National Health Service (Performers Lists) (England) (Amendment) Regulations 2023

Lord Allan of Hallam Excerpts

Thursday 13th July 2023 Lords Chamber

Obviously, overall, I can see the argument for these regulations, but it is really unfair and discourteous to the profession that some kind of proper consultation was not gone through. There are also a number of issues where an impact assessment would have been absolutely appropriate. Having said that, I hope we can have a short but informed debate. I beg to move.

[Lord Allan of Hallam (LD)]

My Lords, we welcome the debate as an opportunity to look at some of the challenges around the number of GPs, dentists, optometrists and other primary care workers that we have available to us. I welcome the fact that the noble Lord, Lord Hunt, has given us that opportunity.

At the core of the statutory instrument, it seems sensible that we should accept registration from other parts of the United Kingdom where people are on the performers list in another part of the devolved system. To many of us, it is perhaps a surprise that it is not already the case that people on a list in one part of the UK are not automatically passported through to other parts. I am interested to hear from the Minister whether he has any information on how much of an issue this has been and whether there is quantitative or qualitative data around whether we have had significant numbers of practitioners in these fields finding that they had a problem as they moved from London to Edinburgh, Cardiff or Belfast and found that there was a barrier to them restarting their work as a professional because of this performers list issue. Any information he has on that would be helpful.

It would also be very interesting to know whether discussions are ongoing about reciprocal arrangements—whether the constituent parts of the United Kingdom will now plan to do something similar when a doctor on the performers list in England enters their system and whether there will be a similar arrangement for automatic entry to the performers list, subject to later checks, rather than having to apply from scratch.

My second point is to reflect on the user experience of trying to navigate the system, either as a practitioner who wants to work and is thinking about how to get on the performers list or as a member of the public. As the noble Lord, Lord Hunt, pointed out, part of the value—or intended value—of the performers list is that a member of the public can see if somebody who they are going to for treatment has been authorised effectively to offer treatment in their area. We want this to be very simple for everybody concerned, but it is quite confusing at the moment.

As part of my research for this debate, I went to a popular search engine and typed in “NHS performers list”. What I got back was a web page from digital.nhs.uk. The website had .uk at the end, so I assumed it was for the UK; the page was called “National Performers List”, and I assumed “national” meant it was for the United Kingdom. I clicked on that and then, on the next page, it told me that it is only for England. Nowhere in this does it explain to me that there are other performers lists for other parts of the United Kingdom. Nowhere am I given a link to say, “If you are interested in Scotland, go here”. The whole experience is a real confusion between the United Kingdom and England—I speak as a supporter of the devolved settlement, but if we are going to do it, let us do it properly. It seems to me that there is no excuse for not making it clear, given that the .uk bit of the service is not for the UK, that this relates to England and, if you do not want that, here is how to get to the other parts of the United Kingdom.

I note in passing that, if you have a problem with this system, the email address is for the Exeter helpdesk. As I think I have referred to before, I spent many happy years working on the Exeter system—the system for registering GPs—and I am pleased to see it still lives on in the helpdesk for people trying to find out about the performers list.

Equally, if you then come back and search for “performers list” for Wales, Scotland and Northern Ireland, you get a real mishmash of results. There is no consistency. Each of the constituent parts of the United Kingdom has some kind of thing that explains the performers list to you; none of them will link to the others or give you consistent information. In fact, the only place you can find it, if you are really lucky, is by stumbling across the website of the National Association of Sessional GPs, which I assume is intended for GPs looking for locum work. It has a really good explainer with links to all of them, but it seems to me that the Government should be at least as good as the National Association of Sessional GPs at signposting people to the right bit of the performers list.

The other significant area of the statutory instrument which is worth looking at is the question of the inclusion of overseas dentists, which I know the Minister is very familiar with and spends time on. Again, the Explanatory Memorandum tells us that this will improve the situation but is not very forthcoming on how. It tells us that one form of EU exemption will be removed and another system put in place. It would be helpful if the Minister could flesh out a bit about why he is confident—I assume—that it will be a genuine improvement. It would be interesting to hear a bit more detail about how he thinks it will be an improvement and how the new assessment process will help.

I have a final couple of questions. One foundational question, which comes back to the point about the impact assessment, is whether anybody has looked at how much value this performers list system actually adds over and above the existing professional registration systems. I do not think we should just take things as read. We have done it like this previously, where we have people registering with a professional body which requires passing all kinds of tests to get on to the register as a practising dentist or doctor within the United Kingdom—then we have this performers list system. I am genuinely interested in whether we have ever thought to ask whether it is useful to have the performers list layer on top of the general registration layer; if so, how useful it is; and whether the cost of having these two layers of registration is justified. It seems to me that we should always ask those questions; otherwise, we will have bureaucracy on top of bureaucracy.

Finally, I cannot miss this opportunity: I noticed today that in the Prime Minister’s announcement about the funding settlement, which is a welcome increase for various public sector professionals, he said that the Government are going to fund it in part by raising visa fee rates. That is critical. Here we are debating a measure which will make registration on the performers list as an overseas professional a little easier—and we all know that we need a continued stream of overseas professionals in this area. However good we are at training people, we are not going to get there for a while. I am interested in and hopeful about the Minister’s views on whether we are not giving with one hand and taking back with the other. We are making registration a bit easier, but we are going to make it a lot more expensive for people to get here in the first place. As I say, I cannot miss the opportunity to flag that there may be some inconsistency in government policy across that piece.

[Baroness Merron (Lab)]

My Lords, I think this debate is all about whether these regulations will do the job they are intended to do. As my noble friend Lord Hunt said at the outset, it is difficult to see whether that is the case in the absence of, for example, an impact assessment. I start by thanking my noble friend for again bringing this issue before the House. NHS dentistry is so important to people’s health and well-being in this country, and it has deteriorated, sadly, over a number of years. This is not an issue with the regulations themselves but whether they assist primary care in the way that it is said they are going to and that we all seek to do.

In terms of the background, there is no doubt—we all know this from our own experience and that of the people we know—that finding an NHS dental practice in the UK which will accept new adult patients for treatment under the health service is something of a rarity. Only one in 10 practices is offering that at present. That situation remains unsustainable.

Community Health Services: Waiting Lists

Lord Allan of Hallam Excerpts

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

We are starting to see a blue- print which is beginning to work. The highest waiting list for adults is related to musculoskeletal issues. Since we put an improvement framework in place, 91% of people are now being seen within 12 weeks—a big improvement. We are moving to self-referral also, and digital therapeutics beyond that. There is a road map in place that we need to apply across other areas.

