King’s Speech

Lord Allan of Hallam Excerpts

Thursday 9th November 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I will largely speak to the health and care aspects of the gracious Speech, while colleagues who are more expert will cover some of the other areas.

I have been very struck that, when talking about the gracious Speech, whatever question the Health Secretary is asked, his answer is the new measures on tobacco control. This was echoed to a certain extent by the Minister today, although he does it far more graciously than his colleague down the way. We have all done media training and know the tactic whereby whatever you are asked you try to talk about the thing you want to talk about. However, in this case it feels entirely inappropriate. It feels as though the Health Secretary is using the fig leaf of the new tobacco control measures to cover up his naked embarrassment at the paucity of serious health and care measures in the gracious Speech.

I am inclined to support the new measures, but they are not a cover for inaction elsewhere and should not be used as such. It does not help the families of people being held in inappropriate mental health facilities, who have been waiting for the legislative reform that they need, to be told that children will no longer be able to buy cigarettes. For someone who cannot get a rapid scan of a potentially cancerous lump because there is a lack of scanners and trained staff to operate them, there may be some comfort in knowing that we will reduce the number of people suffering cancer in future but it does not get them the help they need today, and the longer they wait, the higher the risk is to them and the less likelihood that they will survive. There is small comfort for an older person struggling to find the social care they need, who believed the former Prime Minister when he said that he would fix social care, to know that although their grandchildren may be protected from the temptation of vaping—that is a good thing—it does not get them the social care they need today. These measures all could and should have been in the gracious Speech.

The other focus in the gracious Speech is long-term planning, particularly long-term staffing planning, as the Minister touched on. These Benches called for that long-term plan and have welcomed it, but we must recognise that a long-term plan is necessary but not sufficient. The journey towards a better health and social care system requires three things: a road map to the destination, but also a vehicle fit for the rigours of the journey and a driver with the skills and energies to get us there. The recent performance of this Government hardly inspires confidence.

I recognise that the Covid inquiry still has a long way to go, but the picture so far has us alternating between horror and shame at the way in which our health system has been managed. The image it paints is of a car veering from side to side, with the former Prime Minister behind the wheel while his passengers—Messrs Hancock, Sunak and Cummings, the latter using choice expletives as though he were an extra from “The Thick of It”—shout conflicting directions at him and so he jerks the wheel from one way to another. The car occasionally veers off into the VIP lane when it gets flagged down by its mates, but it can hardly be described as a picture of good management. We should give some leeway to the Government, because there was no road map for the specifics of the Covid pandemic we suffered. However, we must also ask what all that civil contingencies legislation and planning was for, given that it appears to have given us very little benefit when we hit the crisis. The driving of that vehicle seems to have been appalling and that is all on the Government, past and present—the same people are in government today, with a few notable exceptions, as those who were driving at that point.

The bright spot is that the vehicle held up remarkably well. That is all to the credit of the staff of our health and social care systems, who went above and beyond. We gave them credit and thanks for it then and should continue to reiterate that today. We have moved on from that episode but it now feels as though the Government are parked up in a lay-by doing route planning but very little else.

Their record on vehicle maintenance is also not looking good. We have record waiting lists that are still growing in many areas. Access to GPs and dentists—the fundamental building blocks of our system—is a daily source of complaint and frustration for millions of people up and down the country, as recognised by the Government when they issue papers describing NHS dental deserts, which are a real thing in many parts of the country today. We have a hospital building programme that will not meet the promises made at election time and staff who are demoralised by a Government who seem to prefer confrontation to conciliation and threats to settlements—settlements which Governments in the devolved parts of the United Kingdom have been able to reach because they approached them with a very different attitude.

This gracious Speech shows us that this Government have lost interest in making real improvements to health and care. If these were a priority, there would be a mental health Bill and long-term reforms to the provision of social care. The Minister said there will be a mental health Bill when parliamentary time allows. Forgive me, but the time of the gracious Speech is precisely when the parliamentary calendar is empty. If this were a higher priority than pedicabs and self-driving vehicles, there would be parliamentary time. It is a choice that the Government have made. We would also be seeing serious efforts to address and update the primary care contracts so that people can get easier access to GPs and NHS dentists. I hope the Minister in summing up may indicate that there is some action in that area. It is clear that this Government prefer to deal with other legislation, which I presume they think is sexier to the electorate, than with the stuff we need to get our health and social care right.

