Streptococcus A: Antibiotics

Lord Markham Excerpts

Thursday 15th December 2022 Lords Chamber

[Baroness Taylor of Stevenage]

To ask His Majesty’s Government what steps they are taking to address reported shortages of supplies of antibiotics, given the increase in cases of Streptococcus A.

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

We are working at pace with manufacturers and wholesalers to expedite deliveries, bring forward stock and boost supply. UKHSA and the NHS are co-ordinating communication to healthcare professionals, including advice on using alternative effective medicines as necessary to ease pressure on supply. Early treatment is vital, so in addition to bolstering supply we are providing information to parents to understand the trigger points for urgent referrals.

[Baroness Taylor of Stevenage (Lab)]

I thank the noble Lord for his Answer, but despite Ministers saying that there is no problem—the Health Secretary has said that—worried parents across the country are going from pharmacy to pharmacy to seek the antibiotics their children need. Can the Minister update your Lordships’ House on the improvements in availability since the Health Secretary said, as in the statement repeated this morning, that he was

“working urgently with manufacturers and wholesalers to explore what can be done to expedite deliveries”?

Further, are there any plans within DHSC to update the concessionary price for amoxycillin and penicillin, so that pharmacies do not have to foot the bill for the rapid increase in costs they are experiencing?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important matter to us all. Yes, they are working very strongly; I had a series of meetings yesterday on this very subject to go through all they are doing on the supply front. Importantly, as we speak, they are putting out advice to medics about suitable alternative antibiotics that can also be used in this case. I am satisfied that they are doing everything they can towards this. Clearly, where there are price problems such as those the noble Baroness mentions, we will also act in that area.

[Lord Sikka (Lab)]

My Lords, the cost of producing strep A antibiotics has not changed but the selling price has rocketed in recent weeks from 80 pence to £19 per packet, mainly because of profiteering by companies. Will the Minister launch a publicly owned company to manufacture generic drugs, which would provide jobs and exports, secure long-term supplies, protect the NHS budget and end the profiteering by drug companies? Does he have any objections to that?

[Lord Markham (Con)]

My general thinking—this is a personal view—is that the market is normally very well placed to supply these things. There was the excellent example of the vaccines, whereby it acted incredibly quickly and got Covid vaccines out as necessary. I think we are always better placed using the strength of the whole market and looking to international suppliers as well. They are always going to be able to provide the necessary medicine to a quicker timescale than our own company would.

[Baroness Finlay of Llandaff (CB)]

My Lords, since the risk of invasive group A streptococcal infection is increased in the presence of other viral infections—any of them; it could even be chickenpox in children—what guidance are the Government giving to all schools on public health measures to decrease cross-infection between children and ensure parents are encouraged to keep those who might be unwell away from school, rather than sending them to school, as is the tendency, because of attendance registers?

[Lord Markham (Con)]

The noble Baroness is correct; it is the coincidence of more than one condition, particularly respiratory conditions, which causes the more extreme cases. The advice is definitely to keep children away from school if there is any question on that at all, especially as we are about to enter a period of school holidays. It is very much the view of the experts that the school holidays should flatten the curve of infections. I should also say at this point that while we are all quite correctly concerned about this, and doing everything we can regarding supply, the current levels are still lower than those we saw in 2017-18, when March and April had the normal peaks of around 2,000 a week. We are currently at around 1,200 cases a week and, as I say, we expect that to flatten out a bit with the firebreak, so to speak, of the Christmas holidays.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Lord, Lord Campbell-Savours, is participating remotely.

[Lord Campbell-Savours (Lab) [V]]

My Lords, as someone on a six-day lockdown and on intermittent antibiotics to deal with a lung condition following surgery, can I suggest, on these shortages, that guidance on antibiotics such as amoxicillin should be updated to allow for greater flexibility of expiry dates? There is too much wastage, and with careful prescription advice and labelling, antibiotics can have a far longer shelf life before deteriorating. Rigid advice on packaging should be relaxed in favour of more flexible expiry dates, as current advice only serves the manufacturers, who sell more.

[Lord Markham (Con)]

I thank the noble Lord and I agree. We are looking at every sensible measure we can to ensure we have the greatest flexibility of supply. Expiry dates are clearly one thing we can look at, and I will take that back to the department. I wish the noble Lord well and hope that he feels better soon.

[Lord Allan of Hallam (LD)]

My Lords, community pharmacies in Northern Ireland were warning back in October of serious problems with the supply and pricing of a range of drugs. While it is welcome that there now appear to be investigations into the wholesale supply chain for antibiotics, may I also urge the Minister to look at whether there were missed opportunities for earlier intervention?

[Lord Markham (Con)]

Absolutely—clearly, we always need to learn in such circumstances, so we will be happy to do that.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Can my noble friend give reassurance that dispensing doctors, pharmacists and others will be reimbursed for the full cost of the increased price of antibiotics?

[Lord Markham (Con)]

My understanding is that there are measures in place to ensure that the people supplying in those circumstances are not losing out because of profiteering. The most essential message today is that that supply is available to anyone who needs it, so I will take that back.

[Lord Turnberg (Lab)]

My Lords, is it the manufacturers in the pharmaceutical industry or the wholesalers—the middlemen—who are making the profits? What mechanisms are available to clamp down on them?

[Lord Markham (Con)]

The key mechanisms always involve broadening the supply chain. I have given exactly that instruction to the department, which is very much taking it on board. It is looking at supply across a number of sources, not just from the UK but worldwide, as well as the substitution of antibiotics. Penicillin is currently the advised one, but a number of others are being advised right now which will also work well, so that there is as much choice as possible.

[Baroness Manzoor (Con)]

My Lords, my noble friend will be aware that, while some people are making profits, 16 children under the age of 15 have died as a result of strep A. Exactly what advice is being given to GPs so that parents have direct access to them very quickly? Of course, there is also a concern about antibacterial resistance as a result of overprescribing antibiotics.

[Lord Markham (Con)]

I thank my noble friend and will take this opportunity to offer that public health advice. A rash, which is often the first sign of a bacterial infection in this case, or a child being floppy, drowsy or dehydrated are all key signs that they should urgently seek medical help. People can call 111 or 999 and be guided through the triaging process to make sure that they get help quickly. At the same time, medics have been told to lower the barrier for prescribing, so to speak, so that they can make sure that people get it early. Although every death is a tragedy, we are clearly now seeing some reduction in the death rate, which is welcome.

[Baroness Merron (Lab)]

My Lords, while many pharmacies are being forced to sell the antibiotics they can get their hands on at a considerable loss, as wholesale prices soar, the Government have been saying that no company should be using this as an opportunity to exploit the NHS. Can the Minister assure the House that the Government have learned from previous mistakes with procurement and are taking measures to ensure that no company profits unduly from the increased demand for medication?

[Lord Markham (Con)]

As I mentioned, no one wants to see profiteering in these sorts of situations. The absolute focus right now is on expanding supply, because that is clearly the first thing you need to do. But you then absolutely need to learn lessons and see that appropriate action is taken against companies doing that.

NHS and Social Care Workers

Lord Markham Excerpts

Thursday 15th December 2022 Lords Chamber

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

I thank noble Lords. I particularly thank the noble Lord, Lord Allan, for introducing the debate. I look forward to working with him, just as I have enjoyed working with the noble Baroness, Lady Brinton—I hope he does pass muster. I am pleased to respond to this Question for Short Debate on the steps we are taking to support the NHS and social care workforce. We all agree that this is an important issue and that we are all indebted to the people who work tirelessly in our health and care services.

Helping the health and social care workforce manage their mental health and well-being is important and we are committed to helping staff recover. That is why we encourage adult social care providers to invest in mental health and well-being services for their staff. The NHS People Plan and the NHS People Promise set out a comprehensive range of actions to prioritise staff well-being. Boards, leaders, non-exec directors and managers across the NHS are being asked specifically to consider the health and well-being of all their staff as a priority.

As the winter approaches, we know that the system has not rested over the summer. It has been fighting the pandemic for years and we know the drain that that has caused. We know that this winter, with rising cases of Covid and flu, we are putting more pressures on staff, alongside the pressures of the cost of living. We understand those pressures and the need to support the workforce. I will try to answer some of the questions more directly later, but we understand the need for the £500 million fund to help with discharge and workforce support.

We understand the importance of pay in making people feel looked after in what they do. We have accepted the recommendations of the latest independent pay review body in full. I apologise if I made a mistake. I thank the noble Baroness for kindly and gently putting that forward. I will go away and make sure I correct that. I thank her again for the way that was put forward.