[Lord Allan of Hallam (LD)]

My Lords, within the published data for wait times in community health services, we see that some people face very long waits for home oxygen assessments, including some waiting for over a year. Given that home oxygen is key for many with respiratory conditions staying out of hospital, will the Minister prioritise looking into why we are seeing these delays, and ensure those who need home oxygen do not face unnecessary waits?

[Lord Markham (Con)]

As noble Lords probably know, we published this data for the first time in March, so it is only now we are getting the data that we can truly work on it. It sets out 35 different areas where we understand those waiting lists for the first time, so we know which ones to prioritise—home oxygen being clearly one of those.

NHS: Doctors’ Strikes

Lord Allan of Hallam Excerpts

Wednesday 5th July 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, that is the last thing anyone wants. I trust all the medics who, first and foremost, care about patient safety to inform their local management so that they can make sure that the correct processes are in place to ensure that patient safety is looked after.

[Lord Allan of Hallam (LD)]

My Lords, yesterday, we discussed the Government’s plans to increase the number of doctors in training. But does the Minister accept that junior doctors are facing real challenges in dealing with the rising costs of living on their current pay rates, especially in their early years? Is this need to retain trainee doctors part of the Government’s submission to the independent review body, so that we do not end up bringing in more trainee doctors at year 1 only to lose them at years 6, 7 and 8?

[Lord Markham (Con)]

Yes, of course, the noble Lord is absolutely correct; retention is key in all this. That is looking at all aspects of the package and work conditions and everything around those. That is what the workforce plan addresses, I hope, because recruitment and retention are key.

Healthcare (International Arrangements) (EU Exit) Regulations 2023

Lord Allan of Hallam Excerpts

Wednesday 5th July 2023 Grand Committee

[Lord Naseby (Con)]

As I understood it, the Schedule on page 5 covers overseas territories and dependent territories. I note that the Cayman Islands is not listed. I have not had time to check whether anywhere else is off the list, but I wondered whether my noble friend could find out and let me know. I ought to declare an interest: one member of my family is working in the Cayman Islands, and there may be others. I recently attended a conference of all the overseas territories and dependent territories, and there seemed to be rather more than appear here, but that may be me and my memory bank. I leave that question with my noble friend.

[Lord Allan of Hallam (LD)]

My Lords, I also welcome this statutory instrument, which seems to be a helpful tidying-up exercise overall. Of course, it is humane and to our credit that we seek the maximum number of reciprocal arrangements so that people in the UK travelling to other countries can get healthcare when they need it and people coming here can benefit from our health service. That is important as a humane response.

First, on the comments from the noble Baroness, Lady McIntosh, I have a GHIC card; I think I was one of the first out of the traps in 2021. My understanding—the Minister will confirm this later—is that the “G” is rather more aspirational than material; that the GHIC is really an EHIC because it does not count in any other places, such as Australia or New Zealand; and that it is really a version of the EHIC rebranded with a rather fetching union jack. I am interested to hear from the Minister whether I have understood that correctly. Of course, it seems to be the Government’s aspiration that, one day, the “G” in your GHIC will be meaningful but as I say, as I understand it today, it is an “E” rather than a “G”.

We are pleased that there was consultation with Ministers in Northern Ireland, Wales and Scotland. Again, a regular theme of the stuff that we debate in this House is that there have been a number of other instances where that has not happened, such as with the minimum service levels Bill. It is good to see that, here, Ministers have given their approval.

I want to ask a few questions. The first is a material one on the scope of UK-insured persons; that is some of the language used in the instrument. My understanding is that there is a difference. For example, as long as they are a UK-registered resident, somebody who is resident and a taxpayer in the United Kingdom—whatever passport they hold—can get a GHIC card and use it in the European Union but they would not be able to do so in Switzerland because it has a narrower category of people who qualify; people there would, I think, need a UK passport to take advantage of the relationship.

That opens up a wider question: what is the Government’s policy? Is it that anyone who is a UK resident and taxpayer here should benefit from the reciprocal arrangements, or are the Government content to leave it such that we limit the scope in some countries? I followed the links to look at the information provided to people on GOV.UK. Oh my God; I am not sure whether I regret going there because it is incredibly complex. If noble Lords look at it, they will see that some countries want a driving licence, some want a passport—some want a UK passport while others want any passport—some want proof of residence and some want the magic card. There is a huge plethora of proofs of identity and qualification. Again, people’s expectations would be that, if they live in the UK and pay their taxes here, they should be able to benefit from the reciprocal arrangement. However, that is not what we see at the moment.

Regulation 6 says that the NHS Business Services Authority has a duty to

“maintain a service making available to the public information”.

Something useful could be done on the BSA working with GOV.UK to give people a much easier way to say, “I am going to country X: do I qualify? If I do, what documents do I need? At the moment, there is a long list that is incredibly confusing”. This is just a thought for the Minister as to whether Regulation 6 would include asking the Business Services Authority to improve the quality of the information offered at present.

My second substantive point concerns Regulation 7, which says that the

“BSA must assist the Secretary of State with the Secretary of State’s exercise of functions”.

Another critical piece of information here is understanding what is happening through this arrangement. What are the costs in and out? How many people from another country are using the NHS? How many people from the United Kingdom are using services in another country? Can the Minister clarify whether, as well as information about the workings of the reciprocal arrangement being provided to the Secretary of State, he anticipates such information being provided to the public and to us as parliamentarians? I do not mean to penny-pinch—as I say, the starting point should be that it is humane to offer treatment at both ends—but it is a matter of information.

The Minister referred to how additional countries might be added to the list. We would all welcome that but, again, when that happens, there will have to be a business case that must make predictions about how much usage of the scheme there will be. I welcome the fact that the Minister says that the addition of another country will come back to us for approval, but I hope that he can also commit to us being given the information we need on existing arrangements and predicted future arrangements to help us make those determinations.

Clarifications on those substantive points about eligibility and the provision of information and data on how the arrangements are working would be really helpful but, substantively, we welcome the instrument.

NHS Long-term Workforce Plan

Lord Allan of Hallam Excerpts

Tuesday 4th July 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I am absolutely sure that the Minister is as relieved as anyone to see this Statement on the NHS workforce plan before your Lordships’ House today, after many years of waiting and promises of it being published shortly, imminently, or at some time in a very extended spring.

