Hospital Beds and Social Care

Lord Kamall Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Dubs]

To ask Her Majesty’s Government what estimate they have made of the number of people occupying hospital beds because (1) there are not enough places in care homes to accommodate them, or (2) there is insufficient domiciliary social care support.

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

Although the number of people continually changes, there are approximately 10,000 people in hospital who do not currently meet the criteria to reside and have not yet been discharged. To drive progress and to support local system arrangements, we have established a national discharge task force to monitor and address the causes of delayed discharges. We have also provided £462.5 million via local authorities over winter to support care providers to increase recruitment and existing care support.

[Lord Dubs (Lab)]

My Lords, I appreciate the Minister’s Answer, but is it not the case that this bed-blocking has been happening for a long time, and that health service hospitals are under enormous pressure because of it? Can he give us some idea of when anything will happen as a result of his proposals? Can he comment on another representation that I have had—that there are empty places in care homes not being used?

[Lord Kamall (Con)]

I begin by wishing the noble Lord and all your Lordships a happy new year. We have started the national discharge task force, with membership from local government, the NHS and national government, and we have looked at the different pathways. There are four pathways: one is direct discharge, one is interim discharge, and one is for those who need a bit more support. But then sometimes individual cases are quite different; sometimes a place is offered, but the family may not be happy, so we have to find other ways. One thing that the national discharge task force has been doing is to look for spaces, wherever they may be, across the health and social care system to see whether they would be suitable for interim—but we are looking at all sorts of solutions in partnership with local authorities.

[Lord Forsyth of Drumlean (Con)]

My Lords, while I welcome the very substantial additional resources given to the health service, will my noble friend revisit the decision to delay making money available for social care purposes? That money is needed now to finance the care workers and finance those places in care homes. Without it, we will continue to see bed-blocking, so it is a policy that is self-defeating.

[Lord Kamall (Con)]

My noble friend makes an important point. In the White Paper, People at the Heart of Care, we have set out our vision for adult social care and outlined our priorities. Throughout the pandemic, we made available nearly £2.9 billion in specific funding for adult social care—£1.75 billion for infection prevention and control, £523 million for testing and £583 million to support workforce capacity and recruitment, as well as all the other measures that I have previously referred to as part of the task force.

[Baroness Greengross (CB)]

What assessment have the Government made of NHS or other publicly owned land that is currently unused and could be converted into accommodation for people who are rehabilitating and no longer need to be in hospital but cannot be discharged into their own home? Does the Minister agree that rehabilitation accommodation, commonly used throughout Scandinavia and other parts of Europe, could ease the pressure on both the NHS and the social care providers?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this issue previously with me in private, and for looking into it. One issue that is very clear to us is that effective use of the NHS estates is a top priority for the Government. We have not yet considered the benefits of using vacant hospital land or unused buildings, but we are committed to utilising the estates to their maximum capacity. Rehabilitation is a critical element of the health and care system, and there are a number of areas that we are looking into, including some of the suggestions made by the noble Baroness—but also best practice from other parts of the world.

[Lord Ashton of Hyde (Con)]

My Lords, I think it is the turn of the Liberal Democrats. The noble Lord, Lord Jones of Cheltenham, wishes to speak virtually, so I think that this is a convenient moment to call him.

[Lord Jones of Cheltenham (LD) [V]]

According to the Alzheimer’s Society, nearly two-thirds of all hospital admissions for people living with dementia are unnecessary and could be prevented with high-quality personalised social care. Does the Minister agree that providing such care will reduce pressure on our NHS? If so, can he outline the steps that the Government are taking to deliver high-quality personalised care to people with dementia?

[Lord Kamall (Con)]

The noble Lord raises an important point about dementia. We have had many debates and discussions in this Chamber about dementia and increasing awareness of the issue, right across educating the workforce in the health and social care sector, and in how we can address specific issues on dementia and healthy living. As part of the reforms under social care, there will be more training and more specific focus on issues including dementia, to ensure that all inhabitants of care homes or recipients of domiciliary care receive appropriate care.

[Baroness Wheeler (Lab)]

My Lords, with today’s reports of hundreds of care homes closing their doors to new admissions because of the rapid spread of omicron, adding to the huge pressure on hospitals, can the Minister explain in more detail why urgent priority funding is not being directed to the provision of step-down facilities to address the escalating crisis? We are told that we have new diagnostic units and resurrected Nightingale hospitals, but step-down facilities in local NHS and community settings, where patients medically fit for discharge can be monitored and properly assessed, have been shown to be working very successfully. Would not that provide the right care at the right time, as promised in last month’s social care White Paper?

[Lord Kamall (Con)]

We have been looking at different pathways out of hospitals, and one of the discharge pathways is step-down care. One issue that the task force has looked at is how we improve and increase accessibility to appropriate step-down care when a patient is unable to go straight to their home.

[Baroness Finlay of Llandaff (CB)]

I will follow on from the question from the Labour Front Bench. Who is taking responsibility for actively recruiting staff so that any step-down beds can be staffed and managed? We have a workforce problem; without actively recruiting back into the workforce people who have experience but currently have left, we will not bridge that gap in manpower and womanpower provision.

[Lord Kamall (Con)]

All noble Lords will appreciate the work and dedication of all our social care workers, especially in these challenging times and with the extra pressure that omicron has brought. Throughout the pandemic, we have provided different types of funding. In December 2021, we announced an extra £300 million to support local authorities working with care providers to recruit and retain staff throughout the winter. This funding is in addition to the £162.5 million announced in October 2021. We recognise the issue, and it is about working with local authorities and others to make sure that this money gets into the system and achieves what it is intended to do.

[Baroness Pitkeathley (Lab)]

My Lords, following on from the question from the noble Lord, Lord Jones of Cheltenham, does the Minister agree that it will be important for the discharge team to also look at the reasons for admission, since many people would not have been in hospital at all—they would never have been admitted—if there had been adequate domiciliary care services? Will the task force focus on those issues as well as the issues for not discharging?

[Lord Kamall (Con)]

The noble Baroness makes an important point. The task force, working with all the various partners, is looking at the different pathways. Most patients can be discharged from hospital to their own home, but a number are held back because they should be discharged from hospital to their own homes but with a new additional or restarted package, which may take time. Patients might be discharged to residential care within the independent and community sector, but one issue is that a number of our care homes are owned privately and are not necessarily as joined up in the system. Patients may also have been discharged to a care home, but sometimes the family may not appreciate or approve of the first venue given and may push back and ask for another one. There are a number of issues that we are looking at; it is very complicated, which I am sure all noble Lords understand. We are trying to really push and get to the bottom of this. Another thing is to make sure that there is education across health and social care staff so that they really understand the needs of particular patients.

[Lord Ashton of Hyde (Con)]

My Lords, the noble Baroness, Lady Masham, wishes to speak virtually, so I think this is a convenient point to call her.

[Baroness Masham of Ilton (CB) [V]]

My Lords, as president of the Spinal Injuries Association, I ask the Minister whether he realises that there are many people who are severely paralysed, some of whom need two or three carers each day living in their own homes. Is he aware that the skilled labour market of carers from Europe has dried up since Brexit, leaving many people in a state of fear and anxiety of being at risk? The Government can help. Will they?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. One thing that the Government announced before Christmas was on visas and encouraging more care workers to come to this country. Where she and I might disagree is that we are going to approach the best in the world, not just Europe—we want the best staff possible.

Public Health: Night-time Working

Lord Kamall Excerpts

Thursday 6th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle]

To ask Her Majesty’s Government what assessment they have made of the effects of increased night-time working on public health; and what steps they intend to take to mitigate the negative effects of such working arrangements.

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

Health and safety at work is covered by the Health and Safety at Work etc. Act 1974 and corresponding regulations. The Working Time Regulations also impose requirements on employers regarding the number of hours worked and scheduled. The Government commissioned a review of sleep and health in 2020-21. While this did not directly address the effects of increased night-time working on health, it covered the impact of shift work, including night-time work. The findings will be published in summer 2022.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for his Answer, but many people will be surprised to learn that one in nine British workers now works at night. The medical evidence is that this is bad for health, whatever ameliorating steps are taken, with higher levels of cancer, heart disease, diabetes, pre-term births and premature births, as well as the impact on family and social life. Are the Government really considering monitoring directly the impacts of that huge increase in night-time working? Are they considering ways to ameliorate it? Are they considering ways to reduce what is clearly an undesirable economic trend?

