Integrated Care Boards

Lord Hunt of Kings Heath Excerpts

Monday 5th September 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. The last I was aware of—and I shall look at it and write to my noble friend—was that, under the visa scheme, we were looking to bring in people from overseas to fill those vacancies. We have historically done that; as I said, after the war we looked to people from the Commonwealth, who came and saved our public services. Clearly, when we are unable to recruit enough people locally, we have to look at those issues and at whether it is something to do with the education system, and whether we can encourage them to come forward. But where there are gaps we will have to look more widely to our partners around the world.

[Lord Hunt of Kings Heath (Lab)]

My Lords, when the Minister took the Bill through the House, he argued that a restructuring was necessary to integrate services, yet outside every acute hospital dozens of ambulances are stacked up every day, often waiting for hours with patients inside, because we have a disintegrated system. Can he show me what the integrated care boards are doing today to end that dreadful practice?

[Lord Kamall (Con)]

One priority of my right honourable friend the Secretary of State—I think he is still the Secretary of State—has been to look at the ambulance system. On a wall in his office, he has all the various things; he has talked to various partners and he has brought people together to see what the problems are, why we are unable to unload patients into hospitals, what the blockages are and how we can address this from a systemic view.

Coronavirus: New Cases

Lord Hunt of Kings Heath Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

The noble and gallant Lord makes a very important point: we have to continue with the living with Covid strategy, and keep an eye on the Covid cases, but also be aware that we need to clear the backlog, and that people have missed appointments. One of the things we are doing is looking more at diagnostics. Many noble Lords will be aware that about 80% of the waiting list is people waiting for diagnosis. Of those waiting for surgery, about 80% of them do not need to stay overnight in hospital. We want to make sure that we get the right balance between monitoring what is going on with Covid and at the same time clearing the backlog.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord just talked about clearing the backlog. He said earlier that the incidence rise is now leading to increased hospitalisations. What impact is that having on the backlog?

[Lord Kamall (Con)]

I asked that very same question when I had the briefing with UKHSA officials earlier, and they said they are still focusing on the backlog. If it gets to a point where it is affecting the backlog, clearly measures may well have to be introduced.

Thyroid Patients: Liothyronine

Lord Hunt of Kings Heath Excerpts

Wednesday 6th July 2022 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they will take to prevent Clinical Commissioning Groups denying thyroid patients access to the drug liothyronine (T3) for the treatment of hypothyroidism.

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

My Lords, I am still here. While levothyroxine is the first-line treatment for hypothyroidism, guidance published by NHS England is already clear that prescribing liothyronine is clinically appropriate for individual patients who may not respond to levothyroxine alone. NHS England is currently reviewing its guidance. As part of the engagement exercise, patient groups and other key stakeholders have been contacted to provide feedback and will be involved in this refresh.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am relieved that the noble Lord is still here to answer this Question. I am grateful for what he said, but he will know that, for a certain group of patients, T3 is highly effective and much more effective than the normal medication that is given. There was a huge price hike a few years ago, and as a result the NHS restricted access; the price has come down, but, unfortunately, access is still restricted. In some parts of the country, patients cannot get prescribed it. Will the noble Lord, rather than relying on advisers, intervene and tell the NHS to stop this postcode lottery?

[Lord Kamall (Con)]

NHS England is currently consulting on this revision, for much the same reasons that the noble Lord acknowledges. At the moment, liothyronine is a second-line treatment when the other one cannot be used or is not appropriate. At a local level, doctors should be advised that they are able to prescribe it. Clearly, that is not getting through. When we went to NHS England with this, it recognised this and said that there will be a consultation.

Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Lord Hunt of Kings Heath Excerpts

Tuesday 28th June 2022 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

At end insert “but that this House regrets that the Order does not make provision about the wider workforce challenges facing the community pharmacy sector”.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I certainly have no objection to this statutory instrument, which, as the Minister said, requires a strengthening of the governance that relates to superintendent and responsible pharmacists. My complaint is that this could have been so much more. My principal purpose in tabling my amendment and allowing us to debate this is to talk about the potential of community pharmacy and my frustration that the Government are doing so little to support the sector. I find that quite extraordinary.

As the Minister said, the NHS is going through an incredibly tough time. We have a huge backlog of patients waiting for treatment, workforce pressures, scary ambulance waiting times, and there is a real sense of demoralisation in primary care. You would think that the Government would have welcomed with open arms the contribution that community pharmacy can make. Instead, however, it seems that the sector continues to be undervalued and starved of investment.

--- Later in debate ---

I turn to the amendment in the name of the noble Lord, Lord Hunt. Of course I have sympathy with the issues that he has raised. Strictly speaking, they are not matters that can be addressed by the legislation before your Lordships’ House today, so while I understand the frustrations, I do not support the noble Lord’s amendment. I thank Members for their interest and for the positive debate today and I commend the order to the House.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to noble Lords who have taken part in the debate and to the Minister. The noble Baroness, Lady McIntosh, was right to raise the concerns of the Secondary Legislation Scrutiny Committee. I was reassured by the briefing we had from the General Pharmaceutical Council. Clearly, it is something we need to keep a watch on.