The plan promises much, but it is the delivery that will count and the difference it will make to the health and well-being of the nation. But at the heart of it, its effectiveness will stand or fall on how successfully it joins up with other key aspects of the NHS and social care. It is not just about delivery: the commitment to updating the plan every two years is essential in the hope that it will be a lasting way out of the continuing workforce shortages that have blighted the NHS for many years. Ministers have a lot at stake and are investing a lot of hope in this workforce plan, not least because the lurch from crisis to crisis has to come to an end, with proper consideration of the long-term challenges ahead.

This long overdue plan started and continues its life against a backdrop of chronic NHS understaffing. It is long overdue. If it had been launched eight years ago, it would have been enough to fill the NHS vacancy levels—yet we have had to wait. Instead, the NHS is short of 150,000 staff, and this announcement will take years to have an impact, while patients continue to wait longer than ever before for operations, in A&E, or for an ambulance. While the plan is a positive step, it is only the first step. Much more detail is needed on how the plan will be implemented and what measures will be used to judge its success. What attention is being given to training staff and key leaders in what quality management looks like?

Retention is key, and the plan has little to say about that. The overall staff leaving rate increased from 9.6% in 2020 to 12.5% in 2022. The plan acknowledges the importance of retaining workers, offering more flexibility and improving the culture in the NHS, but it is light on detail about how it might do that. We know that more NHS strikes are planned—and that work culture, bullying and harassment continue to be a real issue, and nearly one in 10 staff experience discrimination. When will there be details on retention, pay and working conditions, such that they can add some detail on how retention might be improved in the NHS?

It is a missed opportunity that there is no social care workforce plan, especially as the NHS workforce plan identifies the impact that delayed discharge due to difficulties securing a social care package is having on patients and staff alike. Without such a plan, it will not be possible to enhance the quality of care and support provided by the NHS—they are inextricably linked. There are currently 165,000 vacancies in social care, an increase of 52% and the highest rate on record. Average vacancy rates across the sector are at nearly 11%, which is twice the national average. What assessment has the Minister made of the impact that having an NHS-only plan will have on the social care workforce? Social care workers already seek jobs in the NHS, where pay and conditions are better. Does the Minister share my concern that an NHS-only plan is likely to exacerbate this situation and the number of vacancies in the social care workforce? Does the Minister consider that this will undermine the ambitions of the NHS plan?

As the King’s Fund rightly observed, the projections are likely to be based on ambitious assumptions. Yet there needs to be realism about the investment in buildings, technology and equipment that is needed to realise productivity gains. Can the Minister say whether and when we can expect plans relating to the various and absolutely crucial aspects of investment? Page 121 of the plan sets out a labour productivity rate of 1.5% to 2% per year. That was never achieved by the NHS or any other comparable health system, so what assumptions are being made in relation to achieving that?

The focus of the plan is crucial. It appears on reading to have been seen through a rather hospital-focused lens, so will the Minister ensure that the lens includes healthcare in the community? At the centre of this plan has to be the patient in all their different facets. In the consultations that took place in the lead-up to the development of this plan, could the Minister advise your Lordships’ House on how patient organisations were involved and which ones were consulted?

It appears that the plan seeks to look to the longer term. As happened in 2000, when the Labour Government of the time produced a 10-year plan of investment and reform which included seeking frequent staff increases, we will look to this workforce plan to make a difference to patients and care and the health and well-being of the nation in the same way as we saw come out of the plan in the year 2000. I look forward to the Minister’s response.

[Lord Allan of Hallam (LD)]

My Lords, I shall try not to be too grudging, as we have been calling for this plan for so long. I start by recognising the enormous amount of work that has gone into this from people working in the NHS and the department over a very long period, but the reality is that the plan is too late for those who are waiting for treatment today and are unable to get it, because the investment was not made in the workforce years ago for it to be available now on the front line. However, the plan certainly is substantive and there is much to welcome in it, looking forward. There are several areas where I hope the Minister can explain the Government’s thinking further.

First and perhaps most importantly, we need a similar, sister plan for the social care workforce. As we have discussed many times across these Benches, health and care work in symbiosis and both have seen too little supply to meet demand in recent years. Can the Minister confirm that the Government have no plans to further reduce capacity in social care by acceding to some of the requests from his political colleagues to limit visas being made available for essential social care staff? Can he say when the Government intend to release a sister plan to the NHS plan dealing with the social care workforce?

The plan also depends on ambitious productivity gains, and these will require certain things to be put in place. First, we need technology that will make life easier rather than more difficult for staff. Will the Minister explain what work is being done to understand how front-line staff in the NHS actually experience the technology they are being provided with, to ensure that we are not setting them back? Technology, when implemented well, leads to productivity increases, but technology poorly implemented can simply add to the frustrations of staff and make their jobs more difficult.

Another key factor in productivity is good management. This is a much less fashionable area to comment on than additional doctors and nurses, but the evidence seems to suggest that the National Health Service is actually quite lean in terms of its management. Will the Minister comment on what is in the plan to boost management capacity so that we can make savings on that other kind of consultant, the management consultant? Far too much is still being spent on externalising management expertise rather than building capacity within the service.

The final area I want to comment on is retention. The plan has hard numbers and new targets for getting new people into training but is much less precise on how we can improve staff retention over the long term. This is of course, quite importantly, a matter of pay and working conditions across all grades of staff. I invite the Minister to comment on some of the press stories we have seen saying that there seems to be some reluctance on the part of the Prime Minister to implement pay review body recommendations in full, something that he himself has said we should rely on to resolve issues particularly around junior doctors. Certainly, understanding that pay is important and that review body recommendations are going to be respected is critical for retention.

We can see that the Government have looked very closely at the specific factors that discourage senior doctors, in particular, from staying on as they approach retirement age. I suggest to the Minister that similarly detailed work needs to be done to understand the precise factors that are leading more junior staff at earlier stages in their career to leave the profession. Similar attention must be paid to resolving those specific issues if we are to address the retention problem.

One way we can motivate staff to stay on is through continuous professional development and retraining into more highly skilled roles, yet training opportunities can be constrained by the capacity of those delivering it. Can the Minister assure us that training opportunities will be provided for existing staff as well as new staff, so that we do not end up holding back Peter in order to train Paul? It will be net negative if we lose staff from the existing workforce through missed training opportunities as we bring in new staff. More generally, is there an understanding of how we are going to build up that capacity for training existing and new staff?

