Nursing: Recruitment

Lord Markham Excerpts

Wednesday 26th October 2022 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what progress they have made towards meeting their target of recruiting 50,000 extra nurses by 2024.

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

This Government are committed to delivering 50,000 more nurses and putting the NHS on to a sustainable long-term workforce supply. We have set up a comprehensive work programme to improve nurse retention, support return to practice, diversify our training pipeline and ethically recruit nurses internationally. We are over half way towards meeting the commitment, with nursing numbers over 29,000 higher in July 2022—our latest available data point—than the September 2019 starting point for this commitment.

[Baroness Merron (Lab)]

My Lords, recent analysis shows that there are over 50,000 registered nurse vacances across all settings in England alone. What assessment have the Government made of the impact of current vacancy rates on patient safety? What is the Minister’s response to the warning of the Chief Nursing Officer that the Government’s pledge for additional nurses, even if it is reached, will not be enough?

[Lord Markham (Con)]

We appreciate that recruitment is an ongoing process, and while I think the whole House would agree a 29,000 increase is a good record—up 9,000 in the last year alone—we cannot rest on our laurels. Vacancies of 50,000 is partially a function of a full-employment economy, which I think we would all support. We are showing that our recruitment is working and, as I say, we are over half way towards our target of 50,000 more nurses.

[Baroness Harding of Winscombe (Con)]

My Lords, a few months ago, the Secretary of State but two said that the NHS long-term workforce strategy would include numerical assessment of both supply and demand of nurses and other clinical professionals but that publishing those details would depend on cross-government agreement. There was broad agreement in this House, in June, that those numbers should be published. Could my noble friend the Minister put on record his support for publishing NHS workforce supply and demand numbers? If he does not feel able to, could he explain how we will know whether 50,000 is the right number of nurses?

[Lord Markham (Con)]

There is a long-term workforce strategy plan being put together, as I think we know, and that builds on the NHS people plan of 2020, which has seen this increase in numbers. I will find out where we are with that, and the details behind that, and write to my noble friend.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, what advice would the Minister give to a senior staff nurse, working in theatre, and at the top of her pay band, alongside agency nurses who are paid two to three times as much as she is for a 10-hour shift? Should she leave the NHS and become an agency nurse herself, or should she vote to strike, as she may well be asked to by her union?

[Lord Markham (Con)]

I would hope and trust that such a respected person would see this position as the vocation that it is and the support that they give. We accept that there are some agency workers being used in this space, because obviously, in terms of safety, we need to make sure we cover that number of people. The whole recruitment plan—which, again, we are on target to achieve—is all about making sure we have enough nurses so that we do not have to use agency workers.

[Baroness Brinton (LD)]

My Lords, following on from the question from the noble Baroness, Lady Harding, can I ask the Minister if there are plans to increase the number of student nursing places at universities and student apprenticeships over at least the next decade? While there is a short-term crisis, there is also a longer-term sustainability crisis, especially with current demographics.

[Lord Markham (Con)]

The noble Baroness is correct that this is a long-term pipeline. We have 72,000 nurses in training at the moment. To be clear, there is no cap at all on student places. We are seeking to increase them as much as possible, and we put a £5,000-a-year grant in so that trainee nurses could enjoy superior levels of financial support than other students. The fact that we have a pipeline of 72,000 shows that this is working, but that pipeline is not capped, so if we can get more people in, we definitely want to do that.

[Lord Turnberg (Lab)]

No matter how many nurses we try to recruit, we never seem to catch up with the rate of loss. What are the Government doing to help retention of nurses? We must try to encourage them and support them to stay. What plans are there to do that, and what plans have the Government got to bring back nurses who have left or retired?

[Lord Markham (Con)]

First, we are actually exceeding the number of leavers. There were 36,000 people who left last year and 45,000 who joined—a net increase of 9,000. That is not to say that we do not want to retain people. I absolutely accept the premise that we do, which is why we have a retention programme in place to ensure that we are able to do so. We also have a restart programme to help people who have left to get back into nursing in a quick and easy way. Overall, the main point here is that the number of joiners is exceeding the number of leavers. We are more than catching the number up; we are exceeding it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as a nurse and the co-editor of the WHO report, State of the World’s Nursing. It is true that we have 9,000 additional nurses, but of the 48,000 who in the last year joined the register for the whole UK—for the four countries, not just England—more than half had trained overseas. Those nurses are very welcome here, but it illustrates that we are not encouraging people who wish to go into nursing to do so, beyond the 72,000 the Minister referred to. That is very much to do with student finance and the lack of apprenticeship opportunities for older people who want to go into the profession. Can the Minister look into increasing those opportunities?

[Lord Markham (Con)]

Indeed, and towards that aim we have set up the nursing associate role, which is a stepping-stone to allow people to ease in and have qualifications on the way to becoming a fully trained nurse. The overall point I make, as before, is that by putting in a £5,000-a-year grant for student nurses, we are recruiting the numbers. I reiterate that 72,000 is a big pipeline but also that it is an uncapped pipeline. The more we can attract, the merrier—whether domestically or, as in the fine tradition of the NHS, from overseas sources.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that the percentage of nurse vacancies is much higher in community care than in any other part of the sector? What is the department doing to ensure not only that we have enough nurses but that they are in the right places?

[Lord Markham (Con)]

That is an excellent point. One thing I probably should have said is that the number of 36,000 leavers includes people who have left NHS trusts and gone into community care, working in GP surgeries. We do not catch that number who come back in again, so the real number is less than 36,000, but the basic premise of the question—making sure we are attracting nurses to the right place—is absolutely the right one. I believe that is the plan in place, but I will check on that and make sure we are doing as requested.

[Baroness Masham of Ilton (CB)]

My Lords, would it be possible to make it quicker and cheaper to get visas to bring to the UK nurses from across the world who would like to work here? We can never have enough nurses without them, can we?

[Lord Markham (Con)]

I totally agree with the approach. I have declared a personal interest before in that my wife is a dentist from the Dominican Republic who came in exactly that way, so I completely support the intent.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, I raised the subject of agency nurses in my maiden speech. In the private sector, it is quite common that if you receive training by an employer and leave within a certain period of time, you repay the cost of that training. If nurses qualify and then transfer to become an agency nurse and rip off hospital trusts, as we heard earlier from the noble Baroness opposite, should they repay the costs of the training they have been given?

[Lord Markham (Con)]

I do not think I can quite agree with the words “rip off”, but I get the sentiment. As I am sure we all have, I have been involved in industries where, if your employer pays for your training and you do not return the contract—for want of a better word—or investment by giving a few years’ commitment to do it, there should be some sort of clawback. I understand the approach, but right now my focus is on making sure we get as many people into training as possible.

Water Fluoridation (Consultation) (England) Regulations 2022

Lord Markham Excerpts

Wednesday 26th October 2022 Lords Chamber

Moved by

[Lord Markham]

That the draft Regulations laid before the House on 20 July be approved. Considered in Grand Committee on 25 October

Motions agreed.

Maternity and Neonatal Services

Lord Markham Excerpts

Tuesday 25th October 2022 Lords Chamber

[Baroness Cumberlege (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in so doing, I declare that I am remunerated for chairing the independent maternity review.

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

I am grateful to Dr Kirkup for this report. Our intention is to review the recommendations alongside existing work to improve maternity outcomes, including the recommendations from Donna Ockenden’s final report. With NHS England, we have established an independent working group chaired by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists that we will use to support our considerations.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that reply. Does he agree that as this has been a series of maternity tragedies across England, we must do all we can to prevent further disasters? Will he, with NHS England, introduce a maternity signalling system that identifies units providing poor care before they cause widespread harm?

[Lord Markham (Con)]

I thank my noble friend. I agree. This was captured in recommendation 1 by Dr Kirkup about having early warning indicators in place. That is what we have set up in the maternity quality surveillance framework, which has the oversight in this area and can escalate concerns and effectively report to the national maternity safety surveillance and concerns group, which can then put the trust into special measures.

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the trustees of the Royal College of Obstetricians and Gynaecologists. I am aware that the Government have allocated an extra £200 million for maternity services over the last couple of years, but according to the Health and Social Care Select Committee this is not nearly enough. It recommends up to £350 million for staffing alone. Do the Government accept that, above all, more funding is needed now for multi-professional training and to support programmes to improve clinical practice? If so, can the Minister say how much funding the Government are prepared to allocate and when?

[Lord Markham (Con)]

I agree. We are putting the money into the training programmes. We have actually put £95 million on top of the £127 million investment into this area. As ever though, what is most important is outcomes not investment. Alongside the tragic instances we have seen, we have seen a reduction in stillbirth of 19% since 2010, a reduction in neonatal mortality over 24 weeks of 36%, and a reduction in maternal mortality of 17%. Alongside these tragic findings of individual trusts, we have an improving picture of maternity care overall.