We have given more than 1 million non-medical NHS workers a pay rise of at least £1,400 this year, which is equivalent to 4% to 5%. We deeply regret that some feel the need to take industrial action despite that. I will address the specific questions on the pay review and the impact of inflation later.

This is more difficult with care workers, because they are paid by people outside our control, so to speak. Our only hope is that with around 70% of the total payments in this area going to wages, the £2.8 billion and £4.7 billion of additional funding will find their way into the pockets of the people who need it. That is something we will encourage. At the end of the day, if you cannot recruit and motivate a workforce, you will not have the care you need—it is simple.

Alongside looking after our staff, we know that demands on the NHS and social care are increasing. Expanding the workforce has to be a priority. While the numbers are increasing—I will not repeat the statistics I often give out—we know we need to do more in this space.

I may be going a little off-piste here, but I think we can be more creative and flexible in the way we do that. I do not think we are making enough use of apprenticeships and other routes in. I give the example of my mother, who left school at 15 with no qualifications, became a mother with three kids and then, in her 30s, found a way into nursing, first as an SEN—an easy entry path—and then as an SRN. Eventually, she became a midwife and worked for more than 20 years in the health service. We need more of those sorts of routes.

Would it not be great if we had a modular system so that a person working at a dentist’s for two years could qualify as a dental nurse? Instead of working in Wetherspoons for most of their training, their part-time work could be in that profession, using and honing their skills. Would it not be great if a dental nurse who was good at their job knew that their qualifications were part of the way towards becoming a dentist? The team is looking at those modular systems in terms of that flexibility. Training and development is clearly a key part. We are funding more places. In the nurse space, it is not limited. There are more than 70,000 nurses in training as part of that, but clearly the workforce plan needs to set out whether we need to be doing more in this space.

I know that we all welcome the workforce plan and I appreciate the comments from all Members of the House, particularly those opposite, that have for a long time been, quite rightly, that we need to do it. I think that we are all pleased that we are doing it. I completely accept the need to ensure that it is detailed enough to be useful, for want of a better word, and that it needs to be iterative, which will involve other people. I understand that such transparency brings pain, because you have inputs from other people who do not always agree with you. However, you get a better product at the end of it. I am afraid that I cannot give more information on a timetable yet, but I will press for more information.

I accept that inflation makes annual pay reviews more difficult. That is the problem with inflation. We have tried to make exceptions for the nurses in the past. Offering what I hope is a sensible view, as we were saying in the debate yesterday, April is not that long away. If we could expedite a process for the independent pay review body, maybe that would be a sensible way forward, where people feel that there is recognition of the impact that inflation has. Sometimes inflation can mean that you need quicker answers than you might normally expect.

On the social care space and the long-term strategy, I know that Minister Whately is very focused on this, to an amazing degree of detail, and on the impact of that £500 million fund and the results. I accept that it took a while to get that money out, and I partially take the blame. We wanted to ensure that it was going out in the right places, which took a bit more time. I hope and expect it to have been worth that time to ensure that it is targeted in the right place. That £500 million is the first instalment, with up to £2.8 billion next year, particularly in the places that work.

I know that it is a favourite thing for the noble Baroness, Lady Brinton, to bring quotes to the Chamber. I liked this one, and look forward to hearing more, particularly as Aldous Huxley is one of my favourite authors. Clearly, we need to make science and technology work for the NHS and not the other way round. On the point around productivity and the IFS, candidly, a lot of that is down to poor systems and the work that must be done to improve that, as the IFS rightly states. We are looking to address these things through the estates programme and the £10 billion per year capital spend, which is a big increase on previous years. In some areas, productivity has gone backwards, but in many areas it has not. We must understand what conditions are enabling us to increase productivity and how we can use that to help those areas that are not as productive as before to catch up and overtake.

I will try to answer some of the other questions. On pensions, as the noble Lord, Lord Davies, mentioned, there will be a further debate on this in the new year. It is a serious issue that, let us face it, we need a solution for, because we know it means that people are voting with their feet and leaving the service. Clearly, we need a solution to it all. It is something that we are taking seriously, with detailed work. We can discuss it further in the new year.

I have to admire the passion for prevention in the speech from the noble Lord, Lord Bird. One of the pleasures of this job is sharing an office with, or being fairly close to, Chris Whitty, and seeing many of the things that he brings such intelligence and value to. If you speak to him about prevention, he will talk about his concern right now for those people who missed out on heart checks—the 50 to 65 year-old cohort who did not have a heart check during Covid. That is one of the things that needs to be high up the list of the things to address in the prevention agenda.

On the other points, I will need to give the noble Baroness some more detail in writing on the findings of the report she mentioned. Given that we are running out of time, as ever, I will provide a detailed response to anything I have not managed to cover.

In conclusion, I again thank noble Lords. I agree with the sentiment that it would have been nice to have had a lot more contributions, but through this programme of work, including by supporting care employers and commissioners, we are helping to build the robust and resilient workforce the NHS and social care systems need for the future. We are working to ensure that the country has the right people, with the right skills and in the right places, and that they are well supported and looked after so that they can in turn look after those who need our great NHS and social services.

NHS Industrial Action: Government Preparations

Lord Markham Excerpts

Tuesday 13th December 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Royal College of Nursing and UNISON have said that they are prepared to call off strikes if the Government will negotiate with them seriously regarding pay. So the key question to the Minister is whether his Government will confirm whether they are prepared to do this in order to avoid disruption to patients in the NHS. As today’s devastating King’s Fund report on the state of the NHS, which was commissioned by the Government, so clearly shows, these strikes are not just about pay. Can the Minister give his view on the wider factors that have led to the strikes and give some commentary as to why the Government have not taken preventive action?

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

I thank the noble Baroness. On the other actions, so to speak, we have already met a couple of times with the union and are very happy to meet to talk about other things we can do on terms and conditions. As regards the main element around pay, we are following the results of the independent pay review body, which, as the House will be aware, has been in existence since 1984. Parties from each side have taken its expert advice and followed it, and that is what the Government have done in this situation.

[Lord Allan of Hallam (LD)]

My Lords, patients will naturally feel very anxious whenever there is disruption to services that they need, but this anxiety can be mitigated by effective communication. Many of us will have had experiences of great communication by the NHS, such as during the Covid-19 vaccination programme, but also of frustrations, where letters are lost or delayed or we are playing telephone tag with hospital administrative staff. What steps will the Government be taking to ensure that patients receive clear, timely and relevant information during the forth- coming industrial actions?

[Lord Markham (Con)]

I thank the noble Lord for the question. Clearly, we want to ensure that there is as little disruption as possible, and appointments will go on as normal where possible. The general advice is that, if you have not been communicated with, you should turn up to your appointment as normal. As ever, there is a bit of fluidity in the situation, because, as I am sure noble Lords are aware, a nurse does not have to give notice of whether they are going to be attending work that day, so there needs to be some fluidity. But the expectation is that, if you have not heard from us already, you should turn up to your appointment and, in all likelihood, you will receive your planned treatment .

[Lord Robathan (Con)]

My Lords, if the military personnel are going to drive ambulances, for which they are paid less than the ambulance drivers and paramedics, will my noble friend ensure that all military personnel get paid a bonus for the work they do?

[Lord Markham (Con)]

First, I will take the opportunity to thank the Armed Forces and anyone else who will be helping at this difficult time. I appreciate that that might cut into some of their plans for Christmas and I appreciate what they are doing in the circumstances. I cannot speak beyond that in terms of any financial support that they might be given, but they will definitely have our undoubted thanks.

[Lord Balfe (Con)]

My Lords, does the Minister accept that many working families are much worse off because of inflation? The image given by the Government is that they have no coherent strategy. We seem to be in a sort of playground situation of shouting at each other, whereas what we need is understanding from the Government as to how they are going to tackle the inevitable fall in the standard of living caused by the excesses that happened during Covid. Will the Government try to get their act together, because the sympathy of the general public is not with the Government? It is not against the strikers. At best it is neutral and at worst it is moving the other way as we get nearer to Christmas.

[Lord Markham (Con)]

We appreciate of course that these are difficult times. Unprecedented circumstances have caused the current inflationary environment, which we appreciate provides challenges to many people. We are trying our best to help them navigate through that. Obviously, the energy support package was a good example of where we are trying to make sure that probably the biggest component of inflation—the increased energy bills—is covered. We will seek to act and do what we can in all circumstances to help people through the crisis.