When I was younger, I had a teacher who would often write on my essays, “Okay as far as it goes”. This would annoy me, but with the benefit of wisdom and age I have to concede that it was often fair and accurate. Today, we might say that this plan, into which I know a huge amount of work has gone, is okay as far as it goes. We can be confident that it will really make a difference only if it is delivered in full, and in particular if there is a sister plan for the social care workforce and a real effort made on staff retention. I hope the Minister will comment on some of those aspects.

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

I thank noble Lords. Before I answer their points, and while I shall not repeat the Statement, it would be remiss of me not to repeat one thing, which is about Lord Kerslake’s passing. Lord Kerslake inducted me into government many years ago when I was a non-exec director at the Ministry of Housing, as it was then, and I always found him a very wise head and a very kind man. I am sure that condolences go from all of us, and particularly from me.

I welcome the constructive responses from the opposite Benches. As we have said, a huge amount of work has gone into this plan from some 60 organisations, including royal colleges, and it is an NHS document. I must admit that while I will take the description from the noble Lord, Lord Allan, of “Okay as far as it goes”, I prefer the description of Amanda Prichard:

“This is a truly historic day for the NHS”.


On a personal note, I am very glad not to have to answer about how quickly it is coming any longer.

On the detailed comments, the noble Baroness, Lady Merron, said that this is a living document, with the two-year update, and that is a critical part. I agree with her that this is going to be effective only if it is a live document that we continue to review, amend and improve as time goes on. On the quality management of staff, this comes to the point about retention. There is no silver bullet, as we know. I liken it to the approach we see in the cycling, in the Tour de France, with Team Sky: there are lots of little things that you have to do and it is the collective effect of putting those things together which really makes the difference.

Clearly, pay is an important element of that; the point of view of the pay review body is clearly going to be very important; clearly, pensions are a big move; clearly, professional development is a big part of it, not just for new staff but absolutely for existing staff as well. It is also about the conditions that people work in; it is not just the culture and leadership but the place they work in as well. That is why I am pleased that the capital parts of this are seen as very important in driving the right culture and environment that people want to work in: these are key to retention and driving productivity. The new hospital programme is a very important part of that, and so is the capital programme generally.

Equally, technology is a key part of this, as mentioned before, and that includes front-line staff. Just on Friday, I was at Chelsea and Westminster, where they showed me at first hand how they found the databases they were using really helpful, with basic patient tracking, making sure they were following them through the whole care pathway and managing their whole journey, so to speak. They were using it and enjoying it, if that is the right word, and that was key.

The point about NHS management and leadership is very important; this plan looks at the medical side, but we all know that leadership is so important for the effectiveness of hospitals and a key part of this.

The noble Baroness mentioned the focus on hospitals. Clearly, hospitals are a very important part of this, but underlying that is a key shift towards primary care and prevention. If you delve into the details of the numbers, you will see that the level of people who need to be trained for primary care is going up and that they are becoming a bigger proportion of the workforce. I think we all agree that that should be the direction of travel. To deliver that, we will need to look at the capital estate behind this and make sure that we have the GP surgeries and everything else in the right places.

I turn to social care. The increase in medically trained people can only be a good thing for social care and the sector as a whole. However, social care is not included here. It is difficult. We can make an NHS plan because we are the employer behind the NHS; whereas there are hundreds, if not thousands, of different employers in social care so it is not for us to make that plan. However, it is for us to make sure that we increase the supply of medically trained people, as set out in this plan. We know how important international workers are to that; we recognise that and the importance of visas. Notwithstanding that, the value of this plan is that, eventually, it will reduce our dependence on the need to recruit internationally. We will see it go from about 25% of recruitment, as currently, to about 10% because we are increasing the supply base and the pool of people who can do that, rather than making a change on the visa front.

As ever, I have tried to cover most of the points raised in the time available. I will follow up in writing on the rest, but I conclude by welcoming this report.

Mental Health In-patient Services: Improving Safety

Lord Allan of Hallam Excerpts

Monday 3rd July 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I welcome the announcement in this Statement that the inquiry to investigate the deaths of mental health in-patients across Essex between 2000 and 2020, chaired by Dr Strathdee, will now be given vital statutory powers. This is an important and long overdue development. Not only have the grieving families suffered the pain and anguish of bereavement, and how they have felt in their fight for answers over so many years, but all of this has been compounded by an inquiry that lacked the necessary powers to seek the truth. It would be helpful for your Lordships’ House if the Minister could shed some light on why it has taken so long to allow the inquiry to do its job thoroughly.

More broadly, and connected with this issue, are repeated scandals in in-patient mental health settings involving abuse, dehumanising behaviour and needless loss of life, such that more than one in three people say they do not have faith that a loved one would be safe if they needed mental health care in a hospital. How will the Government seek to restore essential public confidence?

The situation set out in the Statement is against a backdrop of some 1.6 million people on waiting lists for mental health treatment. Their condition is deteriorating and can reach crisis point. At the same time, the incidence of poor mental health continues to rise. Those in poverty or financial difficulty are particularly at risk, to mention just one group. With the cost of living crisis continuing unabated and children from the poorest 20% of households four times more likely to develop serious mental health difficulties by the age of 11 when compared with the wealthiest 20%, this is an upward and unequal trend that the Government have to tackle. I hope the Minister can comment on how this will be properly dealt with.

I will pick up some particular aspects. Families of patients in Essex will welcome the news that this inquiry will be put on a statutory footing, but across the country those failed by inadequate mental health services are in desperate need of answers and need change. In March 2022 the CQC released its Out of Sight report to identify what progress the Government have made in addressing the culture, behaviour and design of services for patients in mental health in-patient settings. Will the Minister tell your Lordships’ House what progress has been made in implementing the recommendations in full?

If we are to bring about change, it is very important that the rapid review of data in mental health in-patient settings translates into action and the report does not simply sit on a shelf in the department. Can the Minister tell your Lordships’ House when the Government’s response to the review will be published and whether he will set out a timetable for when the recommendations are to be implemented?

Over the past year there has been a flurry of reports, as we know only too well in this House, of patients being failed in the care of mental health trusts around the country. Have Ministers actually met the leaders of those trusts to find out what has gone wrong? If not, do they plan to meet and when?

The Government have shelved the 10-year mental health strategy and, despite promises first made in 2018 to reform the outdated Mental Health Act, legislation has repeatedly been delayed. The Joint Committee on the Draft Mental Health Bill published recommendations for improving legislation in January, but thus far Ministers have still not responded to the report and the Bill is yet to be introduced to the House of Commons. Will the Minister please update the House on when it can be expected?