[Lord Kamall (Con)]

I start by thanking the noble Baroness for the article that she sent a link to, which addressed some of the issues around her Question. The sleep review is looking at all these issues. As she rightly says, there are some links between fatigue and certain ailments and diseases. On some of them, the academics are still challenging each other, but that is all part of the review.

[Lord Scriven (LD)]

My Lords, a wide body of research has revealed that a number of health conditions are related to night-shift working. In the Netherlands, breast cancer is now recognised as an industrial disease for female night-shift workers. What policies are the Government undertaking to deal with this body of research that points to health for night-shift workers being unequal?

[Lord Kamall (Con)]

The Government commissioned a review of sleep and health from the former Public Health England for 2020-21. That reported just before Christmas and is now being considered by Ministers and other officials. We are hoping that the Office for Health Improvement and Disparities will publish the findings in 2022. The review looked at a number of different things, including trends over time, optimal levels of sleep, links between mental and physical health, the economic impact and factors that hinder interventions to promote sleep. As the noble Lord rightly says, there is research out there about how workers can experience gastrointestinal disturbance and sleeping disorders and the possible association with breast cancer, cardiovascular disease and diabetes. All that will come out in the review, I hope.

[Baroness Lister of Burtersett (Lab)]

My Lords, does not the evidence about the poor conditions experienced by night workers underline the need for stronger employment rights for those in the so-called gig economy, in which many night workers work? When, therefore, will the Government finally publish their long-promised employment Bill?

[Lord Kamall (Con)]

The noble Baroness makes an important point. Indeed, the article the noble Baroness, Lady Bennett, sent me talked about the impact on delivery drivers of not being allowed to rest or take shelter in restaurants and takeaways—being sent away and not having access to bathrooms and other facilities. The Government are looking at getting the balance right on this, in terms of flexibility, because some people value zero-hours contracts as long as they are not exclusive and they can work around them. We are looking at the various categories of workers. Because this is employment, I have been trying to get more answers; I apologise that I do not have all of them, but I will write to the noble Baroness.

[Baroness Merron (Lab)]

My Lords, night working can place a strain on people’s health through increased incidents of depression, diabetes and cardiovascular disease. Can the Minister tell the House what work the Government are doing with unions and employers to reduce this link between night working and ill health, and what account they are taking of the TUC report which calls for greater attention to the pressure of night working on home life and relationships?

[Lord Kamall (Con)]

A number of noble Lords have made the very important point that there is clearly an impact on individuals of working at night, including fatigue, wider pressures and disruption to family life. The sleep review has looked at this and reported just before Christmas, after consulting a wide range of stakeholders. The Office for Health Improvement and Disparities will publish its report in the summer of 2022, I hope.

[Lord Grocott (Lab)]

My Lords, given that so few people work night shifts from choice—some do but most do not—is it not ironic that, very often, these night-time jobs are quite low paid? Is it not a strange commentary on our society that, all too often, the people working in the least popular and more difficult and challenging jobs are also the lowest paid?

[Lord Kamall (Con)]

One of the issues of technology is how it has changed the nature of work. We have seen over time how older jobs have disappeared and new types of jobs and industries and different working practices have appeared. It is really important to make sure that workers, wherever and whatever times they work, get the best facilities and conditions possible. Sometimes that is done directly by unions, which work with employers and companies, and other times it is done directly, but it is important. One of the things we are looking at in the review is how deprivation of sleep affects many people, especially those who work at night.

[Lord Hamilton of Epsom (Con)]

My Lords, I totally accept that night work may affect the health of many night workers, but the noble Baroness, Lady Bennett, said that it is bad for the economy. Surely if night work increases, this should increase productivity.

[Lord Kamall (Con)]

It depends on why people are working at night—it really ranges. For example, when I was a student, I did a night shift from 10 pm to 8 am to pack the shelves for the next day. Sometimes drivers decide to work at night; some Uber or Bolt drivers tell me that they prefer night-time working because the roads are clearer then. There are different reasons—as the noble Lord indicated, sometimes it is the only job available to some people. It is really important to make sure both that customers and others are getting the services they want and that workers are treated decently and with dignity.

[Lord Foulkes of Cumnock (Lab Co-op)]

Does the Minister agree that if the start time of this House on Tuesdays and Wednesdays were brought forward to 11 am, it would save some elderly people from late-night work?

--- Later in debate ---

[Lord Kamall (Con)]

This is why I was so looking forward to coming back here today. The noble Lord makes an incredibly important point about the effects of night-time working on noble Lords. It is really important that we push the Government to understand the impact it is having on our health.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, many of those who work at night are nurses, doctors and care workers because their jobs demand and require it. Their situation has been exacerbated during the Covid pandemic. Can the Minister indicate what work the Government are doing to look into ways of ameliorating and mitigating their situation, so that they can continue to carry out their work unhindered and unencumbered, as they are exposed daily and nightly to the ravages of Covid and other diseases?

[Lord Kamall (Con)]

I think all your Lordships would agree on the incredible dedication of our medical and health and social care staff, before and particularly during the pandemic. We have to remember that a lot of these conditions are governed by the Health and Safety Executive guidance on managing health and safety risks, which includes guidance on shift work and fatigue, to make sure employees are treated with as much dignity and respect as possible.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Wilf Ward Family Trust is a charity that looks after severely disabled adults in north Yorkshire. Following the court case last year over pay for sleep-in shifts, it has had great difficulty in filling these roles and reaching an accommodation with the staff. Could my noble friend look into this—perhaps I could have a word with him afterwards—to see if that situation has been resolved to the satisfaction of both the adults in care and those providing that care?

[Lord Kamall (Con)]

As my noble friend will appreciate, I cannot comment on the details of a specific case, but I would welcome a conversation with my noble friend. The general issue has to be that we make sure that patients are treated as well as possible but that staff and employers are treated with as much as dignity as they deserve.

[Lord Flight (Con)]

Approximately what proportion of total working is represented by night working?

[Lord Kamall (Con)]

There are various surveys and debates, and it depends on whether you work purely at night-time or sometimes your shift might involve working at night-time. One estimate is that, at the moment, as many as one in nine workers works at night, but it depends on where you draw that definition.

Health and Care Bill

Lord Kamall Excerpts

Wednesday 5th January 2022 Lords Chamber

Moved by

[Lord Kamall]

That the Bill be considered in Committee in the following order: Clause 1, Schedule 1, Clauses 2 and 3, Clauses 5 to 14, Schedule 2, Clauses 15 to 17, Schedule 3, Clauses 18 to 27, Schedule 4, Clause 28, Schedule 5, Clauses 29 to 40, Schedule 6, Clauses 41 to 43, Schedule 7, Clauses 44 to 61, Schedule 8, Clauses 62 and 63, Schedule 9, Clauses 64 to 68, Schedule 10, Clause 69, Schedule 11, Clauses 70 to 74, Schedule 12, Clauses 75 to 80, Clause 4, Clauses 88 to 94, Clauses 135 to 144, Schedule 17, Clauses 145 to 148, Clauses 81 to 87, Clause 95, Schedule 13, Clauses 96 to 109, Schedule 14, Clauses 110 to 120, Schedule 15, Clauses 121 to 134, Schedule 16, Clauses 149 to 154, Title.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Lord Kamall Excerpts

Wednesday 15th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 13 December be approved.

Relevant document: Instrument not yet reported by the Joint Committee on Statutory Instruments

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

My Lords, I beg to move that the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021 be approved and shall also be moving the Health Protection (Coronavirus, Wearing of Face Coverings) (England) (Amendment) Regulations 2021 and the Health Protection (Coronavirus, Restrictions) (Entry to Venues and Events) (England) Regulations 2021.

Despite our progress so far and our investment in treatments, the omicron variant has been designated a variant of concern and so we must act now, as quickly as possible, to slow its spread. The UK Health Security Agency predicts that omicron will become the dominant strain within one to two weeks across the whole country. In response, the UK’s four Chief Medical Officers have raised the Covid alert level to 4, its second-highest level.