While the Minister may not want my sympathy, I praise him for his ability to defend this very thin gruel with quite a helpful speech. I believe that he personally is sincere in his interest in improving health and care and that he is making valuable contributions to those road maps, particularly on staffing and the new hospital programme. However, his, our and the country’s problem is with the drivers at the other end of the building. They are not a new Government—however hard they try to push the message otherwise—but a Government who have been in power as a single party for the last eight years. The people in charge now—the drivers at the other end—have been at the heart of that poor Administration and they are now too tired and unfocused to give us the solutions we need.

I hope that, over the coming year, the Government will keep working on these long-term road maps for where health and social care need to go, as these are valuable. Can the Minister in responding say whether that includes looking at GP and dental contracts, which are a priority? I hope they will face up to the maintenance challenge, so that this incredible vehicle that is our NHS is not allowed to deteriorate beyond repair. Will he say how they will deal with the deficits that are publicly building up in NHS trusts across the country? That needs to be dealt with this year—it is not a long-term issue—as they are facing real deficits and cash crises.

I will happily travel down the tobacco control lane with the Government to explore the effectiveness of the measures, but I can close only with a statement with which I know the Minister will have to disagree: the best way now to improve health and care in the United Kingdom is for this Government to hand the keys over to somebody else so that they can drive, as soon as possible.

Ultra-processed Food

Lord Allan of Hallam Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

The rationale was very clear. The measures that we introduced by the modelling showed that in what we were trying to do we were attacking the things that cause 95% of the reduction in calories—namely, the product positioning, which has the support of 78% of people to reduce the so-called pester power. Early evidence shows that it is working, because foods that are not high in the bad stuff have gone up by 16% and those with high sugar, salt and fat content have gone down by 6%, all through the product positioning. It is working, but the most important thing is that we have gone after the big numbers, those that effect 95% reductions in calorific intake.

[Lord Allan of Hallam (LD)]

My Lords, to follow on from the questions asked by the noble Baroness, Lady Boycott, there is a public expectation that the delayed junk food advertising regulations will mean that children will be less likely to see ads for products from companies such as KFC and McDonald’s. But my understanding from the Minister’s previous comments is that the Government’s expectation now is that the advertising will carry on as before and children will continue to see just as many ads, albeit with the products reformulated to get around the ad ban. Is that correct?

[Lord Markham (Con)]

I have said many times that the prize is reformulation. I do not think that any of us should have a problem per se with the food if the bad stuff is taken out. Diet Coke is a perfect example. It is not particularly good for you but not bad for you either, so why should Coca-Cola not be able to advertise Diet Coke? If you take out the bad stuff, we should encourage industry because advertising works. It wants to advertise, so if it is encouraged to take out the bad stuff, that is a big incentive.

Suicide Prevention Strategy

Lord Allan of Hallam Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

What the strategy is trying to do is to look at those high risk groups and the risk factors behind them. One of the biggest risk factors causing suicidal thoughts are financial difficulties, which of course out-of-work disability benefits come into. One of the highest groups in terms of priority are middle-aged men, who are often the people suffering in this space. There are other groups as well, such as children and young people, pregnant women, new mothers and autistic people. There is a range, and what we are trying to do in this strategy is hit those areas of highest risk. To put this into context, those people on all DWP benefits in the reviews done on suicide make up less than 1% of the population of suicides. What we are trying to do is hit the major risk groups.

[Lord Allan of Hallam (LD)]

My Lords, the suicide prevention strategy says that DWP staff will be trained to identify benefit claimants who express suicidal thoughts and escalate these appropriately. Can the Minister confirm that the DWP will collect data on out-of-work disability benefit claimants who are caught or flagged by the system, so that we can understand whether or not this new policy is as effective as we would all want it to be?

[Lord Markham (Con)]

Yes, and I had the opportunity, because I used to be the lead NED at DWP, to go along to a number of jobcentres and see the sorts of work that they do. They have two things. They have an independent review of each of these, and those are the stats I was using: they get about 50 cases a year in these categories. Where there is a serious case they have a serious case review, independently chaired with a Permanent Secretary on it as well.