When it comes to mental health, taking a preventive approach would mean fewer patients needing to use in-patient services in future. Have the Government considered shifting the system towards prevention by providing mental health support in every school, for example, and a mental health hub for young people in every community? Ensuring that there are enough staff to provide adequate services is vital to improving patient outcomes, so can the Minister say some more about what plans the Government have to retain staff, to recruit new staff and to expand access to mental health treatment? I look forward to hearing from the Minister on these points.

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to have an opportunity to discuss mental health provision, and my comments will very much follow on from those of the noble Baroness, Lady Merron. We are also interested in the Government’s latest thinking about the draft mental health Bill. Now that the workforce plan is out—we will discuss it tomorrow—our new refrain may be, “When will the Government get on with the mental health Bill?”. It is long overdue, and a huge amount of work has gone in that is clearly fundamental to trying to deal with some of the structural issues.

Turning to some of the issues raised in the Statement, I first want to ask about people’s journeys when they are in need of mental health support. The Statement said that 111 will now provide mental health advice, which is very welcome, but can I ask the Minister for his thoughts on what is happening in primary care? My understanding is that at the moment mental health nursing provision is not a requirement of all general practices—some offer it and others do not. Can the Minister, who I know cares about joined-up, seamless services, give us some insights into the Government’s thinking on ensuring that people who present with mental health problems to general practice—which is the first port of call for many of them, before they even get to 111 or 999—see more consistency of support available at that level?

Thinking about the review—a major part of what is in the Statement—a significant proportion of providers of mental health in-patient services are private sector, which has been the case for some time. Can the Minister confirm that they will be included in the review and comment on whether the inspectorate’s powers will be applied equally to the private and public sectors? That is critical to understanding what is happening in all settings.

Will the Minister also talk a little about the input the review may get from related services? Again, we know that the police, local authorities and accident and emergency departments often pick up the pieces where mental health provision has not been made available. Can the Minister assure us that the review will also look at all those other parties to this journey of care that people require? Can he also comment on the data questions? I have seen evidence from freedom of information requests to the Office for National Statistics asking about deaths of people in mental health in-patient settings. My understanding is that the data is not recorded consistently. If we are to have a review and to understand what is happening in the mental health sector, it would be helpful to know what measures the Government will take to improve the consistency of data collection so that, when someone unfortunately suffers a tragic incident, we know where they were at the time and have the data available to build up the national pattern.

The final issue I want to ask for the Minister’s comments on is out-of-area placements. Will he acknowledge that it remains a serious issue that many people with serious mental health conditions are able to get treatment only in places that are far from home and therefore far from their families and support networks? I note from the Statement that the Government are providing three new hospitals. This is of course welcome, but I hope the Minister will also be able to confirm that there is a locality-based strategy, with the Government thinking hard about matching local facilities to local need so that we can end the situation in which people at a time of extreme distress are sent very far away from home, which can only add to the crisis they are facing.

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

I thank noble Lords for their questions and their general welcome for the Statement. On timing, we had hoped that doing it on a non-statutory basis would have been sufficient. The advantage is that you get the results that much quicker; you can often get them within a year, versus three years. We have many examples of where it has worked quite well, such as the Kirkup report. To answer the question of why it is taking so long, in the first place we had hoped that doing it on a statutory basis would not have been necessary. There was a course correction in January, when we were not getting the response we needed and not enough staff were making themselves accessible. There was some improvement at that point, but it was felt by the chair that it was not sufficient, hence the decision now.

We believe that we can build on the work that has been done so far, so we are not starting again from zero. However, there are some lessons. On a number of occasions, trusts and staff have responded well to a non-statutory inquiry, but we have learned from this that sometimes it needs to have the teeth of a statutory inquiry so that it is taken seriously enough. Somehow, there was an impression that, because the inquiry was not statutory, it was not seen as serious enough to trigger that. There is a key lesson to learn from all of that.

How we can seek to restore confidence is absolutely the right question to be asking. We believe that the additional investment of £2.3 billion that we are putting into this space is a key part of that, and the increase of 27,000 staff is another. We are learning from the reviews that we are doing, and we are quickly learning from the rapid review. We are working fast, so I cannot give an exact date for those results. We asked for it to be a rapid review so that we could get on with it and make the most of the findings.

The other key part of this is the Healthcare Safety Investigation Branch. We are asking it to look into a number of questions, one of those being out-of-area in-patients and the impact that has. I think we all agree that it is best if people can have in-patient services locally. That is one of the key parts that it will be asked to review. On the timing of that review, it will start in October and should be able to conclude within a year. We should get results back quite quickly.

On the timing of the mental health Bill, we are working through the parliamentary calendar now. We do not know the timings yet, but the scheduling is being looked at.

The noble Baroness mentioned the prevention agenda. I completely agree that care in the community and the training of staff in GP settings and schools are vital to this. As noble Lords have heard me say at the Dispatch Box before, we are making good progress: about 35% of schools are trained up in mental health support. Last year it was only 24% and next year we think we will be pushing 50%. Those are big increases, but I freely accept that 50% is not 100%. A lot of progress is being made in that area but we accept that a lot more needs to be done.

As for the private sector being included in the review, I have every reason to think that it should be and that there should be equal powers, but I will check that. I am talking off the top of my head now as it seems perfectly sensible, but I will come back properly on that.

I will do likewise with the comments on the recording of and use of data. Again, one of the rapid review findings was that we do not have enough real-time data. That is very much the direction of travel but, again, I will come back with more detail. As ever, noble Lords will know that I like to bring all these things together in a lengthy letter where I hope I am able to cover any points I did not cover here.

There are steps in the right direction, and the investment I talked about is another step in the right direction. I completely agree with the emphasis that it is vital we restore confidence in this area.

Lung Cancer: Screening

Lord Allan of Hallam Excerpts

Monday 26th June 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the National Screening Committee for its work and welcome this Statement, which outlines the only response that makes any sense: the establishment of a national targeted lung cancer screening programme. I also pay tribute to the many individuals and organisations that have worked over many years for this, in particular the Roy Castle Lung Cancer Foundation, which, in addition to campaigning, has been delivering its own scans since 2016.

I very much wish to associate these Benches with the thoughts of the late and much-missed MP for Old Bexley and Sidcup, James Brokenshire. I acknowledge the work he did in bringing this cancer screening programme about, which was continued by his wife Cathy. This is a very fitting Statement with which to honour his memory.