As far as timelines are concerned—and I declare an interest as a member of the GMC—the Minister will be aware that there is a huge backlog of regulatory instruments that need to come forward to make changes to the regulatory system. I hope he will be able to give a great deal more priority to this issue over the next few months.

The noble Baroness, Lady McIntosh of Pickering, mentioned dispensing doctors. Noble Lords will perhaps not be unaware that there is sometimes a tension between community pharmacists and dispensing doctors, but that does not mean that dispensing doctors do not have a valuable role to play in future.

The noble Lord, Lord Grade, made important points about closures and funding. I do not know whether anyone really understands how community pharmacy is funded. It is certainly a very complex situation, which in four years as the Minister responsible I am not sure I ever quite discovered. The noble Lord raised a substantive point there.

I was glad to have support from the noble Baroness, Lady Brinton. She spoke well about the fact that community pharmacies had to step up because access in other parts of primary care has become so difficult. My noble friend Lady Wheeler made an important point about minor ailment services and savings that could accrue to the NHS if community pharmacy were used more.

I was grateful for the Minister’s response. He painted the picture that in actual terms you could say the health service has more staff, but he will know that respected think tanks and analysts have been saying for many years now that, because of the nature of healthcare and demographic changes, we have to run very much faster to meet the new demands. That is where the problem arises in community pharmacy. The Minister will not be surprised that, because of the long-term challenges, many noble Lords in this House regret that the Government did not accept this House’s recommendation that we have a proper long-term workforce strategy which is funded to try to forecast and deal with those issues.

On the substantive issue of community pharmacy, it faces many challenges. Many community pharmacy businesses are facing a viability situation. I do not think that the current contract the Minister talked about is really doing what it needs to. I am hopeful about the talks that he mentioned and potential agreement in the future, but at the moment I doubt that the Government are really going to come up with the goods. It is a tragedy because here is a profession and a sector which could do so much more at a time of huge pressure. It needs to be given the wherewithal to do it. I wish to test the opinion of the House.

Vaccinations

Lord Hunt of Kings Heath Excerpts

Wednesday 15th June 2022 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what lessons they have learned from the high uptake of Covid-19 vaccinations in the United Kingdom; and what plans they have, if any, to apply similar strategies to increase vaccination rates for other conditions, such as shingles or influenza.

[Lord Hunt of Kings Heath (Lab)]

My Lords, on behalf of the noble Baroness, Lady Greengross, I beg leave to ask the Question standing in my name on the Order Paper.

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

We have seen high levels of Covid-19 vaccine uptake by being flexible and innovative in how we get vaccinations into patients’ arms and being supported by strong national and targeted communications and community-led initiatives. We have sought to learn lessons from the rollout and the NHS is working collaboratively with partners to design future NHS vaccination services for Covid-19 vaccines and other vaccination and immunisation programmes, considering how we can better use data to improve access to information.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. One of lessons of the pandemic was that flu vaccines were given free to people aged between 50 and 64. The Government have said that from next autumn people will have to pay. The Minister will be aware that vaccination rates around the world, particularly in Australia, have increased dramatically. Will he reconsider this policy, given that we need to encourage that age group to have the vaccine?

[Lord Kamall (Con)]

The noble Lord is absolutely right; we have received advice on the flu vaccine and at the moment it is free to those aged 65 and over. The issue, frankly, is balancing resources. A number of people in the system are saying that if you keep mandating vaccines, it means they cannot get on with tackling the elective backlog. On balance, at the moment it seems better to focus on the elective backlog, but UKHSA and others are monitoring the situation very closely.

GP Access

Lord Hunt of Kings Heath Excerpts

Tuesday 7th June 2022 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they are taking to address the delays experienced by patients trying to access their GP.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I remind the House of my interest as a member of the General Medical Council.

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

The Government remain committed to improving access to general practice. This will be done by increasing capacity to deliver appointments. We spent £520 million to improve access and expand general practice capacity during the pandemic. This was in addition to £1.5 billion announced in 2020 to create an additional 50 million general practice appointments by 2024. To help manage demand and help patients to get timely access, we have improved the telephone system available for all practices. This improved functionality has helped them to free up existing phone lines for incoming calls and is available at no additional costs to practices until the end of April 2023 while we work on long-term solutions.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister’s Answer seems a long way from the reality. Every day, patients have great difficulty in getting access to their GPs. It is also clear that the profession is highly demoralised, with many wanting to retire early. Only a few weeks ago, this House voted to ask the Government to develop a long-term workforce strategy, funded for the NHS. Why did the Government consistently turn that down?

[Lord Kamall (Con)]

I am sure the noble Lord will remember from the debates on the Health and Care Bill that that Act provides for workforce plans every five years. In addition, Health Education England has been commissioned to do work on workforce needs of a much more decentralised nature, rather than top-down from Whitehall and Westminster: at the trust level and the CCG level and, in future, at the ICS level to look at needs and the mix of skills that are needed to serve local populations.