Children’s Health: Ultra-processed Foods

Lord Allan of Hallam Excerpts

Wednesday 25th October 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the noble Baroness, Lady Jenkin, for prompting this debate. I shall use my brief remarks to make a modest proposal that I hope will offer the Minister a creative way to address issues related to food quality and health. In short, this is that we should require large retailers to make data about food purchases available, within a controlled framework, to support research and policy development.

The argument for this will be familiar to anyone following the regulation of online services, where we are responding to concerns about the diet of information being served to people and how this may lead to various kinds of harm. The logic for this approach is as follows. Policy-making should be evidence-based, using data both to predict the impact of new measures and to evaluate the effectiveness of previous interventions. Where there is a significant public interest in making policy interventions in an area, this creates the case for requiring organisations to make useful data available. There is a major public interest in understanding the relationship between food consumption and health outcomes for both adults and children in the United Kingdom. Major retailers have very sophisticated and comprehensive datasets about food purchases that would be of enormous value to researchers and policymakers.

Any concerns about commercial confidentiality can be resolved within a sensible framework, just as they are in other areas, such as banking and online services. Similarly, we can look at good practice elsewhere to ensure that useful data can be provided, while not compromising the privacy of individuals. Companies may be willing to share data in the public interest, and such a voluntary approach is worth exploring in the first instance. If that proves insufficient, a regulatory requirement should be considered. We have many examples to build on of where regulation requires private businesses to provide data to support public safety goals; we can look at financial services and the pharmaceutical industries to see that working well today.

The models that are being developed right now for online services may be especially useful for a read-across to food retailers, given the similar nature of the challenge: we are seeking to identify patterns of harmful behaviour within a very high volume of normally benign activity. I hope the Minister will agree that it is worth some of his department’s time and effort to explore the benefits of this approach. If we can move from anecdote to well-sourced evidence, this will help us in all our work in this place on measures related to health and food consumption. If we are able to take retailer data about food purchasing practice and match that up with health data, which I know the NHS has in abundance, we can start to draw valid conclusions. Whether you are with the noble Lord, Lord Krebs, or the noble Baroness, Lady Bennett, in terms of your starting assumptions, having that data will allow us to have a much better-informed debate. I hope that this is a useful modest proposal that the Minister will look upon kindly.

Paediatric Care: Wating Times

Lord Allan of Hallam Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for bringing this question up; this is an important area, and we all know that a year in the life of a child aged 10 is a lot more impactful than it is to a 60 or 70 year-old. It is a question very well put. Since receiving this Question, I have been working on it with the department and talking to the relevant Ministers about what we can do specifically. We are expanding capacity generally through the CDCs and the 95 surgical hubs designed around this space, but we are putting in measures with ICSs and tiering to make sure we are specifically addressing children’s wait times as well.

[Lord Allan of Hallam (LD)]

My Lords, it is naturally very stressful for any parent when they face a long wait for their child’s paediatric referral. That stress is often compounded by the fact that it is left to the parents themselves to chase things up through confusing referral systems and systems that are still far too manual and depend on paper letters that get lost. Will the Minister make a priority of improving the information flow to parents about a child’s referral, so that they can quickly and easily see what is happening and know what to expect?

[Lord Markham (Con)]

That is a point very well made. as the noble Lord knows, that is one of my priorities and what we are trying to do with the app. There will be a number of launches, but already we are seeing hundreds of thousands of messages going out via the app to make sure that people are getting them on time. That has become the backbone of our communication system and will expand across the piece to try to cover exactly the points the noble Lord raises.

Adult Social Care (Adult Social Care Committee Report)

Lord Allan of Hallam Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I also congratulate the committee on a very comprehensive and useful report. My noble friend Lady Barker is very sorry that she cannot be here, due to family emergency—rather illustrating the point of the noble Lord, Lord Bradley, that caring affects all of us at various times in our lives. I am sure that she will listen to the debate later and certainly appreciate the comments of the noble Lord, Lord Polak, about the usefulness of her contribution to the committee.

I will pick up on three issues we need to hear more about from the Government. I agreed with the point made by the noble Baroness, Lady Andrews; I looked at the government response and it is very much, “We have got this; it is under control”. However, I do not think they have got this, and we need to hear more from them.

The first issue is around population care needs assessments. The point about data has been raised by the noble Baroness, Lady Fraser, and the noble Lords, Lord Polak and Lord Dubs. I do not think it is a data problem. We are swimming in data. We need the more useful offspring of data, which is information. The Government are, we think, about to spend £500 million to try and transform the health system’s data into useful information. The question has already been raised, however, about whether that will be integrated with care data and whether we can get useful care information out of that kind of project.