[Baroness Brinton (LD)]

My Lords, in yesterday’s Statement on Dr Kirkup’s report, the Minister told us that 23 hospitals are in maternity safety support programmes—special measures—and that, while four are coming out, another 10 are due to go in. Can he assure the House that extra resources, including extra supervision, will be there to ensure that mothers and babies in those hospitals are absolutely safe?

[Lord Markham (Con)]

Yes. Resourcing the special measures programme—for want of a better name—is vital to all of us. I am pleased to see in the case of East Kent that, of the 67 special measures recommended, it has now passed 65 and the two remaining ones will be completed by the end of November.

[Lord Patel (CB)]

My Lords, this is the most recent of several reports identifying failures of maternity units in England. The CQC identified 40 maternity units that had failing safety standards. Bill Kirkup has not only produced a brilliant report but identified the way forward, by developing a matrix of standards of safety and outcomes that would apply to all maternity units to make them all high calibre, high standard and safe. Will the Minister agree that, by meeting Bill Kirkup, Ministers could ask him to identify the areas to draw up these standards? Because time is short, if the Minister agrees I will be happy to meet him to enlarge further.

[Lord Markham (Con)]

I agree about wanting to implement the recommendations. My colleague Dr Johnson, the Minister in the other House, already met with Dr Kirkup this week. We also undertook to come back in the next four to six months with where we are on each of the recommendations. I will bring that back to the House then.

[Lord Lansley (Con)]

My noble friend referred to the first recommendation for the prompt establishment of a taskforce to develop maternity and neonatal outcome measures. It is over a decade since we introduced the NHS outcomes framework but, far too often, it is not used as the basis for accountability inside the National Health Service. Will he say whether that first recommendation will be acted on immediately?

[Lord Markham (Con)]

As I mentioned before, we have already put this in place with the maternity quality surveillance framework. At the same time, if we feel that more needs to be done, it will be included in my review of the recommendations and report back to the House in four to six months.

[Baroness Andrews (Lab)]

My Lords, one of the significant things about this devastating report is that it does not deal with a list of one-off recommendations, as previous reports have. It deals with systemic issues that mean that the whole service is challenged. One of those, as we have already heard, is the difficulty in identifying risks. The other is why we do not hear what families are saying, which is clearly an issue in preventable deaths. One of the specific recommendations is that the Government should now bring forward a Bill that would place a duty on public bodies not to deny or deflect or conceal information from families. That should be a priority. Will the noble Lord take that back to his senior Ministers and get them to acknowledge it?

[Lord Markham (Con)]

We all acknowledge a duty of candour. That should be fundamental to the leadership and to everyone in every trust. In this case, I was pleased to see the trust completely accept the findings and its failings and apologise unreservedly. That is something we need to make sure that all trusts do. We have the framework in place to do that but, if we do not, we will not hesitate to act further to ensure that it is.

[Baroness Finlay of Llandaff (CB)]

My Lords, this alarmingly clear report flags up flawed teamworking as a major failing throughout. That also reflects previous reports. It also points out the unintended adverse consequences of using the phrase “normal births”, which should perhaps be replaced by “safe births”. Will the Government consider the problem of teamworking? Although there already is a joint group between the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, there also needs to be commissioning guidance to make sure that services are commissioned only when there is joint education and training, audit, and co-production of guidance with parents who have experience of the unit.

[Lord Markham (Con)]

Again, we agree with Dr Kirkup’s third recommendation that teamwork is vital in all this. Some £26 million has been invested in maternity teamwork training, and a core curriculum has been set up for professionals in this area. Strong leadership has been established, with two national maternity safety champions and a number of regional and local maternity safety champions. We believe that we have the framework in place for these independent working groups but, as we review these recommendations, if we find they are inadequate we will not hesitate to act further. We will bring this back to you in the four-to-six-month timeframe when we report on the recommendations.

[Baroness Hussein-Ece (LD)]

My Lords, the duty of candour has been in place for some years now, but there still seems an ingrained culture of denial and blame deep-rooted within these services. This is the third such report since 2015 and one of its central tenets is that women are just not listened to and are ignored, resulting in terrible deaths and disabilities for so many children. Can the Minister give us his assurance that the duty of candour and listening to women will be at the heart of the Government’s response?

[Lord Markham (Con)]

Yes.

[Baroness Merron (Lab)]

My Lords, Dr Kirkup’s extraordinary report cites a lack of junior staff and, critically, a shortage of midwifery leadership as contributing to the tragedies at East Kent. In the absence of a comprehensive workforce strategy from the Government, and more midwives leaving than joining, what is being done right now to tackle the considerable number of midwifery vacancies that the NHS is suffering? It currently stands at well over 2,000.

[Lord Markham (Con)]

The number of midwives has been stable over the last four years. We have seen a slight decline over the last year, which is why we have a training and recruitment programme to recruit 1,200 more midwives. In my main point, I echo the comments that Dr Kirkup made: working under pressure is no excuse for staff being rude and aggressive. While we want to recruit the extra numbers, I think that the whole House agrees that there is no excuse for what happened at East Kent.

Water Fluoridation (Consultation) (England) Regulations 2022

Lord Markham Excerpts

Tuesday 25th October 2022 Grand Committee

Moved by

[Lord Markham]

That the Grand Committee do consider the Water Fluoridation (Consultation) (England) Regulations 2022.

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

My Lords, in moving that these regulations be approved, I shall also speak to the Health and Care Act 2022 regulations.

The water fluoridation provisions of the Health and Care Act will come into force on 1 November, and in doing so will transfer the power to initiate new schemes, or to vary or terminate existing schemes, from local authorities to the Secretary of State. Public consultation will continue to be an important aspect of proposals, and the focus of today’s debate is the draft consultation regulations, which set out the process that any future consultations must follow. We know that some have strong feelings on the subject of water fluoridation and consultations relating to it, and we were keen to gather public opinion before laying these draft regulations. We therefore launched a public consultation on 8 April, which ran until 3 June 2022, seeking views on whether future water fluoridation consultations should be restricted only to those affected locally and bodies with an interest, as has previously been the case, or whether they should now be open to all, given the shift of responsibility from local authorities to central government.

We received 1,228 responses; 94% came from individuals and 6% from organisations. The majority of respondents favoured a consultation which is open to all. The draft regulations do not therefore restrict those who can respond to any future consultation. However, we understand that it is those living, working and studying in the areas in question who are directly affected, which is why the regulations also provide for consideration to be given, as part of the decision-making process, to whether those who may be particularly affected by any future proposals should be given additional weight.

Although public opinion and the extent of support for a water fluoridation proposal will continue to be important, consultations are not referendums. It is right that regulations provide for a range of other factors to be taken into account when considering a water fluoridation proposal. This includes, but is not limited to, the strength of evidence underpinning any arguments made by respondents. It is right that due regard is given to those arguments that are properly supported by sound evidence.

We are committed to scientific evidence surrounding water fluoridation underpinning any proposal. The department continues to review scientific papers published both in this country and internationally as part of the continuous monitoring of the evidence—including those on the epidemiology and toxicology of water fluoridation —and every four years the department will continue to publish a summary report on our knowledge, in line with the Secretary of State’s responsibility for monitoring the effects of the water fluoridation arrangements on the health of the populations served by schemes. I provide assurance that, if the balance of evidence in favour of water fluoridation as a public health measure were to change, a review of the current water fluoridation policy would take place.

Another important element in deciding to proceed with a water fluoridation proposal is the cost-benefit analysis of such proposals. Any new proposal will have to demonstrate that the benefit to health will represent good value for the investment of public money proposed.

We want more of the country to benefit from water fluoridation, and many noble Lords may be aware that yesterday we announced, subject to the outcome of this debate and future consultations, that funding has been secured to begin expansion across the north-east into Northumberland, County Durham, Sunderland, South Tyneside and Teesside, including Redcar and Cleveland, Stockton-on-Tees, Darlington and Middlesbrough. I know that the local authorities in these areas are strong supporters of water fluoridation. In accordance with the regulations we are debating, we will hold a public consultation on this proposal next year. This expansion would enable an additional 1.6 million people to benefit from water fluoridation, which will help to reduce the level of tooth decay in the area and over time will reduce the number of children who need to be admitted to hospital for tooth extractions.

I turn now to the draft Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022, starting with mandatory training on learning disability and autism. People with a learning disability and autistic people experience poorer health outcomes in comparison to the general population. There is a need to address the significant and persistent health disparities faced by this group of people. That is why the Government have introduced, from 1 July 2022, a requirement in the Health and Care Act for CQC-registered service providers to ensure that their employees receive specific training on learning disability and autism. Introducing mandatory training on learning disability and autism is intended to ensure that health and social care employees have the skills and knowledge to provide safe, compassionate and informed care. The Act also creates a duty for the Secretary of State to publish a code of practice which will outline how to meet the new requirement on mandatory training. The code of practice is being developed and we expect to publish a draft for consultation early next year.

