Integration of Primary and Community Care (Committee Report)

Lord Allan of Hallam Excerpts

Thursday 9th May 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, and all the members of the committee for a very useful report on the challenges of integrating primary and community care, and for some potential solutions. I am grateful particularly for an opportunity to talk about data and technology in the health and care system, which is one of my favourite topics. I also congratulate the noble Lord, Lord Jamieson, on a thoughtful maiden speech. I was delighted to hear that he studied and began his career in my home city of Sheffield. Once people have followed the advice of the noble Lord, Lord Altrincham, to get their health sorted out in Greater Manchester, he might agree that they might then want to cross the Pennines to get a decent higher education in Sheffield.

The recommendations in the report on structure were really interesting and substantive. I shall talk about them first, then go on to the data. The report talks about integrated care boards, integrated care services and integrated care partnerships. If I may coin a Latin-based neologism, we could refer to them all as ICXs—integrated care entities. Some valid questions are already being asked about their effectiveness. Having to talk about them in this convoluted way in a sense already indicates that there are some real questions of accountability: who is doing what? To an extent, the thing that is supposed to pull everything together is itself causing some confusion. I read the Government’s response and, on the recommendation on maturity, they said that they were going to start a three-year research programme. This is great and serious, but three years from now will be a long time from when the ICXs were set up.

The Government also talked about the CQC process and about NHS England surveying people to ask about the effects on them in 2025-26. Does the Minister feel there is a sufficient sense of urgency? Trust and morale once lost are very hard to rebuild, and there enough indicators out there. The Government have placed a lot of store on the ICXs delivering all this. If they cannot deliver more quickly, and if we have to wait another three or four years before we really start to understand it, there are some genuine questions to be asked. None of us wants another reorganisation, but we need this thing to work, as the committee’s report has highlighted.

I turn to my favourite subject. Building to some extent on the comments from my noble friend Lady Barker, we need to understand that an interaction with the health and care system is, in technical terms, an event. The real priority is to get a proper record of that event. Three things need to be noted. Who was the person who had the treatment? Which organisation treated them? Ideally, that would go down to the individual, but certainly we want to know the organisation. Furthermore, where did it happen? With these three accurate identifiers, it is possible to start to pull the data together, whichever system it is stored in.

Each person has an NHS number. I shall be interested to hear from the Minister as to how he feels about the rollout of the NHS number. This report talks particularly about NHS organisations. To what extent is this being used within the NHS and other organisations? It is still certainly my experience—and that of others—that hospitals want a hospital number. Why do they want this? Why are they not dealing with the NHS number? It is critical that there is a real push to make sure that the NHS number in which we have invested and which is given to people is being used.

The Government have invested in something called the unique premises reference number—the UPRN. Every single premises in the United Kingdom has its own number. Government policy is to use that everywhere but, again, we are not seeing this happen. I am ready to hear from the Minister about the extent to which this is being pushed out across health and care so that, when talking about where someone is treated, it always means the same place.

Lastly, is there a unique set of basic organisational codes? There are tens of thousands of records so, in that way, it would be possible to identify the organisation that treated someone. Absent all of this, there is something called fuzzy matching. For example, John Smith, who lives in the High Street, was treated at some vaguely named health centre. Humans like that, but computers hate it—computers need precision. Those are the basics. We can then move on to the content of what happened in the interaction. Again, that is complicated. I think we would go a long way and solve a lot of the problems highlighted in the report by just knowing who the person was, uniquely, where they were treated and which organisation dealt with them. That could be done much more quickly.

The report’s recommendation on the data protection guidance was really important. My noble friend Lady Tyler talked about the Government’s response as being vague and technocratic. We end up talking about data protection in these very technical terms, and end up saying that data protection law says no as a default response. If we think about it in much more human and intelligible terms, would anyone be surprised that the data was used in a particular way? This is a basic human test that we can all understand.

If I go to an A&E department, and my medical data goes to the ward then to my GP, I am not going to be surprised—in fact, I will be surprised if it does not make that journey. If you pass it on to a dentist or an optician, I may be okay with that, but I would probably want to have a conversation about it, and say it is fine for some of my medical data to go to dentists and opticians some of the time. If you pass it to a pharma company for something totally unrelated to my own personal care, I might be very surprised and very angry. It is about applying those kinds of human tests.