I hope the Minister can talk some more about what commitment the Government have to extracting useful care needs assessment information from the data that the ONS and others have already. For example, I saw in the report that the first projections are around people who do not have children; the Office of National Statistics already has that data, so we need to take that and transform it into something useful in the context of care. In doing that, the assessments need to be brutally honest. There is no room for fake optimism here. We need to know what the real needs are and those projections going forward. The old maxim of hoping for the best but planning for the worst is particularly relevant in these contexts.

Having done those population care needs assessments, the next stage is the workforce plan. Now we have a sense of how much care we are going to need, we can start to plan for the numbers of people we will need to meet those requirements. It is really important we are not overoptimistic, and visas for overseas care workers have been mentioned a few times. In an ideal world, it would be great if we were able to get the care workers we needed domestically, but we should be brutally honest if we are not going to meet the requirements. Let us not gloss over it: we should continually evaluate those needs and adjust the visa regime accordingly.

I know this is very sensitive, particularly in the Conservative Party, but we need those care workers. It is not like fruit picking. We cannot say, “We will just not grow the fruit any more if we cannot get the fruit pickers”. These are people who need care. We need to be honest about the balance between those we can train domestically and those we will need to provide visas for because the care needs delivering now; it cannot necessarily wait.

The ageing population is going to be a problem here. More and more people are going to do the informal care and, precisely because of that, be no longer available to enter the market as a paid-for care worker. Again, we need to be honest about the changing demographics and how they will change the availability of workers. It is not going to be like it is today in 10 or 20 years’ time. If there are more people in their 40s and 50s looking after people in their 70s and 80s, that may have an impact on the very workforce we are trying to target in our plans.

The third area is pay. Again, having worked out the needs assessment and the plan for the workforce we need, we need to think about how to attract people into the profession. This affects both paid and unpaid workers, as has been raised in the debate. Both the wage rates for the paid workers and the support available for the unpaid workers matter.

I am sure that the noble Baroness, Lady Bennett, will be happy when I say I am very confident that my party will have a proposal around care in our election manifesto. We have already said that we think there needs to be a higher living wage available for care workers, and we should be talking about that now because that is the only way we are going to solve the crisis. If we are going to will the ends, we have to will the means. I hope the Minister can say that. I have heard him say it all before and he will cite the big numbers the Government have already put in, but those numbers need to be set against inflation and other pressures that have been eating away at the value of those salaries. There needs to be something more fundamental than just saying, “Here is another announcement of a big number”.

The final area is one that has been raised with me, which is the question around who provides care to individuals. This is a question of the choice of carer gender for intimate personal care. It is a very sensitive issue and I do not want to go into the broader issues around gender and identity. Something very specific, though, that has been raised is that there are people—particularly those who have long-term intimate care needs, because they are often younger people with disabilities—who may not be able to choose the gender of the carer who provides that care to them.

I think we can all understand why that is a very sensitive area. Part of the solution is to have a bigger workforce available: if there is more choice of carers out there, it will enable people to exercise a choice over the gender of the person who provides personal intimate care. That is important because there have, sadly, been incidences of abuse. It is also a matter of the right of an individual and their own self-determination that they have some choice over who provides care to them.

I close by thanking the committee and the many members who are here today for a report that is of great benefit to anyone who is trying to understand and respond to the ongoing crisis in care in this country. The noble Lord, Lord Polak, talked about a guide: this is a guide for us as policymakers. I recognise the need for a guide for the person trying to employ carers, but this is a great guide for us as policymakers to the key questions we should be asking. I hope that the Minister will be able to offer some constructive comments on the points I have raised around population needs assessments, care workforce planning and ensuring that carers are properly rewarded.

Nursing Courses: Reduction in Applications

Lord Allan of Hallam Excerpts

Tuesday 19th September 2023 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. Clearly, we want to recruit, but we also want to retain our workforce and again that is what the long-term workforce plan is all about—trying to look at a clear professional development path and other things we can help with, such as childcare support and the culture and leadership, and really make nursing a very successful and rewarding career structure. There is a lot to do on it, but I think there has been a lot of good progress as well.

