Health and Care Bill

Lord Hunt of Kings Heath Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I offer the support of the Green group for all the amendments in this group. My name is attached to Amendments 51 and 87 and it would have been attached to others had there been space. I can only commend the noble Baronesses, Lady Meacher, Lady Tyler of Enfield and Lady Finlay of Llandaff, for identifying a serious lacuna in the Bill and for providing practical, careful and sensible solutions to that.

The noble Baroness, Lady Finlay, said that the Bill was “by adults for adults”. The other amendments in the group address only half that phrase. It addresses the “for adults” part but not the “by adults” part, which is what my Amendment 103A aims to address. Young people are experts in being young people. We may think about the life experiences of a 12 year-old or an 18 year-old, but none of us really knows what it is like to be 12 or 18 at this moment. A phrase often used particularly by marginalised groups is “Nothing about us without us”—given the hour, I will spare noble Lords the Latin version.

Young people are undoubtedly a marginalised group in our society in that their voice is far too rarely heard. As I have reflected previously, they are hugely underrepresented in this place and in the other place. The under-18s do not have the vote. The under-25s in the voting population, for structural reasons that could be fixed but have not been, do not have the same kind of voice.

I entirely accept that, among paediatricians and social workers, there are many older people who have much expert knowledge, but it is crucial that we actually hear. My amendment seeks to address ICBs and sets out that, in statute, there should be an advisory board consisting of young people on every ICB. I believe that this is an important addition to ensure that young people’s voices are heard. It might be said that many ICBs may set up such a structure, but that is not the same as it being statutory, ensured in the Bill with a message from Parliament saying, “You have to listen to these young people’s voices”.

I doubt that I need to address this in detail, particularly with the occupancy of the Chamber for this group, but I want to mention the Children’s Society’s Good Childhood Report 2021, which looked at 10 to 17 year-olds. Among them, one in 15 were unhappy with their lives—the highest level in a decade. We know that children who are unhappy at the age of 14 are significantly more likely to display symptoms of mental ill health, to self-harm or, sadly, to attempt to take their own life by the time they are 17.

As the report makes clear, the pandemic is only part of this story. There is a climate emergency and a pervasive fear about the future that young people have lived their entire lives through. We are talking about people whose whole life experience, virtually, has been since the financial crash. One thing that we know addresses a sense of powerlessness, with all its negative effects on mental and physical health, is giving people a sense of empowerment—that is, a sense that they can take control of their lives, make choices and make a difference. I often see this with young climate strikers.

I believe that the measure proposed by my Amendment 103A would ensure that this group of amendments collectively addresses the two sides of the problem that the noble Baroness, Lady Finlay, identified. I want to take this forward and I invite noble Lords who are interested to talk to me about it. This should be included in the Bill. Let us hear from children and young people and make sure that ICBs listen to the children and young people they serve.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much agree with the noble Baroness and I support the broad thrust of these amendments. As this is my first intervention on the Bill, I should declare my interests as a board member of the GMC and the president of GS1 UK, the British Fluoridation Society and the Hospital Caterers Association. I am also a trustee of the Foundation for Liver Research.

I support Amendment 51 in the name of the noble Baroness, Lady Tyler. As she said, she, the noble Lord, Lord Bichard, who also put his name to the amendment, and I are members of the Lords Public Services Select Committee, which has just produced a report on vulnerable children. When taking evidence and listening to the arguments, it was sobering to hear that it is now estimated that the number of vulnerable children has accelerated, particularly during Covid, so that more than 1 million children are growing up with reduced life chances. Too many of them end up in our criminal justice system but, despite this, there is no government strategy to deal with vulnerable children.

The result is a lack of co-ordination both nationally and locally. Too many children fall through the gaps. Public services intervene far too late to prevent some of these children from getting into difficult circumstances. Although the amendment deals with only one aspect, it is but one aspect of a more general problem that we believe the Government need to address. The particular problem that we wish the Committee to take account of is the silo working that continues to be evident both nationally and locally, as well as the frustrating unwillingness of public bodies to share data even though it is abundantly clear from both the law and the Information Commissioner’s comments that they are perfectly able to do so.

I do not pretend that passing an amendment to the Bill will change everything overnight, but we look to the Government to be firm in their intent. It is unacceptable for public bodies, many of which have a direct relationship with government, to refuse to share information for all the miserable reasons of tribalism and managers not being willing to let go. We need to do something here.

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I hope the Minister will see the parallel here: a mandatory duty to improve is exactly what the Government want, and have committed themselves to by laying the Bill before Parliament. Therefore, it should be made clear in the statute. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness, Lady Walmsley, brought us very persuasively to the point of Clause 14, which I must say I am extremely puzzled about, because it purports to set out the whole set of arrangements that have to be gone through before integrated care boards can be set up as statutory bodies. However, it appears that that has already been done.

