Diabetic Prevention Programme

Lord Scriven Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

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

[Lord Scriven (LD)]

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

Social Care: Adults

Lord Scriven Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Lord Kamall (Con)]

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

[Lord Scriven (LD)]

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

[Lord Kamall (Con)]

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

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

Lord Scriven Excerpts

Monday 20th June 2022 Grand Committee

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

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

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

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

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

I commend these regulations to the Committee.

[Lord Scriven (LD)]

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

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

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

--- Later in debate ---

[Lord Kamall (Con)]

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

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

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

[Lord Scriven (LD)]

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

[Lord Kamall (Con)]

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

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

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

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

Personal Protective Equipment: Waste

Lord Scriven Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

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

[Lord Scriven (LD)]

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

[Lord Kamall (Con)]

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

NHS: Abuse of Nurses

Lord Scriven Excerpts

Tuesday 5th April 2022 Lords Chamber

[Lord Kamall (Con)]

The NHS is looking at a number of different ways of tackling violence towards staff, as well as supporting them in how to handle difficult situations and giving them well-being support. On the specific issue that the noble Baroness raises, it is probably better if I commit to writing to her.

[Lord Scriven (LD)]

My Lords, the individuals who abuse healthcare staff should understand and then pay for the harm they cause and be helped to change their behaviour. To augment existing arrangements, will the Government therefore look at implementing an NHS restorative justice scheme?

[Lord Kamall (Con)]

We are looking at the way in which abusers are treated. On 13 November 2018, the Assaults on Emergency Workers (Offences) Act 2018 came into force, and since 2020 we have also been working with the Ministry of Justice in consulting on doubling the sentence for such assaults to two years. The Government are now legislating for this through the Police, Crime, Sentencing and Courts Bill. In addition, a Joint Agreement on Offences Against Emergency Workers was agreed between NHS England and NHS Improvement and the Crown Prosecution Service in January 2020.

Health and Care Bill

Lord Scriven Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Scriven (LD)]

My Lords, I support the amendments in the name of the noble Lord, Lord Lansley, and declare my interest as a vice-president of the Local Government Association.

There has been a whole debate at Second Reading and in Committee about the equality of local government and the NHS in this regard. Importantly, local government focuses on place because it is used to doing so. If, as the noble Lord, Lord Lansley, has said, the legislation does not include powers to delegate right down to local government so that it can work with the NHS—which it sees as its key responsibility—then there will be a gap, and this will not be seen as a true partnership. More importantly, the powers that would unleash some of the issues central to the Bill—better integration, reducing health inequalities and improving health outcomes—will not be achieved. There will not be the powers of delegation that will be allowed to place when innovation starts.

That is why the amendments tabled by the noble Lord, Lord Lansley, are important, particularly Amendment 96, on the roles of the place board. If the Government do not take this forward, it will be a total abdication. Place will be important in unleashing innovation, and the noble Lord, Lord Lansley, has rightly pointed out this gap in the legislation.

[Baroness Walmsley (LD)]

My Lords, the noble Lord, Lord Lansley, has made some important and sensible points, and I look forward to hearing the Minister’s reply.

My noble friend Lord Scriven raised the important question of the role of local authorities. I simply want to add that I happen to know that some of the chairs-designate of the ICBs would really like to know the answer to the question posed by the noble Lord, Lord Lansley, early on in his speech. What is the relationship of the health and well-being boards to the ICBs? If those people are confused, it is not surprising that noble Lords are too.

Health and Care Bill

Lord Scriven Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

We have a world choked with plastic. We have a world wildly overheating. We have a world—as the noble Baroness, Lady Young of Old Scone, said—where biodiversity is in collapse. I think the NHS is starting to focus on these things, but we need to see, as the IPCC said, that health and environment are not two separate issues. We live in the environment, and we have to look after it in every part of our activities.

[Lord Scriven (LD)]

My Lords, I rise for the first time on Report and declare my interests as laid out in the register, particularly as a non-executive director of Chesterfield Royal Hospital NHS Trust and as a vice-president of the Local Government Association. We on these Benches welcome this suite of amendments, with a caveat of clarification that the noble Baroness, Lady Young of Old Scone, raised, to do with not just the climate but the implications for the environment.

The reason we welcome this suite of amendments is that it is vital that there is mandatory guidance from the centre to all parts of the system in the NHS. The only thing I seek to push the Minister on is that she said the guidance would be out within 12 months. I ask that, as we are in a crisis and this is important, it is done as soon as possible. The reason for this—I have experience of it from Chesterfield—is that some of the procurement or building decisions made today will not come around for maybe three or four years, but the design and implications that start today have life cycle implications for both the climate and environment over a long period. So, I strongly push the Minister to ask that the guidance is out as fast as possible, and we do not wait for the whole 12 months.

[Baroness Walmsley (LD)]

My Lords, I, too, am a member of Peers for the Planet and I congratulate the noble Baroness, Lady Hayman, and the noble Lord, Lord Stevens, on their engagement with the Government and thank them for taking their concerns on board.

I have previously raised the fact that a big way in which the NHS can reduce its emissions is by having energy-efficient buildings, and I should like reassurance that any new buildings and refurbishment of the NHS estate will involve highly insulated and low-energy buildings. There are so many things that the NHS can do by using low-energy lighting, reducing microplastics, using compostable single-use plastic or not using plastic at all and using microwaves to deal with clinical waste, because they are much more energy efficient. How will all this be reviewed after the Bill has passed? Will there be any reporting back on how well the NHS has been able to respond to this challenge?

