have to look at all these options, but, at the same time, technology is not enough: we also have to change the work processes to match the changes in technology.
Viscount Hailsham (Con)
My Lords, a problem that I have encountered in Lincolnshire is that when one tries to get a telephone appointment with the GP, one is offered a point in a spectrum of a number of hours. One simply cannot sit at one’s desk waiting for a call back within a spectrum of a number of hours.
Lord Kamall (Con)
That is exactly why, as technology has improved, you should be able to book a specific time. In fact, in some practices, it has gone backwards since the 1970s. When I was a child, my mother was able to phone up and ask, “Can my son have an appointment on Tuesday next week?” These days, you have to phone at 8 am hoping to get in the queue to book an appointment. Technology should improve that, and we hope that once we are able to recover, we will be able to use technology to book in advance.
Baroness Wheeler (Lab)
My Lords, the BMA’s Rebuild General Practice campaign has warned that GPs’ lack of time with patients, workforce shortages, heavy workloads and administrative burdens mean that patients’ safety is being put at risk when they attend a surgery. Data shows that GPs are conducting nearly 50% more appointments, but staff vacancies continue to soar and GP numbers to decline. In the light of this, can the Minister explain to the House how the Government expect to achieve their target of an extra 6,000 GPs by 2024—just two years away?
Lord Kamall (Con)
I thank the noble Baroness for reminding us of the target. We have been quite clear that it is important that we have as many healthcare professionals as possible and fill the vacancies as soon as possible. We made £520 million available to improve access to GPs and expand general capacity during the pandemic. That is in addition to the £1.5 billion announced in 2020 to create an extra 50 million general practice appointments by 2024, by increasing and diversifying the workforce.
Lord Bethell (Con)
My noble friend is entirely right that the technology offers benefits, but the health infrastructure plan, promised some time ago, has not yet been published. That will outline the framework for investment in the technology he mentions. When will the update be published?
Lord Kamall (Con)
My noble friend will be aware from when he was a Minister that there were other priorities in tackling Covid, trying to get a vaccine and procuring much-needed equipment. This was therefore all delayed, but we are now working with stakeholders to ensure that the updated capital strategy sets a clear direction for the system, taking into account significant events since the first publication. The multiyear settlement confirmed for 2021 allows us to take the next step forward. We expect the paper to be published at some time in 2022.
Lord Reid of Cardowan (Lab)
My Lords, did not the noble Lord, Lord Austin, hit the nail on the head when he said, regarding GPs, to give the patients choice? Back in the days when we reduced the waiting list from 1.1 million to just under 400,000, we reduced waiting times in hospitals from over three years down to 18 weeks. We did that primarily by giving the patients the choice to go to another hospital if they were not getting the service they needed and making the money follow the patient’s choice. Is that not the way to solve the GP problem?
NHS: Gambling Treatment Services
Lord Kamall Excerpts(2 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Lord Bishop of St Albans
To ask Her Majesty’s Government, further to the announcements that the NHS (1) will no longer accept money from GambleAware, and (2) is establishing two additional NHS gambling clinics to meet demand, what plans they have to agree a long-term independent funding settlement for NHS gambling treatment services.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
In 2019, the NHS committed to establishing 15 specialist gambling clinics by 2023-24. Five clinics are now operational across England, with a further two to open by May. This rollout carries a budget of £15 million, including £6 million allocated for 2023-24. After this, NHS England will provide recurrent annual funding of £6 million. The Department of Health and Social Care and NHS England and NHS Improvement are currently undertaking a review to ensure there is a coherent pathway of advice and treatment for those experiencing gambling-related harm.
The Lord Bishop of St Albans
I thank the Minister for his reply, but it is quite extraordinary that, at a time when the NHS is in such dire straits, with such financial pressures, we are picking up the costs incurred by an industry. This announcement has shown that far more resources are needed to deal with the outcome of problem gambling, and that the current voluntary levy is simply inadequate to provide the level of independent research, education and treatment that we need. Will the Government commit to introducing a compulsory levy of, say, 1% of gross gambling yield on the polluter pays principle, so that taxpayers are not picking up the huge bills being created by this problem that exists right across society?
Lord Kamall (Con)
I thank the right reverend Prelate for his follow-up question and for raising the issue in the first place. He is absolutely right that we must think about this across government; DCMS leads the policy, but the Department of Health and Social Care is co-operating with it to look at the health issues. Gambling used to be considered a syndrome, but it is now recognised as an addiction. We are committing resources to it through our long-term plan, and will open 15 NHS specialist gambling clinics by 2023-24, with £15 million of funding over the period.
Lord Watts (Lab)
My Lords, do we not need a mandatory levy now? The Government should be setting up a body made up of independent experts, charities and the NHS to decide what services are required and where they should be provided.
Lord Kamall (Con)
The former Public Health England, now the Office for Health Improvement and Disparities, works closely with us, particularly on this issue. We understand the call for a compulsory levy. Indeed, as I am sure many noble Lords will be aware, DCMS recently conducted a review of the Gambling Act 2005. The DHSC was part of that, looking at the impact of gambling on health. Gambling is now recognised as an addiction, as opposed to any other issue. We are looking at this and considering all options. The Government received 16,000 responses to the consultation; we are looking at that and will publish the White Paper soon.
Lord Butler of Brockwell (CB)
My Lords, with respect, the Minister did not really answer the question about the financing of these services. Does he accept, or understand, that those who treat and research gambling conditions are reluctant to accept funds that are voluntarily provided by the gambling industry?