I register a very strong protest with the Minister at the actions of NHS England in going ahead and establishing these bodies, issuing extraordinary edicts such as no local authority councillor being able to serve on an ICB. What right does a quango have to say that local authority councillors cannot be represented on ICBs? This is absolute abuse of parliamentary power, because quangos do not have the right to set out what should happen on governance issues at local level in the NHS without parliamentary endorsement.

NHS England has put out a note that says that, subject to parliamentary progress, arrangements for the new statutory bodies are to come in now, on 1 July. How can that be, when we have not even gone through the sections that deal with the composition of integrated care boards? It is quite possible that your Lordships might insist on Report that local authority councillors are members of the ICBs. That is not impossible, so what will happen? Will the Minister say that, despite what Parliament says, the ICBs will go ahead, or does it mean, as I read this legislation, that the Government have to start again?

Lots of issues will be raised in this and the next group, not least the outrageous governance issue, which says that NHS England basically appoints the chair and the chief executive officer is also at its disposal. There is no attempt locally to have a board that elects its own chair or one that is appointed independently; they are essentially place-people put in there by NHS England. These are matters that Parliament should decide. I accept that Parliament may say that it is happy to go ahead on that basis—but I strongly object to this clause. It is dishonest; it purports to go through a process from the start that says that this is how ICBs will be set up—but they have all been set up, the boundaries settled and the chairs nominated, without any proper public accountability process whatever.

I hope that, when we come to agree Clause 14, the Minister will think again and that he will issue instructions to NHS England to withdraw the letter that says that the new arrangements will come into place on 1 July. I do not understand how that can possibly be.

[Lord Davies of Brixton (Lab)]

My Lords, I speak to my Amendment 45. This is a disparate group of amendments, dealing with the issue of integrated care boards. I strongly support the comments already made. My amendment addresses another issue. There are questions about what the boards are; the issue is for whom they provide services, and how they are defined.

I have been made aware of a case that raises real questions about how this is going to develop. The case was reported in September, in the Manchester Evening News, about a woman who suffered burns while on holiday. She returned to her local urgent care centre in Rochdale and was advised that, because of long waiting times, she should go to another A&E in Bury. When she arrived there, she was told that that centre did not treat people from Rochdale, because of rules laid down by the integrated care board predecessor, which had established the rules in that part of Lancashire. She was left literally on the pavement, unable to obtain the care that she required.

That is a specific case under the existing rules, but it points out the lack of clarity in the Bill about how the integrated care boards will operate. The fear is that they will be membership bodies along the lines of health management organisations in the United States, which are responsible for providing services to members. That contrasts with the residential basis on which the NHS was based, at least up to 2012.

Proposed new Section 14Z31(4) gives the Secretary of State astounding power to set out which ICB is responsible for a particular individual’s care. I hope that the Minister will be able to provide some reassurance, but the problem with membership-based organisations is that, first, there will be cherry picking of patients and, somewhat counterintuitively, at the same time they will be competing for the less expensive patients. Without far more clarity through the Bill from the Minister, people will have reasonable fears over how these new organisations will work and how people will attain the services that they currently expect from a seamless provision of services. My amendment seeks to address the issue of it being a single service. We have these 43 ICBs, or whatever they are, but it is a single service, and patients can access services wherever it is best for them and not best for the service.

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[Lord Hunt of Kings Heath (Lab)]

My Lords, I accept that but how can NHS England give guidance to say that no local authority councillor can be on the ICB? That is not for NHS England to say, and how can it do it prior to the Bill going through Parliament? It is for Parliament to decide these matters, not a quango.

[Lord Kamall (Con)]

I apologise to the noble Lord because I was coming to answer that point, but maybe in too long-winded a way. One issue that was clearly raised, and very strongly felt in the contributions from more than one noble Lord, was about banning councillors from sitting on boards. There is nothing in the Bill that expressly bans this. We recognise the points raised in this debate and will raise them directly with NHS England. It is not statutory guidance.

[Lord Hunt of Kings Heath (Lab)]

I am sorry but this is a very important point. They have made the appointments and are not going to start again, which of course they should, because this is an absolutely hopeless position. No one from NHS England has ever had the guts to come here to explain why they are making this decision, and who will believe it? The chair of the ICB is appointed by NHS England. They know that NHS England does not want local authority councillors on the boards. Who are they going to take notice of? They are going to take notice of NHS England. The Minister has to tell NHS England to stop sending out this ludicrous guidance and telling the NHS that the new arrangements will start from 1 July. It cannot possibly do so if we go through what is contained in Clause 14.

I sympathise with the noble Baroness, Lady Walmsley, but the fact is that we must have a three-month consultation process on the proposals. This is the problem we are in: none of this stands up because Parliament is being treated with absolute contempt by NHS England.