Although we do not yet have a complete picture of omicron’s severity, it has become increasingly clear that omicron is growing much faster than the previous delta variant and is spreading rapidly all around the world, so its higher transmissibility means it still threatens to overwhelm the NHS. We are seeing increased transmission rates reflected currently in case rates, and the current doubling time for omicron cases is now between two and three days. We need to act now to help slow the spread of the variant and reduce the chances of the NHS coming under unsustainable pressure, while buying time to deliver more boosters.

On 8 December, the Government announced that it was now necessary to implement plan B measures in England in response to the risks of the omicron variant. This includes: extending regulations on face coverings to make them mandatory in most indoor public settings from 10 December; asking those who can work from home to do so from 13 December; and making vaccine or test certification mandatory for entry to certain venues and events from this morning.

Today, we are debating the regulations that bring about the legal requirements for face coverings and certification. These regulations are sunsetted or due to expire on 26 January 2022, but they will be reviewed by the Government in early January. We are also debating regulations that bring important changes to self-isolation requirements to enable fully vaccinated contacts to take part in daily contact testing.

From 10 December, face coverings have been mandatory in most indoor public spaces in England. However, they are not required in hospitality settings such as cafés, restaurants and pubs, or in nightclubs. Exemptions apply—including for children aged under 11 and for those unable to wear a face covering for health or disability reasons. Evidence from the UK Health Security Agency respiratory evidence panel suggests that all types of face covering are, to some extent, effective in reducing transmission.

From today, showing the NHS Covid pass is mandatory as a condition of entry to certain settings in England. This is not a vaccination passport, and people will have different ways to show that they are eligible. Negative test results provide some assurance that an individual is not infectious when the test is taken and for a short time afterwards.

There is evidence to suggest that vaccination reduces the likelihood of infection or transmission to a small degree with delta, which continues to circulate. Early evidence suggests that vaccine effectiveness against symptomatic infection after two doses is significantly lower against omicron than against delta. Nevertheless, a moderate to high vaccine effectiveness is seen in the early period after a booster dose. Vaccine effectiveness is also likely to be higher in preventing severe, rather than mild, disease, and it continues to be vital in response to the high levels of delta cases that continue to circulate.

Covid status can also be shown through proof of a negative test taken in the previous 48 hours, which demonstrates that you are less likely to be infectious, as well as proof of medical exemption or evidence of participation in a clinical trial.

Certification will apply in a limited number of settings, including venues acting like nightclubs; indoor events with 500 or more attendees likely to stand and move around; outdoor events with 4,000 or more attendees likely to stand and move around; and all events with more than 10,000 attendees. Vaccine or test certification will not eliminate the possibility of infectious people attending or transmitting the virus in these settings, but it will help to reduce the risks.

The test, trace and self-isolate system continues to be one of the key ways to control the virus and to protect our nation. Yesterday, the Government introduced a policy of daily testing for all fully vaccinated contacts of people who have tested positive for Covid-19. This will identify—or help to identify—the virus quickly and help to break chains of transmission without requiring large numbers of people to self-isolate. To support this, we have removed the requirement in the self-isolation regulations for all close contacts of suspected or confirmed omicron cases to self-isolate, regardless of their age or vaccination status. This was introduced as a temporary measure on 30 November. Unvaccinated adult contacts will continue to be legally required to self-isolate, unless they are participating in an approved workplace daily contact testing scheme. We will constantly monitor and review the data.

Lastly, let us all urge everyone who can have the vaccine to get boosted now. More than 24 million booster or third doses have already been administered across the UK. Our target is to offer this to every eligible adult in England by the end of December.

I thank everyone involved in the vaccination programme for their continued efforts to maintain this tremendous progress over the important weeks ahead. I understand that there are concerns among noble Lords across the House about these regulations. It is always a difficult balance and we hope we have got the balance right. I look forward to continued scrutiny by noble Lords and to their valuable contributions to this debate.

[Lord Robathan (Con)]

My Lords, I will start with a quote:

“It always suits Governments … to scarify the population.”


This was specifically about the ID cards Bill in 2005, when

“only a handful of principled Tories stuck up for liberty, and they were duly overwhelmed by the Government.”

The same person promised to “eat” his ID card if asked to show it to an official—so I expect that noble Lords will recognise the author of the quotes, who was then the Member of Parliament for Henley and editor of the Spectator.

Roosevelt famously said in his 1933 inaugural speech during the Depression—others had said it before—that

“the only thing we have to fear is fear itself”.

So what is going on? Why are the Government scarifying the population and stoking fear?

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, this has been a proper House of Lords debate and I thank the Minister for introducing the regulations with such clarity. I need to declare an interest as a non-executive director of an NHS hospital.

I would like to start my remarks by quoting my honourable friend Wes Streeting, the shadow Secretary of State for Health and Social Care, who said yesterday that

“it should not be for me, as shadow Secretary of State, to point out”

to some Conservative MPs, following remarks made in the media in recent days,

“that we are not living in the 1930s and that the Secretary of State and his team are not Nazis.”—[Official Report, Commons, 14/12/21; col 954.]

It is sad that my honourable friend felt that he needed to say that. Our history is peppered with examples of where we required citizens to act in a way that served both their own self-interest and the interests of others. That does not make us a totalitarian state. I believe that the public are less outraged by the fact that some obligations are being placed on them than by the antics of those who blatantly and arrogantly imagine that the obligations do not apply to them.

On these Benches we will be supporting the Government today, as we did yesterday, and we will vote with the Government if the noble Lord, Lord Robathan, chooses to test the opinion of the House on either of the fatal amendments before us. Actually, the noble Lord said that these Benches would go further than the Motions before us. That is not true—but what is certainly true is that we have tended to be two or three weeks ahead of the Government. We have said “We think you need to do this, that or the other”—and I can testify to this, having been here for nearly two years, saying this —and the Government have said “No, no, no”, and two or three weeks later that is exactly what happens.

We will act in the national interest, as we have done throughout the pandemic, putting public health before party politics, by supporting the Motions under consideration now. Our task today—as it has been throughout the pandemic—is to consider what is best for the health of our nation and how to discharge our responsibility to protect our NHS.

The noble Lord, Lord Fowler, absolutely nailed it when he said that we had to listen to the CMO, the CSO, the other scientists and the public health experts, and follow the course of action that they were recommending. This was echoed by the noble Baroness, Lady Hayman, who said that we should be listening to the advice we are given. My noble friend Lord Davies put these regulations into proportion in terms of what they are seeking to achieve. There is no doubt that sacrifices have impacted on lives, livelihoods and liberties; that is why noble Lords need to scrutinise and question how the Government are dealing with this issue, or indeed mishandling it. I say to the noble Lord, Lord Robathan, and other noble Lords that we would be having this debate today whether or not he had put down his amendments.

On Sunday the Prime Minister made a totally unnecessary broadcast which served to panic people and create worry and confusion. Presumably he was trying to re-establish leadership credibility for himself, which clearly did not work with his own Conservative Benches. The broadcast was irresponsible in its lack of preparedness and clarity. As well as displeasing Mr Speaker, as the Prime Minister tends to do, it held Parliament in contempt yet again.

The lack of clarity is clear, for example, as NHS England and the Prime Minister have made conflicting promises on the booster rollout, leaving plans to deal with the rapid spread of omicron mired in chaos and confusion. On Sunday evening, the Prime Minister said:

“Everyone eligible aged 18 and over in England will have the chance to get their booster before the New Year.”


However, the NHS has promised a different target, pledging to offer all adults the chance to book a booster rather than receive one. Pressed on the conflicting advice, NHS England said:

“The NHS vaccination programme will offer every adult the chance to book a COVID-19 booster vaccine by the end of the year”.


Perhaps the Minister could clarify for the House which it is. If the Prime Minister has promised 1 million vaccinations a day, how is that supposed to be achieved?

I think it was even worse for local government than for the NHS. A local council leader in London, with a London-wide strategic role, said that 72 hours’ notice would have been helpful. It is not the need to up the vax and testing capability but the lack of planning—hence no tests, no testing ability and vaccinations not available. There was not one mention of local government in the Statement we heard on Monday. Had the relevant Government departments talked to local government, and when did they do that? It begs the question: did the NHS even know about Sunday’s statement before it was made?