There is a legal basis behind this that is missing. Will the Minister look at making sure that the people who work in the system are given training to understand the principles behind data protection? I suspect a lot of it is very detailed, telling them what the law says and how to tick the boxes; that is what gets us into this frozen position where data does not flow when it should, and people are surprised it is not flowing. Sometimes data may end up flowing where it should not, because people have not understood that it is happening. In their response, the Government talked about the secure data environment and things like OpenSAFELY. Those are very good solutions for dealing with areas where people would not want data to be flowing freely. We have created a place to deal with that, but let us get the data moving to where we want it to go.

Finally, I wanted to touch on workforce. The NHS workforce plan, which we have all welcomed, rightly focuses on doctors, nurses and other associated medical professions. However, when we are talking about this kind of work, in a lot of cases we need people to be skilled up. We need a very skilled workforce in other disciplines—for example, in change management, which is itself a discipline. Encouraging people to work differently is not something that happens overnight, and it is not necessarily a medical skill. The ICXs would benefit from having a skilled workforce who understand how to do change management.

Contracting is rightly a major feature of the report. It is about writing better contracts and being more insistent with those you are contracting with. It is not just about pounds and pennies and value for money. It is about saying, “We are not going to buy your system if it hasn’t got the right data standard, and I am going to insist on that because I know I can. I am not just going to sign whatever you stick in front me”. That kind of contracting ability is really important. Data analysts, who can look at all the data generated by these systems and figure out what is going on, are highly skilled professionals. I do not think we have got to the point in the workforce plan where we understand that need and how we are going to meet it.

We have an excellent report, and I thank the committee for what they produced. It has zeroed in on some of the real priority areas. The Government’s response is well intentioned but thin, and I hope that the Minister can put a bit more flesh on the bones of what they are going to do in practice.

Immunisation: Children

Lord Allan of Hallam Excerpts

Wednesday 8th May 2024 Lords Chamber

[Lord Markham (Con)]

I thank the right reverend Prelate. First, I completely agree that using faith leaders is often a very good way to reach hard-to-reach communities, particularly as it is often ethnic-minority communities that have lower rates of vaccine uptake. Whooping cough has been a concern; we had about 850 cases in January 2024 compared with about 550 for the whole of 2023. We are deploying a number of strategies that have been proven to work in areas such as MMR: using outreach groups, having leaflets in 15 languages and having recall programmes. In the case of whooping cough, if we can get pregnant mothers vaccinated, that is 97% effective.

[Lord Allan of Hallam (LD)]

My Lords, I know the Minister agrees that it would help if parents had online access to their children’s vaccination records and, with his customary efficiency, he kindly wrote to me following a previous exchange on the digital red book to say that parental access to baby records is being piloted in 70 general practices. Can I ask the Minister to give us a ballpark date for when it might be rolled out to the other 6,000-odd GP practices in the United Kingdom? Will it be shortly, soon or in due course?

[Lord Markham (Con)]

Or “none of the above”. The noble Lord is quite correct. Of course, data is vital in this whole area, and getting that sharing of data and understanding with people is vital. I will come back on the precise date, but I hope it will be soon.

International Health Regulations: Amendments

Lord Allan of Hallam Excerpts

Tuesday 7th May 2024 Lords Chamber

[Lord Markham (Con)]

The key thing that we are looking at here, which I would hope that all of us could agree on, is that we will not agree to anything in this process which impacts our sovereignty as a country and our ability to react to a pandemic in a way that is appropriate for this country and this Government. I hope that we can all rely on that, and that is very much our approach to these negotiations.

[Lord Allan of Hallam (LD)]

My Lords, objective 2 of the UK’s Global Health Framework says that the Government will:

“Reform global health architecture, including through a strengthened World Health Organization, driving more coherent governance and collaboration across the international system”.


Aside from producing a winning sentence for policy buzzword bingo, can the Minister point to any specific global health architecture wins that the Government have had in the year since that policy was published?

[Lord Markham (Con)]

I am not sure in what year that policy was published. However, I can talk about how, when we were president of the G7 in 2021, we led the calls to donate vaccines on a worldwide basis, which led to 1.2 billion doses being donated to countries all around the world, led by Britain’s initiative with AstraZeneca. That was great global co-operation and we can feel very proud of it.

Homecare Medicines Services (Public Services Committee Report)

Lord Allan of Hallam Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the committee for looking into this service, which is important to so many people, as we have heard, and involves significant if not fully understood public expenditure. I think we have it to the nearest penny on national insurance; we appear to be in that kind of rounding on this form of expenditure.

As someone who is still learning about many aspects of the NHS service, I am also extremely grateful to the noble Baroness, Lady Morris of Yardley, who gave us a masterclass in how to present a problem very efficiently and concisely and then describe possible solutions to it. Anyone can just pick up the report or her speech and understand what is going on in short order, which is extremely appreciated.

