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

Lord Hunt of Kings Heath Excerpts

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

Lord Hunt of Kings Heath Excerpts

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

Lord Hunt of Kings Heath Excerpts

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.

Cancer Drugs: Licensing and Approval

Lord Hunt of Kings Heath Excerpts

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.

NHS: Fracture Liaison Services

Lord Hunt of Kings Heath Excerpts

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.

Public Health Grant to Local Authorities

Lord Hunt of Kings Heath Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important point about needing to tackle disparities across our nations. The ring-fenced grant that we provide to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. Also, the grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived. In addition, noble Lords will be aware of the new Office for Health Improvement and Disparities. The pin-light focus of that office is on health disparities and how we tackle them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I must say that that is a rather surprising answer. The Minister will know that the Prime Minister has promised to help level up the health expectancy of the poorest areas, but I take the Minister to his answer. The Health Foundation stated in the summer that there is no sign of concerted action to do this and:

“Current plans appear to be partial and fragmented, and many deprived areas where people are likely to have poorest health have not been identified as priorities for investment.”


Will the Minister reconsider his answer to my noble friend?

[Lord Kamall (Con)]

The noble Lord raises a very important point about how we tackle these disparities. This is one of the reasons. Given that a lot of powers to intervene at local level are in the form of local authority grants and local public health officials, it may well sometimes come across as fragmented. This is why the Office for Health Improvement and Disparities is very important to take an national overview of areas of disparity and target them.

Smoking Cessation: Prescription of E-cigarettes

Lord Hunt of Kings Heath Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the MHRA a considerable number of times, which is a great tribute to the work that it is doing. Can he tell us why it is facing budget cuts at a time when we need our independent regulator in this country to be doing all it can to regulate and encourage new innovative products, including pharmaceutical products, to the market?

[Lord Kamall (Con)]

As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.

Health Care and Adult Social Care

Lord Hunt of Kings Heath Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

I do not see myself as someone who is able to offer jobs advice or careers advice. But the points made by the noble Lord help to explain in many ways some of the pressures that care home providers are facing when recruiting in a competitive market. The Government have looked at funding and how we can work with care providers, particularly as many are in the private sector, as I said earlier. They are not directly controlled by the Government and we can therefore work with local authorities and care providers on how to make sure that they pay a competitive salary to attract care workers to work in the social care system, as opposed to some of the more competitive sectors that the noble Lord mentioned.

[Lord Hunt of Kings Heath (Lab)]

My Lords, one of the areas where there is most pressure has been that of unpaid carers. Not only are they having to take on a much greater load but for a long period they could not even visit their loved ones in care homes. In all the programmes that the Government are taking on, can the Minister say explicitly what is going to be done to support carers in their invaluable role?

[Lord Kamall (Con)]

I think that all noble Lords will agree with the point made by the noble Lord about the importance of unpaid carers and also paid carers. In relation to unpaid carers, we hope that as the social care reforms, in particular, come through, patients will be able to take advantage of social care. That will remove some of the burden from unpaid carers and free up their time. We are, however, looking closely at the implications and consequences of some of the proposed reforms.

NHS England Funding: Announcement to Media

Lord Hunt of Kings Heath Excerpts

Tuesday 26th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question. Last week we had a discussion on healthy ageing and making sure that the population of the UK is able to live healthy lives for longer. That is very much part of the overall thinking on health reform and we hope to have more details in due course.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister says that Ministers are dealing with workforce shortages. But surely he knows that, throughout the health service, there is a critical crisis. No one is in charge; it does not seem to be the responsibility of Ministers, Health Education England or NHS England. Who will sort this out and who will be held to account?

[Lord Kamall (Con)]

The noble Lord makes a valid point on workforce shortages. The Chancellor will confirm wider health budgets at the spending review, which is in only a few more days. We have already increased training places this year and will feed through into the available workforce. Ensuring that we have the workforce necessary to support this expansion will be driven by a combination of things, such as enforced workforce productivity, including from the spending review digital diagnostic investments, which are expected to deliver a 10% to 15% workforce productivity uplift. We are also looking at existing Health Education England funding, which will provide a pipeline for growth in training numbers.