The consequential amendment proposed today seeks to remove the requirement for the Care Quality Commission to issue statutory guidance about the mandatory training requirement, by amending Section 23(1) of the 2008 Act. This carve-out clause should have been applied during the passage of the Health and Care Bill. If the Act is left unchanged, registered service providers will have two sets of guidance: statutory guidance issued by the Care Quality Commission and, subsequently, the code of practice issued by the Secretary of State. Removing the requirement for the CQC to issue statutory guidance will mean that registered providers will have a single source of guidance once the code of practice is published. The Care Quality Commission has agreed to keep all its statutory guidance, which was published on 1 July 2022, available to registered service providers until the code of practice is published.

Lastly, I turn to virginity testing and hymenoplasty. Safeguarding vulnerable women and girls is a top priority for the Government, which is why we were one of the first countries in the world to ban virginity testing and hymenoplasty. Virginity testing and hymenoplasty have no scientific merit or clinical indication and are a violation of human rights. These degrading and intrusive acts have an adverse impact on women and girls’ physical, psychological and social well-being. They can lead to extreme psychological trauma in the victim, including anxiety, depression, post-traumatic stress disorder and suicide, and physical trauma including damage to the hymen and vaginal wall, bleeding, infection and sexual difficulties. As such, we are proud that the Health and Care Act 2022 made carrying out, offering, and aiding and abetting virginity testing and hymenoplasty illegal.

As these are new offences, certain changes to other legislation are necessary to protect vulnerable groups. The Scottish Government have requested a change to be made to the Foster Children (Scotland) Act 1984, which contains a list of matters which disqualify a person from fostering a child in Scotland. The consequential amendments proposed today would add to that list the conviction of an offence of virginity testing or hymenoplasty in relation to a child. The change would also flow through to assessments by adoption agencies in Scotland under The Adoption Agencies (Scotland) Regulations 2009 in relation to the suitability of prospective adopters.

The 2009 regulations require those suitability assessments to be carried out by reference to a range of information, including whether the prospective adopter or any member of their household has been disqualified or prohibited from keeping a foster child under the 1984 Act. This change would have the effect of disqualifying or enabling the disqualification of individuals convicted of virginity testing or hymenoplasty offences from fostering or adopting in Scotland.

Similar changes were made to English and Welsh law in negative regulations under the Health and Care Act 2022. Scottish provisions on this matter are set out in primary legislation requiring an affirmative procedure. It was unfortunate that we were not able to make this amendment in the Health and Care Bill, as the need for the change was not identified during the Bill’s passage, but the priority is to put in place these restrictions now. This change will help to protect girls and young women from so-called honour-based abuse.

[Lord Reay (Con)]

My Lords, I have spoken previously in the House in Committee and at Second Reading of the Health and Care Bill about how the Government’s water fluoridation policy is considered to be misguided by numerous eminent scientists in the UK and overseas, including government advisers. They warn that fluoridation causes a variety of health ailments, including damage to the foetal brain. I hope to offer my noble friend the Minister some constructive comments on how to improve the water fluoridation consultation process, which is unsatisfactory and inadequate in many respects.

First, the consultation should be more prescriptive as to the minimum level of publicity required from the Secretary of State to promote the policy. The current framework gives scope for minimal effective publicity, as the media requirement is merely defined as that which the Secretary of State considers appropriate. In comparison, in the case of public health initiatives concerning Covid, the NHS has texted those patients registered and sent letters to relevant individuals based on their ages. The same has applied to screening tests for various cancers. In addition to the NHS database, local authorities have council taxpayer databases and electoral register databases, which could be used for public information notifications. It is particularly straightforward to do that on a locality-by-locality basis, as would apply for fluoridation schemes. There could also be a specification for notices in local papers and in the national press.

Secondly, the consultation period is quite short, given that the public are expected to gather information and evidence, analyse data, review scientific evidence, carry out cost-benefit exercises and marshal arguments on a variety of aspects of a given scheme. Six months would be a more reasonable period.

Thirdly, no objective process is stipulated whereby the Secretary of State can realistically assess

“the extent of support for the proposal”

under Regulation 5(1)(a). What about the extent of opposition to the proposal? There should be a requirement for independent public opinion-polling and also canvassing of the views of parish, borough, city and county councillors. A local referendum should be considered. It stands to reason that, if a local proposal is to have any real democratic legitimacy, the view of a majority of the local populace should not be overridden.

Fourthly, it is difficult to see how the Secretary of State can gauge the cogency of arguments, ethical considerations or scientific evidence without being guided by a panel of relevant experts. These should be recruited independently from the Department of Health, by nominations from bodies such as the royal institutes or other professional bodies for engineers, statisticians, accountants, economists, scientific research bodies, toxicologists, ethicists and the like. They should be similar to commissions of inquiry or standing advisory bodies, chaired by legally qualified personnel.

Fifthly, Regulation 5(1)(b) should prescribe that particular weight should be given to representations made by individuals who would be affected by the proposal. Conversely, it is difficult to see why any weight should be given to anybody with an economic interest in favour of a proposal, because a public interest health policy should not promote private economic interests.

Sixthly, as far as “capital and operating costs” are concerned, in Regulation 5(1)(c), the relevant costs are the full range of costs, including establishment costs, insurance costs, admin costs, consultation costs, any extra security costs, extra wear and tear or corrosion costs, monitoring costs, safety training costs, additional computer software costs and many others. A narrow compass on these costs would generate some very misleading results.

On Regulation 5(1)(c), it is no good looking at the above costs in isolation: there has to be a comparative cost-benefit analysis, taking into account a range of alternative options such as no scheme, a lesser or more targeted scheme, alternative dental preventive health schemes such as providing fluoride via milk or tablets or topically, public education or in-school training, and so forth. This should include an analysis of the successful Childsmile programme in Scotland, which, through education and dentist visits to schools has been shown to reduce tooth decay in children.

--- Later in debate ---

With those comments, I welcome the regulations and thank the Minister.

[Lord Markham (Con)]

I thank your Lordships for your contributions today. First, as the noble Lord, Lord Hunt, said, the principle has been decided in previous debates, and the debate today has been about the consultation and the implementation. As for the comments made by the noble Baronesses, Lady Brinton and Lady Merron, there is strong evidence in favour, as illustrated by the Australian dentist cited by the noble Baroness, Lady Brinton. As the noble Lord, Lord Hunt, said, we must at all times be driven foremost by the medical evidence, so I agree that the highest stakeholder in this process should be the science.

At the same time, the noble Lord, Lord Reay, makes good points about ensuring that the consultation is properly done, so I completely hear his comments about making sure it is well publicised so everyone has the opportunity to contribute to the debate, ensuring that sufficient time is given so that everyone has a chance to submit their piece, and having proper experts assess the consultations. I think we could also all agree as a principle that private, commercial interests should not be a factor that people can use. I hope those are items on which we could all agree.

On the point about health research and different cases emerging all the time, as noble Lords will be aware, under these provisions we have committed to publish the latest evidence every four years so that if things change, we are able to change with them. I hope that will give the safeguards and make sure that we are always led by the science and the medical evidence, as the noble Lord, Lord Hunt, said.

On the points about learning disability, virginity and hymenoplasty, I welcome the thanks; it was before my time, but I know that it was very much a team effort. My understanding is that it was very much the Lords working at its best, with cross-partisanship.

A very good point was raised on the foster parent household definition. I have just phoned a friend, but I am not sure my friend has given me the answer. I understand the point that you can often have an elder—a household member who might not actually live there but who can be hugely influential—so I will come back in writing on that. It was a well-made point.

I hope I have covered all the points raised in this debate. Again, I thank noble Lords for their contributions and trust that we have been able to answer them, apart from the household point, which I will come back on in writing.

I am glad to see that we mostly agree on the benefits of water fluoridation. The regulations reflect the consultation responses from the public and will not restrict those who want to respond to future public consultations on water fluoridation schemes.

I trust that my answers have provided reassurance that removing the requirement for the CQC to issue statutory guidance on mandatory learning disability and autism training will not leave service providers without clear guidance. I trust that they have also provided reassurance that amending the Foster Children (Scotland) Act 1984 will help protect children being fostered and adopted in Scotland from virginity testing and hymenoplasty.

Finally, on a personal note, reflecting on the 10 debates and speeches I have done today, it is with pleasure that I feel I am playing a small part in doing something very good here. I thank all noble Lords for their contributions.

Motion agreed.

Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022

Lord Markham Excerpts

Tuesday 25th October 2022 Grand Committee

Moved by

[Lord Markham]

That the Grand Committee do consider the Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022.