I am also especially pleased to be taking part in a debate with my noble friend Lord Willis. We shared an office for eight happy and productive years at the other end of the building, but we very rarely get to speak in debates with each other. It may be a decade or two since this last happened.

The Minister will not be surprised at the area I wish to focus on in my remarks, which is the gap between how the NHS works and the state of the art for other services in our lives. I encourage the Government to be perhaps even more ambitious than the report says. I hope that I am pushing at an open door with this particular Minister.

Homecare medicines are of course more complex than other products delivered to the home, so there is no simple comparison with an Amazon-like service, but some of the tools used in these other services are certainly relevant and provide a benchmark for what is possible, if you are trying to deliver the best possible service in 2024. As we work through the report’s recommendations and the Government’s response, I want to look first at recommendation 3 on KPIs, which many participants in the debate have mentioned.

What we see increasingly in other areas is real-time performance data rather than periodic collection of performance indicators. Real-time data is more useful and certainly less prone to the kind of gaming that can be done with KPIs. We see that in the NHS where people work to get to their quarterly target; they rush the drugs to the noble Lord, Lord Blencathra, because they want to tick that one off to meet their target, but you cannot cheat real-time data in the same way. I hope that the Minister will consider that. Certainly, if I were the owner of a contract I would want to know in real time whether the thing that I contracted for was actually being delivered.

When someone visits a home to deliver a product, or if they are going to provide a service, it is very easy these days to log that using commonly available tools. This does not have to be a big bureaucratic exercise. It can be a click or two, and then that data goes to the person who contracted with the service so that they know it has been delivered. We all experience this in our daily lives. I will use the comparison that when I order drugs for my cat, which I do, I am told when they are going to arrive. When they arrive, the button is clicked and the person who supplied those drugs knows that they have been delivered. If it is good enough for my cat, it is certainly good enough for half a million people who receive these services.

That is especially important if it is a market in which a buyer is paying a main contractor—in this case, the medicine manufacturer—who then subcontracts the delivery part of the service. Once it gets more complex, that is no reason not to have real-time data but a reason to prioritise having it, so that you do not end up playing pass the parcel. The noble Lord, Lord Blencathra, said he wondered if people sometimes do not want to know the breakdown, because they do not have to own it. No: someone needs to own this. If I were a clinician or a manager in an NHS trust and I had 500 or 1,000 patients dependent on the homecare service, I would want to know in real time what they were getting. I would expect everybody in that chain to pass the data back, so I could see whether it was working or whether something had broken down.

Here, I think about another initiative that the Minister is keen on, which is virtual wards. We do not send people home and ask them to tell us in three months whether the service on the virtual ward was delivered. The clinician is there with real-time data about what is happening to that person at home. I do not see why the homecare medicine service should be any different. If you can easily collect the data, it should be going back to the clinicians so that they can see whether there is a breakdown and, as other noble Lords have said, plan to fill the gap if they need to. This is critical for the patient interest. This kind of visibility of real-time data is possible. It is even more ambitious than the KPI recommendation, but I hope that the Minister will commit to looking at how it could be built.

The other piece of transparency that has been referred to, particularly by the noble Lord, Lord Carter, is the transparency of costs in recommendation 5. I was also struck by the government response citing commercial confidentiality. That did not work for me, frankly. There should absolutely be commercial confidentiality at the point at which you award a contract, before somebody has signed the deal. However, there is no reason for a high degree of commercial confidentiality to continue after the deal has been signed unless it is because of the imbalance of lawyers. The noble Lord, Lord Blencathra, spoke about that. If I were a lawyer for a company, I would say to the NHS, “You have to keep it all secret once I have signed the deal”. The NHS does not have to agree to that. The NHS can say: “As a condition of the contract, we want this data to be put out there and we are not going to agree a contract that has commercial confidentiality in it beyond that which is strictly necessary”.

The report rightly talks about competition in this space. The way to encourage competition is to let the market have as much information as possible so, when the next round of contracting comes up, you can draw on what the cost base was for the previous contractors. That is not in the contractors’ interests, but it is in the public interest. I would expect to see that filtering through. I hope the Minister will look again at this. The block use of commercial confidentiality was in the government response, but we need to get much more granular and find out if there are real reasons or if it is simply for the convenience of the contractor or because it had better lawyers when doing the negotiation. We should be able to take that out.