[The Lord Bishop of Chelmsford]

My Lords, even prior to the strikes, agency nurses were being brought in to ensure that shifts were safely staffed. I should be grateful if the Minister would set out what assessment the Government have made of the cost to the NHS of employing agency staff, compared with that of a pay rise that would work towards an arguably better and more stable workforce?

[Lord Markham (Con)]

I do not have those figures to hand, but I believe there is a Question on this subject tomorrow, when we will be talking very much about the use of agency staff and bank staff. From memory—the right reverend Prelate will get the exact figures when I have done a bit more swotting up overnight—I think the cost of agency and bank staff work this year is around £3 billion. Clearly, the workforce strategy will be all about making sure we can recruit staff to minimise that.

[Lord Lansley (Con)]

My noble friend referred to the NHS Pay Review Body. As Secretary of State, I thought it was rather important that I did not determine the pay of nurses, for example; the pay review body made recommendations and I adhered to them. Will the Government continue to explain that they are not refusing to negotiate on pay with the trade unions but adhering to a long-established principle? The trade unions appear to be seeking somehow to overturn last April’s pay award, when they should be providing evidence to the pay review body on what the pay award should be next April, with the remit letter already published.

[Lord Markham (Con)]

I thank my noble friend for his question. He is quite right. As mentioned before, this body was set up in 1984 and extended to other areas of the health service in 2007. Since then, Governments of all colours have followed its recommendations because, after all, it is the expert in this field. We have honoured that in full because it is right that the experts determine it. Working towards making sure that the next settlement in April—which, let us face it, is only three or four months away—covers the latest situation would be a good way ahead.

[Lord Rooker (Lab)]

Is not the total silence of all members of the pay review body since it delivered its report to the Government remarkable? Has anyone asked them, bearing in mind that they delivered their report when inflation was about 3% or 4%, whether they believe the figures in their report are still relevant today? Forget last April or next April—we are talking about today. The pay review body has been loaded up with a responsibility by the Government which in a way is not solely its responsibility. The Government do not have to accept its recommendations, as the Scottish Government have not. Has anybody asked it whether, in the present circumstances and with inflation so high, it still stands by the report it delivered in the middle of last year?

[Lord Markham (Con)]

My understanding, based on the long time that this has been in place, is that this is an annual review. April is now quite close; for that April review, it can take into account all the factors, including what happened to inflation during the year. I expect it will take all that into account, quite rightly, in what it comes up with for that next pay review. It is a long-established principle that it is there to do this. I trust it to get the right answer in time for April.

[Lord Deben (Con)]

Will my noble friend be very careful to stick by the case being put forward? We know that those arguing it want to hide behind some discussion of the mechanisms in order not to say what they really think about the pay rises. The Government have a responsibility to stick by the system. If we lose that, it will be the Minister who makes decisions always, which is what we have tried to avoid since the 1980s.

[Lord Markham (Con)]

I agree. Clearly, there are difficult choices; if we changed the position, we would have to take money away from other parts of the system, such as the elective care fund and other front-line services, which we clearly do not want to do. It is absolutely right that we let the experts guide us in this, as all Governments have done for more than 30 years.

Food (Promotion and Placement) (England) (Amendment) Regulations 2022

Lord Markham Excerpts

Tuesday 6th December 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is a pleasure to follow the noble Baronesses, Lady Walmsley and Lady Merron. They have said practically everything I wanted to say, and as the Minister may find it depressing for me to say it a third time, I will not.

What I do want to focus on is the key role of Parliament, and in this case your Lordships’ House, in scrutinising statutory instruments. We all have to accept that the period during which Liz Truss was Prime Minister was a somewhat extraordinary, though very short, one. I note in parenthesis that the Minister was appointed on 10 October, after these incidents had happened, so I think we need to recognise that he is responding to something that happened before he was in post. He was, however, appointed by Liz Truss.

The key thing is the sleight of hand in turning something that was absolutely openly discussed during the passage of the Health and Care Bill, and which was only to be used as a very short-term emergency measure, into what has clearly become a highly political move. While I have perhaps been slightly harsh on the time during which Liz Truss was Prime Minister, her successor has chosen not to reverse this, which tells me that this is a move by the Government.

I have to echo the points made by the noble Baroness, Lady Walmsley, about the evidence to our eyes during the passage of the Health and Care Bill of those who had heard the lobbyists and were fighting hard against the amendments the Government wanted.

I have just a couple of questions. We do need to see the evidence. The Secondary Legislation Scrutiny Committee was right: it is not appropriate to ask Parliament to scrutinise something without the evidence. Where is it, when will we see it and why do claims about the cost of living contradict the Government’s own evidence in the impact assessment available at the time? It is important that Parliament sees the detail of the responses to the Government’s consultation from every sector—food and drink, supermarkets, health bodies, not-for-profit organisations and charities—and the public, in whatever way they responded. Do the Government plan to publish that consultation?

Given the concern expressed by everyone who has spoken this evening, and indeed the Secondary Legislation Scrutiny Committee, and the evidence of our own eyes in your Lordships’ Chamber during the passage of the Health and Care Bill, it might be helpful if Ministers could publish all the meetings that all Ministers have had with food and drink industry members this calendar year, which about ties in with the beginning of the passage of the Health and Care Bill—at least, the first consultations prior to legislation arriving here in your Lordships’ House.

Finally, I suspect this may be slightly beyond the power of the Minister, but I do hope he will go back to the usual channels and seek guarantees that this sleight of hand will not be used again, especially given the delay on advertising HFSS products on TV and online before the provisions are due to come into effect on 1 January 2023. We absolutely must have that 21 days to decide whether we want to pray something in aid and bring forward regret Motions. However, there is a bigger issue here: the reputation not just of your Lordships’ House but of the Executive, and the power of the Executive just to ignore the systems that are in place. We need to make sure that scrutiny can be done effectively.

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

My Lords, I thank the noble Baronesses, Lady Merron and Lady Walmsley, for securing this important debate to discuss the Food (Promotion and Placement) (England) (Amendment) Regulations 2022. I also pay tribute to the Secondary Legislation Scrutiny Committee for its 15th report of the 2022-23 Session, which considered the amendment.

I thank noble Lords for their constructive and thoughtful contributions to the discussion on tackling the significant challenge of obesity. From this debate and our previous discussions, the good news is that we are all agreed on the need to take action. We are all aware of the stats: 40% of kids are overweight when they leave primary school, 25% are obese and, as the noble Baroness, Lady Walmsley, said, there is a huge impact on the economy of £58 billion per annum and a huge impact on the NHS of £6.5 billion. That is notwithstanding the huge impact on individuals’ personal health and well-being as well.

We are also all agreed on the strategy that we need to take: reducing overconsumption of food and drink high in calories, sugar, salt and fat. I think we all know the main levers available to achieve that but, to paraphrase the OECD, there are four key steps: information/education, increasing healthy choices, modifying costs and restrictions on promotions and product placements. We have made good progress on each of those. We have extensive education programmes and traffic-light labelling on food, we are working with industry to reformulate food recipes, we are putting calories on menus to signal healthy choices and we are ensuring a healthy start to life through nutritionally balanced school recipes. Furthermore, the sugary drinks tax levy has had a huge impact, with a 47% decrease in sugar.

Finally, the introduction of restrictions on product placement has had a high impact on the look and feel of our supermarkets. It is early days but a year-on-year change in the consumption of these types of products—two months into this, I guess—shows an 8% fall in sugar content, a 5.7% fall in salt consumption and a 6.4% fall in fat, which shows that these restrictions on product placement are working. Furthermore, analysts calculate that the steps we have taken here will account for 96% of the reductions in calorific intake. I repeat: the actions that we have taken, thanks in large part to all of us in the House, account for 96% of the projected reduction in calories. The early signs from the evidence that I gave show me that those actions are working.

I turn to the 4% and the thing we have not done, the subject of the regret Motion tonight: the delay to the ban on promoting foods high in fat, sugar and salt—the so-called BOGOF, or “buy one, get one free”, promotions. I emphasise that this is just a delay to the ban to give people time to adjust. I am delighted to say that Tesco and Sainsbury’s, accounting for 42% of the market, have already voluntarily banned BOGOFs of these types of food products. I am confident that the rest of the market will voluntarily follow, whether they are supermarkets following the lead of Tesco and Sainsbury’s or food companies reformulating their recipes to reduce fat, sugar and salt to avoid the so-called BOGOF ban.

By working with the food industry, we have taken action to address 96% of the problem, and we are working collaboratively with industry to implement the remaining 4%. Those figures probably give the best answer for the delay, though I concede that maybe I say that as a data analyst—and it was before my time.