Motion agreed.

East Kent Maternity Services: Independent Investigation

Lord Markham Excerpts

Monday 24th October 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I want to start from these Benches by sending my deepest sympathies to the bereaved families and to say that we admire the parents for their campaigns over many years against the dreadful treatment by the east Kent hospitals trust for more than a decade. I echo the thanks and gratitude from the noble Baroness, Lady Merron, to Dr Kirkup and his team. Once again, he has risen to the challenge of providing a very clear picture of what has gone wrong at a hospital trust.

The trust failed to read the signals over an 11-year period. The Kirkup report puts this very bluntly and is exceptional in the way it uses evidence. Yes, there is the evidence of the voices of mothers and their families and the evidence from staff, but equally important is the use of data, especially the CESDI data from the Confidential Enquiry into Stillbirths and Deaths in Infancy. In the section headed “What happened to women and babies”, paragraph 1.16 says that

“we have not found that a single clinical shortcoming explains the outcomes. Nor should the pattern of repeated poor outcomes be attributed to individual clinical error, although clearly a failure to learn in the aftermath of obvious safety incidents has contributed to this repetition.”

This short paragraph encapsulates how failings have become cultural in the trust. Paragraph 1.19 says that

“we have found that the origins of the harm we have identified and set out in this Report lie in failures of teamworking, professionalism, compassion and listening.”

It is really worrying to have the report from the CQC of a few days ago, which echoed these exact points but more broadly across maternity services in England.

As has been mentioned, there is a wider problem. We know that. The reports on Morecambe Bay, Shrewsbury, Telford and now Nottingham, where Ms Ockenden is now working, show that systemic and cultural failures, especially with the complexity of regulators, are creating real problems. There is the idea that clinical staff will allow favouritism and the opposite of growing and supporting staff, while letting things fester and not caring to drag patients into their concerns.

Can the Minister outline the timescale for the independent working group report referred to in the Statement? The creation of the group is welcome; its main remit is to advise the maternity transformation programme in England—but by when? Is the work of the group revealing that other maternity services have problems, even if we do not know how severe they are or if they are as severe as East Kent?

In the section on the actions of the regulators on page 9, at paragraph 1.50, Dr Kirkup identified that

“the Trust was faced with a bewildering array of regulatory and supervisory bodies, but the system as a whole failed to identify the shortcomings”.

It is good that it is reported that NHS England and Innovation sought to bring about improvements, but every other trust is also facing that same complexity of different regulators. Are the Government looking at the roles of regulators and how their competing demands can be streamlined to avoid this problem?

The Commons Minister said that she would review all the recommendations and provide a full response once she has had time to consider it. I think we all appreciate that the NHS has a very large workload at the moment, but can the Minister say roughly what timescale we are looking at?

One key problem in many maternity services is with the workforce, especially midwives. Although NHS England made an exceptional grant in March of £127 million as a boost for

“safer and more personalised care”,

can the Minister say—I echo the point made by the noble Baroness, Lady Merron, which he will not be surprised to hear—where the workforce plan is for the next decade for maternity services? A year’s extra money is not going to help with training the midwives of the future and ensuring that maternity units are professionally and adequately staffed.

Dr Kirkup also criticised NHS England for firing chairs and chief execs too frequently, indulging in a blame game that reinforced the culture happening inside East Kent. It is no longer good enough to say, once again, that this must never happen again. This is the third devastating report in under seven years, and another is now being prepared in Nottingham. What will the Government do in the next three months to ensure that further appalling practice will be uncovered and dealt with immediately?

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

Dr Kirkup’s report, published last week, contains some stark and upsetting findings. As mentioned, the report examined more than 200 births in east Kent between 2009 and 2020 and found that, had care been given at nationally recognised standards, 45 babies might not have lost their lives and many more families might not have experienced such distress at what should have been a time of joy. He also found a toxic culture in the trust, with a disturbing lack of kindness and compassion, and victims’ families even blamed for their devastating losses. The report underlines that the NHS needs to be better at identifying poorly performing units and at giving care with compassion and kindness, as well as team working with a common purpose and responding to challenge with honesty. I take all the findings and areas of concern extremely seriously.

I want to thank Dr Kirkup and his team; his experience has been invaluable and I know that his approach to putting families first has been welcomed. I also know that hearing the accounts of families has been a harrowing experience at times, yet, as he said, it is difficult to imagine just how hard it was for the families as they relived some of their darkest days. I am profoundly sorry to all the families who have suffered and continue to suffer from these tragedies. I pay tribute to the families who have come forward to assist the review; it is thanks to the tireless efforts, courage and determination of families in east Kent that we have been able to shine a light on maternity failings in East Kent Hospitals University NHS Foundation Trust.

Before directly addressing the recommendations, I want to put the tragic findings in the context of an improving service overall. Since 2010, stillbirths have declined by 19%, neonatal mortality over 24 weeks by 36% and maternal mortality by 17%. That is not to undermine the seriousness of the circumstances.

On the recommendations, I echo the comments already made. I know that it is top of Minister Johnson’s agenda in making sure that there are speedy, but also measured, responses. As part of that, I want to touch on some of the points made, particularly by the noble Baroness, Lady Brinton, about the use of data as part of the early warning indicators. I think we all agree that that is key to this area. This is exactly the work that the national maternity safety surveillance and concerns group was set up for: to make sure that there is methodical oversight in this area. It is in its power to recommend that people are put into the maternity safety support programme; 23 hospitals are currently in it and it is recommended that four have progressed enough to come out again, but another 10 have been identified that may need to be put into it.

It depends on how you look at it, and whether you take solace in these trusts being identified, or whether you are concerned about the number out there. Personally—I hope I echo the comments of all of us in the House—I believe it is much better that we identify them and deal with it, however uncomfortable that might be in the meantime. The lesson we have learned from these unfortunate cases, as recognised by the noble Baroness, Lady Merron, is that we have seen a failure of leadership and accountability here.

I am glad to see that, in responding, the trusts have been unequivocal in accepting unreservedly the failings on their part and have apologised wholeheartedly. As we know in these times, when dealing with these situations the first thing that has to happen is recognising that the problem exists.

I will need to write to the noble Baroness about the extra investment and how that spend is being allocated. It is very much on the agenda of Minister Johnson to look at that and at the improvements that have been made.

On the shortage of midwives, the picture as I understand it right now is that we have had a stable number of midwives—around 21,500—over the last four years. Within that, we do have the target, as mentioned, to increase it by 1,200, and that is part of the £95 million investment towards this. I accept that doing that is more than a one-year plan and needs to be part of a much larger picture.

I welcome the CQC focus on this area. It is something that we all agree needs to be an area of focus; if that makes for some uncomfortable findings then so be it. It is only when we understand those areas that we can really get on and make sure that we deal with them. I hope that we are looking to move on in these areas.

The Maternity Safety Support Programme is a force for good, and I am glad to say that, in East Kent, they have been working on the improvement plan as part of the support programme, and 65 of the 67 actions have now been completed, with the final two to be completed by the end of November. That is not to be complacent: that work should have been done a lot earlier, but I am glad to see it is being worked on now.

I have tried in these answers to respond to the questions, but I will follow up in any areas where I have not. In summary, I again thank and pay tribute to those families whose tireless determination to find the trust in telling their stories has brought us to this important point. The Government will be reviewing and considering all the recommendations from the report. We will listen, learn and act to ensure that no other family has to ever experience the same pain in the future.

[Baroness Gohir (CB)]

My Lords, I thank noble Lords for being patient with me, as I am still learning the rules. I draw attention to my interests in the register. Given the continuous maternity concerns raised in this and many other reports, including by women’s groups, is it time to have a maternity commissioner? As the noble Baroness, Lady Merron, mentioned, what needs to happen to ensure that we get that change? Could the answer be a maternity commissioner who is independent and who then holds the Government to account?

[Lord Markham (Con)]

The noble Baroness is right to say that it is clear that we have not got it right to date, as shown by the fact that these instances have come up. We are taking the right steps with the Maternity Safety Support Programme that we have put in place, and its ability to put trusts into special measures—as I say, that has already been done on 23 occasions and it is being considered for another 10. I believe we have got those early warning indicators in place now, and trusts are being held to account. At the same time, we have to be open, to make sure that we continue to look at and review this, to see whether it has sufficient teeth and, dare I say, intelligence to properly identify these areas. If it does not manage to do that, we must make sure we put in something else, in addition to what is there already.

[Baroness Cumberlege (Con)]

My Lords, I have had a very long interest in maternity services, and it seemed to me, on this occasion, that I could make a few comments. This report is truly remarkable. It is investigating the tragedies and failures, the lack of care, the divisive attitudes among professionals, and the lack of teamwork and much else. The report is really here partly due to the pressure of patients and the public, who wanted to bring to the attention of the Government the failures in East Kent.