[Lord Allan of Hallam (LD)]

My Lords, the NHS Long Term Workforce Plan will make funding available for an increased number of nurse training places, which is of course welcome, but the increase in capacity for the NHS will happen only if there are sufficiently qualified candidates applying for those places and completing the training. Would the Minister be willing to share the assumptions his department made about application and attrition rates when setting the targets in the workforce plan, so that we can compare those assumptions with reality as revealed by the numbers in the Question today?

[Lord Markham (Con)]

Yes, my understanding is that all the workings behind the long-term workforce plan are currently being analysed by another body— I am not quite sure whether it is the NAO, the ONS or whoever. The point is that all the modelling and the underlying assumptions are being analysed, and I believe there will then be a report on them so that everyone can see what we are trying to do and how reasonable those assumptions are.

National Health Service: Major Conditions Strategy

Lord Allan of Hallam Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

We are investing about 11% of the economy—£160 billion—in the NHS, and the conditions in the major conditions strategy account for 60% of all the causes of death and long-term illness. What we are really talking about is prioritising spend around prevention and personalised care, as the noble Baroness said, and channelling the money we are already investing towards those aims, on which I think the whole House agrees.

[Lord Allan of Hallam (LD)]

My Lords, in June, the Government announced a ring-fenced AI diagnostic fund of £21 million to support the major conditions strategy. Will the Minister update the House on progress with the rollout of that fund? What other steps are the Government taking to ensure that NHS patients in all parts of the country can benefit from the latest developments in artificial intelligence?

[Lord Markham (Con)]

AI is a key point. Take stroke, which is one of these conditions. I saw a very good example in the Royal Berkshire the other day of what we all know as the golden hour, and the results from it. The Royal Berkshire has AI scans that go straight to the responsible physician, who can say straightaway whether a thrombectomy, for instance, is needed, the timing of which is critical. That is now being used in that cluster of hospitals and will be one of the six key technologies, the roll out of which we will encourage across the board to others.

Reinforced Autoclaved Aerated Concrete: Hospitals

Lord Allan of Hallam Excerpts

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

First, we are doing everything we possibly can to make sure that the programme is accelerated as quickly as possible for good-safety reasons and for clinical reasons as well. In terms of the other hospitals, it is a case of making sure every step of the way that we have structural engineers and we take every safety measure. I managed to visit a lot of these hospitals over the summer and saw first hand the expert work they are doing there.

[Lord Allan of Hallam (LD)]

My Lords, to give credit where it is due, the DHSC has produced a very good fact sheet on RAAC in the NHS. I draw the Minister’s attention to the last line of it—the place where the bad news is usually buried. It says:

“Privately owned primary care estate is not part of the national programme. NHSE has issued RAAC guidance to private landlords who hold the responsibility for surveying and maintaining their own property”.


That reads a bit like “not our problem”. Can the Minister assure the House that the department will ensure that those smaller primary care settings get surveys done quickly? How will the department be staying on top of that?

NHS: Staff Numbers

Lord Allan of Hallam Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Like all of us, I am sure, I was appalled to hear about that study. The most fundamental purpose of any employer is the safety and well-being of their staff, obviously, and I am afraid that the hospitals that allowed that to happen and allowed that culture to take place clearly failed. Clearly, we need to get to the bottom of that. As I often say, it starts with the leadership in each hospital and the culture that is built up within each college. Those are the people who need to be looking at themselves in the mirror and asking whether they have the right culture to make sure that everyone feels safe in the workplace.

[Lord Allan of Hallam (LD)]

My Lords, we know that the Minister is a big fan of data dashboards for tracking such things as the flow of patients through hospitals. Does he agree that such a dashboard would be an excellent way for us to track the Government’s progress against all the various targets that they have put into their workforce plan? Will he commit to producing one?

[Lord Markham (Con)]

I believe that the whole point of the workforce plan is that every couple of years there is a review of our progress against it and how it needs to be adapted, since it is a moving feast. So, absolutely, it is vital and something we are working on. Overall, the things that we said that we would do we are on course for. We said that we would increase the number of nurses by 50,000 over the course of this Parliament. It is currently 47,000. We said that we would increase doctors’ appointments by 50 million. That is currently on track. So a lot of good work has already happened. A lot of targets have been hit. Yes, there is more to be done and we are happy to track it.