North East Ambulance Service

Lord Hunt of Kings Heath Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

Noble Lords are absolutely right to talk about the culture. Years ago, during my academic career, I looked at organisational change; one of the very difficult issues is that while you can change structures and processes, it is about how you address the culture. Quite often in organisational change, or any change, there is a cultural lag. Sometimes the lag is due to individual values and sometimes it is much more widespread than that, and there are questions about how the culture grew in the first place and how to address those roots. Sometimes it is about personnel change and sometimes it is about retraining. There are a number of issues when it comes to changing culture, which is quite often more difficult than structural change.

The Government have been clear, as has the NHS, that there are clear guidelines around the use of NDAs by the NHS, including that it should not prevent staff speaking up about concerns relating to the quality or safety of care. It will be important for us to discuss all the issues further with the trust, the CQC and others, to determine the appropriate steps to take from here, including on NDAs.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister makes a very interesting point about culture but does he not think that, whatever review is undertaken, it needs to look further? If this is proven to be so, what are the reasons why management would seek to take the action that it did, and to what extent is pressure on managers from higher up the system causing them to cover up because of punitive action? In other words, does he agree that the culture is set by Ministers at the top? If they deal with the health service in a punitive way, as they have often done over many years, they should not be surprised if the system responds by seeking to cover up what has been happening.

[Lord Kamall (Con)]

I recognise that the noble Lord was a Health Minister but I must say that, in my time as a Health Minister, I have never found it to be an adversarial relationship but always quite co-operative. In conversations that I have had with individuals I have met in the NHS, they have been quite clear that I have no power over them, as it were, but that we can discuss concerns—although, clearly, the Secretary of State does exercise certain powers. However, the culture goes deeper than this and the noble Lord is absolutely right to suggest that we have to understand the roots of that culture and the incentives and disincentives to certain behaviour. I am sure that this will all be looked at as we try to learn what went wrong in this case.

National Institute for Health and Care Excellence

Lord Hunt of Kings Heath Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes an important point about how this fits into the life sciences vision, and NICE is very aware of it. In fact, only last week, I saw a draft business case for NICE for future years, and it takes on board the very point the noble Baroness refers to. NICE is looking at making sure that is has more timely advice and that it can respond quickly; it has also increased capacity, not only for conditions like this but for more digital devices.

[Lord Hunt of Kings Heath (Lab)]

Can the noble Lord explain what he means by a more proportionate response? Does that mean that NICE is reducing the number of stages that are involved in this process? Is it going to increase the capacity it has? How is it going to actually deliver the improvements that the noble Lord has explained?

St George’s Hospital: Patient Deaths

Lord Hunt of Kings Heath Excerpts

Wednesday 18th May 2022 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the coroner’s ruling on patient deaths at St George’s Hospital which found that deaths were “unnecessary” and the result of “inadequate” NHS-led investigations; and what steps they will take to prevent such failings in future.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and in so doing declare an interest as a member of the GMC.

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

NHS England and Improvement will review the coroner’s prevention of future death reports and respond within the agreed timescales. The coroner’s investigations are ongoing. The Government are committed to improving the standard of investigations into serious patient safety incidents in the NHS to create a culture of learning from mistakes and to improve patient safety.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister. This is a serious issue. An independent review into cardiac surgery at St George’s Hospital found evidence of shortcomings and a number of avoidable deaths. This finding has been totally contradicted by the senior coroner for inner west London, who found the methodology used in the review completely flawed and said of a particular case that the coroner was dealing with that the doctor’s approach had been without reproach. Given the review that will now be undertaken, does the Minister accept that, if the coroner is right, the whole method used by the NHS for these reviews will come under question?

[Lord Kamall (Con)]

I understand the premise behind the assertion and the Question but, as I explained to the noble Lord yesterday, a number of issues are ongoing—the coroner’s inquest, an employment tribunal and a number of other reviews—which, sadly, I am not allowed to comment on. However, I can say at the moment that we are committed to improving the standard of patient safety investigations. We have set up the independent patient safety investigation service and HSSIB to look at this, as the noble Lord will know from the Bill, and we have a number of independent investigations guidance for standard operating procedures by NHS England and Improvement for teams to use.

Folic Acid Fortification

Lord Hunt of Kings Heath Excerpts

Wednesday 6th April 2022 Lords Chamber

[Lord Kamall (Con)]

Call me old-fashioned, but I anticipated that there would be questions about further delays. When I asked the officials about this, I was advised that once the Northern Ireland elections were out of the way, they could get on with the consultation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to come back to the level of fortification. There are rumours that the Government are going for a minimal level which will not be very effective. My understanding is that the most up-to-date research shows that folic acid is not at all harmful. Therefore, will he assure me that the technical working group that he is going to take forward at some point will look to implement a level that is going to be effective?

[Lord Kamall (Con)]

I understand the noble Lord’s question but the expert Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has advised on the level of fortification needed to prevent neural tube defects. It wants a level that is not considered to pose a risk to health. The advice it has at the moment is that supplementation of folic acid can mask underlying vitamin B12 deficiencies, particularly in older adults. If noble Lords with medical experience disagree, I will be very happy to facilitate a meeting with my officials.