I thank my noble friend for his report. The recommendations are different from the usual recommendations, in that they go much wider than just East Kent; they go across the country as a whole, and they are very important. On reading that report, has he any ideas about how to stimulate the doctors, nurses, midwives, obstetricians, managers and leaders not only in East Kent but across the country to take note of what it is saying? It very much affects not just them but parents, families, friends and childbearing women, and it is important that they have optimal care that is kinder, compassionate, more personal and safer. What action are the Government going to take, working with NHS England, because there are a lot of partners in this area of maternity? Will he ensure that the recommendations are not ignored—that they are not just put on a shelf and forgotten—and will he come back to Parliament within, say, four to six months to explain what progress has been made in implementing them in the four areas cited for action? I would very much welcome that, because I want to see this report implemented and not just put on another shelf.

[Lord Markham (Con)]

I thank my noble friend for her question; I know this is an area in which she has longstanding interest and expertise. She refers to embedding compassionate care and, perhaps like all of us, I am surprised to learn that, unfortunately, we may need training in this area; but I agree that it needs to be done because it is fundamental. A culture and leadership programme has been put in place, and we have set up national guardians, the idea being that everyone in every trust has the freedom to speak up. There are 800 of them as of today. I take this issue seriously and I commit—if I am here—to come back within four to six months to report to the House on the progress made, as requested.

[Lord Berkeley of Knighton (CB)]

My Lords, all too often we hear sentiments of regret and apology—“we have learnt lessons”; “it must not happen again”—and of course, in a sense, what else can you say? My noble friend’s suggestion of someone with specialist knowledge overseeing this is very helpful, but does the Minister agree that this is another area where we have to encourage people to whistle-blow? It is not a term I like much, because it suggests something which is not pleasant, but very often there are people who are alarmed and think something is wrong, but who are too frightened to speak out. If we could foster a culture where that fear is diminished and people feel able to speak out, and that they should, we might get much earlier warning.

[Lord Markham (Con)]

I agree, and if I may I would like to quote Dr Bill Kirkup in the report:

“Clinicians should not have to live in fear”


where “honest clinical errors” are made. That is exactly the point: we need to introduce a culture whereby people feel able to do that. He goes on to blame systemic failures in leadership, a point that the noble Baroness, Lady Brinton, made, and which is very pertinent here. We are talking about honest mistakes. Everyone wants to do a good job and tries do a good job; it is where they feel that they cannot bring up and honestly discuss those issues that we have a systemic problem, so I agree that it begins and ends with the leadership.

[Lord Inglewood (Non-Afl)]

My Lords, I know nothing about health policy, Kent or the hospitals in Kent, but our grandson was born in one of the hospitals of the east Kent trust earlier in the summer. We have heard about some of the horrifying things that have happened. There is no excuse for that, but in all hospitals and such establishments there are people who, despite the problems, are doing the real job to the best of their abilities. I should simply like to put on record our gratitude to the staff involved in the birth of our grandson.

[Lord Markham (Con)]

I thank the noble Lord. As he rightly points out, the vast majority of workers are very diligent and good at what they do, and that should rightly be recognised. At the same time, I do not think any of us here wants to sweep under the carpet the problems that clearly exist. We need to be sure that, among the fantastic work, we are ever vigilant to root out the bad.

[Baroness Bennett of Manor Castle (GP)]

My Lords, a Department of Health statement on the appointment of the first ever patient safety commissioner—on which, as your Lordships’ House well knows, the noble Baroness, Lady Cumberlege, was a driving force—noted that the NHS Patient Safety Strategy was published in 2019

“to create a safety learning culture across the NHS”.

The statement also noted that it had introduced a statutory duty of candour, which requires trusts to inform patients if their safety has been compromised. I think everyone in your Lordships’ House is well aware that our NHS staff are exhausted, overstretched and overworked. When I read that statement, I could not help thinking about how there are different reports, strategies and approaches coming from all kinds of directions. Can the Minister assure me that staff are being given clear leadership from the very top and a clear framework in which to work, rather than a continual barrage of directions without the resources to deliver them?

--- Later in debate ---

[Lord Markham (Con)]

I believe that staff are now being given that framework. Historically, as the report shows, they have not always been given that. Clearly, if this report is really going to lead to meaningful change, we have to make sure that the framework is adhered to going forward. That is what I believe the maternity support programme is all about.

Cost of Living: Public Well-being

Lord Markham Excerpts

Thursday 20th October 2022 Lords Chamber

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

My Lords, I thank the noble Baroness, Lady Drake, for securing this important debate, and all noble Lords across the Chamber who have contributed to the constructive and thoughtful discussion. To answer the noble Baroness, Lady Smith, I found the debate fascinating and respond with pleasure.

I thank the noble Baroness, Lady Drake, for framing the debate in terms of the ONS study on public welfare and for highlighting that to me ahead of time. I welcome the contributions from the noble Lord, Lord Layard—it is good to see my ex-lecturer at LSE— and the thoughtful contributions from the noble Lord, Lord O’Donnell, and the right reverend Prelate the Bishop of Oxford. I believe this is an excellent basket of measures which should act as a North Star for the Government. Many moons ago, I worked a lot in Nigeria setting up digital TV, and I learned that one of the poorest countries in the world can actually be one of the happiest.

I would like to look at the impact of the cost of living on those 10 measures. I have excluded two—the environment and governance—because I was not sure how much the cost of living impacted them. I am not so sure on the governance point now, but that may be above my pay grade anyway. As I reply, I will look at how the cost of living measures impact the other areas: personal well-being, our relationships, our health, what we do, where we live, our personal finance, the economy, education and skills. I will not pretend today to have all the answers, but what I will try to do, crucially, as requested by the noble Baroness, Lady Gohir, is set out what the Government are doing to ameliorate the impact of the cost of living in these areas.

I turn first to energy prices, which we probably all agree is having the biggest cost of living impact. Of course, it is driven by the Russian war in Ukraine, but brought home to us here on our doorsteps. Many speakers today have mentioned this, including the noble Baronesses, Lady Tyler, Lady Smith, Lady Primarolo and Lady Janke, and the noble Lord, Lord Sikka. It impacts our personal finance in terms of the well-being measures, the economy and, as many have said, our health. As the noble Baroness, Lady Merron, said, its impact is as much as £1.4 billion a year.

I think we all agree that the price freeze was bold and decisive and has united support from all sides of the political spectrum. It gave peace of mind to all households. To echo the point made by the noble Baroness, Lady Drake, 77% of households are anxious about the impact of fuel prices on the cost of living. A measure that seeks to address this for all households will go a long way towards removing that anxiety, bringing financial stability to many households and helping them with their health and well-being.

At the same time, I think we probably accept the comments about whether we should have more targeted support. We will review that after six months. It is probably a sensible thing to do to make sure that we are using such a large investment of public money in the best way possible. In the meantime, in addition to the price freeze, the Government have sought to act to make sure that the 8 million poorest households receive an extra £650 per year.

Thirdly, I turn to the price freeze for business and institutions. To answer the noble Baroness, Lady Janke, that also applies to schools for the next six months. The price freeze will help the whole economy because industry, schools and hospitals are all impacted by the increase in the cost of fuel. It will help the whole economy and jobs and, by helping to keep inflation down by as much as 5%, it will have knock-on benefits in terms of the level of interest rates needed to contain inflation.

Undoubtedly, as mentioned by many speakers, including the noble Baronesses, Lady Sherlock and Lady Tyler, and the noble Lord, Lord Monks, all this has had an impact on interest rates and inflation. While I am sure we all recognise the need to increase interest rates to reduce inflation and the impact that that has on mortgage costs, it would be blind not to recognise the turbulence in the markets caused by the mini-Budget, as mentioned by the noble Lords, Lord Howarth and Lord Monks, and the noble Baroness, Lady Smith.

The impact on the cost of government debt, mortgages and our ability to finance our spending plans is crucial and affects us all in terms of public well-being. So I think we would all agree that the inescapable truth from the past few weeks is that we must find a way to make sure that, as necessary as energy price caps are and as important as investment in health and other services is, we show financial discipline and show that we can live within our means. We have to give confidence to the markets to bring down the cost of government debt and mortgages, which we know have such an impact on every single household.

To that point, I welcome the comment on the stability of Ministers. Speaking as a Minister of only three weeks, I wish for some stability. However, again, I believe that that is above my pay grade.

I want to place what we are doing in the context of needing to work within this fiscal constraint. The markets have demonstrably proved that we must live within our means.

I turn next to food prices; again, this point was recognised by many speakers, including the right reverend Prelate the Bishop of Oxford and the noble Baroness, Lady Merron. Food insecurity clearly has an impact on health, but it also impacts productivity, the economy, education and skills—all key measures of quality of life and well-being. That is why it is so important that we make sure that our children have a nutritious upbringing, which is why the free school meals programme is so important. All infant school kids get a free school meal, as introduced by the Government. Today, that 37.5% level is the highest on record, I believe.