We cannot yet be sure about the severity of the omicron variant, but we can be certain, as many noble Lords have said, that it is spreading faster than any other variant. Even if a smaller proportion of omicron victims are hospitalised, the rapid advance of the virus through the population could see large numbers of people admitted to hospital during the months in which the NHS is already under the greatest pressure. The winter months present pressures on the NHS in any normal year, and we know that this is far from a normal year.

The NHS is contending with winter pressures, a serious backlog, the delta variant and now this variant. Many of the challenges are understandable, given the unprecedented challenge of the Covid-19 pandemic, but we have got to be honest and acknowledge that confronting them has been made much harder because the country went into the pandemic with waiting lists already at 4.5 million, 100,000 NHS staff vacancies and a shortage of 112,000 staff in social care. My noble friend Lord Rooker was quite correct on that. We support the NHS and care services in the task they have been set. Let me say from these Benches to every NHS worker, every GP, every pharmacist, every public health official in local government, every member of the Armed Forces and every volunteer stepping up to meet this enormous task that we are with them 100% and thank them again.

The measures put forward for consideration today are an attempt to slow the spread of the virus, while trying to protect Christmas so that people can enjoy the festive season. They are about limiting interactions in the workplace, wearing face coverings in settings where the virus finds it easiest to spread, testing before we attend large indoor gatherings, and getting behind the booster rollout to ensure that everyone who can be protected is protected.

The goal in the end must be to learn to live with the virus. That means effective vaccination, antiviral treatments and public health measures that have a minimal impact on our lives, jobs and businesses. No one enjoys wearing a mask, but it is nothing compared with the costs that more draconian restrictions have for our lives, livelihoods and liberties. Masks are simply a price worth paying for our freedom to go out and live our lives during this pandemic.

On the introduction of a Covid pass for large indoor gatherings, the Labour Party argued against vaccine passports without the option of showing a negative test. Further, we argued that such passes should not be required for access to essential services. On both counts, I am pleased to say that the Government listened and amended the proposals, so we will support this measure today. I regret that colleagues on the Liberal Democrat Benches do not feel able to do so, but let me be clear: we in the Labour Party support Covid passes because we support British businesses. We want to give people the confidence to go out and about—to go to venues and to the theatre—despite the presence of this virus.

With passes and lateral flow tests, venues can operate at 100% capacity. Look at Italy, France and Denmark—countries with strict Covid rules. All have seen their retail and recreation sectors fare far better than those in the UK. However, for the passes to work, people must be able to access tests readily and easily. We cannot continue in this situation where tests are out of stock, so I ask the Minister whether this has been resolved or when it will be.

For months, we have called for workers to be given the flexibility to work from home and we support the guidance to work from home where possible. However, how does the Minister explain the contradiction that many noble Lords have asked about, which is why, at the same time, the Government are allowing them to go to Christmas parties? By limiting the interactions people have at work and by lowering infections, we hope to preserve their ability to go ahead with social events anyway.

Noble Lords have talked about ventilation in schools. We know that young people have borne the brunt of this pandemic, and we owe it to them and their education to support them and staff to make sure our schools are properly ventilated. The Christmas holidays seem to us to be an ideal time to get young people vaccinated. When does the Minister expect to know about this matter and share it with the House?

I hope this is my last contribution on Covid this year. I therefore end by wishing all noble Lords a safe and happy Christmas.

[Lord Kamall (Con)]

I start by thanking noble Lords for their valuable contributions to this debate. They showed the very best of debate in this place, in the range of views covered—some political, some scientific and some challenging the Government on constitutional issues. This demonstrates the importance of these discussions and I welcome all contributions, whether or not I agree with them. That is the purpose of debate and discussion.

I remind some of my noble friends behind me and other noble Lords why we have acted now and gone to plan B. We want to slow the spread of the virus, after looking at the replication rate; we want to buy time for more people, especially the older and more vulnerable, to get their booster dose; and we want to give our experts crucial time to gather and understand the data about omicron.

Noble Lords, and indeed noble friends, look at the experience of South Africa. As the noble Lord, Lord Birt, and others have said, its experience is different. It has a younger population, with an average age of about 29, when our average age is in the mid to high 40s. Given our experience at the beginning of the Covid pandemic, when a disproportionate number of older people died, surely it is right that we collect data to make sure that the most vulnerable people are safe before we go forward.

I turn to some specific points raised by noble Lords. As I said, my noble friend Lord Robathan asked about the data from Africa, which we will continue to monitor. We will monitor whether it is different or milder here.

The noble Baroness, Lady Bennett, mentioned the risk of exponential growth and I thank her for making that point. We do not want to see waiting times and patient numbers starting to overwhelm hospitals. By the time we had waited for exact data, it might be too late. The noble Lord, Lord Davies, rightly spoke about the limited data available. I assure the House that we will continue to review the data as it comes in.

Health Protection (Coronavirus, Restrictions) (Entry to Venues and Events) (England) Regulations 2021

Lord Kamall Excerpts

Wednesday 15th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 13 December be approved.

Relevant documents: Instrument not yet reported by the Joint Committee on Statutory Instruments

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

My Lords, I beg to move.

Amendment to the Motion

Moved by

Health Protection (Coronavirus, Wearing of Face Coverings) (England) (Amendment) Regulations 2021

Lord Kamall Excerpts

Wednesday 15th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 9 December be approved.

Relevant document: 24th Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.

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

My Lords, I beg to move.

Amendment to the Motion

Tabled by

Breast Screening

Lord Kamall Excerpts

Tuesday 14th December 2021 Lords Chamber

[Baroness Meacher (CB)]

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

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

Recovery of screening has been an ongoing priority and all NHS breast screening providers are now operational. We allocated £22 million towards mobile breast screening units and £50 million towards increased regional capacity, and have collaborated across cancer alliances, primary care networks and NHS England and NHS Improvement regional teams to promote uptake. We know inequalities in screening exist, exacerbated by changes to service provision during the Covid-19 pandemic. Inequalities remain key in restoration planning, and guidance was recently published on reducing inequalities in breast screening.

[Baroness Meacher (CB)]

My Lords, I thank the Minister for his reply. He appears to be aware that it is in fact minorities and socially deprived women who have been hardest hit by the shortfall in screening take-up due to Covid. I understand from his response that the Government are issuing guidance. What action will that guidance envisage to ensure that these minorities and deprived women receive screening for breast cancer?

[Lord Kamall (Con)]

The noble Baroness raises a very important point; we need to tackle inequalities not just in this area but across all healthcare. One of the things we have been looking at is research into why women in certain areas do not come forward. That is why we have invested in mobile breast screening units, so that we can take screening services closer to those people who are reluctant to come forward.

[Baroness Walmsley (LD)]

My Lords, we heard the Minister’s Answer about the money that has been pledged, but the elective delivery plan promised by the end of November has not been published. Can he say when it will be published and how it will help to find and treat the just under 10,000 fewer than usual women who would have been diagnosed with breast cancer between March 2020 and October 2021?

[Lord Kamall (Con)]

The plan will be published in due course. When we look at the backlog for the breast screening programme, we see that all 77 NHS breast screening providers are now operational and screening women. Some have caught up, and others are not predicted to recover by the end of March 2022. That is why NHS England and NHS Improvement have comprehensive plans, including spending and investment.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as I can testify, breast cancer screening is vital. Allied to this is the need for funding for secondary breast cancer. I know that an audit has been launched here in England, but there are no such audits for secondary breast cancer in Northern Ireland and Scotland. Will the Minister use his good offices with those appropriate Ministers to ensure that such audits are established and that this House can be furnished with ongoing reports of the audit here in England, and the results thereof, to ensure that funding can be deployed into oncology, nursing and care support?

[Lord Kamall (Con)]

I thank the noble Baroness for raising the importance of co-ordination and sharing information across the devolved Administrations. I have meetings scheduled with health Ministers from the devolved Administrations, and I will make sure that my office puts this on the agenda.

[Baroness Finlay of Llandaff (CB)]

My Lords, following on from the question of the noble Baroness, Lady Ritchie, will the Minister tell us how the stage of presentation of breast cancer has altered over the past two years? How many women presenting with stage 3 and stage 4 cancers had never been screened?