Health and Care Bill

Lord Scriven Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

So my amendment is there to ensure that this does not get forgotten in the way that services are commissioned and planned for, and so that rehabilitation is viewed as an integral part of the follow-on after the acute phase, as people get home, transition from hospital into the community and look towards resuming their life. It might well be very different from the life they had before, but this would enable them to fulfil their potential.

[Lord Scriven (LD)]

My Lords, I support the amendments in the name of the noble Lord, Lord Crisp, to which I have added my name. I think the noble Lord had to table these amendments because the Minister said when we discussed this in Committee that his challenge was to ensure that

“primary care is better represented and not dominated by acute trusts.”—[Official Report, 20/1/22; col. 1854.]

We expected something to come back that did exactly that, because the very fact the Minister said that suggested that the Government had accepted that there was a potential imbalance with the role of primary care.

I come back to the purpose of the Bill, which I did a number of times in Committee. The purpose of the Bill is to bring about effective integration, improve health outcomes and reduce health inequalities. That is underpinned by making primary care central to healthcare planning and ideas about healthcare, following through on those plans and having primary care as an equal partner in the ICB. So we moved away from who we want on the board to asking very simply for primary care to be treated as an equal in the planning, implementation and monitoring of what will happen in health and social care in the area. It is disappointing that, despite the Minister’s suggestion that he would go away and look at this, nothing new has come back since Committee to deal with that.

What new has come back on Report which makes sure that primary care can be better represented and not dominated by acute trusts in this new system? My worry is that the Bill giving this to NHS acute trusts and foundation trusts signals which are most important within the system. If primary care does not have that equity, there will be unrealistic expectations and uninformed decisions made in planning for final decisions and tactical, not transformational, systems and services, which will not represent the full view of primary care. It is for those reasons that I support the amendments of the noble Lord, Lord Crisp, and look forward to the Minister bringing to the House’s attention what new proposals are in here on Report to do with the challenge that he set himself: to ensure that primary care has a bigger voice and is not dominated by the acute sector.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I added my name to the amendments of the noble Lord, Lord Crisp, and echo the remarks of the noble Lord, Lord Scriven, on the Minister’s offer in Committee to go back to see how the potential dominance of acute trusts could be mitigated by ensuring that the voice of primary care was heard loud and clear in the various decision-making bodies.

It is a pity that it is a very late hour, because primary care warrants a much wider debate, given the challenges it undoubtedly faces. We are all aware of the workforce issues, such as the reluctance of many GPs to take on partnerships and that so many GPs will do only part-time work, partly because of the pressures. It is because of those challenges and because primary care is so valued in this country that we need some assurances that the people running the new system being introduced through this legislation will be concerned with and listen to primary care.

It is somewhat ironic. The noble Lord, Lord Lansley, is not here any more, but in a sense, we are seeing a transformation from what he hoped would be a GP-led system through clinical commissioning groups to one which looks very strongly acute care-led in the integrated care boards. As someone who was spent quite a lot of my time in the health service around acute trusts, I do not particularly worry about acute trusts being listened to, because we depend on them so much. We really need assurance that integrated care boards will take primary care seriously.

Finally, whatever concerns and reservations we on this side of the House had about clinical commissioning groups, some GPs undoubtedly rose to the challenge of leadership within them. I should be very concerned if they were lost from the new arrangements. It would be good to know that the Government recognise that and will ensure that a place is found for them in the new system.

Covid-19: Lateral Flow Tests

Lord Scriven Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I should perhaps start with some background on this and why we have reached the situation we are in. Her Majesty’s Government began the large-scale procurement of Covid-19 test kits at the height of the pandemic. To ensure supplies for the universal testing offer, Porton Down assesses tests offered to Government. It found that three-quarters of those offered failed to meet their stated performance in their instructions for use. For most testing technology, the manufacturer needed only to do self-assessment to meet the CE marking rules, but clearly, when they were tested, they were not meeting those standards. We considered that the current standard was insufficient and did not keep bad tests off the market. That is why we had a public consultation in April that showed strong support for a more rigorous regime. In terms of avoiding a cliff edge, as it were, if they have not been validated, we are looking at solutions.

[Lord Scriven (LD)]

My Lords, reports indicate that the Government are seeking to implement testing only in health care settings and for the most vulnerable people, along with stopping the requirement to self-isolate if a person has Covid-19, in the next two weeks. What evidence from SAGE and NERVTAG do the Government have to show that at present, this is in the best public health interest of the country?

[Lord Kamall (Con)]

I am not aware of any announcements or measures that accord with the noble Lord’s question.

Covid-19: Lockdowns

Lord Scriven Excerpts

Wednesday 9th February 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend raises an important issue about the trade-offs that had to be considered when the Government announced the lockdown and plan A measures. They also announced measures to restrict the transmission of the disease. Costs and benefits had to be weighed up. It was often a nuanced decision. We are clear about the backlog in tackling mental health issues. In debates on the Health and Social Care Bill, many noble Lords across the House have expressed the importance of tackling mental health issues in this country. We hope to put that at the forefront of future health policy.

[Lord Scriven (LD)]

My Lords, all papers with modelled counterfactuals are excluded from the report mentioned in the noble Lord’s Question. As this is the most common method used in infectious disease assessments, does the Minister agree that this has the practical effect of excluding most epidemiological research from the review?

[Lord Kamall (Con)]

Had I still been in academia and was asked to referee this paper for a journal, I would have pointed out a number of issues, including the focus and bias on one particular study, for example, and the studies that were excluded without justifying why.