So we are trying to give children a good foundation by having a healthy start and healthy food at school. We are also expanding that with a £200 million holidays and activities food programme to make sure that children can enjoy that when school is out. We also have the Healthy Start scheme to help 300,000 lower-income households. At this time, I thank the right reverend Prelate the Bishop of Oxford, the Church and all those who have a role in helping with food banks, because I know that that area provides a lot of comfort to people.

I turn to the impact of all this on mental health. The point was ably made by the noble Lords, Lord Hendy and Lord Layard, and the noble Baroness, Lady Gohir, among others, that the cost of living crisis causes more stress and anxiety. That is why the £2.3 billion of additional funding per annum that has been put in place to fund mental health services for an extra 2 million people per annum is a key recognition on the part of this Government of the importance of mental health to our general well-being. I believe that all areas have now set up a 24/7 urgent helpline to assist people in this. On a wider scale, the Treasury has set up the Breathing Space programme to assist people and give them breathing space when they need to manage their debts. These are difficult times and I will take this opportunity to urge anyone struggling with their mental health to seek support. Help is out there.

I turn to the pressures on the NHS. Again, many noble Lords’ comments recognised this issue today and, in terms of the broader measures of public well-being, how crucial health is in that—and, therefore, how NHS delivery is crucial to the health and well-being of our country. As a new Minister, I am under no illusions about the cost of living pressures and how they might add to the NHS challenges.

I have spoken previously about our plan for patients. I am confident that our focus on ABCD is the right approach. I will not repeat those points now. At a time of unprecedented investment in the NHS and a larger workforce than ever, my focus is to make sure that, by working with the NHS management team, we really are driving performance as well.

We have all seen examples of NHS brilliance—I had the chance to see some recently at Chase Farm in Watford—but we have all seen examples of poor performance that we know is not good enough. With tight budgets and the cost of living, maximising our return on this investment is more important than ever. That is why a lot of my focus is on making sure that not only are we expanding bed capacity by 7,000, we are expanding capacity in the right places. We must make sure that the beds are being used to most effect to relieve the pressures. Again, this will benefit the whole flow through the system, right back to ambulance and A&E waiting times. At the same time, we must make sure that the 50 million extra GP appointments we are delivering are available to meet demand in the places that need it most.

The noble Lords, Lord Layard and Lord Pendry, also mentioned the key part that adult social care plays in this whole system. As we all know, how we look after our loved ones is key to our relationships, to how we feel about ourselves and to our decency as a nation. Freeing up 13,000 hospital beds—13%—is key to ensuring that our loved ones are cared for in the right place: in care homes and not hospitals. It is also key to creating capacity in our hospitals to improve the flow right the way through the system, so that we can make sure that ambulance and A&E wait times improve. The £500 million discharge fund is a welcome addition to help solve this problem. Again, my job is very much making sure that we spend it in the right places to ensure that it is making a real difference.

In response to the point made by the noble Lord, Lord Pendry, at the same time we are working to recruit staff. Key to that, in the age of full employment, is looking to overseas workers, in the fine tradition of the NHS. I am glad that they have been added to the essential worker list so that we can have access to these markets. As the noble Lord, Lord Pendry, said, we must help people to see acting in the care sector as a vocation, not just a job.

I echo the points made by the noble Lords, Lord Howarth, Lord O’Donnell and Lord Hendy, around the role of work and employment. Work is not only key to our personal finances, it is key to our skills, our health and our own sense of worth and personal well-being. It is also key to a public sense of well-being and of benefit to the economy. In short, work pays. While I am delighted that unemployment is at a record low, as has been mentioned, we need to attract millions of people back into the workplace. Many people in their 50s stopped working during Covid. As the noble Lord, Lord O’Donnell, said, we need to find ways of attracting them back. As a former lead NED at the Department for Work and Pensions, I know about the work that the new Secretary of State, Chloe Smith, is putting in to help people on disability benefit back into the workplace. That is not only good for them and their income; it is good for their self-worth and vital to the economy. That is why we have put £1.3 billion into supporting disabled people and people with health conditions to help them back into work. It is good for them, good for their income and good for the economy.

In closing, I am grateful for the thoughtful contributions from noble Lords and to the noble Baroness, Lady Drake, for securing this debate.

[Lord Sikka (Lab)]

My Lords, will the Minister respond to my request for a public inquiry into the deaths caused by the Government’s policies? I referred to austerity, Covid deaths, deaths while people have been waiting for NHS appointments and poverty. I am aware that there are people here in the Gallery whose families and friends died. They are suffering anguish and they want an inquiry.

[Lord Markham (Con)]

No, I am not going to respond to that point at the moment.

The Government recognise how important it is to protect and promote the well-being of the British people, particularly the most vulnerable. The measures I have outlined today will do just that. We are delivering unprecedented levels of support due to the rising costs of living, and this will already be helping millions of people across the country. The increased costs of living are impacting everyone in a variety of ways, particularly the most vulnerable in society. The situation is very fast moving and I hope noble Lords will share my enthusiasm for continuing an open dialogue as the Government closely monitor the impact felt to ensure that the right support is delivered.

Menopause

Lord Markham Excerpts

Tuesday 18th October 2022 Lords Chamber

[Baroness Thornton]

To ask His Majesty’s Government what steps they are taking (1) to support women going through menopause, and (2) to increase general awareness about the challenges it poses.

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

My Lords, the menopause is a priority area in the women’s health strategy. The NHS has a programme to improve clinical menopause care in England and reduce disparities in access to treatment. It is also developing an education and training package on menopause for healthcare professionals. We have appointed Professor Dame Lesley Regan as the women’s health ambassador for England. Her role includes raising awareness of women’s health issues, including menopause.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. Today is World Menopause Day. My Question is broader than those which concern only the medical response, so I would regard the Minister’s response as inadequate. Given the doubling of menopause-related discrimination claims in a year, showing that we are losing working women from the economy who are otherwise at the peak of their skills and experience, should the Minister not counter employer mismanagement of a transition that all women go through by requiring the HSE and the EHRC to publish advice on this urgently, as neither of them do so?

[Lord Markham (Con)]

I thank the noble Baroness. I agree that it is fitting that we should be having this debate today, World Menopause Day. I completely agree with the importance of this subject for employers, productivity and the economy as a whole, as well as for women’s health.

As I am sure the noble Baroness is aware, 10% of people end up leaving their job during menopause. That is a real loss to business and those individuals. That is why, through our strategy, we are appointing an employee champion in this area. Their job will be to reach out to employers and work with them to make sure that this subject is very high up on their agenda. As an employer myself, in my personal entrepreneurial life, I agree that it is an area of utmost importance.

[Lord Patel (CB)]

My Lords, women with post-menopausal symptoms are disadvantaged by not getting the treatment they need due to restrictions put on the treatments by local formularies. Does the Minister agree that we need a national formulary where all hormone replacement therapy treatments are available to women who need them, and that that national formulary should be made mandatory? If he does not agree, why not?

[Lord Markham (Con)]

I agree that we want to make sure that there is national access. I understand that, whereas we had 30% take-up as long ago as the 1990s, with the incorrect scare around some of the causes since then, that rate is only about 15% today. There is clearly a need to increase awareness and the ability for people to receive treatment.

I am aware of the issue around formularies; I have heard that they believe that it can be resolved. I will take it away and write to the noble Lord to make sure that it is properly dealt with.

[Baroness Brinton (LD)]

My Lords, in the initial Answer that he gave to the noble Baroness, Lady Thornton, the Minister said that access to support during the menopause is vital. Does he therefore agree that, for health and economic reasons, the menopause should be added to the quality and outcomes framework to encourage doctors to investigate and treat patients who present with symptoms associated with the menopause?

[Lord Markham (Con)]

Yes. The noble Baroness will be aware that only 55% of women showing symptoms felt able to talk to GPs about it and another 30% felt that there were delays in diagnosis. Clearly, more work needs to be done. I know that it is part of the core curriculum—that is not the proper phrasing; please excuse me. The whole point of appointing a women’s health ambassador is to make sure that every avenue and channel is used to maximise access, whether at the level of GPs or as part of the education or formularies.

[Baroness Gale (Lab)]

My Lords, what consideration has been given to allow women who need treatment for the menopause to have free prescriptions, as they do in Wales, for example, where no one has to pay for any prescriptions, and in Scotland and Northern Ireland? Only in England are there prescription fees. Free prescriptions would be a great help to women and would remove a financial barrier to accessing treatment.