[Lord Kamall (Con)]

I hear the strength of feeling from the noble Lord. I will take this back to the department and discuss it with my right honourable friend the Secretary of State. I hope noble Lords are reassured by that. I may not get the perfect answer, but I will try. I understand the strength of feeling on this issue; no one can fail to do so. Let us put it this way: it was not subtle but direct. It is really important that, as the Minister here, I take this back and reflect the feeling of the House in my conversations with the Secretary of State, and his subsequent conversations with NHS England. I will take that back and look at the consultation process and the CCGs consulting all the relevant local authorities.

I understand the point made strongly by the noble Lord, Lord Scriven, that we have to be careful about prescribing in a top-down way how to work locally. I have always been a strong believer in localism and making sure that powers go down to a local level rather than being taken away. Let me again assure the noble Lords, Lord Scriven and Lord Hunt, and other noble Lords that I will take this back, because clearly there is concern. I had not appreciated the strength of that concern. At Second Reading the noble Lords, Lord Stevens and Lord Adebowale, said, “We are already doing this. It makes sense to go ahead and put it on a statutory footing”. But I have now heard the other side of the argument, and it suggests that I should go back and have a stronger conversation with, in effect, my boss—my right honourable friend the Secretary of State. I hope that gives some reassurance.

On Amendment 44, in the name of the noble Baroness, Lady Thornton, I assure your Lordships that we intend to provide as much stability of employment as possible while ICBs develop their new roles and functions. I hope that noble Lords are aware that there is already an existing commitment that staff transferring into ICBs will transfer across on their current terms and conditions in line with the NHS Terms and Conditions of Service Handbook. NHS pension rights will also be preserved. As a result, staff transferring into ICBs will not see any change to their existing conditions.

However, the Government are concerned about forcing ICBs to adopt conditions and practices that the ICBs do not believe work best for new staff. We believe that it is important to give ICBs flexibilities relating to staff terms and conditions; they are there for a reason. For example, when it is difficult to recruit and staff are going elsewhere, this would include allowing ICBs the flexibility to diverge from collectively agreed pay scales in order to attract staff from elsewhere or with unusual or valuable skills, or to reflect local circumstances. It will also give ICBs the flexibility to support joint working and bring in staff currently working in local authorities or foundation trusts, for example, supporting integration and the joint working approach that the Bill hopes to encourage.

I also note that ICBs having the independence and flexibility to choose whether to adopt collectively agreed pay conditions and pensions for new staff is not unique, as the noble Baroness, Lady Thornton, acknowledged. NHS foundation trusts, which are already free to exercise their discretion in adopting such conditions, overwhelmingly choose to honour and apply such terms to their staff unless there are good reasons to diverge.

On the proposals for very senior managers, existing procedures are in place to ensure that the most senior staff within the NHS are appointed with fair and equitable salaries. Proposals to pay very senior staff more than £150,000 must be similar to those for other equivalent roles or be subject to ministerial oversight.

The Government are in the process of finalising the procedures that will apply for ICBs. The specifics may differ but the effect and intention will be the same: to afford ICBs agency in setting pay at competitive rates so that we can continue to attract the most senior and experienced leaders, while putting adequate checks and balances in place to ensure appropriate use of taxpayers’ money and keep senior public sector salaries at an appropriate level. The Government believe that this amendment, which also asks for ICPs to approve annual salaries in excess of £161,000, is unnecessary. I am happy to have further conversations.

I now turn to the amendments on how the ICBs will function once established, starting with that in the name of the noble Lord, Lord Davies of Brixton, which relates to the question of treatment outside the ICB area. The new clause in question provides that NHS England must publish rules for determining the people for whom integrated care boards have responsibility. Importantly, this clause ensures that everyone in England is covered by an ICB.

We intend that the rules set by NHS England should replicate the current system for CCGs as closely as possible. This means that the ICB will be responsible for everyone who is provided with NHS primary medical services in the area—for example, anyone registered with a GP. It will also be responsible for those who are usually a resident in England and live in their area if they are not provided with NHS primary medical services in the area of another ICB.

It is important to remember that no one will be denied healthcare on the basis of where they live. We want to ensure that, under the new model, bodies that arrange NHS services—decision-making bodies—are required to protect, promote and facilitate the right of patients to make choices with respect to services or treatment. This means allowing patients to choose to be treated outside their ICB area. Choice is a long-standing right in the NHS and has been working well for some time. The Bill continues to protect and promote it. However, I am afraid that we have concerns about this amendment, as it places a requirement on providers rather than commissioners. It would not be reasonable to expect providers to provide services regardless of whether they were funded by an ICB to do so, and it is important that ICBs should be able to make decisions about with whom they contract and where they prioritise their resources.