[Lord Kamall (Con)]

I thank the noble Baroness for giving me advance notice of the question, and so giving me the chance to get some information. Data on cancer stages is currently published only annually, and NHS Digital is publishing the data from 2019 on Thursday 16 December. The latest data from 2018 shows that nearly 86% of breast cancers were diagnosed at stages 1 and 2, meaning that about 15% were diagnosed at stages 3 and 4, but this was pre-pandemic. I will make sure that I get the updated data as soon as possible.

[Baroness Thornton (Lab)]

My Lords, in October, when we last had a Question on this issue, the Minister was asked about the need to ensure that innovative new treatments such as Trodelvy reach patients as quickly as possible. I gather that this issue is still not resolved. As yet, there is no agreement between the drug company Gilead and the NHS, which means that access to this transformational treatment is extremely ad hoc and unfair. Will the Minister please help to expedite this issue with NICE, the MHRA and the manufacturer?

[Lord Kamall (Con)]

As the noble Baroness will acknowledge, the MHRA and NICE are independent, but I can, of course, raise the issue with them.

[Baroness Fookes (Con)]

My Lords, can my noble friend confirm that the incidence of breast cancer increases with age? If I am right in that, what plans do the Government have to help older women?

[Lord Kamall (Con)]

The statistics we have show that four out of five breast cancers tend to develop in women over 50. Therefore, screening is really for women between 50 and 71, which will catch most of them. The 2012 review of breast cancer screening, the Marmot review, estimated that inviting women between the ages of 50 and 70 reduces mortality in the population invited by 20%. It also found concerns about screening women outside those ages and overdiagnosis.

[Lord Stirrup (CB)]

My Lords, this issue, like many across the NHS, is exacerbated by what the Financial Times today referred to as a workforce crisis. When will the Government take urgent action to stem the large and increasing outflow of trained medical personnel that is proving so debilitating to the provision of health services across the board?

[Lord Kamall (Con)]

In previous debates this week I have outlined what we are doing to increase recruitment. On the specific issue in the mammography workforce, Health Education England is providing £5 million to support a new training and development programme through the National Breast Imaging Academy. That itself will increase recruitment, improve screening targets and increase early diagnosis of cancer.

[Baroness Sheehan (LD)]

My Lords, while we wait for the routine screening programme to get back to normal, is there a fast-track mechanism for women who believe they have themselves detected a lump or a worrying change in their breast tissue to be screened and seen by a specialist?

[Lord Kamall (Con)]

The method for booking screenings has now changed, so people can book online on demand, rather than waiting for a referral.

[Baroness Bryan of Partick (Lab)]

Does the Minister agree that it is beyond doubt now that screening is beneficial? Can he assure us that no credence is given to those arguing that screening leads to overtreatment? Can we say that that is scotched?

[Lord Kamall (Con)]

The Government completely agree with the sentiments expressed by the noble Baroness.

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Masham of Ilton, wishes to speak virtually, and I think this is a convenient point for me to call her.

[Baroness Masham of Ilton (CB) [V]]

My Lords, as GPs are having to work in vaccination centres, would it be possible for people who think they have or may have cancer—breast cancer or other cancers—to go straight to secondary care for investigations? GPs cannot do everything at the same time. Does the Minister agree with me that it is important to have a speedy diagnosis for cancer?

[Lord Kamall (Con)]

I think all noble Lords would agree with the noble Baroness that it is important we have speedy diagnosis. On the specific question, I will check and get back to her.

[Lord Boateng (Lab)]

My Lords, will the Minister accept that, at the same time as aid and assistance to the developing world is being cut in the health sector, we are increasing the recruitment of doctors and nurses, not least from Africa, while Africa is experiencing a real issue with the distribution of the Covid vaccine? Is there not something terribly wrong there?

--- Later in debate ---

[Lord Kamall (Con)]

I thank the noble Lord for raising the issue; I know he has been a strong champion of Africa over the years. The fact is that, when it comes to recruitment, we adopt ethical guidelines in line with the World Health Organization. I will give him one example. Recently, I had a discussion with the Kenyan Ministry of Health about sending Kenyan nurses. I asked whether we were depriving them of their nurses, and was told “No; we train far more nurses than our health system can absorb, and therefore we see this as a powerful way to increase earnings for our country.”

[Lord Aberdare (CB)]

My Lords, further to the question asked by my noble and gallant friend, Lord Stirrup, the Minister’s answer related to what was happening in the recruitment of new staff. Can he say something about what the Government are doing to retain existing staff?

[Lord Kamall (Con)]

I have previously announced government investment in retention programmes and looking at getting back those who have retired and increasing training places in medical schools and elsewhere.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, going back to the question from the noble Baroness, Lady Fookes, could the Minister remind the House exactly what is the rationale for not including women over 70 in the screening programme, given that, as he has conceded, vulnerability to breast cancer increases with age?

[Lord Kamall (Con)]

The Marmot review found that screening women outside the ages of 50 to 70 could lead to overdiagnosis and to referring women for unnecessary tests and overtreatment. But women in other categories with a very high risk of breast cancer—those with a family history, for example—are often screened earlier and more frequently. Women are not automatically invited for breast cancer screening if over 71, but they can request screening themselves.

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

Lord Kamall Excerpts

Tuesday 14th December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 9 November be approved.

Relevant document: 21st Report by the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

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

My Lords, I will make a Statement on measures to make sure that our health and care system is as safe as possible in the battle against Covid-19 by making vaccination a condition of deployment for more health and social care settings.

Across the UK, the overwhelming majority of British people have played their part by getting vaccinated against Covid-19. Over 81% of people over the age of 12 have had two doses, a figure that rises to around 91% when you look at NHS staff. The impact of this outstanding vaccination effort is clear. The UK Health Security Agency estimates that at least 127,000 deaths and 24 million infections have been prevented as a result of the Covid-19 vaccination programme. In addition, around 260,000 hospitalisations have been prevented in those aged 45 years and over.

But we still need to do more. Uptake rates vary between different health and care organisations and across the country, and, despite the incredible effort to boost uptake across the country, over 94,000 NHS staff are still unvaccinated. It is important that our health and care staff get jabbed to protect the vulnerable who are in their care and to protect the NHS workforce in the wake of new variants, such as omicron. We made vaccination against Covid-19 a condition of deployment in care homes from 11 November this year. Contrary to initial fears, we are not aware of any care home closures where vaccination as a condition of deployment has been the primary cause.

Today, we are putting before your Lordships the regulations to extend this requirement to health and other social care settings, including NHS hospitals and GP and dental practices, regardless of whether a provider is publicly or privately funded. Anyone working in health or social care activities regulated by the Care Quality Commission will need to be vaccinated against Covid-19 if they are deployed to roles that have direct contact with patients or service users, apart from a few limited exemptions—for example, for medical reasons.

I hear the concerns that have been expressed or raised about the impact of these measures on the workforce, especially during these winter months. For this reason, we are allowing a 12-week grace period to give people the chance to make the positive choice to get protected. We are committing to enforcement of the requirements by 1 April next year, subject to the will of Parliament.

We are also increasing the number and diversity of opportunities to receive the Covid-19 vaccine, using the booster campaign to make the most of walk-ins, pop-ups and other ways to make sure that people are getting the vaccine as easily as possible. The NHS has already written to all providers providing early guidance, setting out what vaccination as a condition of deployment means for the system, as well as advising on next steps to boost uptake and help to ensure smooth implementation. After consulting on the policy in September, we have seen a net increase of over 55,000 NHS staff vaccinated with a first dose.

These steps complement key interventions that we have made to support services, including bolstering capacity across urgent and emergency care and the wider NHS, including with a £250 million investment in general practice, £55 million for the ambulance service and £75 million for NHS 111, and publishing an adult social care winter plan, including £388 million to support infection prevention control and £162.5 million for workforce recruitment and retention. In addition, we have invested £478 million for support services, rehabilitation and reablement care following discharge from hospital, and we are ensuring that health and social care services are joined up.

Although the Government believe that these measures are a proportionate way of protecting those at greatest risk, we recognise that some noble Lords have asked whether we should or would extend these measures even further. So let me state clearly that although we have seen plans for universal mandatory vaccinations in some countries in Europe, we do not support them here. The Government have no intention of extending condition of deployment to other workforces or introducing mandatory vaccination more widely.

At this point, I would like to address head on some of the concerns your Lordships may have regarding concerns raised by the Regulatory Policy Committee and the Secondary Legislation Scrutiny Committee about these regulations. I sympathise with noble Lords who are concerned with some of the procedural aspects of the passage of this legislation, but in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable.