There is no doubt that diagnosing more people earlier is absolutely crucial. This programme will certainly improve that, but it does have to go hand in hand with treatment that is available rather quicker than is currently the case. The UK currently lags behind the European average for five-year survival rates for lung cancer. More broadly, since 2010, ever more cancer patients have waited longer than is safe to see a specialist. The target of 85% of patients to start treatment from initial GP referral within 62 days has not been met since 2015.

Can the Minister tell your Lordships’ House whether this extension of screening will be matched by the necessary improvements in access to treatment? If the treatment programme is to be improved—as surely it must be—how will this be done, and when? Will it be new money or a diversion from existing resources that funds the programme and any associated improvements in treatment?

Turning to the areas where lung disease is most prevalent, notably those with the greatest deprivation and health inequality, can the Minister give an assurance that resources for the screening programme will continue to be targeted at the areas that need it most? With existing health structures already worse in these areas, how will they be improved to support the delivery of the lung cancer screening programme?

Despite the Government’s support today, it has taken nearly nine months to act on the recommendation of the National Screening Committee, and there is now a timeline to reach 40% of the eligible population by March 2025, with full coverage by March 2030. Can the Minister say whether work is going on to hasten the timeline of this rollout?

The Health and Social Care Select Committee’s report last year into cancer services concluded that a lack of serious effort on cancer workforce shortages risks a reversal in cancer survival rates. While we have been promised the NHS workforce plan this week, after many years of waiting, I note that the Government’s press release had just one line on the workforce necessary to make the screening programme a reality, saying that additional radiographers are due to be appointed. Can the Minister assure the House that when we do get the workforce plan, it will address the major shortages that were outlined by the British Thoracic Society, whose report identifies workforce shortages as the main challenge in the provision of healthcare to those with lung conditions?

As the Minister rightly pointed out in the Statement, smoking is indeed the leading cause of cancer, causing 150 cancer cases every day and one person’s death every five minutes due to smoking-related ill health. It is therefore important that alongside diagnosis, we work to stop people smoking in the first place and support those who do smoke to quit. Yet the number of people quitting has slumped since 2010 and smoking cessation services have been cut. Can the Minister confirm when we will get the awaited Government response to the review of tobacco control policies, led by Dr Javed Khan?

It is not only smokers who have lung cancer and other lung conditions. The context in which all of this takes place is a range of other factors in addition to smoke and smoking, and that includes air quality. It would be helpful if the Minister indicated what is being done to tackle these broader challenges. Furthermore, it is not the diagnosis of lung cancer only that will improve through the screening programme, but also that of conditions such as cystic fibrosis. What expectation does the Minister have in this regard?

My Lords, I am sure we all want to see this national, targeted lung cancer screening programme save lives, and I hope the Minister can give the reassurances I seek today.

[Lord Allan of Hallam (LD)]

My Lords, I would like to follow the noble Baroness, Lady Merron, in welcoming the Government’s acceptance of the National Screening Committee’s recommendation to introduce a targeted lung cancer screening programme, and echo her tribute to the late James Brokenshire, whom I dealt with in a previous capacity when he was a Minister advocating for child safety online. I found him to be very effective; a firm Minister who was also very pleasant to deal with—the most effective model for all of us.

The new programme is especially welcome as a step towards addressing the glaring health inequalities we face in the United Kingdom. I hope the Minister will reassure us that sufficient data will be collected in order to understand whether it is having the kind of impact the Government intend, as he outlined in the Statement.

I hope the Minister can also provide more information about how it can be delivered, given that we already have dire shortages in capacity to deliver diagnostic tests. This shortfall is reflected in today’s report from the King’s Fund, which shows a serious gap in CT and MRI scanner capacity between the UK and comparable countries. When can we expect to see investment from the Government in additional scanners, to bring us up to something more like the international mean? As well as the lack of machines, we do not have sufficient people to operate them or to assess the test results. I invite the Minister to refresh his formula for when we may see the long-awaited NHS workforce plan, including the element that relates to radiologists, perhaps updating it from “shortly” to “in the next week”, as it surely has to come before the 75th<sup>anniversary of the NHS on 5 July.

The concern we continually have with announcements of new services by the NHS in the current context is that they will come at the expense of existing services; the noble Baroness, Lady Merron, also referred to this. I believe this is a rational and reasonable concern to have, given the evidence of missed targets and unacceptable wait times that is all around us. I hope the Minister can give us further assurances that, as the Government will the end of catching more cancers earlier, they will also be willing to will the means to deliver on this promise.

Anyone with eyes in their head can see that vaping is being cynically promoted to young teenagers; it is all around us in high street shops and in the evidence from the litter around schools. The Statement refers to the role of vaping as a tool to help existing smokers give up their harmful habit, but there is increasing evidence that vaping is creating new nicotine addicts, with associated risks. The Australian Government have found that young people who vape are three times as likely to take up smoking, and they have plans to bring in a range of measures to suppress vaping among young non-smokers. Can the Minister explain what assessment the UK Government have made of the Australian evidence of vaping leading to higher smoking prevalence among young people, and are the UK Government considering similar measures to reduce vaping use here? It took us five years to follow Australia in introducing plain packaging for cigarettes. I hope we can follow faster here, on vaping.

The new screening programme is welcome, but it must be properly resourced with both machines and people. I hope the Minister can give us some insights into how that will happen, and at the same time explain what action the Government intend to take to reduce vaping among non-smokers, so that we do not end up creating a new wave of people who are at risk of lung cancer.</sup>

[Lord Markham (Con)]

I will start with a small correction to the Statement. It should have said:

“We are investing £123 million in AI tools such as Veye Chest, which allows radiologists to review lung”


scans, not X-rays. I do not whether the etiquette is that I should have said that during the Statement. I repeated the Statement verbatim because I was told I should, but the correct word is “scans”.

I thank both the noble Baroness and the noble Lord for their comments and support. I too had the pleasure of working with James Brokenshire, and I realise what an effective and kind person he was. Like others, I am delighted that we are making these positive steps today and welcome the constructive and supportive comments.

Regarding trying to show that we are matching the will with the means on MRI scanners, that is exactly what the 100-plus CDCs are all about. It is a recognition that we do not have the same diagnostic capability, as highlighted by the King’s Fund report. That is what the investment in those centres is all about. My understanding is that about four million tests have already been done, so we are looking to match that. We will need 184 radiographers and 75 radiologists to do this work, but the other big support will be the use of AI. We are seeing some promising technology, which will help to a large degree. I am glad to say that a lot of this will be set out in the long-term workforce plan in the coming days—a new formulation. In other words, pretty soon.