--- Later in debate ---

[Lord Markham (Con)]

With constraints on the public purse, I like many others believe that targeted support is probably the best form of support, and 60% of women receive it free. At the same time, as I am sure the noble Baroness is aware, to prevent it being a barrier to the others, next year we are introducing a fixed cap so that the costs should be a maximum of only £19 per year, which I believe will not act as a disincentive to the 40% who can afford to pay.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The menopause is associated with an increased risk of heart attacks and strokes as a result of falling oestrogen levels. Despite this, women are consistently less well represented in cardiovascular clinical research than men. Is the Minister content that the ongoing publicly funded research effort in cardiovascular disease will be able adequately to address the challenge of postmenopausal heart disease?

[Lord Markham (Con)]

I will not pretend to be able to give a detailed answer at this point. I am aware that part of the funding through the health and wellbeing fund is to make sure that women’s reproductive health is included in some of those research programmes, but I will look specifically at the cardiovascular point and respond in writing.

[Baroness Hussein-Ece (LD)]

My Lords, is the Minister aware of the report from the Fawcett Society which estimated that 900,000 women have left the workforce and countless others are reducing their hours and avoiding promotion because of their menopause symptoms? The Minister partially addressed this in response to the noble Baroness earlier, but what plans do the Government have, if any, to stem the flow of those experienced women leaving the workforce, which has an ongoing impact on equalities and the ability of women to pursue their careers in the way that men do?

[Lord Markham (Con)]

I again agree with the point. Helpfully, the noble Baroness, Lady Thornton, pointed me towards the excellent Fawcett Society report this morning, for which I am grateful. It makes for a very interesting read. As I mentioned earlier, the statistic that 10% of women during the menopause end up leaving employment is a telling one. That is what the appointment of health ambassador for the employers is all about. I hope that noble Lords will see the seriousness with which I take this subject, because it is vital not only to women but to the economy and business as a whole. This time next year—if I am still here—I commit to doing a stocktake report on the progress that we have made on this over the year, because I think it is vital.

[Baroness Chakrabarti (Lab)]

My Lords, I am grateful to the Minister for the very serious tone of his response to this Question. I declare an interest which is not in the register but is self-evident from my date of birth, which is public information. Will he readdress that part of my noble friend’s question that was about the EHRC and whether that public body has a role in setting out guidance for employers? Will he, in the light of his commitment on this subject, suggest that the Equality Act needs to be at the very least enforced and possibly beefed up in this regard?

[Lord Markham (Con)]

I apologise if I have not answered the point on the EHRC satisfactorily and it is best that I follow it up in writing to make sure that I do so.

On the Equality Act, as I am sure everyone is aware, menopause should be covered as a protected characteristic within the terms of discrimination, be it on grounds of sex or age, and I believe there are cases where it has been shown to be used correctly in that regard, so the capability is there. However, if there is not adequate reason for redress under the Equality Act, that would obviously need to be looked at in the future.

Childhood Obesity

Lord Markham Excerpts

Monday 17th October 2022 Lords Chamber

[Baroness Boycott]

To ask His Majesty’s Government what is their strategy to prevent childhood obesity?

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

We are working with the food industry to ensure that it is easier for people to make healthier choices and increase progress on the reformulation of foods. In addition, there is a range of support to help children living with obesity and being overweight to achieve and maintain a healthier weight.

[Baroness Boycott (CB)]

I thank the noble Lord for that very brief Answer. I wondered whether, in the current spirit of U-turns, the noble Lord could tell the House whether the Government will reverse their initial idea of reviewing the policies agreed by the previous Tory Government to ban two for the price of one offers on unhealthy food and to restrict advertising of foods high in fat, sugar and salt to kids during the times they watch TV. Health campaigners and medical professionals have called the possible reversal of this decision staggering and an incredible blow to the health of this country. I would be grateful for anything the noble Lord could add.

[Lord Markham (Con)]

I thank the noble Baroness for bringing this issue before us. I know that she is a passionate campaigner in this area, with a strong track record. I like to believe that we have had a multi-pronged strategy, because this is a complex area. Look at the four areas the OECD recommends in terms of addressing this complex issue. First, on information and education, we have been working very strongly on education programmes, labelling and the traffic lights, and with menus and restaurants. Secondly, on increasing healthy choices, again, we have worked with industry on recipes. Thirdly, on modifying cost, obviously the sugar tax has shown big reductions there. Lastly, on the restrictions on promotions and placements, again, 1 October saw us change the way items are presented to take away some of the problems of pester power. There is a big formulation of approaches. It is probably appropriate at the moment, with so much going on, that we seek to review their success. I know that the delay in the timings is all about giving ourselves that opportunity.

[Lord McColl of Dulwich (Con)]

My Lords, could the 40 million people in this country who are obese or overweight be encouraged to become familiar with the medical fact that, if they were to make do with one less meal a day, it would help their health and the NHS and they would live to a normal age not plagued by dozens of very unpleasant diseases?

[Lord Markham (Con)]

I thank and agree with my noble friend. He is correct. The cost of obesity to the NHS amounts to around £6.5 billion a year; obviously, this is in addition to not being very good for the people concerned in terms of healthy lifestyles. That is why we have a programme of action, as I outlined. This is something we feel it is important for us to get on with, not just for children but, as the noble Lord referred to, to help adults in this area as well.

[Lord Krebs (CB)]

My Lords, last year, the Government published a report on the promotion of food. I shall quote a few sentences from it:

“Although promotions appear to be mechanisms to help consumers save money, data shows that they increase consumer spending by encouraging people to buy more than they intended to buy in the first place … The latest data shows that we buy almost 20% more as a direct result of promotions. Consumers typically do not stockpile these extra purchases to take advantage of the lower price, instead they increase their consumption.”


It went on to say that the latest data

“shows that shoppers who buy more of their food and drink on promotion tend to purchase more HFSS”—

high-fat, sugar and salt—

“products, in greater volume, and are more likely to be overweight or living with obesity.”

Does the Minister agree with this analysis, published by his Government last year? If so, what are the Government doing about it in policy terms?

[Lord Markham (Con)]

I thank the noble Lord. The figures to which he refers are a mixture of the pricing of these so-called “buy one, get one free”-type promotions and their positioning in a supermarket. In fact, the data shows that as much as a 50% increase in sales can be driven by where these promotions are placed in a supermarket. That is why the focus now is on what changes will be made on 1 October to reduce the purchase of a lot of the types of food groups we are talking about by moving them away from prominent areas. Once we see the results of those changes, we will be in a position to review some of the pricing and promotions to which the noble Lord refers.

[Lord Rennard (LD)]

My Lords, this morning, this month’s Chancellor reversed nearly all last month’s Chancellor’s tax changes. Meanwhile, increasing levels of childhood obesity are adding considerably to the cost to the NHS of treating conditions such as diabetes. Can the Minister confirm the commitment to the soft drinks industry levy, which has been successful in reducing the level of sugar in soft drinks and provides funds for sporting activities in schools and school breakfast clubs?

[Lord Markham (Con)]

My Lords, as the House will be aware, the tax on sugar in drinks has reduced consumption of sugar by 44%, so I totally agree with the sentiment. We have been successful in this. We are looking to improve in the area of sugary food, where we have managed to reduce some of that content by as much as 13%.

[Lord Hunt of Kings Heath (Lab)]

My Lords, has the Minister seen the startling statistics showing the number of economically inactive people aged 50 and over, much of which is caused by ill health, with obesity thought to play a major role. Given that, why on earth do the Government need to fudge around and review? Why do they not get on with an assertive campaign to tackle obesity?

[Lord Markham (Con)]

I do not believe that we are fudging around. Noble Lords will see some very firm action. If the noble Lord goes into the supermarkets today, he will see a very big difference in how you see the food. There are big changes. I totally agree on the importance of this. I was the lead NED of the DWP, so I know how many inactive people there are in the workforce and how much better it will be for them and the economy if we can get them active and into work. I completely agree with the sentiment and the action that we are taking to drive it forward.

[The Lord Bishop of London]

My Lords, the National Food Strategy to tackle obesity, the new tobacco control plan and the health disparities White Paper were key to the Government’s aim to level-up health. The most recent NHS Providers report found that 95% of trust leaders said that the cost of living had either significantly or severely worsened health inequalities in the local area. Given the worsening situation, can the Minister confirm when the health disparities White Paper will be published? If not, can he point to what else the Government are doing to reduce inequalities in health?

[Lord Markham (Con)]

I thank the right reverend Prelate. I agree with the sentiment of the question. We see figures whereby, as I am sure we are aware, the least deprived people will have half the levels of obesity of some of the more highly deprived ones. On education and the need to look at those inequalities, I agree. I cannot yet commit to a date when the inequalities report will be published; I do not have that information. However, as soon as I know, I will let the House know.