On Amendment 53, in the name of the noble Baroness, Lady Walmsley, I hope I can assure the Committee that the Government are committed to ensuring continuous improvement in the quality of services provided to the public. As your Lordships will be aware, there is already a wider range of duties in relation to the continuous improvement of services. Clause 20 imposes on ICBs a duty as to the improvement in quality of services. Furthermore, the ICB must set out how it proposes to discharge that duty at the start of each year in its joint forward plan and explain how it discharged the duty at the end of each year in its annual report. I hope this goes some way to meeting the noble Baroness’s concerns.

Clause 16, which this amendment seeks to alter, recreates for ICBs the commissioning duties and powers currently conferred on CCGs in the NHS Act 2006. It ensures that ICBs have a legal duty to commission healthcare services for their population groups. It also recreates Section 3A of the 2006 Act, which provides the commissioning body with an additional power to commission supplementary healthcare services in addition to the services they are already required to commission. This power enables ICBs to arrange for the provision of discretionary services that may be appropriate to secure improvements in the health of the people for whom it is responsible—or improvements in the prevention, diagnosis and treatment of illness in those persons—so it is important that the clause remains as it is currently drafted.

The Bill will ensure that the existing local commissioning duties conferred by the NHS Act 2006 will transfer over to ICBs. This is set out in proposed new Section 3, which is also to be inserted by Clause 16 on page 13. I hope that the noble Baroness, Lady Walmsley, will be reassured that it rightly uses “must” rather than “may” when referring to the arranging of services. I can therefore assure the Committee that ICBs will continue to commission the services previously delivered by CCGs. That will ensure that service delivery for patients is not impacted.

Amendment 159 in the name of the noble Baroness, Lady Wheeler, touches on the important relationship between ICBs and ICPs. I remember that, when we had an earlier consultation, the Bill team had a diagram about how ICBs and ICPs would work together; It might be helpful if I ask for that to be sent to noble Lords so that all of us can have more informed conversations about the intentions of the amendments and the issues that noble Lords want to raise. I will make sure that that is done.

This amendment would add a requirement for the Secretary of State to make regulations to establish a dispute resolution procedure if an ICB fails to have regard to an assessment of needs, an integrated care strategy or a joint local health and well-being strategy in respect of the ICB’s area. The Bill was introduced to ensure that existing collaboration and partnership, working across the NHS, local authorities and other partners, is built on and strengthened; I recognise the concerns raised by the noble Lord, Lord Scriven.

We intend for these assessments and strategies to be a central part of the decision-making process of ICBs and local authorities. That is why we are extending an existing duty on ICBs and local authorities to have regard to relevant local assessments and strategies. The ICB and local authorities will be directly involved in the production of these strategies and assessments through their involvement with both the ICP and health and well-being boards at place—that is, at a more geographical level. As a result, they have a clear interest in the smooth working of the ICP.

More widely, there are several mechanisms to ensure that ICBs and local authorities will have regard and not intentionally disregard the assessments and strategies being developed at place in their areas. First, health and well-being boards have the right to be consulted.

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Moved by

[Lord Hunt of Kings Heath]

25: Clause 14, page 11, line 20, at end insert—
“ NHS Appointments Commission (1) There is to be a body corporate known as the NHS Appointments Commission.(2) The NHS Appointments Commission has the function of—(a) appointing the Chair and ordinary members of integrated care boards;(b) other duties as set out in regulations under subsection (3).(3) The Secretary of State must by regulations provide for—(a) the establishment and constitution of the board of the Commission;(b) the financing of the Commission;(c) the duties of the Commission.(4) The Commission must prepare and submit an annual report of its activities to Parliament.”Member’s explanatory statement
The amendment would provide for an independent commission to have responsibility for the appointment of the chair and ordinary members of integrated care boards.

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[Lord Hunt of Kings Heath (Lab)]

My Lords, in moving Amendment 25, I will speak to other amendments in this group, which follows on from the previous group and the last comments made by the noble Baroness, Lady Walmsley. On day two in Committee, we had an interesting discussion about the composition of integrated care boards. My noble friend Lady Thornton and other noble Lords argued for specifying in some detail the composition of ICBs, including having representation from mental health trusts, public health, staff and the patient’s voice.

Equally, the noble Lord, Lord Mawson, discussed the problems that arise when members on committees are seen to represent what he called “other agendas”. The noble Baroness, Lady Harding, was supportive of that view, although she argued that

“we should think more about what we want the integrated care boards to do”.—[Official Report, 13/1/22; col. 1303.]

and how we will measure this, rather than exactly who is on them. I see the force of that argument; I for one am pretty uncertain about what exactly these integrated care boards are all about.