The Government have responded to the concerns raised by the Regulatory Policy Committee and the Secondary Legislation Scrutiny Committee as quickly as possible and have provided further information to your Lordships, including on the actions on workforce capacity—as I have set out—and the steps we are taking in collaboration with the NHS and adult social care sector to mitigate the risks to small business, which is of particular concern to the Regulatory Policy Committee. An updated Explanatory Memorandum has been provided to Parliament, and the department’s consideration of the RPC’s concerns has been published on the government website.

The updated Explanatory Memorandum provides further information on the scientific and clinical rationale for the policy, the exemptions that have been provided and those not provided, and the steps we have taken to further encourage uptake of vaccinations and to mitigate workforce issues. The Secretary of State also wrote to all Peers on 10 December to set this out.

In these difficult times, we have seen the very best of those who work in health and care. We have seen care, compassion and conscience. Noble Lords across the House continue to pay tribute to the heroic responses across the health and care sectors. Today’s Motion is about protecting not only health and care staff but the patients in their care. By protecting patients and staff, we protect the NHS from being overwhelmed. I commend this Statement to the House.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I just want to make a quick adjustment: we are of course debating the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021.

Amendment to the Motion

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a non-executive director of an NHS hospital. I thank the Minister for explaining this statutory instrument, although I have to confess that I had a moment of panic during his opening statement. I thank him also for explaining his understanding of how the Government arrived at this point. I note that the department has at last produced at least something called an impact assessment, as well as other documentation. This was the subject of my Motion to Regret, now withdrawn. That does not mean that I no longer regret the lackadaisical manner in which this Government approach their accountability to Parliament and the legislative process.

As most noble Lords, including the noble Lord, Lord Cormack, have said to the Minister in clear language, we still wish to know how the legislation will operate. We hope that the Minister will be more forthcoming about, for example, the “significant workforce capacity risk” which the Secondary Legislation Scrutiny Committee mentioned in its very critical report. We note that the committee was damning in its criticism, and I thank my noble friend Lord Cunningham for speaking about the fact that these things are not an option but a requirement.

I say to the noble Baroness, Lady Noakes, that we agree with her criticism of the Government’s handling of these issues. We absolutely agree about the procedure, the drafting and the lack of justification that supports the legislation. I have been commenting on this from this Dispatch Box since March last year. However, the noble Baroness did not say that this was necessarily the wrong way to go. I withdrew my regret Motion because, today, given the new clear threat of omicron, we need to focus on the way forward. I do not believe that that is a political reason for withdrawing the Motion. Had the noble Baroness tested the opinion of the House on her fatal Motion, we on these Benches would have supported the Government, just as we are doing right now in the Commons. The Labour Party has acted, and will always act, in the best interests of our NHS, our public health and our nation.

Of course, we want everyone working in the NHS to take up the vaccine. It is safe and effective, and the Government should be focused on driving up vaccination rates through persuasion, education and support for the vaccine-hesitant, as many noble Lords, particularly those on the Liberal Democrat Benches, have said. We know that omicron is now a clear threat. It is important that the elderly and the vulnerable, and those being cared for in healthcare settings, are protected. Vaccination also protects staff from severe disease, so we will not oppose the Government on this.

Compulsory vaccination for NHS staff is a difficult question—of course it is—as the right reverend Prelate the Bishop of St Albans and my noble friend Lord Hunt explained to the House. We would all much prefer that all front-line NHS staff voluntarily agree to have the vaccine. The latest SAGE advice, however, suggests that omicron may increase the risk of hospital-acquired infections. Vaccination will not eliminate all transmission, but it will reduce the risks and protect both patients and staff in the NHS from severe disease. It may also reduce staff absences caused by Covid.

Of course, there is a precedent for certain NHS staff having to be vaccinated, for example against hepatitis, and given the evidence that being vaccinated reduces the risk of transmission, it is reasonable to ask whether those who are looking after our loved ones should themselves have taken every step possible to reduce the risk that they may pass the virus on to those whom they are caring for, many of whom may be elderly and vulnerable.

However, ahead of any rollout, the Government must ensure that this change does not make the staffing crisis in the NHS any worse and must work with the royal colleges, NHS Providers and the trade unions to agree a framework for how this change is rolled out. The trade unions and royal colleges have been critical of the proposals for compulsory vaccination, ahead of what will be, and is becoming, a very difficult and challenging winter for the NHS because of the implications this could have for staffing. So we welcome the fact that the Government have pushed the date back to April 2022, but we continue to be concerned about the implications that mandatory vaccination for NHS workers will have on staff shortages. We have asked the Government to set out a plan for this.

For the record, on the separate issue of mandatory vaccination for the public, the Prime Minister probably puzzled the whole nation—he certainly puzzled me—when he floated this idea. We are opposed to this—as is the Minister’s boss, I expect. We are opposed to the use of Covid status certification for access to essential services. Forcing the general population to have the vaccine would not only be wrong but impractical. The Government have not brought forward any measures to introduce this, and we would not support any future attempt to do so.

Finally, all of us want to enjoy Christmas safely this year. We all want to protect our NHS, which has been suffering from staff shortages and record waiting lists and has been performing miracles for the last 18 months. Our best defence against all variants of the virus, including omicron, is that we all get vaccinated.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords for taking part in this debate. I apologise to noble Lords for getting the terminology wrong at the beginning. I will make sure that that is corrected in future.

I thank my noble friend Lady Noakes for raising this important issue, and for challenging us and rightly holding the Government to account on many procedural issues. I accept that your Lordships perform an essential role in scrutinising the measures that we have put forward today. That is one of the things that makes me very proud to be a Member of this House. I recognise the strength of feeling of your Lordships for and against what we are proposing and about the procedures thus far. I know that these feelings are sincere and heartfelt.

I now turn to some of the point raised by noble Lords. My noble friends Lady Noakes and Lord Cormack and the noble Baroness, Lady Brinton, raised questions about the red-rated impact assessment from the Regulatory Policy Committee. I hear the concerns of this House, and I acknowledge that, due to the necessity to move as quickly as possible and minimise the risk to those who are vulnerable, we were unable to publish the full impact assessment alongside the regulations being laid. We set out a statement of impacts, and the full impact assessment has now been published on GOV.UK, but I accept the argument made by noble Lords that this is rather late. We have also now published additional consideration of the points raised by the RPC in relation to private businesses.

My noble friend Lady Noakes also asked what the Government have done in response to the criticisms of regulations from the Secondary Legislation Scrutiny Committee. I reassure noble Lords that we have published the updated Explanatory Memorandum to provide additional information on the specific concerns raised. I also accept the criticisms that this could have been more timely. This includes more information on the scientific and clinical rationale for the policy, the exemptions that have been provided for, those not included, and the steps that we have taken to further encourage uptake of vaccinations and to mitigate work- force risks.

The SLSC also raised concerns about the impact assessment on process. We have worked hard and as quickly as possible to finalise the impact assessment that we feel best captures the likely impact of this novel policy in the uncertain circumstances that we are still living through and the need sometimes to react quickly. As my noble friend Lady Noakes rightly said, this impact assessment was laid before the House in advance of this debate.

My noble friend Lady Noakes also raised the question of whether a cost of £270 million is value for money, considering the impact assessment. While it is not possible to model the non-monetised benefits that this policy would have due to the limited data available, the health benefits through reduced infections and deaths among health and care users—as well as the wider community—from the workforce being vaccinated are likely to be large and should be considered when focusing on costs.

A key benefit is the impact of reassurance to patients and care users that they are being looked after by staff who are vaccinated. This avoids the very dangerous situation of people feeling wary of going to the NHS and other health and care providers, which can have dangerous long-term implications regarding health outcomes for our society. This is non-monetised, yet it remains a highly significant factor.

My noble friend Lady Noakes also asked about the workforce impact of this legislative instrument. As of 5 December, 521,000 staff in all care homes, or nearly 96%, have been vaccinated with the first dose, and 511,000 staff, or 94%, are reported to have received a second dose based on responses from 99% of providers. Although NHS workforce figures are dynamic as people join and leave, since the Government consulted on the policy in September, the latest published figures show an overall net increase of NHS staff vaccinated with a first dose of over 55,000.