I agree with the noble Baronesses, Lady Merron and Lady Brinton, that the so-called sleight of hand clearly was not great. I am pleased to take that from this debate, and I commit to doing better for as long as I am here.

The noble Baroness, Lady Walmsley, asked about the benefits challenge. The action that we have taken is focused on 96% of the forecast decrease in calorific intake, which again shows that we have acted where the benefits are most likely to accrue. My rough maths says that, if 42% of the market—Sainsbury’s and Tesco—voluntarily introduce this, we are now looking at addressing about 98% of the calorific intake that we had forecast to reduce. By any measure, that shows very strong analytical evidence of good reasons for doing so, and for giving people time to adjust and make the other changes.

On the 21-day rule, a consultation on this instrument was conducted between 3 and 17 August 2022. This was a short consultation shared with key stakeholders, including trade industry bodies and organisations, non-governmental organisations and enforcement officers. We sought views on the proposed text of the instrument. A summary of the outcome of the consultation was provided in the published Explanatory Memorandum. We explained that the consultation received 11 responses, including from organisations that represent over 50 health organisations, and industry trade bodies that represent manufacturers and retailers. All proposed changes suggested as part of the consultation were considered in the light of ensuring that this instrument served the intended purpose of delaying the implementation of the volume price promotion restrictions by 12 months.

[Baroness Brinton (LD)]

My question was whether the detail of the consultation responses would be published in the future. I appreciate that the Minister may not be able to answer that now, but even though there may not have been responses from many people—and it sounds as though there were not—it would still be useful for us to see that to do our job. Can he take that back? It is the normal convention that the results of public consultations are published; if not word by word, there is certainly more of a summary provided than there was in the Explanatory Memorandum.

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Baroness and am happy to take that back.

I hope that I have answered the questions. In all honesty, I cannot go into some of the details of whether there were other reasons behind it. As ever, being the data anorak that I am, I will fall back on the fact that what we did addresses 96% of the forecast reduction in calories. As ever, I will happily follow up in writing on anything that I have not covered.

I thank the noble Baronesses, Lady Walmsley and Lady Merron, for bringing forward the debate tonight. We are all agreed on the need to tackle obesity, and I want to focus on those things that we agree on. We are agreed on the actions and that those implemented already, such as the sugary drinks tax levy, have resulted in an almost 50% reduction in sugar, and that those recently implemented account for 96% of the projected reduction in calories. Our only slight disagreement is over time, concerning the remaining 4%, but by working collaboratively, we have already brought the biggest two supermarkets on side, and we will have 100% implementation within the year. We are working with the industry and we are backed by the science in what we are doing. Most of all, the action taken to date is working.

Children in Care: CAMHS Waiting Times

Lord Markham Excerpts

Monday 5th December 2022 Lords Chamber

[The Lord Bishop of Southwell and Nottingham]

To ask His Majesty’s Government what assessment they have made of the length of the waiting times for children and young people in care who need to access the support of Children’s Adolescent Mental Health Services; and what steps they are taking to reduce those waiting times.

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

We do not have a national waiting time standard for these services, so this data is not available. However, increasing access to these services is a priority. We are expanding mental health services through the NHS long-term plan. Funding for mental health services will increase by at least £2.3 billion a year by 2023-24 so that an additional 345,000 children and young people, including those in care, can access NHS-funded mental health support.

[The Lord Bishop of Southwell and Nottingham]

I thank the Minister for his Answer and declare an interest as a foster carer of more than 10 years. In my diocese, in Nottingham city and Nottinghamshire, 1,040 children and young people waited more than 12 weeks between referral and second contact last year. Surely, those delays are unacceptable. Does he agree with the president of the Association of Directors of Children’s Services, Steve Crocker, that His Majesty’s Government need urgently to undertake a full review of children’s mental health services to ensure they are able to meet the growing demand we have seen placed on them, especially for looked-after children, who are four times more likely to experience mental health issues than their peers?

--- Later in debate ---

[Lord Markham (Con)]

I have some personal experience in this area, so I agree that we need to see people as quickly as possible. On the investigation, we have recently undertaken a call for evidence, which closed in July with 5,000 responses that we are going through. I think that our response to that will answer many of the questions, but I would be happy to meet the right reverend Prelate and discuss this further when we have those results.

[Baroness Tyler of Enfield (LD)]

My Lords, the Select Committee looking at the Children and Families Act 2014, which I have had the honour to chair, is publishing its report tomorrow, and the frankly dire state of children’s mental health services runs through it like a stick of rock. Our inquiry received harrowing evidence of waiting times of up to two years for children already in crisis; specifically, we heard that there are very long waiting lists for post-adoption trauma support. What are the Government doing to improve mental health support for this particular group of children?

[Lord Markham (Con)]

I will need to write to the noble Baroness to give a specific response in that case. It is an area of concern where I think we are increasing awareness, and any diagnosis needs to start with awareness. By definition, that means that more people are diagnosed or come forward, which is a good thing, but it then means that often it takes longer to see those people—I do not say that as any sort of excuse but just as an explanation. As we increase our understanding in this area, and I think that we would all agree that over the last 10 to 15 years there has been a huge increase in understanding, that means that more people are coming forward, but it means also that we need up our game in terms of supporting them.

[Lord Laming (CB)]

My Lords, following the noble Baroness’s question, the Minister will well understand that children do not come into care for trivial reasons; most of them have had a very poor and traumatic start to their young lives. The state has taken on the responsibility to be a good parent to those children. Would it be possible for them to be given priority in the waiting lists for these essential mental health services?

[Lord Markham (Con)]

I would agree. In any case, especially where there is high demand in an area, we need a form of triaging so that we can agree the clearest areas of priority, such as those mentioned.

[Lord Porter of Spalding (Con)]

My Lords, my noble friend has quite rightly mentioned the amount of money that the current Government are finding to attach to this issue, and predecessors of his at the Dispatch Box would have all said similar things. The country is investing billions of pounds in children’s mental health, quite rightly—that has a huge effect on people’s lives, and it also has a huge knock-on cost to other parts of the Government’s spend if it is not done properly. What assurance can my noble friend give to the House that those billions of pounds are being spent properly on the services they are being given for, and are not being used to subsidise bad management decisions such as PFI contracts?

--- Later in debate ---

[Lord Markham (Con)]

I thank my noble friend. As ever, we need to make sure that every pound is well spent. These services come under the regulatory and inspection regime of the CQC. Also important in this space—probably most important of all—is understanding and getting early intervention, which means having more people in schools who understand and can help assess and identify some of those children early on. That is why the programme to intervene in schools and develop a senior mental lead is critical. Half of all secondary schools are taking that up right now. Half is not all, so there is more work to be done, but it is good progress.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, the Minister may be aware that all young people who get sentences from youth courts get CAMHS assessments, which is a good thing. However, does he think that young people who have out-of-court disposals through YOTs should also get CAMHS assessments, because a very high proportion of them would have mental health needs?

[Lord Markham (Con)]

Generally, we need to try to assess as many people as we can. I remember in my school there was a child in our class who we just thought was naughty and got into all sorts of trouble, but now, having had my own personal experience later on, I know that he had an autistic spectrum disorder. Clearly, he needed help and he was not assessed, so, as a statement, I agree that we need to increase assessment as much as we can for all these cases.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the provision of services in schools, which is very welcome, but does he accept that thousands of young people are now being home educated? Will he ensure that there is parallel support for those children in terms of mental health provision?

[Lord Markham (Con)]

I agree. Arguably, if you are being home schooled, you probably need a lot of help. As the noble Lord will be aware, a lot of the services are related to social prescribing, where often people with mental disorders can be helped by involving them more in community activities. Clearly, those who are home schooled are much more likely to be isolated.

[Baroness Altmann (Con)]

My Lords, I congratulate my noble friend on his previous answer about triaging so that those in care can get urgent mental health support. Does he have any targets in mind as to the proportion of children in care with mental health needs who could be seen within, let us say, six months rather than the current waiting time of up to two years?

[Lord Markham (Con)]

I thank my noble friend. The NHS has recently set out a national framework for the practical pathways that it expects ICBs to follow in terms of getting diagnoses. To be very open with my noble friend, given demand, setting targets in this space is probably not the wisest thing to do, but we understand that we need to get on top of this.

[Lord Stirrup (CB)]

My Lords, clinical staff are at crisis point throughout the NHS. What contribution are staffing levels in this area making to current waiting lists, and what is being done to address it?