The noble Lord, Lord Hunt of Wirral, went to the heart of this when he raised an issue that has troubled me right from the beginning: the provision that NHS trusts and foundation trusts are to be members of the integrated care boards. As he said:

“Organisations that provide the bulk of NHS services”


are therefore brought into the work of commissioning. The current system is one where commissioners—CCGs—hold providers to account

“objectively determining whether they are best placed to provide a service and assessing their performance”

and, as he said, the question then arises as to how the new integrated care boards can

“continue to perform that role.”

He felt that the membership of provider appointees on those boards at least created a risk of

“a conflict of interest between the roles of those individuals on the board and any roles they may hold with provider organisations”.—[Official Report, 13/1/22; col. 1297.]

In response, the Minister said that

“each ICB must make arrangements on managing the conflict of interest and potential conflicts of interest, such that they do not and do not appear to affect the integrity of the board’s decision-making processes. Furthermore”—

this is a very relevant point—

“each appointee to the ICB is expected to act in the interests of the ICB. They are not delegates of their organisations, but are there to contribute their experience and expertise for the effective running of the ICB”.—[Official Report, 13/1/22; col. 1308.]

Up to a point, Lord Copper. I am now totally confused as to what ICBs are. I must admit that I thought that reason for having all the key local players around the table was to brokerage deals, sort out the flows of money and keep the show on the road, but the Minister’s vision seems to be for a rather more rarefied forum, where members of the ICBs have to leave their interests behind them and think Olympian thoughts in the interests of the greater good. However, when you think of an ICB, with members of a major trust sitting around the table, and local authorities represented not by their political leadership but by officers, how on earth can they leave their principal interests behind them? Surely the responsibility of the CEO of a trust or presumably of a local authority or the director of adult social care is to represent the interests of the organisations on that board.

I will give a couple of examples. On page 21, the Bill states in relation to new Section 14Z50 on the joint forward plans for an integrated care board and its partners that

“an integrated care board and its partner NHS trusts and NHS foundation trusts must prepare a plan setting out how they propose to exercise their functions in the next five years.”

That is fine, because that is probably one of the most important things that they have to do, but what are the trusts’ chief executives on the ICB expected to do? Are they expected to sit there and declare that it is a conflict of interests and therefore take no part in the discussion, or are they there to represent the interests of their trust, because the forward plan is very important to the success or otherwise of their organisation? It would be the same with the local authority representative, even though that representative, because they are an officer, will have to report back all the time to their political leaders to get the green light to what they have to agree to within the ICB board, which is why it is so stupid to keep local authority councillors off that board.

The Minister says, “Oh well, if it all goes wrong, we can use regulation powers to put it right”. But we are at the beginning of this process, and we need to get it right now. I very much ask the Minister to think again about the structure of ICBs and how on earth you can expect them to operate if the large trusts that they are supposed to commission serve round the table. It is really a nonsense in governance terms. Only NHS managers could have come up with this—and, oh dear, it was NHS managers who came up with it. Much though I love them and have represented their interests, I agree with the noble Lord, Lord Scriven, that accountability and democracy do not come very easily to them, and you can see that in the complete mess that we see before us today.

We then come to the question of whether these ICBs are accountable at all locally. I see no evidence of that at all; they are clearly part of a top-down managed hierarchy. How can you explain the reasons for the chair being appointed by NHS England and not by the board itself? How can the chair be removed from office only by NHS England? The chair should hold office at the confidence of the board. It should be the board that decides whether the chair is competent to continue, subject to external regulatory interventions, as of now, where that is necessary.

Secondly, why does the appointment of the ICB members have to be approved by the ICB chair? I am sorry that the noble Lord, Lord Scriven, is not here. If I, as leader of Birmingham City Council, for instance, decided that my director of adult social care should go on to the board of the Birmingham and Solihull ICB, what right does the chair have to give their approval or not to that appointment?

We have already discussed the nonsense of local authority councillors being left off, but let me just make one other point. If you were the chief executive of the local authority appointed to an ICB, where you are making big decisions about finance, does the Minister imagine that that officer will do it off their own bat, or does he think that every step of the way they will report back to the leader of the council and the cabinet member for social care? Of course they will.

The problem is that NHS managers think local government is run in the way the NHS is run; they think the officers are in charge. But they are not, because you have political, democratic leadership. It is the same with Ministers in government, which it seems is why they have got themselves into such a mess in relation to this governance.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Lord Hunt of Kings Heath Excerpts

Tuesday 14th December 2021 Lords Chamber

[Lord Framlingham (Con)]

My Lords, I had not intended to contribute to this debate, but I will say a few words. First, I am completely against any compulsory vaccination of any kind. It goes completely against all that we should believe in and I am totally opposed to it. Secondly, I recently put down two Written Questions to the Minister’s department: one about people who had been vaccinated and one about people who had tested positive with antibodies. I wanted to know the difference between the two; I wanted to know about protection from the disease and about transmission of the disease. The Answers that I got said, “We’re looking at it, but as far as we can tell at the moment, there is no difference”—it was 84% versus 85%. There is no difference between the protection that the vaccine offers and the protection given by antibodies in the normal course of events. Surely we are not going to vaccinate people who have the antibodies. It is absolutely pointless, particularly if they are thousands of schoolchildren. Can we not test people who have the antibodies and tell them that they do not need to be vaccinated? That seems to be common sense.