My noble friend Lady McIntosh also raised valid questions about the impact on the social care workforce. We are not aware of any care homes where VCOD is the primary reason for closure, but we continue to work with our regional assurance team, which works closely with regions across the country to understand the local and regional pressures, and offer support and advice as appropriate.

In social care, we have already put in place a range of measures to help local authorities and providers to address workforce capacity pressures; indeed, I have announced some of those in this House. As in healthcare, there will be a 12-week grace period for workers in the wider social care sector before requirements come into force, which will give all unvaccinated staff time to get their jab. We are focusing every effort on promoting and encouraging vaccine take-up across social care, and £300 million was announced for the workforce on Friday 10 December to support the care sector over winter.

My noble friend Lord Cormack, the noble Lords, Lord Cunningham and Lord Hunt, and several other noble Lords have eloquently raised points about the use of retrospective legislation and emphasised the importance of parliamentary processes. I sympathise with noble Lords who are concerned about some of the procedural aspects of the passage of this legislation.

As my noble friend Lord Cormack rightly said, in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable. Vaccination is our best defence against Covid. It reduces the likelihood of infection and therefore helps to break chains of transmission, as the noble Baroness, Lady Thornton, rightly acknowledged. It is safe and effective. The legislation will protect those receiving care in all health and social care settings as well as our valuable health and social care workforce themselves.

I agree with my noble friend on the point about reviewing the use of such legislation. I assure noble Lords that Regulation 5 sets out the requirement for the Secretary of State to carry out an annual review of these regulations, taking into account clinical advice and accessibility and availability of authorised vaccines, and to publish a report setting out the conclusions of this review.

On my noble friend Lord Cormack’s suggestion of an ongoing Joint Committee, I apologise if the response I suggested was inaccurate. I suggest that I discuss it with him so that I can learn from his experience of parliamentary procedures.

The noble Baroness, Lady Tyler, referenced the importance of encouraging the hesitant. I completely agree. We both come from the same part of London; indeed, she informed me that we went to the same school. We come from an incredibly diverse area, and we understand the different concerns and pressures in many of these communities; as noble Lords will recognise, I myself come from one of these communities. But as she will know, the NHS has focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking campaigns not only based on function, such as at midwifery staff, but directed at different communities, such as ethnic-minority groups and students, as well as using the booster campaign as an opportunity to re-engage staff. I repeat my gratitude to noble Lords across the House who have suggested to me ways that we can address many of these communities, including working with interfaith communities and networks which really understand these communities and have the trust of many individuals.

Medical Schools: Training Places

Lord Kamall Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Robathan]

To ask Her Majesty’s Government how many training places for new doctors there were in medical schools and other institutions in (1) 2000–01, and (2) 2021–22; and what plans they have, if any, to increase the number of places for 2022–23.

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

In the 2000-01 academic year in England, there were 4,300 government-funded medical school places. Initial data shows that, in 2021-22, 8,460 places have been taken up, including additional places for students who completed A-levels in 2021 and had an offer from a university in England to study medicine subject to their grades. The Government continue to monitor the number of medical school places that they fund to ensure that it is in line with NHS workforce requirements.

[Lord Robathan (Con)]

My Lords, the Answer is quite encouraging, but doctors and other medical staff are working flat out on our behalf, and we are told that there are not enough doctors. That is because we are not training enough. Some 21 years ago, Gordon Brown confected a row over a girl called Laura Spence, who was well qualified but was not able to get into Oxford to read medicine because there were not enough training places. We have had all three major parties in government in those 21 years, and there are still not enough training places. Rather than taking doctors from the poorest countries in the world, where they are needed, and bringing them here, does not my noble friend think that it is time to make sure that we train enough doctors in this country and that there are enough training places for them so we can actually service our own needs?

[Lord Kamall (Con)]

I thank my noble friend for the question, but there are record numbers of medical students in training. There are currently more than 35,000 doctors in undergraduate training and 60,000 doctors in foundation and speciality postgraduate medical training. On the international market, we follow strict ethical guidelines, in line with the World Health Organization guidelines.

[Lord Watts (Lab)]

My Lords, is it not the case that the extra doctors that we were promised by 2016 will not be enough to compensate for the number of doctors who will retire? Can the Minister say something about what he is doing about the number of doctors who are going to retire shortly, which will cause even more of a shortage?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord raises an important question, but the fact is that we are training more doctors, and we are recruiting internationally where it is ethical to do so. On retirements, we are looking at a scheme that lasts until 2024 to allow doctors to come back without it affecting their pension.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a fellow of the Royal College of Physicians. Do the Government accept the report from that body, Double or Quits, which has shown that we need 15,000 medical school places annually? Doubling the number of medical school places to that number would cost £1.85 billion, which is only one-third of what hospitals currently spend on agency and bank staff. Therefore, an increase is an investment to save.

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

[Lord Naseby (Con)]

My Lords, as well as increasing the numbers, is it not equally important that we ensure that every newly qualified doctor, on whom we spend well over £200,000, signs up for at least four years in the NHS, as do every male and female who joins our Armed Forces today?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. I will look into it and get back to him.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, will the Minister indicate what research has been carried out into the training opportunities for specialist doctors post-graduation who wish to pursue careers as consultant orthopaedic surgeons? At the moment, because of Covid investment resources, there are no training opportunities for them in Northern Ireland. Will the Minister raise this issue and indicate what efforts will be made to address it?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing the experience of Northern Ireland. It is really important that we ensure that we have more training places and that we address the types of training that we do. As the noble Baroness will be aware, it is no longer a simple question of nurses and doctors: we are training a number of physicians’ assistants and specialists, and we will continue to do so.

[The Lord Bishop of St Albans]

My Lords, this latest Covid omicron variant has made us realise that we are one human race, and we are now facing a scandal whereby we are relying on bringing in doctors from some of the poorest parts of the world to look after our needs. For centuries, this country was renowned for sending doctors and nurses abroad and founding hospitals in all parts of the world. What consideration have Her Majesty’s Government given to ensuring not only that we are producing enough of our own doctors but that we are expanding our tertiary education and bringing in more people to send them back to help some of these countries as part of our global Britain initiative?

[Lord Kamall (Con)]

When training doctors from abroad, we follow international guidelines and World Health Organization ethical guidelines. For example, when I recently had a meeting with the Kenyan ministry to talk about the UK-Kenya health partnership, the point was made to me that they were training far more people than they had places for in their own country. They thought that their talent was a valuable export, while at the same time, remittances went back to their country.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Does the Minister accept that long-term workforce planning requires an effective apparatus that is able to understand the changing population demographic, changes in the nature of the delivery of healthcare and how technology and innovation might impact that? Do Her Majesty’s Government have a view about establishing such an apparatus as part of the current Health and Care Bill before your Lordships’ House?

[Lord Kamall (Con)]

There has rightly been much discussion of workforce planning for the NHS and adult social care, and the Bill will build on this. Clause 35 will bring greater clarity and accountability in this area, requiring the Secretary of State and the NHS to produce a workforce plan.

[Baroness Merron (Lab)]

My Lords, with the intensification of the Covid booster programme, more doctors will, of course, be diverted from their usual roles, making it even harder for people to get an appointment at their local surgery, and record waiting lists will continue to increase. What revisions will the Minister make to existing plans for numbers of training places to meet the need for more trained staff, including doctors, nurses, lab technicians and auxiliaries? How will the Minister respond to the report from the Royal College of Surgeons that 13,000 planned operations have been cancelled in the last two months alone?

[Lord Kamall (Con)]

The focus and priority for the next three weeks is on omicron and making sure that people get their boosters as quickly as possible. It is not only doctors who are involved: nurses, pharmacists and, incredibly, a number of civil servants are now taking part in that programme. For the next three weeks, the focus is on getting more jabs into arms.

[Lord Sikka (Lab)]

My Lords, successive Governments have poached doctors from comparatively poor countries to meet the shortages here. As the Minister knows, it costs a vast amount of money to educate and train a doctor, so developing countries have been deprived of their talents. Will the Minister explain that, or give an undertaking that the Government will provide compensation to poorer countries for stealing their assets?