[Lord Markham (Con)]

I do not know what contribution it is making to waiting lists. However, I do know that the long-awaited workforce plan—which noble Lords opposite have quite rightly asked me about many times, and I am very glad to say we are now producing it—will include these types of people as well, because they are clearly a very important component of the workforce that we need.

[Baroness Merron (Lab)]

My Lords, care-experienced children and young people are disproportionately affected not only by mental ill-health but by barriers to getting support. Bearing in mind that this group of young people often experience multiple placement moves, which are often far away from home, can the Minister say what work is going on to ensure that services are designed around this specific requirement?

[Lord Markham (Con)]

I thank the noble Baroness. As noble Lords are aware, we think that in-patient care should happen only in the most extreme and serious cases. It is much better to have care in the community and local support around that. That is very much where we are coming from. The response to the independent review of children’s social care, which the DfE is leading, will be published in the new year, and I would be happy to update the noble Baroness when we have those findings.

Invasive Group A Streptococcus and Scarlet Fever

Lord Markham Excerpts

Monday 5th December 2022 Lords Chamber

[Baroness Brinton]

To ask His Majesty’s Government what assessment they have made of their guidance to doctors and to parents in light of the increase in Strep A, iGAS and Scarlet Fever cases.

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

The UK Health Security Agency has declared a national standard incident to co-ordinate the public health response. It is working with schools and GPs where there are outbreaks to provide information on scarlet fever and iGAS. A rapid surveillance report and communications to the health system have been published to ensure heightened awareness among front-line clinicians. We are also putting out key messages for parents to understand the trigger points for urgent referrals of children with more serious cases.

[Baroness Brinton (LD)]

My Lords, UKHSA has reported today that, in the last 10 weeks, it has received 4,622 notifications of scarlet fever, compared to an average of 1,200 for the same period over the previous five years—that is more than three times. Parents with very sick children report being turned away from hospitals or GPs not prescribing antibiotics. Local directors of public health are talking to schools and GPs, but can I ask the Minister what else can be done to ensure that all cases of potential strep A and scarlet fever are tested for, and treated as appropriate at the earliest moment, to avoid serious illness and death?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, the UK Health Security Agency is to work in collaboration with the public health agencies in Scotland, Wales and Northern Ireland. What level of collaboration has taken place on issues around strep A and scarlet fever, and what have been the results and outcomes? I am aware that there have been some cases in Northern Ireland.

[Lord Markham (Con)]

I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will be aware that, on social media, there have been a number of recommendations by health professionals that concerned parents should go to their GP to seek advice. Yet he will know that GPs are under considerable pressure. The GP patients survey showed that over a third of people did not see or speak to anyone when they could not get an appointment at their GP practice. What special arrangements are being made to ensure that parents can get through the system to get advice?

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Lord. At this point, I put out the general message that, if parents are aware that their child is unwell, particularly drowsy or dehydrated, that is when they should look to seek medical advice. They should start by using paracetamol and ibuprofen. Clearly, if there is no response, they should be particularly concerned and absolutely making sure that they are getting access to the surgery—to a nurse, as well as a doctor, in this case. This is clearly a priority area. We need to make sure that there is access for those people.

[Baroness McIntosh of Pickering (Con)]

Following on from the question by the noble Lord, Lord Hunt, if the child presents symptoms after 6 o’clock at night or over a weekend, they will clearly be dependent on out-of-hours service. What is the department recommending that they do? Should they go to A&E in these circumstances? It is obviously absolutely vital that, if the child has meningitis or scarlet fever that may develop complications, they should be attended to and given medical assistance as soon as possible.

[Lord Markham (Con)]

I can probably draw on a personal illustration. In answer to a question a couple of weeks ago, I mentioned how I used 111, and in this case I think the advice would be to use 111. In that instance, I was able to get access to a doctor. On that basis, if the symptoms are there, to take that example, a doctor can arrange for a prescription to be sent to an out-of-hours pharmacy. The most important thing in these circumstances is to get antibiotics quickly. The first thing I would say is to use 111. Obviously, A&E is always there, but a more effective route would be through 111.

[Baroness Merron (Lab)]

My Lords, the Minister and noble Lords will know that parents across the country are deeply worried by this situation. To pick up the point that the Minister has just made about the 111 service, perhaps he can respond to the concerns that have been raised by some medical experts that the NHS’s 111 service is not fit for purpose in effectively identifying and triaging critically ill children.

[Lord Markham (Con)]

All I can say on that is that, clearly, that is not acceptable and we need a situation where it can, and that is why we should have inspectors. If we are using 111 as a backbone service, as we are in this case, it is vital that people are getting proper advice. By the way, I see a lot of that, and it is something that I am personally involved in now, as well as using it digitally—a lot of these things can be done through the use of the apps and so on—but, clearly, we need to make sure the advice people get is sound.

[Lord Cormack (Con)]

If a parent has not had a response from 111 within an hour, should they not then ring 999?

[Lord Markham (Con)]

I would advise—and again this is personal advice—that, if they have not got a response and they are concerned about their child, it is probably better and quicker for them to drive, if they are able to. Clearly, if there is a 999 ambulance response because they cannot get to the hospital quickly, then that is a fallback, but if they are able to drive with their child and they are concerned in that way, my advice would always be to go for safety first in this. Again, as a parent of a four year-old and seeing the chatter on social media over the weekend, I know this is an area of concern. Clearly, we need to make sure that reassurance is there for everyone.

[Baroness Browning (Con)]

My Lords, I had scarlet fever twice as a child, two years running. I seem to recall a doctor called at my home, diagnosed and prescribed. Also, at that time—it was the late 1950s—my library books were taken away for fumigation, and I was kept in isolation. Why can we not have that sort of service today?

[Lord Markham (Con)]

That is a serious question, and I think many of us would love that kind of service, but we know we are living in an age where the community doctor in that way does not exist. It was way before my time, but I think changes were made to GPs’ contracts which means that, unfortunately, that is not part of the standard service that people have any more, which is why we rely on 111 and other services as back-up.

Health Promotion Bill [HL]

Lord Markham Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

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

Like the noble Lord, Lord Addington, I would like to declare an interest in that I still play rugby. If noble Lords take nothing else from this debate, I hope they will find that they have another willing, if perhaps not that able, rugby player to join the team. I hope that my contribution on the pitch will elicit a bit more than apathy, some sympathy and maybe a bit of empathy from my noble friend Lord Kamall. As a keen sportsman, I thank the noble Lord, Lord Addington, for providing the opportunity to debate this important issue. I hope I can do rather better than his impersonation of what I might say in this debate.

On the rationale for OHID’s creation, I must admit to not knowing the genesis or etymology of the change of name, but I will find out. As we know, it was established in 2021 as part of the Department of Health and Social Care, following the closure of Public Health England. Its core aim is to reduce preventable ill health and health disparities. It works towards this under the professional leadership of the CMO, which we felt was key, and the director-general of OHID within the department.

Many noble Lords, including my noble friend Lord Lansley, asked why it was felt that it would be more effective as part of the department. When reforming the public health system, this was carefully considered. This was before my time, but my understanding is that many stakeholders were engaged in this and the feeling was that having it as an in-house, in-the-tent department was the best way to go. The option of creating an arm’s-length body to sit alongside the UK Health Security Agency was considered, but it was felt that establishing those functions within government outweighed the strengths of an independent ALB. The fear was that the proposal outlined in the Health Promotion Bill would create an office for health promotion with limited advisory functions. This would simply replace or duplicate many activities which are already under way in OHID.

In forming OHID, we were clear about the distinct advantages of convening functions—something I have become very aware of in the short time I have been a Minister—and the ability to access expert advice, analysis and evidence, alongside policy development and implementation. The decision to make OHID a core part of DHSC was taken because influence and proximity to decision-making matters. In addition, advice is offered widely from across the system and there needs to be a mechanism for summarising it for Ministers.

OHID is empowered to work across national government, using evidence to influence policy and ensure greater consideration in cross-government decision-making of the links to and importance of preventing ill health and tackling disparities. We only have to think of policy considering the health impacts of housing, the potential of indoor and outdoor air quality to promote or negatively impact health, and the consequences of ill health, including for high levels of economic inactivity, for current and important examples. OHID is taking action on the major preventable conditions which drive ill health and early death, including cardiovascular disease and some cancers, and the risk factors that cause those conditions, including tobacco, obesity, alcohol and drugs. OHID does this work alongside local government, the NHS, academia and industry.