[Lord Hunt of Kings Heath (Lab)]

My Lords, it seems that we have come down to debating two specific issues. The first is, of course, the question of mandatory vaccination for healthcare staff and whether we should support it. The second is the way in which the Government have been treating Parliament over not just this issue but the hundreds of statutory instruments that have been brought in relation to Covid, many of them by the Minister’s department.

We are entitled to a full response as to why the impact assessment was published so late. As I said, I am afraid that this is not the first occasion. I have been following the work of Big Brother Watch over the Covid experience. It has set out clearly the hundreds of SIs that have been brought here retrospectively and the impact on parliamentary democracy. We all know that we are in the middle of a crisis and that, of course, the Government have to act quickly—we all understand that. Even so, the one thing that we are entitled to say is, if they are doing that, they should be able to produce the documentation to justify the action that they are taking.

The mandatory vaccination of healthcare staff was not a decision that was suddenly reached in the last few days; it has been trailed for weeks in the consultation. I declare my interest as a member of the GMC board. I am not speaking on its behalf, but the GMC and many other organisations responded to that consultation, so there is no excuse, in this instance, for there not to be a full impact assessment published alongside the SI so that my noble friend Lord Cunningham and his committee can consider it with ample time and we can then enjoy their recommendations to us.

Dementia: Art and Music-based Interventions

Lord Hunt of Kings Heath Excerpts

Monday 22nd November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question. As an amateur musician—I stress “amateur”—I know that there is no better feeling than when you connect with your audience as a live musician. Music tugs at your heartstrings. Music touches your soul. But it can also unlock the mind. This shows the importance of music in social prescribing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I hope that patients get the benefit of what I am sure is the Minister’s excellent playing. He has been very positive in his responses, but he will know that the arts sector has been very stretched financially during the Covid years in particular. Will he open discussions with organisations such as the Alzheimer’s Society, with an offer of some funding to develop some of the schemes that we have heard about today?

[Lord Kamall (Con)]

I thank the noble Lord for his invitation to perform live—I am not sure that he will feel the same way after hearing my blues band. Last year, NHS England and NHS Improvement, in collaboration with the National Academy for Social Prescribing, the Alzheimer’s Society and Music for Dementia, facilitated a series of webinars. We are working in consultation with them. In February 2021, Music for Dementia also published social prescribing guides for link workers to help expand music prescriptions. The important thing here is that we are consulting with stakeholders.

New Hospitals

Lord Hunt of Kings Heath Excerpts

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

The Government have said that we will deliver 40 new hospitals by 2030 and in October 2020 we published the full list of the 40. This includes eight schemes that were announced by previous Governments but are to be delivered this decade and 32 new hospitals. We have also confirmed that we will identify further new hospital schemes, the process for which is ongoing, with a final decision to be made in spring 2022. This means that 48 hospitals in total are to be delivered over the decade.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have here the New Hospitals Programme Communications Playbook, which the noble Lord’s department has put out and which makes it clear that if you build a new wing of a hospital, that counts as a new hospital. What is worse is that NHS bodies are being instructed to lie and propagandise on behalf of the Government. Will he withdraw this disgraceful communication?

[Lord Kamall (Con)]

I hope that the noble Lord will recognise that whenever a new project is started and there is a decision to build a new hospital in a community, it surely makes sense to look at whether there is space on existing sites. Otherwise, if we start criticising new hospitals on existing sites, there may be a perverse disincentive for a hospital to say, “Well, let’s build elsewhere”. when there is a perfectly good site. It is important, whatever you call it, whatever the semantics, to recognise that we are building modern, digital, sustainable hospitals for the future.

Covid-19

Lord Hunt of Kings Heath Excerpts

Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

On future vaccinations, my noble friend raises an important point, and many will have seen in the media and elsewhere all the discussion about living with this vaccine. At the moment, we have boosters at six months; as the technology and the understanding get better, it seems likely that we will move to annual vaccinations, as we do flu jabs. I cannot say that for definite, but the trend is going that way, given the development of the virus, the variants and the waning immunity over time. The effectiveness of each vaccine at the moment is six months, but one can see the longer term. However, please do not take that as a given—if that is incorrect, I will update the House.