I now want to speak to a favourite theme, which is the stubborn persistence of paper-based systems in the National Health Service; they are lurking around way beyond their sell-by dates. We have excessive tolerance for this. It is flagged in recommendation 11. It really hurts to see that inefficiency persist when we have actually already paid for the electronic system; we are just not using it. If you have not built the system, that is one thing, but we have built an electronic prescription system yet this important service has somehow just not bought into it; that is really painful.

The government response did not have any timeline for when this will be delivered. It expressly said that the Government cannot give a timeline. I know the Minister will be uncomfortable about the persistence of the paper-based system and I hope he can give us additional assurances on that today. Can we please be less tolerant about people not using the electronic system? It benefits everyone, including the contractors. They will save money if they move over to the electronic system. They may have inertia, but I think we can be insistent, given that it is for everybody’s benefit.

I would like us to be more ambitious. We need to be mammals about this and not be overly sensitive to the fate of dinosaurs who choose not to evolve. In saying that, I am not talking about the service users, many of whom are really familiar with the technology. I am talking about the service providers, some of whom are not moving on. If they do not want to move on, I worry about why they are still in this business. We need people who are willing to move on and use the latest tools.

It is a very useful report. There are many other recommendations to which I hope the Minister will respond positively. I hope he will particularly pick up three areas that I and other noble Lords have highlighted. First, NHS service managers should have real-time access to performance data for homecare medicine services, just as they would for the other services that they are delivering. It is reasonable to expect providers to offer this capability. Secondly, there are benefits in being much more open about the costs of service delivery. We should not use commercial confidentiality inappropriately to stop this. Thirdly, we should be aggressive—I would use that adjective—in moving everything on to the electronic prescription service. We have paid for it, and we should use it.

I again thank the committee and the noble Baroness, Lady Morris, in particular for her introduction to this. I echo the positive note and the fact that, as she said, these are things that can be done now—that is critical. We do not want a response that says things will be done in a year or two years; we want things that will be done in 2024.

NHS England: Ovarian Cancer

Lord Allan of Hallam Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Markham (Con)]

Absolutely, and I hope noble Lords have seen that I am keen to learn from wherever. I would be interested to understand more in this case. As I think we are all saying in these arguments, it is about making sure that we are being sensitive and inclusive in language, but that we are also being very clear in our language about what we mean so that health always comes first.

[Lord Allan of Hallam (LD)]

My Lords, I recently looked at the prostate-specific antigen screening programme advice, which was very good and met the requirements that the Minister has set out. However, I got there only because of a Peer-to-Peer networking episode, where I bumped into another Peer who said, “You really need to go and look at the PSA screening”. It struck me then that this journey into screening programmes is still very confused and ad hoc. Will the Minister look at that and at how we can make sure that whoever you are and whatever your gender, your age and your other risk factors, you get the direction you need into the right screening programme?

[Lord Markham (Con)]

I thank the noble Lord; he is always very good at bringing up some of those cases. I will look into it and make sure that we do that.

Covid-19 Vaccination: Coronary Disease

Lord Allan of Hallam Excerpts

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for this question. The ONS has provided this information and made it available for research purposes to make absolutely sure that we get to the bottom of this issue. For the understanding of noble Lords, every medical vaccine has side-effects, but the MHRA has investigated this, and the side-effect that people are worried about is heart inflammation. One to two people per 100,000 who have had a vaccine experienced side-effects, but, for people who have had Covid, it is 150 per 100,000. Having these vaccines is a much safer route to go.

[Lord Allan of Hallam (LD)]

My Lords, there is one substance that we put into our bodies during Covid that has been clearly linked to thousands of excess deaths: alcohol. Are the Government carrying out studies into what happened with alcohol consumption during the pandemic, who was most at risk and how we can ensure that in any future pandemics we do not see excess deaths? We are talking about 2,500 excess deaths during 2022.

[Lord Markham (Con)]

The noble Lord is quite right. There were much wider effects and impacts in the lockdown, and alcohol intake was one of them; mental health, particularly of our children, was another. My sincere hope is that these are the kinds of issues that the Covid inquiry should really be investigating: the wider impacts on society caused by lockdown.

NHS: Long-term Sustainability

Lord Allan of Hallam Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am very grateful to the noble Lord, Lord Patel, for this opportunity and for the reminder of the time of the coalition Government, which I think we might accurately describe as the last sustained period of strong and stable government that we had in this country. It is a moment to remember the work done by my friend Norman Lamb, who I think was recognised as an excellent Minister for mental health and care. Essentially, the good bits were ours and the bad bits were theirs, including the pointless NHS reforms, and that is all we really need to reflect on with regard to the coalition Government.