In terms of the comments about screening being targeted at those most in need, that is where I have been most pleased by the pilots. Use of the mobile trucks really made a difference in those areas most in need. It really made a difference in the most deprived areas, which, as the noble Baroness, Lady Merron, mentioned, have higher levels of smoking. I am glad that it is targeting those areas.

Can we work to hasten the timetable? I think we would all like to but what we are trying to do here is to put down plans that we are confident we can hit. To answer the money question, it is £1 billion of extra investment during that time and that increases over time so that by the end it is about £270 million extra per annum.

What does that mean in terms of the Dr Khan responses? As I mentioned, we are committed to the smoking cessation results. As part of that we are considering all the points in the Khan review. I think we all accept that vaping is much better than smoking. We are very much trying to encourage vaping over smoking. But you have to be careful of the side-effects of that. As we have seen, vaping can be used in a somewhat cynical way—to borrow the phrase—with young people. More work undoubtedly needs to be done in that space but it is recognised that there needs to be a balance. I think I will need to come back in writing on air quality and cystic fibrosis.

I have tried to cover the points at this stage and look forward to further questions.

NHS Procurement: Palantir Contract

Lord Allan of Hallam Excerpts

Thursday 22nd June 2023 Lords Chamber

[Lord Markham (Con)]

Again, it is important to say that the whole point of this transition arrangement was to allow us to have an open bidding process across loads of suppliers, knowing that, when they were able to put their solution in place, their transition arrangements were in place. That opened up the field to British suppliers and suppliers from around the world. We have had an open process, which has been going on for a number of months now and continues. We expect a contract award around autumn time and I can assure the noble Lord that we have looked at a whole range of suppliers to make sure that we get the best outcome.

[Lord Allan of Hallam (LD)]

My Lords, can the Minister confirm something that he said in a previous answer: namely, that whoever wins the federated data platform contract will not have the right to use any NHS data outside the terms of that contract? Secondly, assuming that the current provider, Palantir, does not get the contract, will the NHS put in place by the end of this transition period procedures to ensure that all the data and access that Palantir had is removed safely so that there is no ongoing situation?

[Lord Markham (Con)]

I thank the noble Lord for giving me an opportunity to clarify that absolutely. The answer is yes on both counts. If Palantir is not successful in winning the contract, no data will remain on its systems; it will be transferred over completely and, as the noble Lord says, whoever ends up winning the contract will be allowed to use that data only in an NHS context—that is, in no other context at all.

NHS: Performance and Innovation

Lord Allan of Hallam Excerpts

Thursday 15th June 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am very grateful to my noble friend Lord Scriven for creating the opportunity for this important debate and for introducing it so well. I can also call him my noble neighbour, as we were previously both elected representatives in Sheffield. In fact, we are so neighbourly that the places in our pantomime names—the “of wherever” bit that we get in our formal titles—are adjacent to each other: Ecclesall in my case and Hunter’s Bar in his, for those aficionados of Sheffield neighbourhoods.

The theme of the debate invites us to consider the current challenges and potential solutions, and I will try to do that in my remarks. There are various ways to describe the state of health and social care in this country. Words such as “crisis” are in common use. Naturally, there is a party-political element to the choice of adjectives that we use, with those in government tempted to play things down and those in opposition to talk them up. In the spirit that my noble friend set out of trying to be more objective in this debate, I will try to use some factual descriptions of the current state of affairs, deliberately avoiding emotive language, that I hope will resonate on all sides of the House.

First, it is clear that health and care services are not meeting many people’s reasonable expectations. Too often, they find that they cannot access services that they believe are necessary for their well-being. In some cases, the services are not available at all, while in others they are there but only after an excessively long wait.

Secondly, and related to the access question, we do not have enough people employed in health and care roles to provide timely services of all kinds in all parts of the country. Many services depend on people having skills honed through years of education and practice. If the right staff are not there, these services simply cannot be delivered.

Thirdly, and related to the staff shortages question, there is poor morale in many parts of the health and care system, which is making it much harder to retain staff and affecting the motivation of those who choose to soldier on. The facile response to the morale question is to say that we should stop talking the service down, but that is to miss the point that there are genuine concerns about pay, work-life balance and career progression, which would affect any worker in any sector. Health and care workers are not immune.

It is possible to both praise the service and its staff and to raise concerns that it is not currently meeting the legitimate needs of its workforce. The focus of the Government has to be to address all these foundational issues, ensuring that supply can meet patient demand, building up the right skilled workforce and creating the right conditions to motivate staff.

Members of this House rightly raise questions in all of these areas across the broad range of health and care services each week. We will continue to press the Government until we see them deliver real improvements. Even if they deliver real improvements, we will want to keep on pressing them because we do not want them to feel complacent and because long-term demographic changes mean that, whoever is in government, they will need to keep running just to stand still and will need a super-human effort to get ahead of the curve.

This brings me to a fourth assertion and the one I want to focus most of my remarks upon: we will fail to deliver the healthcare that people need and deserve without introducing significant innovation into the NHS. That has been the theme of so many contributions today. However, this has to be the right kind of innovation. It is not an alternative to increasing investment in health and care but a complement to it.

There is a saying that if you only have a hammer then everything looks like a nail. To reinforce the point made by the noble Lord, Lord Crisp, I think about structures and legislation, and the hammer that we have as politicians is to pass more laws. We have seen successive Governments seeing innovation in Bills that create new structures for health and care but do not necessarily deliver wider innovation than the structure. We can all hope that these structural reforms will deliver. I know the current Government place a lot of store in the integrated care board model that is currently bedding in. However, the fact that restructuring happens repeatedly suggests that it is not enough to deliver the upgrade we need. The noble Lord, Lord Turnberg, reminded us that more can be done through better integration. That happens in some parts of the country but it is not spreading everywhere.

Others have spoken about a range of areas of potential innovation, which I hope the Minister will agree are worth exploring. My noble friend Lord Addington was right that we need to think about how health and care is dealt with across government. Departments considering things such as our sports, education or environmental strategies equally have a role to play in promoting health and care. Other noble Lords have brought other areas of expertise to bear. The noble Baroness, Lady Bennett, talked about the environmental challenges and some potential opportunities.

It is apparent that there is no shortage of ideas for how we could innovate our way to better health and care outcomes, but there seem to be systemic barriers to ensuring that innovations are taken up across services. I think that has come out in this debate, where we have heard that some of the examples of good practice are isolated examples rather than things which have become standard practice.