I would like to highlight some of the achievements that have resulted so far. To answer my noble friend Lord Kamall’s point on the health promotion task force, the real north star for the cross-government action we see now was publication of the levelling-up White Paper and the commitment in it to improve healthy life expectancy by five years by 2035 and narrow the gap by 2030. This provides a clear, ongoing framework and commitment—covering DfE, DCMS, DWP, BEIS, DLUHC and the Department for Transport to name just a few—to work across government and really address the major drivers of ill health.

Last December, we published a cross-government drug strategy, backed by new investment totalling almost £900 million over three years, with more than £500 million for local authorities. They are required to provide 54,500 new drug and alcohol treatment places over the next three years. Going back to last week’s debate on tobacco, my belief is that we are on target for our smoke-free objectives, but again, I will check on this and confirm. Another great example is our effort to tackle health inequalities early on. The investment of over £300 million in family hubs and Start for Life will deliver new and expanded family health networks in 75 local authorities.

We are improving joint local working on population health and reducing health inequalities through integrated care systems. This includes an expectation that local directors of public health will play a vital part in informing the strategy developed by the integrated care partnership and the forward plan of the integrated care boards.

In all of this, as was so wonderfully put, exercise is the “wonder drug”. We really recognise its importance. That came through very strongly in the contributions of many noble Lords. The drivers of physical inactivity are deep-rooted and influenced by the places we live, work and play in. Change will not happen overnight.

During preparation of the national plan for sport and recreation report, which lays the foundations for the Health Promotion Bill, noble Lords provided the Government with plenty to consider. The evidence is clear that physical activity is good for health. Being active offers wide social benefits, brings people together, maintains friendships and through active travel, as was mentioned, can help connect people and places. We remain committed to the former Prime Minister’s commitment on active travel.

As we are all aware, activity levels have declined due to the pandemic—I am probably more aware than most of how hard it is to get 15 out on a rugby field on a Saturday. This is not good for children’s healthy development and is putting adults at greater risk of disease. Furthermore, there is a disparity in physical activity levels, as was identified by many speakers. This affects groups including women, older people, people living with long-term conditions, people from lower-income areas and people from black and Asian ethnic-minority groups. The Government recognise the challenge and the renewed efforts needed to ensure people have the access, opportunities and motivation to be active in their everyday lives. Our commitment to the sport and physical activity agenda will continue.

In quarter 1 of 2023—not quite 2022, I accept—the Government will publish a new sport strategy and a new school sport and activity action plan. We believe there is an opportunity for this refreshed strategy to focus on two areas: strengthening action to address inactivity levels, and making the sector more sustainable for the future. We will continue to proactively engage across government and with the wider sector to effectively inform and shape the strategy. This will allow us to ensure that action is focused on the key issues and the right direction for the future.

As mentioned by the noble Baroness, Lady Bennett, everyone should have access to local, safe and inclusive opportunities to play sport, get active and stay fit to benefit their health.

At the heart of the government policy on physical activity are the UK Chief Medical Officer guidelines, which set out how much and which forms of physical activity are essential across a healthy life course. Through our work on the Everybody Active, Every Day physical activity framework there is consensus that long-term, system-wide action is required; physical activity is everyone’s business.

The Government provide primary schools with £320 million per year for PE premium and school active sport, to support schools to provide high-quality PE and at least 30 minutes of physical activity within the school day. This is at the heart of the school sport activity programme, which enables schools to use a whole-school approach to embedding PE and school sports. I will write to my noble friend Lord Moynihan on the specific points he made on access to those activities.

Our action includes continuing to provide ways for people to access local parks and green spaces through the Department for Transport’s walking and cycling initiatives, and the setting up of Active Travel England to support local councils to help people walk and cycle to work, the shops and to school.

Our world-leading digital and social media campaign Better Health provides digital resources and signposts to opportunities to support people to start to become and stay active. As I have part of the digital agenda, I will look to the use of wearables as another way in which we can increase participation and information. Digital health behaviour change approaches such as Couch to 5K have now had 5 million downloads, and Active 10 provides opportunities for people to build up activity levels.

We recognise that progress has not always been as fast as we would like. Our plans should help to change that. Sport and physical activity are golden threads that run through and align actions of government departments, local government, the NHS, sporting bodies and communities. Understanding the data and evidence on what works and what does not is vital to delivering our ambition to shift the status quo and address inactivity. By doing so, we can create access to more opportunities for everybody, especially people living in underserviced communities, to enjoy leading more active and healthier lives.

I am aware that many questions have been raised in this debate. As a new boy I understand that my response to a Private Member’s Bill is slightly different, but nevertheless I commit as in other debates to follow up in detail and writing on all the points, because I want to make sure that the points raised today have an appropriate response.

It is a privilege to be speaking after such accomplished speakers: some of the sports athletes here today, former Ministers and Secretaries of State for Health, chairs of sporting organisations such as ukactive and others, and top health professionals. They make my Saturday afternoon rugby efforts look rather weak in comparison.

We are all united in wanting to find the best way to promote healthy living through sport, education and active lifestyle. I know we want the same thing, which was probably put best by the noble Lord, Lord Crisp, as health creation, prevention and services. Some strong and passionate views were expressed on that and some excellent points were made.

I think noble Lords are also aware that I have a very broad background, with many leadership roles in businesses, charities and arm’s-length bodies, and I have been involved in four government departments and now government itself. Honestly, I have seen many different organisational models, both centralised and decentralised, setting up ALBs and having departments inside government. I can say from personal experience that in every one of those, in each instance it took a while for a new organisation to bed down and become effective. It took probably at least a year before you could really see its effects, and I believe that is the same in this instance. Therefore, while I understand and support the reasons expressed today, it is important that we need to give OHID time to take root, to see the publication of the sports strategy by DCMS with our involvement in quarter 1, and judge it on the results. However, I undertake, having listened to this debate today, to come back to the House and speak again on this subject when I believe it has had a proper amount of time to see whether it is working or whether we need to think about some other ways of setting it up.

For these reasons, I maintain my belief that the best way to achieve the objectives set out—which, as I said, were described so well as health creation, prevention and health services—is by OHID as a key and central part of government.

NHS Dental Contract

Lord Markham Excerpts

Thursday 1st December 2022 Lords Chamber

[Lord Young of Cookham]

To ask His Majesty’s Government what plans they have to review the NHS dental contract.

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

In July, the department announced a package of improvements to the NHS dental system, which included reform of the 2006 contract to ensure that dentists are remunerated more fairly and patient access is improved, especially for those with higher oral health needs. Implementation of these changes is under way, and we recently laid legislation in Parliament to deliver them. We continue to work with NHS England and the dental sector on further reform, which we plan to announce in 2023.

[Lord Young of Cookham (Con)]

I am grateful to my noble friend for that reply and for the recent modifications to the contract. But does he agree that much more radical reform is needed to that contract, which was described as “not fit for purpose” by a Select Committee in another place, if we are to address the exodus of NHS dentists, encourage more to join, address the 91% of dental practices that no longer admit new adult patients and help areas of the country with no NHS dentists at all? When will we have the longer-term radical reform referred to the last time I asked this Question, in May?

[Lord Markham (Con)]

I thank my noble friend, and I declare an interest: my wife is a dentist, although she is not practising at the moment. This is one of those rare occasions when it is a case not of announcing new spend but of making sure that the £3 billion we spend is fully utilised. To answer the question directly, it is absolutely right that we need a radical package to make sure that dentists are contracting against their UDAs and finding working in this space worth while and profitable, so that we get the full use of that. I will happily come forward with further proposals, planned for 2023, on what we are going to do in this space.

[Baroness Boycott (CB)]

My Lords, one reason why young children now go into hospital and have anaesthetics is to have all their teeth out, largely as a result of sugary diets. As we see through our Feeding Britain network, a lot of children do not have toothbrushes and definitely do not have toothpaste. Scotland has been trialling some really efficient systems whereby dentists go into school, give out free toothbrushes—which a lot of toothbrush manufacturers will happily supply—and get children into the habit of cleaning their teeth. Given the massive absence of dentistry, which will take a long time to fix, can the Government look at a simple measure such as that, which would greatly improve the nation’s teeth, especially our kids’? It is a nightmare to have all your grown-up teeth taken out at eight years old; you are stuck with lousy teeth for ever, and it is not fair.

[Lord Markham (Con)]

I agree, and I understand the problem. I also agree that we need to look at a broad range of measures. I was delighted that we passed the statutory instruments on water fluoridation recently, and we should look at new ideas. I was also delighted to see oral health advice included in the new family hubs being set up. We are willing to look at measures that work elsewhere as well, such as free toothbrushes in Scotland.