On public transport: I went to a funeral today, and as I was travelling back on the underground, it said, quite clearly, that you must wear a mask, so that is being encouraged. It is part of plan B if we have to move to plan B, but all that data is being analysed and constantly updated with different factors. There is no one trigger for moving to plan B. In previous appearances at the Dispatch Box, I have read out the list of all the factors that are considered. At the moment, the main message is: the vaccine works. We want to encourage people to get the vaccine and especially try to reach those communities that have not even had their first or second vaccine yet.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a trustee of the GMC and the Royal College of Ophthalmologists. Can I ask the Minister about the impact on the NHS generally and the pressure it is under? He will be aware that the Academy of Medical Royal Colleges issued a statement a few weeks ago on its concern about the abuse of NHS staff. What are the Government doing to ensure that NHS staff are able to go about their work without the horrific abuse that many have had to endure?

Secondly, I refer the Minister to the report of the Royal College of Physicians, a census that shows that 48% of advertised consultant posts across the UK were unfilled last year? Does this not show that Covid has exposed the frailties in the NHS? Unless the Government grip this workforce issue quickly, the pressures on the service are going to get worse and worse. What are the Government doing?

[Lord Kamall (Con)]

The noble Lord raises a really important point on staff, doctors, nurses and other healthcare workers in our health system. The Government have a zero-tolerance approach to abuse and harassment; we are investing in better security at GP surgeries and are committed to working with the NHS to make sure our primary care workers feel properly supported. We are also constantly having conversations with trusts and the NHS generally about making sure that staff feel safe to work and how we can make sure that that happens. Anyone who has visited a hospital recently will have seen the signs about zero tolerance.

We are constantly talking to NHS England about workforce pressures. We are looking at specific campaigns—for example, we have announced social care recruitment—and other campaigns to attract more workers to the NHS.

Clinical Negligence Claims

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Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises an important point. However, in looking at the system overall, there is no evidence to suggest that the rise in overall costs is due to a decrease in NHS safety. Nevertheless, safety and learning from incidents are essential in their own terms. Our ambition is for the NHS to be the safest in the world and for maternity safety to be a priority, and there are various schemes in place.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the Minister tell me why the Government do not move to repeal Section 2(4) of the Law Reform (Personal Injuries) Act 1948, which essentially disregards treatment that the claimant may receive under the NHS? Can he also do something about the record of NHS Resolution in paying damages in 80% of litigated cases, with its lawyers being paid on a win-or-lose basis and therefore incentivised to carry on with unsustainable defences?

[Lord Kamall (Con)]

The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.

In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.

David Fuller Case

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Tuesday 9th November 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am sure that the appointment of Sir Jonathan Michael will be very welcome; I have no doubt that he will do a very robust piece of work. My noble friend mentioned support for families, and the Minister made a number of comments about the support given, including care worker support and compensation. If families wish to appear before the inquiry, will the department consider making financial support available to those families in relation to legal advice, so that they can articulate their concerns before the inquiry?

[Lord Kamall (Con)]

I am afraid I am not able to answer the noble Lord’s question directly, because clearly there are some legal issues around it. I am sure he will understand if I try to find an answer and write to him.

Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

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Tuesday 9th November 2021 Lords Chamber

[Viscount Stansgate (Lab)]

My Lords, I will intervene briefly to support my noble friend’s Motion to Regret. She has outlined the government by press release approach that has been taken. I find myself in considerable agreement with the noble Lord, Lord Cormack. In fact, I remember him reacting last week or the week before to a Statement that had in its title on the annunciator “Announcement to the media”. The noble Lord quite rightly said that it is not the business of this House to have to debate something that has already been put out to the media. Ministers are supposed to come to the Dispatch Box and give the House the information directly.

I entirely agree on the issue of secondary legislation as a way of making progress rather than primary legislation. Although there are difficulties with primary legislation—look at the Police, Crime, Sentencing and Courts Bill, which is a mega Bill if ever there was one, so there are disadvantages even for large Bills—in general I support my noble friend’s Motion to Regret. Although this is not a matter for a vote, I hope the Minister will take back something of the cross-party unease expressed by the noble Lord, with which I find myself in considerable agreement.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I echo my noble friend Lord Howarth’s tribute to Mr Duncan Selbie, the former chief executive of Public Health England. He is a very fine public servant who led PHE with great skill and aplomb over a number of years. I feel very sad indeed that his career ended in the way it did. Shame on Ministers who allowed this to happen.

I also have to say shame on Ministers for the way in which Parliament has been bypassed in relation to these crucial decisions about the future of our national public health arrangements. Were it not for the fact that staff had to be transferred, there would be no parliamentary debate or scrutiny whatever about these important changes.