Like other Members of the House, as I was preparing for the debate I was contacted by a range of organisations that are thinking about innovative solutions in diabetes care, ophthalmology, cancer research, virtual wards—the list goes on. It is great that we have those ideas, but in this debate we need to think about why those ideas are not becoming standard practice. I was also fortunate to participate in a round table recently organised by someone who advises me, Peter Lacey of the Whole Systems Partnership. He brought together experts in different fields across health and care to pitch excellent ideas for how we might make real changes. I was impressed by just how much thinking there is out there.

We also read every week of projects bringing in new technologies such as AI. I accept fully my noble friend Lord Scriven’s point that it is not all about the technology but about the people, and again, we see these instances of pilot projects. I was reading just this week about the use of AI to detect breast cancer in Aberdeen. We are told that this can make a huge difference today, yet I fully expect when I read those stories that, in a year’s time, those projects will still be isolated to the particular trust that has brought them ahead.

I have a particular interest in how the innovative use of information technology might create step-change improvements. I want to introduce some of those ideas into the debate, but not because they are the most important. I am fascinated by examples such as that of the community health visitor that the noble Lord, Lord Crisp, raised. All those things are fascinating but it is sometimes helpful to talk about the things you know about the most. In my case, I have some expertise in information technology.

To be very clear from the outset, this is not about building more apps but primarily about ensuring that data and information can flow between people and services in ways that will add the most value to all parties. If noble Lords are interested in the argument for why we should focus on good service structure and design rather than just building more apps, I recommend an article from as far back as 2013, by Tom Loosemore, that the Government Digital Service called We're not ‘appy. Not ‘appy at all. It recommended that the Government hold back on seeing the solution as simply another app on your phone. Anyone who deals with the NHS will find, as I have done, that they have a whole folder on their phone of the different apps that different parts of the NHS have told them they must use to contact them. Some are good, some not so good, some get integrated and some do not, but it is not about the apps; it is about the flow of the data.

In the spirit of bringing positive ideas to the debate, an example of the kind of tool that is going in the right direction is a service called Patients Know Best. Other noble Peers may benefit from it if they live in the right parts of the country, because I understand that it is available only in certain health trust areas. This provides patients with immediate access to test results, with helpful contextual information so that, when they have a blood cholesterol test, they can see the result as soon as it is processed by the lab and go and get information about what that result means for them. These kinds of services should be standard practice everywhere; if someone has a test done then there should be secure online access to the results as a matter of course. Yet as I said, I understand that my access to that service is dependent on the part of London I live in, and people who live further down the road may not have access to it. I am curious about the Minister’s thoughts on why services such as these are not universally available.

The second innovation that has potentially huge value is the development of trusted research environments for health data. It is often said that a fortunate by-product of the fact that we have a unified NHS is that data about health activity and outcomes is more consistently available than in other countries, where it might be scattered across small and competing providers. Although we have our own issues in relation to how usable the underlying systems are, our unified national structure provides a good starting point in being able to pull together large-scale datasets.

One of these research environments is the OpenSAFELY.org project, which provides access to GP data not by taking it and sending it off somewhere else but by having infrastructure in the data centres of the main GP record providers so that researchers can access that data securely. We should be making more use of services such as that, having built them. I understand that it is not the universal access method; there are still plenty of people doing research using alternative methods and we have yet to get to a point where the innovation has become standardised.

That brings me to my final point, which overarches all of these areas—tools such as those patient tools and trusted research environments, but also good practice, such as community health visitors and other examples that have been raised. It is the question of how we ensure that innovation spreads. The way innovation spreads through the NHS at the moment is neither fish nor fowl. There has been a reluctance to dictate from the centre, under the assumption that market forces are somehow necessary to drive innovation, yet we do not see the best products and services winning as we would in other markets.

By way of an example, look at how the smartphone market developed; it was ruthless. Products from former giants such as Nokia, BlackBerry and Microsoft were beaten into submission by services from Apple and Android, the services that we all use today. There are bigger questions about competition that stand outside this debate, but the outcome we have seen there is the ubiquitous adoption of some very capable devices. By comparison, it can feel as if some parts of the NHS are still running on Nokia and BlackBerry while others are running ahead with their much better smartphones, and that produces very uneven outcomes. One thought I would like to leave the Minister with is whether there needs to be a different form of central direction to make sure that innovative services and models are delivered more rapidly.

At Oral Questions earlier we had a very good Question from the noble Lord, Lord Crisp, about a palliative care service developed in Derbyshire, and the Minister said, “We want all ICBs to do this”. It sometimes feels as if there are plenty of carrots on offer but insufficient sticks. What happens when a service is available, when we know that the technology is there simply and easily to introduce something such as immediate access to blood tests, but some parts of the country are not choosing to adopt that? What mechanisms may be used to encourage—and, to go further, require—that take-up to happen?

Again, I point the Minister to previous examples in which the Government Digital Service has existed not just to produce standards and say, “Here are the standards; go and do it”, but has had strong political support and would use much more persuasive measures to get different parts of government to adopt the latest thinking around digital. That is not exclusive to digital; it is a much broader question.

There is a need for a real sense of urgency in rolling out innovations in the health service, whether in technology, people, drugs or delivery models, if we are to have any chance at all of getting aligned with, never mind ahead of, the demand curve. I believe the Minister shares that sense of urgency. Perhaps he is not yet institutionalised enough to have given up on the idea that rapid change is possible. I hope that today he can offer us some glimmers of light that might encourage us to believe that change is possible. Again, I thank my noble friend and neighbour Lord Scriven for creating the framework for this interesting debate.

General Practitioners: Recruitment and Retention

Lord Allan of Hallam Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

First, I would agree—I think we all agree—that continuity of care is very important. We absolutely want a career structure that attracts and retains exactly those types of people, so that they feel it is more rewarding, both financially and as a job, to work in such a practice environment.

[Lord Allan of Hallam (LD)]

My Lords, I expected this Question to be the cue for our weekly reassurance from the Minister about the workforce plan, which will be coming “shortly”, “imminently”, “in the blink of an eye”, or whatever the latest formulation will be. In spite of all the reassurances that he has given about numbers, the stark reality remains that many people up and down the country find it extremely hard to see a GP when they need to, and that has knock-on effects for everyone else, including accident and emergency services. Does the Minister have anything new to offer that might give us some confidence that we will turn the corner in the near future?

[Lord Markham (Con)]

The primary care plan was a very good example of something new, substantial and backed by £1.2 billion of investment to beat the 8 am morning rush and use technology—which I know the noble Lord is very interested in—to allow people to self-help in a lot of these situations.