[Baroness Brinton (LD)]

My Lords, the British Dental Association has proposed four simple emergency measures—changes which could be made to the dental contract that would make an enormous difference. The Minister referred to the regulations. Regulations in respect of the workforce will make significant changes too. They were in Forthcoming Business and then removed. When will they be heard in this House? This reform is urgently needed.

[Lord Markham (Con)]

As mentioned, the new package of measures, which is all about encouraging dentists into the NHS space, will be brought forward next year. The workforce plan is now under way. However, central to all this is not the budget but making sure that it is fully utilised. As the noble Baroness said, that will happen by having more NHS dentists. We currently have 3,500 in training, which is working towards that, but, clearly, we need to work further.

[Lord Sherbourne of Didsbury (Con)]

My Lords, does my noble friend the Minister agree that the state of NHS dental care in this country over many years is a national scandal? Following on from the question from the noble Baroness, Lady Boycott, on the importance of making sure that children not only pursue proper dental health but eat the right food and do not have the wrong drinks, is he aware of the charity TasteEd, which is doing a huge job in schools to encourage children to eat the right kind of foods for health of all kinds?

[Lord Markham (Con)]

I thank my noble friend. We need a 360-degree approach. It is not just about dentists on the ground, although we agree that we need more in the NHS; it is also about healthy eating, water fluoridation, and oral health workers in the family hubs, for which a £300 million budget has just been announced. I agree that we need to take all those actions.

[Baroness Merron (Lab)]

My Lords, following much pressure, including in your Lordships’ House, the Government have promised for next year independently verified workforce forecasts for the number of doctors, nurses and other professionals. Can the Minister confirm that the space to which he has repeatedly referred in this Question will include dentists? If so, can he commit to an assessment within this of the impact of the NHS dental contract on recruitment and retention?

[Lord Markham (Con)]

My understanding is that the staff plan will include dentists, but I will confirm that in writing. I absolutely accept that the contract changes must attract people into the profession. For the dental deserts, we need to encourage, for example, a dentist who has been in practice for eight years to set up a new practice. They are used to being a dentist, but they are not used to raising the money to set up a new clinic in a new area, which is what they need to do. Clearly, that is the sort of support we need if are to tackle the dental desert issue. I am under no illusions as to what needs to be done, and we are working on it.

[Lord Scriven (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association. Does the Minister agree, despite the new package that has just come forward, with the Conservative chairman of the Local Government Association Community Wellbeing Board, who has said that the Government should urgently commit to a comprehensive dental workforce strategy and increase councils’ funding of the public health grant in real terms to help deal with the dental desert in many parts of the country?

[Lord Markham (Con)]

I thank the noble Lord. As I mentioned, dental deserts are very much a part of the package we are looking at. To give noble Lords an idea of the sense of direction, another approach to the workforce issue is a modular escalator system, and we are talking to the BDA about training. For instance, on the way to becoming a fully qualified dentist, might a dentist become part-qualified, allowing them to do some dental nurse treatments, thereby adding to that capacity in the meantime? These are all measures we are looking at to increase the workforce.

[Lord McColl of Dulwich (Con)]

Can the Minister tell us what proportion of the population is actually receiving fluoride in their drinking water?

--- Later in debate ---

[Lord Markham (Con)]

I will need to write to give the exact number. From memory, it is not a big number at the moment—less than 10%—but I will confirm that. That is why I was pleased that we agreed the measures the other day, so that we can expand that. Evidence shows that in areas where water is fluoridated—again, I am speaking from memory and I will confirm it in writing—tooth decay declines by as much as 20%, so it does work.

[Baroness Jolly (LD)]

What advice does the Minister give to people in Cornwall for whom the nearest NHS dentist is 50 miles away but there is no public transport from the local town to the practice?

[Lord Markham (Con)]

I am aware of some of the dental deserts. Some 700 urgent care centres have been set up to try to cater for such cases, and they have seen 4 million people. In total, there were about 26 million treatments last year. About 75% of patients who wanted to get an appointment were able to. Clearly, that leaves 25% who were not. We need to work further on that, including in Cornwall.

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

My Lords, the Minister’s replies have been exceptionally helpful. I wonder whether he and the Government could consider what might be done to get non-practising dentists back into practice.

[Lord Markham (Con)]

It is a good question. I will take the noble Lord’s compliment of being exceptionally helpful; I hope I can give another helpful answer. We need to look at everything we can do to attract dentists. The contract is fundamental to that, because, unless it is attractive for them financially, it will not help.

[Lord Bird (CB)]

Is it possible also to look at some of the innovations that are done socially, especially for homelessness? We have brought back travelling dentists, and maybe they can go to Cornwall and other places. We have invested in a business in Plymouth that goes around hostels, and it has been remarkably successful.

[Lord Markham (Con)]

As mentioned before, we are open to all ideas to try to tackle this problem. As we all know, it has been going on for a long time—probably decades. A 360-degree solution is needed; we are open to looking at everything.

Care Homes: Severely Disabled People

Lord Markham Excerpts

Wednesday 30th November 2022 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of reports that some care charities have been forced to evict severely disabled people from their care homes because of disputes with local authorities about fees.

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

The disruption of care where it negatively impacts vulnerable service users is unacceptable. Under the Care Act, local authorities have a duty to shape their markets and provide services to those with eligible needs. The Government are providing up to £7.5 billion over the next two years to support adult social care and discharge. This historic funding boost will help local authorities to start addressing waiting lists, low fee rates and work- force pressures in the sector.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but I cannot say that any of it was a surprise to me. Will he acknowledge that this is just the latest manifestation of a long-standing problem? For years, the social care system for adults with complex disabilities has been held together by charities and not-for-profits that have poured literally millions from their reserves into subsidising the services they provide for the NHS and local authorities. Now these organisations are in financial trouble and can no longer afford to do so. Those who are suffering are those in greatest need. Does the Minister agree that the whole system of funding for social care is broken and that the only solution is complete root-and-branch reform, not the piecemeal solutions offered by the Government?

[Lord Markham (Con)]

I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.

[Lord Laming (CB)]

My Lords, does the Minister agree that there was a time when, if the local authority asked to see the parents, they assumed that this was for a review of what progress had been made by their offspring in residential care? More recently, parents are saying that they fear any approach by a local authority, because it may say that it will have to move their child to a different arrangement because it cannot afford to pay the fees now being set.

[Lord Markham (Con)]

As I say, we are working on this. The CQC has a vital role to play and we had a discussion recently with the Association of Directors of Adult Social Services, which welcomed the relief the Autumn Statement brings in this area. I can only reiterate that we have listened and acted.

[Lord Wigley (PC)]

My Lords, I draw attention to my registered interests. Do not these cases underline the need to ensure that the additional costs of severe disability, whether incurred in charitable establishments, commercially run accommodation or at home with families, should be met consistently from central sources rather than falling on local authorities, which may have neither the expertise in the degree of disability nor the resources to meet them?

[Lord Markham (Con)]

As ever in these areas, there is a debate to be had on centralism versus localism. I happen to believe that local authorities and healthcare systems are best placed to understand the needs of the people in their area, and I will continue to support that. Clearly, where help is needed, we are there. I reiterate that we have funds to support them from the centre, including a £2.3 billion increase for mental health, to give one example. Generally, I would keep to the principle that it is best that local people and authorities identify and meet local needs.

[Baroness Brinton (LD)]

My Lords, the Minister just referred to mental health funding and referred earlier to the increased funding to cover delayed discharges and get more people coming out of hospital into social care. Neither of those affects severely disabled adults; funding for them from central government to local government has not been increased. I repeat the question of the noble Baroness, Lady Pitkeathley: does the Minister think that the provision and arrangements for this particular group of people are broken?

[Lord Markham (Con)]

No—it is for local authorities to decide how best to use the funding we have put in place, as I said. That means looking at the needs of local people and how best they will put this in place. The 22% increase in funding can be channelled to exactly these types of places and people if a local authority believes that that is in the best interest.

[Baroness Browning (Con)]

Does my noble friend accept that many disabled people in residential and nursing care are of an age such that there are no parents or close relatives left and there is no one with a lasting power of attorney? How can that vulnerability be coped with by the state in a way we would all approve of?

[Lord Markham (Con)]

My noble friend identifies an ageing demographic, the challenges that brings to all of us and the pressure on adult social care and the centres. As I have said, this is a challenge, but there are high levels of satisfaction in the sector: 89% of people are satisfied and 64% are very satisfied. So, although we have not got this right in every case, we are broadly on the right track and getting good results.