Why did it happen? It would seem to me that it was simply a panicked reaction which was merely a front for Ministers’ own mistakes, and the attempt by Mr Hancock and his fellow Ministers to shift blame for their own inadequate leadership in responding to the pandemic is really all too characteristic of the way the Government approached it. It was dishonest because Ministers pretended that PHE was an independent body that had its own life, but it did not. I know that PHE’s record is not without criticism, but the fact is that it was fully part of the Department of Health. The noble Lord, Lord Lansley, legislated for that and deliberately wanted to make it like that, and for Ministers to try to shift the blame from them to a group of officials —and they are officials—was simply not acceptable.

My fear is that the new arrangements are being set up in the same way, with the same uncertainties about who is actually accountable for what they do. The UKHSA is an executive agency sponsored by the department, so it is the same category of organisation as Public Health England, which was described on the Government’s website as

“an executive agency with operational autonomy.”

It is noticeable that, on 13 July, the Government published a document setting out UKHSA’s remit and priorities, in the form of a letter from the noble Lord, Lord Bethell, then Parliamentary Under-Secretary of State for Innovation, to Dr Jenny Harries, the UKHSA’s chief executive. It stated that:

“UKHSA is accountable to the Secretary of State for Health and Social Care and the Parliamentary Under Secretary of State for Innovation”,


which I think means to the Minister, but unlike PHE, the letter from the noble Lord, Lord Bethell, made no reference to UKHSA having operational independence from the Government. I ask the noble Lord, Lord Kamall, whether that omission was deliberate.

I have the same question about the Office for Health Improvement and Disparities. We are not debating that tonight, but it comes within the package of new measures that are being brought in. This is not, I understand, an executive agency but is described on the Government’s website as “a high-profile group”. The website does state that

“OHID is part of the Department of Health”,


So, again, there is no pretence at independence.

We are at risk of repeating the same mistakes that occurred with PHE. Ministers proclaim these new bodies, they are given a veneer of independence, but as soon as something goes wrong, or Ministers do not like the messages—and they often do not like the public health messages these bodies give out—Ministers jump in and attempt to micromanage. Accountability is confused, reporting lines are blurred, the public are certainly confused and Parliament is unable to scrutinise them effectively because they come within the Minister’s responsibilities as part of the department.

Of course, the ultimate test of these arrangements is how they will work if another dreadful pandemic hits us, or in relation to how we will improve the overall health of the people of this nation. Clearly, the jury is out on that—we do not know—but I would have more confidence if these bodies were more independent and subject to much greater parliamentary scrutiny than they are apparently going to be.

NHS: Fracture Liaison Services

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Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

I am not sure about the specific case that the noble Baroness raises, but I will write to her. However, generally, there is an investment of £2.3 billion to increase the volume of diagnostic activity and to roll out at least 100 community diagnostic centres, to make sure that we are taking diagnosis closer to patients in their communities.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I do not understand. The noble Lord and his Ministers are taking powers in the health Bill going through the Commons at the moment to issue directions to NHS England. So why on earth can he not issue a direction to NHS England to simply say that every integrated care system must have one of these services, given the evidence that noble Lords on his side of the House have given about the benefit of doing so?

[Lord Kamall (Con)]

The Government recognise the importance of FLS, as does the NHS. That is one of the reasons why they are looking to roll out these community diagnostic centres, to make sure that the technology and the scanning is as close to the patients as possible. Just this morning, I had a meeting with one supplier who is talking about a partnership with a number of integrated care systems to make sure that they roll out the systems as close to patients as possible.

Cancer Drugs: Licensing and Approval

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Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her Question. Clearly, there is distress and concern at the delay between MHRA approval and NICE licensing. The drug Trodelvy was licensed by the MHRA for both unresectable locally advanced and metastatic triple-negative breast cancer through Project Orbis. On NICE’s appraisal of Trodelvy to determine its clinical and cost-effectiveness for use in the NHS, NICE hopes to have guidance next year but, in the meantime, NHS England, NHS Improvement and NICE continue to work with the manufacturer to explore options for interim access to Trodelvy.

[Lord Hunt of Kings Heath (Lab)]

My Lords, despite what the Minister says, the fact is that innovative new drugs such as the cancer drugs the noble Baroness mentioned are reaching patients in this country far too slowly. We lag behind many other countries. How can we expect to be a centre of science and research if the NHS is so slow to develop the medicines that are produced?

[Lord Kamall (Con)]

I think noble Lords will agree with that frustration at the speed of approval and licensing, but in most cases it does happen speedily. One of the central issues is making sure that there is confidence in the ability to purchase. We are looking at a number of different ways to accelerate the process, including through ILAP—the accelerated partnership—while also making sure that MHRA and NICE can speak where they are allowed to, given some of the legal restrictions on their discussions. For example, I went a couple of weeks ago to a board-to-board meeting between MHRA and NICE at which they discussed issues of common concern.