[Lord Vaizey of Didcot (Con)]

My Lords, this Government have done two things which cannot be criticised. One is to appoint my noble friend as a Health Minister; he is a welcome addition to this House. The second is to junk the ban on junk food advertising. There is no evidence that junk food advertising has an impact on obesity. It is an anti-growth measure that restricts our broadcasters’ ability to generate revenue. For as long as he is in his post—the next six or so days—I hope that he maintains this policy.

[Lord Markham (Con)]

I thank my noble friend for his warm wishes and his wishes for my longevity in this position. I agree that on the scale of carrot and stick with these sorts of measures, we come down much more towards the carrot and the use of education to promote the right sort of food, rather than the stick, and that is what we are seeing in terms of results.

[Baroness Merron (Lab)]

My Lords, analysis of the national child weight management programme by the Local Government Association has found that not only are the Government heading towards missing their goal of halving child obesity by 2030 but, on current trajectories, childhood obesity is increasing. Do the Government remain committed to their target and if they are, what will they do differently?

[Lord Markham (Con)]

My understanding is that the figures for childhood obesity have been fairly flat for a number of years, apart from for the year of Covid, when they all went up. The year after that, they came down again. To me, that demonstrates the importance of free school meals and the action we are taking there for people to have good, calorific and sensible types of food. We have seen significant reductions in childhood obesity in the last year. To my mind, what is important in all this is the emphasis we are putting on the free school meals programme. We have the highest ever number of people on free school meals, up from 15% in 2015 to 23% today. Part of that is free school meals for all infant schoolchildren, so that we can make sure that their food is as healthy as possible.

Skills for Care Report

Lord Markham Excerpts

Thursday 13th October 2022 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they plan to take in response to the report by Skills for Care The state of the adult social care sector and workforce in England 2022, published on 11 October, which shows that there are 165,000 vacancies in the social care workforce and that this workforce has shrunk for the first time in 10 years.

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

My Lords, we are investing in adult social care. We have made £500 million available to support discharge from hospital into the community and bolster the workforce this winter; that is on top of record funding to support our 10-year plan as set out in the People at the Heart of Care White Paper. We are backing recruitment at home and abroad with a £15 million international recruitment fund and a new domestic campaign, which we will launch shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister. I expected him to mention the £500 million workforce fund, of course, but he will know that it has been described as a drop in the ocean and that councils are calling for far more to be pumped into better pay and recruitment in the social care workforce. I do not want to be disrespectful to the new Minister, who I know has a lot on his plate, but I wonder whether he and the Government really understand the scale of the crisis in social care. Some 50,000 people left an already inadequate workforce last year; that is not surprising when they can get better pay and conditions in Tesco, and when one in five care workers is in poverty despite being in full-time work.

The previous Prime Minister told us that he would fix social care. The current Prime Minister has withdrawn the levy that would eventually have provided extra funds, with no indication of how those funds will be replaced. Is the Minister aware that, meanwhile, thousands of older and disabled people, both in their own homes and in care homes, are being neglected and deprived of services in a way that no decent society should tolerate? Will he acknowledge both the depth of the crisis and the fact that we need a step change in the way we value social care and the dedicated people who provide it?

--- Later in debate ---

[Lord Markham (Con)]

First, let me say that we value social care. As the noble Baroness will be aware, the £500 million was in addition to a £5.4 billion increase over three years. Again, that underlines the importance that we see behind adult social care and how it is a crucial part of our whole plan, as outlined in ABCD, not only to give the right conditions and dignity for the elderly people whom the noble Baroness mentions but as a vital way of releasing space in our hospitals—this drives right through the system—to create space both in A&E and through the rest of the care system. It is an area of vital interest and something that I can assure noble Lords has a lot of focus from the department.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I strongly welcome the Government’s action to put care workers on the shortage occupation list this year, which is important for unlocking immediate supply. However, might I ask the Minister to note two key points from Skills for Care’s report, which are important for further action for sustainable care workers? The first is that, although the retention rate has remained more or less stable since last year, the starter rate has fallen from 37.3% to 30.8%. Can I suggest that the Minister looks at more incentives for starters? The second point is that, on average, employers with favourable work metrics such as high levels of learning and development have better CQC ratings. Given the UQ coming up later, that is another critical area to look at for improvement.

[Lord Markham (Con)]

My Lords, my noble friend is correct that this is also a labour supply issue. Part of the benefit of living in an economy with full employment is, of course, that there is little unemployment. Part of the downside of that is the competition for jobs. My noble friend rightly points out the need to recruit more in this sector; that is why I am pleased that she mentioned the work we are doing to add this sector to the essential workers list so that we can recruit people from overseas and get essential workers in.

[Lord Patel (CB)]

My Lords, I welcome the Minister to his post. I look forward to working with him. In that spirit, I ask him this: where might I find the data relating to the long-term planning for the NHS and social care workforce? If such data does not exist, will he agree that such planning data should be made available as a matter of urgency?

[Lord Markham (Con)]

My Lords, my understanding is that there is a 10-year plan as part of a workforce plan, which rightly looks at the issues raised by the noble Lord. As I mentioned in my answer to the previous question, the workforce is key to this sector. We employ 1.5 million people; I think that they account for about 5% of our whole workforce. So making sure that this is an area that people want to come and work in, that people enjoy and that people see as a vocation is vital and will be part of the plan. I will look up the data requested and reply in writing.

[Baroness Chakrabarti (Lab)]

My Lords, I, too, welcome the Minister to his place. I congratulate him on the tone of his responses so far. I agree with him that the workforce is key. Another feature of the report is that a quarter of the adult social care workforce are on zero-hours contracts and get paid £1 an hour less than healthcare assistants on average. Given the projection in the report that, if we are to keep up with our ageing population, we will need the best part of 500,000 more of these workers by 2035, we must address their low pay, must we not?

[Lord Markham (Con)]

The noble Baroness is correct that a number of people are on zero-hours contracts. As I am sure she is aware, their employment is through a number of agencies and local authorities, but it is an issue in a number of places and goes to the wider conversation about how we make this sector an attractive place to work. Earlier, my colleague mentioned the Skills for Care working group, which found that a significant proportion of all employers—around 20%—have a turnover rate of only around 10% versus the 29% average. So, clearly there are areas where certain employers do a fantastic job of not only recruiting but retaining, and making the sector an attractive place to work. I believe that the whole emphasis of the conversation we are having now is exactly about how to make this sector an attractive place to work because, as we all know, it is a vital part of our care and health system.

[Baroness Brinton (LD)]

My Lords, the Minister referred to the £500 million investment in social care but this is only his fourth day in the job. Many people in your Lordships’ House know that that money is for winter pressures and was omitted from the budget for the NHS and social care at the beginning of the year. Without it, social care would be in even deeper trouble than it is now. The noble Baroness, Lady Chakrabarti, made an extremely important point about zero-hours contracts. The problem of staff working in domiciliary care is that there is not enough money even to allow them to be paid for travelling between clients. There is a real shortage of money. This is a group of dedicated workers who are being treated very badly. Will the Minister undertake to look at this particular problem?

[Lord Markham (Con)]

Any industry with the sort of turnover rate that was mentioned earlier demonstrates that there is a need to look further into it, so I absolutely accept the premise of the question and, as I mentioned before, the importance of this area. As I have said before, this is also about looking at areas of best practice because we can always look to spend more money but we know that there are limitations on the public purse. I would not be doing my job if I did not try to see where we can learn from good employers, employ those practices and see whether we can spread them wider so that everyone has the same level.

The other point that I made previously was about opening this up. We know that our healthcare system is founded on good workers from all around the world. They can be a bedrock. I am delighted that we are looking into that area now. We are starting to see good numbers of people coming in from abroad. It is an excellent level of entry into our country. There are a number of things we can do to improve the situation but I completely agree with the noble Baroness on the importance of tackling it.

[Baroness Wheeler (Lab)]

My Lords, the Health Foundation has described the Skills for Care report as yet another signal of a social care system on its knees, with care providers struggling to compete with other employers and, in many cases, unable even to pay the national minimum wage to essential care staff. As we have heard, the figures are that one in five residential care workers in the UK was living in poverty, and that was before the cost of living crisis, compared with one in eight of all workers, which is a shocking figure in itself. When will the Government commit specifically to addressing the appalling low pay and poor working conditions throughout the social care sector?

[Lord Markham (Con)]

My understanding is that the pay of carers is always at least the national living wage. I will look into that, but that is my understanding. That is not to say that where they deserve, and should be paid, more that this should not be the case, but the national living wage is set, as the noble Baroness will be aware, exactly as it says: a national living wage. In terms of the cost of living pressures, the energy price cap is of course about focusing on those people who need it most, so there are a number of measures that we are putting in place to ensure that this happens. Most of all, it is about ensuring that this is a good, safe and enjoyable vocation for people.