[Baroness Wheatcroft (CB)]

My Lords, eight out of 10 of the largest providers of care for the disabled and children are at least in part private equity owned and, in many cases, wholly so. Their interest rates are already their major concern, and these are going up. Is the Minister concerned that these private equity-owned homes will be forced either to cut what they do and serve their customers less well, or close? If he is concerned, what is he doing about it?

[Lord Markham (Con)]

The financial health of this sector is an area of interest; we all of course recall some of the problems and failures about 10 years ago. I had a meeting on this subject just this week, identifying the health of the providers to see if that is of concern. The margins made in this space are fairly typical of other industries, so they are not indicative of an area under particular stress. But I have my mind on this issue and will keep an eye on it.

[Baroness Wheeler (Lab)]

My Lords, ADASS reports that in the past four months,

“64% of councils … reported that providers in their area had closed, ceased trading or handed back council contracts”

either through an inability to recruit staff or escalating care home running costs. We all know that the extra funding to councils, which the Minister repeats in almost every response, just about props up existing services and does not provide the sustainable and long-term funding that was promised to commence with the again delayed social care cap. When will the Government fulfil their pledge to fix social care?

[Lord Markham (Con)]

My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend yet had an opportunity to read the Economic Affairs Committee report on social care, a “national scandal”, which points out that in care homes in both the private and the charity sectors, people who pay their own costs subsidise others to the tune of 40%? The local authority rates are simply unsustainable, and this issue is therefore urgent and needs to be addressed. Simply talking about inputs all of the time is no good; we need to see what is happening to the outputs, which is a tragedy.

[Lord Markham (Con)]

Funnily enough, the meeting on the sector’s financial health that I mentioned was precisely in response to the Question last week, so that I can make sure that proper work is being done in this space. I will not pretend to have the answers to that yet because, as my noble friend mentioned, a long-term review needs to be done. But rest assured that I am working on this.

Covid-19: PPE Procurement

Lord Markham Excerpts

Wednesday 30th November 2022 Lords Chamber

[Baroness Smith of Basildon (Lab)]

My Lords, I have raised the issue of fraud in PPE contracts previously. Apparently, PPE Medpro was awarded contracts via the VIP lane amounting to £200 million, despite it not even existing when Ministers were first contacted. Then, just over a year ago, the noble Lord, Lord Bethell, then the Health Minister, admitted that the department was engaged in ongoing

“discussions (potentially leading to litigation) in respect to 40 PPE contracts with a combined value of £1.2 billion covering 1.7 billion items of PPE.”

The following January, the noble Lord, Lord Agnew, resigned, criticising the Government’s track record in countering fraud across government. In relation to the PPE contracts of £1.2 billion, will the Minister update the House on how much of that money has now been returned to the taxpayer? Can he say what amount is outstanding, either where negotiations continue or where legal action is now being taken or is pending? If he does not have that information immediately to hand, will he commit to write to me and place his letter in the Library?

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

I thank the noble Baroness, and I commit to write with the precise figures. To put it into context, we should remember that this was at a time when unprecedented action was required. Of the 38 billion PPE items ordered, 98% were delivered and just 3% were unfit for purpose. Within that, clearly there is action that needs to be worked on and action is being taken to pursue those damages. I will put those in writing, so that the noble Baroness can understand them all. As I say, it is good if noble Lords recall that the priority at the time was clearly getting equipment to help protect and save lives, and that was what was done. Were mistakes made? Of course. Are we seeking to address those now by going back to take action against those people? Yes, of course we are, but we need to keep it in the context that the undoubted priority was to buy PPE and protect lives.

[Baroness Brinton (LD)]

My Lords, from these Benches we echo the questions that the noble Baroness the Leader of the Opposition has asked. We note that at least 71 PPE deals were awarded to firms, of which at least 46 were put into the VIP lanes by Conservative Ministers and officials during the Covid pandemic, as well as by some MPs and Peers, before a formal eight- stage due diligence and checking process was put in place. There were also deals made not for PPE during that period, including for testing and some non-health ones.

I think we all agree that the wastage and profiteering should never happen again, but we warned from these Benches, as did other Members across the House, in the early stages of the pandemic that all the right contracting arrangements, protocols and scrutiny needed to continue. The Minister has said that the pandemic posed problems, so will he push for a separate, independent-led inquiry able to examine the whole procurement process, including the VIP lanes, and analyse forensically the bids, profits, wastage and catalogue of links to Ministers, MPs, Peers and others who had influence on them?

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that there have already been three NAO reports and three PAC reports on this, so it has been covered in depth. I think people have accepted that mistakes were made and that the high-priority lane, so to speak, should not have been on the basis of referrals but more burden of proof should have been put on the applicants, so we could get more information and sift it that way. Again, to put it all into context, there were 19,000 applicants at the time. This was led by officials, and they put the high-priority lane in place to try to sift those. Also, of the 430 that went into the high-priority lane, only 13% actually ended up in contracts. Are there lessons to learn from this? Of course, but the NAO and PAC reports have outlined those lessons.

[Lord Browne of Ladyton (Lab)]

My Lords, experience tells us that the best deterrence against fraud and corruption are the twins of transparency and accountability; in the absence of such transparency and accountability, the reporting of the saga of PPE Medpro risks tainting others by association. So, for transparency if nothing else, will the Minister agree that relevant correspondence between PPE Medpro or its representatives, and Ministers or their officials, should be published and placed in the House of Lords Library, perhaps soon after the current investigations are concluded? Also for transparency, surely the public are entitled to understand what due diligence was conducted on this company and other similar ventures that emerged, apparently from nowhere, during the initial stages of the pandemic?

[Lord Markham (Con)]

I thank the noble Lord. As I am sure we are all aware, this is subject to a criminal investigation at the moment, so in terms of paperwork we need to let that take its due course. What I can talk about is what we are doing as a department on that, particularly in terms of the contracts for gowns which were defective, and it is in that area that we are in dispute with them. We have made a claim and put in place a process so that we will take it to court, and we will pursue that if we do not come to a negotiated settlement which is satisfactory.

[Lord Alton of Liverpool (CB)]

Can I take the Minister to the present rather than the past, and to two Written Answers which he gave to me yesterday on the 120 million items of PPE which are currently still stored in the People’s Republic of China and costing taxpayers £770,000 every single day—three-quarters of a million pounds, daily? I asked the Minister how much this has cost to date, but in telling me that the cost has been £16.3 million, he simply took the period of April to September. I would be grateful if he could produce a more complete set of figures and say how much longer we are going to go on paying £770,000 every day to companies linked to the People’s Republic of China, to the Chinese Communist Party, and to goods that have been made by slave labour in the Xinjiang region.

[Lord Markham (Con)]

I will happily provide those updated figures in writing; I thank the noble Lord for his question because it sparked a number of inquiries on my front. As he will be aware, I am only two months into this job. But one of those very questions—a hard question for us to think about—is the cost of storage versus, dare I say, scrapping it, because we have tried to donate all we can from it, and, God forbid, having to buy it again if there is another pandemic. In many cases it is cheaper right now to scrap it and buy it again at current prices. Of course, you cannot be certain whether prices could then get inflated again, but I hope your Lordships can tell from this answer that I am very much looking into the cost-benefit of the best approach.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend pay tribute to Industrial Textiles & Plastics of Easingwold which, together with Barbour and Burberry, submitted an application to the Cabinet Office for a number of gowns, and are still waiting for a reply? They donated these gowns free at the point of use to local hospitals. I believe that they should have had a contract from the Government and am at a loss to understand why they did not. Is there any reason that the Cabinet Office failed to reply to them?

[Lord Markham (Con)]

I do not know why they did not reply. What I do know is that there were many companies like the ones mentioned who wanted to do their bit. They stepped up to the mark and provided all sorts of goods and services, sometimes at no cost and for no profit, because they all wanted to be part of the wartime effort. I will find out why they did not get a response.

[Lord Allan of Hallam (LD)]

My Lords, there is considerable public interest in understanding whether businesses were stepping forward at a time of crisis, sourcing PPE helpfully and passing it on to the NHS, with a minimum mark-up to cover their costs, or rather seeking to maximise profit. Will the Minister agree to publish sufficient information about the distribution of profit margins made across the community of suppliers for us to make that determination?

[Lord Markham (Con)]

I do not believe we could possibly have that information; obviously, we would need to know the cost base of these companies to supply it. I am afraid that I do not believe we can do that. Further to my last reply, some companies supplied things at a very reasonable margin and did a great job, but unfortunately, as we have seen in some of the examples, others were not so publicly spirited—let me put it that way.