--- Later in debate ---

[Lord Kamall (Con)]

The Government follow strict ethical guidelines on international recruitment, in line with WHO guidance, which says we should not be taking nurses and doctors from countries and depriving their health services. But where countries have a surplus—a number of developing countries around the world actually train more people than they have a use for in the local system—they see it as a valuable source of income.

[Lord Scriven (LD)]

My Lords, it is not just a question of the total number of doctors but the number in certain specialisms where there is already a dearth of professionals. What are the Government doing to ensure that, as more doctors come on, they are particularly geared to specialisms where there is already a dire dearth of doctors?

[Lord Kamall (Con)]

When it comes to workforce plans, particularly in local areas where there is understaffing, we are very much focused on specialisms that are understaffed.

[Lord Turnberg (Lab)]

My Lords, we are losing doctors more rapidly than we can train them, and it has been like that for a while. The average age at which a physician retires is now 58; it used to be 62. What are the Government doing to help doctors stay in post and to bring them back part-time after retirement to help the NHS?

[Lord Kamall (Con)]

As the noble Lord will be aware, there is a temporary measure to bring doctors back, without affecting their pensions, which lasts until 2024. We are looking into whether that should be continued, as well as increasing the number of training places.

Covid-19: PCR and Lateral Flow Test Providers

Lord Kamall Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government what due diligence they carry out on companies listed on GOV.UK, that offer travel PCR and lateral flow tests for COVID-19.

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

The private sector has stepped up extremely rapidly, and most of the tens of thousands of travellers have had an excellent and professional service. However, we do not tolerate any providers taking advantage of customers. All providers in the PCR international travel market are required to meet robust minimum standards, and we remove those we identify as having fallen short of them. Since we launched the travel service, we have removed over 100 providers.

[Lord Scriven (LD)]

My Lords, for many people that is just not their lived experience. The approved supply list for the two-day PCR test on GOV.UK is fundamentally flawed. Many thousands of people either do not receive the test results within the two-day timeline or at all. Despite many people reporting these companies to NHS Test and Trace, they remain on the list as of today, making tens of thousands of pounds while undermining the public health effort. What will the Minister do to ensure that this kind of procedure stops?

[Lord Kamall (Con)]

It is important to distinguish between PCR tests if you are contacted by NHS Test and Trace and PCR tests for travel purposes. If you are contacted by test and trace, you are sent a PCR test for free. But when it comes to travel, the view is that the traveller should bear that cost rather than the taxpayer. After I saw this Question, I went on to one of these websites and tested it out for myself. As the noble Lord says, the price quoted is often not the first price. I have had a conversation with those that provide it, and they are looking at a number of different solutions.

[Baroness Rawlings (Con)]

My Lords, why can vaccines only be obtained through the National Health Service, while Covid tests valid for travelling can only be obtained privately?

[Lord Kamall (Con)]

I am not sure I completely agree with the premise of my noble friend’s question, but I will double-check. The decision had to be made that if people are contacted by test and trace, it is only right that they are sent a PCR test. But if they are travelling, should the taxpayer bear the burden of the cost of their PCR test, or should they? A number of travel companies are now recommending PCR tests for their passengers.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, it is not just Matt Hancock and Randox, or Rupert Soames at Serco: a large number of these companies that have multimillion—even multibillion—pound contracts for testing have links with Tory members, MPs and Peers. Is this just a coincidence? Is it serendipity? Or is it something more sinister?

[Lord Kamall (Con)]

I suggest that if the noble Lord would like to take a PCR test before he travels, he goes through a number of price comparison websites and chooses the one he feels is more suitable for him.

[Lord Cormack (Con)]

My Lords, there are rumours circulating—more than rumours, I think—that we are running out of testing kits. Is that true? Can my noble friend give us some reassurance on that front?

--- Later in debate ---

[Lord Kamall (Con)]

I thank my noble friend for bringing that to my attention. I was in a meeting with my right honourable friend the Secretary of State for Health and Social Care as well as other Ministers today. We were told categorically that we have ordered many more tests to enable people to test more often.

[Baroness Thornton (Lab)]

My Lords, there are hundreds of private test companies to choose from when you are heading abroad, and that is part of the problem. Which? carried out some mystery shopping in the autumn and revealed a list of companies that give the most reliable and best-value tests—I share that information with the House—and also the ones to avoid as being rip-offs and unreliable. Is the Minister aware of this consumer research? What notice will the Government be taking of the ones that Which? recommends not to use? Have they yet been removed from the Government’s list?

[Lord Kamall (Con)]

I thank the noble Baroness for making noble Lords aware of that particular comparison website—let me put it that way. We try carefully not to recommend particular private providers or comparison websites, but this market is developing, and there are lots of comparison websites out there looking at this market. As we start to have more testing and do more diagnoses at home, this market will develop.

[Lord Bilimoria (CB)]

My Lords, I was one of the first people in the country to call for lateral flow tests, going back to August last year, and I am delighted that the Government now provide these free to businesses and the public. Can the Minister assure us that these tests will continue to be made available free as we continue to fight this pandemic? Secondly, as president of the CBI, let me say that the aviation sector is suffering hugely. Is there a need for pre-departure PCR tests when we could use lateral flow tests?

[Lord Kamall (Con)]

Let me assure the noble Lord that there will be sufficient tests; and if you are contacted by test and trace, you will either be asked to take a lateral flow test or be sent a PCR test. But when it comes to international travel, we feel it is only right that the traveller or the company bears the cost. At the moment, travel companies are offering and recommending specific PCR tests.

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

--- Later in debate ---

[Lord Kamall (Con)]

I thank the noble Baroness for suggesting another price comparison website. There is an accreditation scheme, and every time companies are reported to the Government, we look at how to remove them. There is a four-stage process for UKAS accreditation, and sometimes when companies are reported, another one pops up.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister say what the average cost to the NHS of both a PCR and a lateral flow test is, so that that can inform people in relation to the cost in the private sector?

[Lord Kamall (Con)]

I do not have the exact numbers, so I will write to the noble Baroness. On loss-leading services, anything under £15 was removed because it was deemed that that was dishonest or underpriced.

[Lord Naseby (Con)]

Following on from that question, I remind my noble friend that, as far as I am aware, all the PCR tests are endorsed by Her Majesty’s Government, but the price varies from £60 to over £120. In that condition, if they are endorsed, will my noble friend talk to the companies concerned and decide on a recommended price level?

[Lord Kamall (Con)]

When I was discussing this with the people responsible for accreditation, they said that often a number of companies are reported to them and they look into them. Quite often companies will then be removed, but they can come back. The issue is that companies sometimes get provisional approval at the first stage while they are going through the full approval process. That will be reviewed in time.

[Lord Harris of Haringey (Lab)]

My Lords, in answering the noble Lord, Lord Scriven, the Minister referred to the fact that 100 companies had been removed from the list, presumably by his department or NHS Test and Trace. He presumably monitors all of this, so could he tell us exactly how many complaints there have been and how many of such complaints are necessary before a company is removed?

[Lord Kamall (Con)]

I am sorry to disappoint the noble Lord; I do not personally monitor this, but I will get the figures and write to him.

[Lord Watts (Lab)]

My Lords, can the Minister explain the wide difference in price from these companies? It seems to the general public that some are ripping clients off, but the Government do not seem to want to do anything about it.

[Lord Kamall (Con)]

One of the issues the Government have is that the GOV.UK website is pretty rudimentary. As this market develops over time, more and more people will look to private comparison websites—noble Lords have mentioned a few of them. It is also important to distinguish between the different types of PCR test. Some companies charge far more but offer a much quicker turnaround than those whose service might take a few days.

[Viscount Waverley (CB)]

My Lords, one might imagine that laboratories would give a reasonably consistent price. This is really all about consistency and fair pricing. That is the issue that needs to be taken into account, and I commend my Cross-Bench colleague for the point she made about the NHS. Given that the written word is often in the eye of the beholder, would it be helpful to have more flow chart-type messaging on the GOV.UK website? The perception is that what is on there is extremely complicated to understand.

[Lord Kamall (Con)]

The noble Viscount makes an important observation. When I looked at the website myself, I saw how confusing it was. When I discussed this with the people responsible, they said that they had changed it over time; for example, it now has minimum prices—one of the suggestions I made was that perhaps it should also have maximum prices. There is also the question of how you categorise, because there are different tests; some can be turned around in 24 hours, while others take a few days.