I have enjoyed hearing a wide range of interesting contributions, including those from my noble friends Lord Scriven and Lady Tyler. I was also very moved by the excellent maiden speech of the noble Baroness, Lady Ramsey of Wall Heath. I share with her having two children born in St Thomas’s Hospital, although, unlike her, I did not have to do the hard work: I was a mere spectator.

I will not cover the issues to which others have applied their much greater expertise but focus on the role of information technology, on which I have some expertise and which has become universally recognised, including in this debate, as a key enabler of the productivity increases that we need in order to make the NHS sustainable. The noble Lord, Lord Kakkar, called for areas where we could have cross-party work; I think this area is particularly conducive to that. I and most geeks do not really care who is in government. We have the phrase, “Code wins arguments”. Unfortunately, elections do not work that way but, in the world of code, if you design a better product that runs more quickly, that is the one you should implement. There is a large community of people who believe in the NHS and can apply those technical skills but do not care who is in government. I ask the Minister whether we could make immediate progress in that area with a non-partisan approach.

I want to talk not about whizzy, cutting-edge technology, which we often go into, but the foundational elements where some of the biggest gains could quickly be realised, because there is a large amount of low-hanging fruit. I will raise five areas with the Minister—essentially, layers that together would form a platform for improved services.

First, we need a comprehensive catalogue of the collection, storage and use of data across our social care and healthcare systems. That does not exist today. The noble Lord, Lord Carter of Coles, referred to this; we do not have a comprehensive catalogue so there are enormous inefficiencies built into the system. There is a natural tendency when building technology to look at the shiny front end and at apps, but that is useful only when you have the back end set up properly. For the NHS and care, that is frequently not the case. It is the boring bit, but it is essential that we walk through and audit all the many systems that we use and document our data. Openness here can really build trust. If people out there can see who has what data and what they are using it for, that will generate trust. When people see it as a black box, trust dissolves and they start to withdraw their consent. An open database is essential.

Along with that, we need openness around the processes and tools used to work with that data. These days, a lot of the code can be open. You can make it reusable. We could reasonably aspire to a position where a new entrant into the market could say to a service such as ChatGPT, “Here’s the data model, some example code and the processes—build me a system”. That is where we will get increased competition in areas such as GP systems, which have come to the fore these days. There are two major suppliers and people ask why there are not more. We could make it a lot easier for people to come in and compete not only on cost but, importantly, with innovative features. We do that by making sure that the data model, the processes and the code base are open.

Once you have that foundation sorted out, the third area is thinking about the content and messaging. There is a very current debate about the fact that online platforms such as TikTok are really good at getting people to engage with them. We see that as devious and dangerous behaviour, but that is what we need in the NHS. When running a screening programme, you want the kind of skills that get people to click on it and sign up for the appointment. We saw some of that with the encouragement for Covid vaccinations, but we get a hell of a lot of other communication from the NHS that is not of that quality. If you are going to set up a screening programme, it is a real waste not to have the kind of skills you need. Software engineers—my profession—are not the people to write this stuff, but a lot of the stuff we get looks like it was written by them. There are really good people who know how to get people to engage, which is what the health service needs. As a general maxim, the systems we use to engage with our healthcare should be at least as good as the ones we use to share cat videos—and I think healthcare ranks a little higher in importance. We can all see that the gap is enormous at the moment.

The fourth area is around ownership. Committees do not own things; named people own things. In the tech sector, when you want something delivered, you say to somebody “Here’s your target—you need to deliver this product”. Often, working in a massively matrixed organisation, you need to get lots of other people who do not work for you to deliver the product, but you need to know who the person delivering the product is and not allow it just to be put into a committee where everyone can pass the parcel.

It requires persuasion, support and, crucially, a service culture. It was interesting that the noble Lord, Lord Hunt, said that “people hate NHS England”. That is a real problem if NHS England is signing up and buying services, such as the federated data platform, and it has to roll them out to a massive variety of organisations—some of them are brilliant; in some, there are two IT support people who are busy trying to help people change their passwords—and you come along and say, “Can you implement this system?” Well, they can, if someone helps them to do it. We need somebody, somewhere, to have that kind of service culture—somebody who owns it and has the tools to say, “I need to get that trust to implement the system, and the way I am going to do it is not just by sending out a directive. I am going to go and hold hands, and help them, and find out what the barriers are. I don’t care what they are—I am going to address them”.