Lord Kamall (Con)
I completely recognise the noble Lord’s point, which is why we welcome the fact that GambleAware will no longer fund the two clinics in London and Leeds. NHS England has stepped forward on that, but we are reviewing this overall, in a holistic way. When we have an issue that is considered across government, we must make sure that it is all joined up. The Department for Digital, Culture, Media and Sport has been leading the review into the Gambling Act 2005, and has asked the Office for Health Improvement and Disparities and the Department of Health and Social Care to feed into it, along with all the other stakeholders.
The Lord Speaker (Lord McFall of Alcluith)
My Lords, the noble Baroness, Lady Brinton, will make a virtual contribution.
Baroness Brinton (LD) [V]
My Lords, Public Health England says that around 246,000 people are likely to have some form of gambling addiction, but last year, only 668 people—with the most severe addiction issues—were referred to the gambling clinics because of a lack of resources. Even with the extra clinics over the next three years, will this number of clinics be able to treat the top 10% of patients, which is 24,000 people? If not, when will the service expand to help them too?
Lord Kamall (Con)
The noble Baroness makes an important point and there is recognition that we must do far more on this. That is why we held a review of the Gambling Act in the first place. As noble Lords will be aware, when the work is cross-government, the Department of Health cannot lead in this area; it can contribute when it comes to the health and addiction impacts of gambling but we are doing this in a joined-up way. The White Paper will be published soon and we are continuing to have conversations with the Department for Digital, Culture, Media and Sport on this issue.
Baroness Manzoor (Con)
My Lords, I echo the point made by the right reverend Prelate. The polluter pays principle is really important, particularly when we think that the gambling industry continues to offer customers VIP packages and streams live sport, which are equally damaging. This badly affect the lives of families and has an impact on individuals’ struggles. I welcome the NHS clinics but we always seem to tackle issues once the horse has bolted. I want my noble friend the Minister to address the issues of prevention and working much more closely with the gambling industry and others in government.
Lord Kamall (Con)
I am very happy to take two questions at once; I will even take three, if noble Lords want, and try to answer them.
The important point that a number of noble Lords are making is that many want to see a polluter pays principle. In economics, this goes back to negative externalities, where you attack things that are considered bad. Some people call them bad; others call them negative externalities. However, when you say that the polluter should pay, who is that? People sometimes say that it should be users but, if you do that, users will end up paying more. Others say that it should be the industry, but will the industry then pass on those costs to users and put those people into even more distress? This is why we want to look at this issue in a joined-up way. Yes, it is about the gambling industry, and this may well be the option we land on, but we want to make sure that we tackle the issue in a completely holistic way.
Baroness Armstrong of Hill Top (Lab)
My Lords, I welcome the Government saying that there needs to be a range of treatment and not just the hard-end clinics. I declare my interest, as in the register, having recently become a trustee of GambleAware; I did that because I want those people who are scared of going for treatment and frightened of the stigma to be able to access early intervention, which means much more work for the voluntary sector. Can the Minister commit to the Department of Health ensuring that the pathway is very clear and will involve early intervention, particularly for women, so that they do not have to end up in heavy-end treatment?
Lord Kamall (Con)
The noble Baroness makes a very important point: people must be treated as individuals—they will have come to addiction from different pathways. We have been engaging with the Department for Digital, Culture, Media and Sport on a number of issues. Additionally, the Office for Health Improvement and Disparities regularly engages with NHS England working-level counterparts, including recently on the establishment of a joint task and finish group on integrating the gambling treatment pathway. Referring directly to the question asked by the noble Baroness, there is no one simple pathway into gambling, and there is a stigma. By putting it at the forefront of some NHS services, we are showing that we are taking it seriously, and that it is not just an affliction but an addiction. We recognise that we must do more to tackle that.
Lord Foster of Bath (LD)
My Lords, I declare my interest as chair of Peers for Gambling Reform. The Minister has talked a lot about treatment, but does he accept that by adopting a public health approach, we would reduce harm in the first instance? Can he give us an absolute assurance that his department is co-operating on all aspects of the gambling review that is currently taking place and that it will be involved in the writing of the White Paper that will, I hope, come before us very soon?
Lord Kamall (Con)
We take the public health aspect very seriously. Public Health England did some work with the DCMS on looking at gambling from a public health perspective, and the Office for Health Improvement and Disparities continues to do that work. While the Department for Digital, Culture, Media and Sport is looking at the gambling industry, we are also looking at this as a public health issue via the Office for Health Improvement and Disparities. I see that the seconds are running out, so I will give the Labour Front Bench time to ask a question.
Baroness Wheeler (Lab)
I thank the Minister for that.
GambleAware recently announced a new major public health campaign to raise awareness of the gambling harms that women experience and to highlight the warning signs and the support that is available. It is particularly focusing on women between the ages of 25 and 55 who gamble online. Can the Minister reassure the House that such vital campaigns will continue to be supported through the long-term funding settlement for NHS gambling treatment and support services?
Lord Kamall (Con)
I am afraid that I cannot answer on the specific initiative that the noble Baroness refers to, but I know we take very seriously that this is a public health issue that we must tackle in a holistic way. We are looking at how we can allocate funding in the NHS long-term plan to tackle gambling addiction and to ensure that we focus more on prevention rather than simply dealing with people once they have a problem.