The fifth element has come up in discussion today: integration with other systems. I sometimes feel there is a nervousness about talking about stuff that is outside the NHS. Increasingly, that is where people are; it has been said in the debate today that people might be consulting an online GP service. We have negative phrases such as “worried well”. I think it is quite nice to be a bit more worried about your blood sugar level or diet, or about lumps and bumps where we should not have them. There is a range of things we should be worrying about, and we have opportunities to get tests done, but there is very little integration between all that and the core NHS. That is something we could fix; again, it is one way to make it sustainable. In many cases, we—or our workplaces—are paying for health check-ups. If the system is right, once we have collected the data, let us get it integrated. We have systems such as Patients Know Best, which are trying to do this. These have been paid for, but they are not universally rolled out and in use.

To pull all that together into an example, let us think of something really boring and old fashioned, like blood pressure checks, which the noble Lord, Lord Patel, rightly raised as a key way of stroke prevention. If you have a standard data model for how to deal with blood pressure checks, or if you had standard code for how it is collected—on a phone or in a private clinic—and put into your record, and if you had an owner of a blood pressure screening programme whose job is to get 80% of the target group screened once a year, we could say, “We do not care how you do it, just be creative and figure out what is the right way. Is it text messages? We don’t care, as long as you get that 80% data”. If it was integrated, that person’s job would be to hustle, hassle and help people, and to work with all providers of mobile phones and workplace networks to get it done. That is the kind of thing that could make a difference.

I hope it is helpful to the Minister to describe a model that could be applied more generically across a lot of the challenge areas that the NHS faces. At the moment, a lot of people know what “good” looks like and what they want, but the structure militates against it because responsibility is too widely distributed, and there are too many people doing individual things in silos. At the moment, the only model we have to overcome that is a directive from NHS England. That is not what you need; you need detailed grunt work on the ground to get us from where we are today to where we want to be, which, as a patient or an NHS staff member, is using systems at least as good as those we use to share cat videos.

Cass Review

Lord Allan of Hallam Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

Understood. Again, I will come back in detail on that point. One of the points made to me about the difficulties of trying to recruit to these eight new services was that, when this is such a toxic space, how do you get good-quality people? I think we agree we need that more than ever, because it is such an essential and sensitive area. So I will take that back and make sure that nothing we are doing, such as that legislation, should have that sort of chilling effect.

[Lord Allan of Hallam (LD)]

My Lords, if I could add to the Minister’s correspondence list, this is really following up the point made by the noble Baroness, Lady Finlay. Dr Cass rightly highlights that we need data about all the young people who present to the services—what service they received and what happened to them over time. Can the Minister include in his letter the measures that the Government will be taking to encourage those young people to participate? If they feel intimidated or that the data is going to be used against them, they are going to opt out, and then we are not going to have the dataset we need to understand the best treatment.

[Lord Markham (Con)]

That is an excellent point—yes.

Midwives: Bullying

Lord Allan of Hallam Excerpts

Tuesday 16th April 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct. It is crucial. We have a whistleblowing system. It has had over 100,000 reported instances. We are trying to inculcate a culture where people feel able and free to stand up and point out an issue.

[Lord Allan of Hallam (LD)]

My Lords, workplace bullying is particularly toxic where managers are involved. This is where non-executive members of the NHS trust boards may come into their own if complaints involve executive members. What is being done to help non-executive members of trust boards be more responsive and able to deal with bullying complaints?

[Lord Markham (Con)]

The noble Lord is absolutely correct. This is the role of non-execs. Having done a bit of work on the Lucy Letby case, I understand that the non-execs should have said something. Obviously, the executives should have found out, but the non-execs clearly had a role. This is an excellent question. I have to be honest and say that I need to come back on it, if I may, so that I can give the noble Lord a full answer and make sure that this is happening.

Immunisation: RSV

Lord Allan of Hallam Excerpts

Tuesday 16th April 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, will the Minister commit to making the vaccination records for new programmes such as RSV available through the NHS app from the outset? I ask this as a parent who has just had to verify his teenage children’s MMR status by hunting down the red books last seen a decade ago to find the tatty piece of paper that is the only record of it. I now have a digital copy through my camera phone, but it would be much more useful to have this kind of record in the NHS app.

[Lord Markham (Con)]

It will not surprise the noble Lord to learn that I totally agree. It is absolutely on the road map. I cannot promise it is there today; it is more there for adults. The child digital red book is another objective we are working on, but that is taking slightly longer. But in terms of direction of travel—yes, absolutely.