Learning Disabilities and Autism: Solitary Confinement in Hospital

Lord Markham Excerpts

Thursday 23rd November 2023 Lords Chamber

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

I add my thanks to the noble Baroness, Lady Hollins, and other noble Lords for their moving, personal and passionate—especially in the case of the noble Lord, Lord Touhig—contributions, from which I have learned a lot. When the timetable came out and I saw two mental health debates together, I must admit to thinking, “That’s going to be a long day. How wise is it to timetable them together?” Actually, having the debates back to back has worked really well, and there has been a real synergy of subjects. It worked and it has added to my education.

I understand the point raised by the noble Baronesses, Lady Wheeler and Lady Watkins, and others, around the delay to reforming the Mental Health Act and their disappointment. I would like to respond to some of those points with things that I hope we can do. This will very much be a feature of the follow-up round table. To answer the question from the noble Baroness, Lady Wheeler, on how we design that, to be honest, it is up to us, and I will happily chat to her afterwards about how we want to use those forums. I definitely have a commitment from Minister Caulfield to part of that, so we can go into the detail afterwards.

I echo the point that the noble Lord, Lord Addington, made on prevention. This struck a chord with me, as I learned early in my personal experience that a normal response often gets a negative reaction. If something happens, people generally respond in a certain way, but with autism we learn that we sometimes have to completely rewire the way that we respond. We know that what we think of as a normal response can have adverse consequences.

I will resist the temptation to trot out the statistics, as the noble Lord, Lord Addington, said, but I will say that there is a recognition from the increase in the numbers of people trained in schools that it is vitally necessary. There has been a lot of growth in it, but I accept that there needs to be more and that it needs to be across the board, as the noble Lord said. A million people have taken the Oliver McGowan training, but there are next steps in that. It needs to be across health and other settings, such as education, as I mentioned, and the police.

We spoke about early support hubs in another debate, and there is a vital role for communities there. I was asked a Question last week about black and ethnic minority people being far more likely to find themselves in segregation or these sorts of circumstances. As it was explained to me, a lot of that is because they do not feel that the early support hubs are suitable for them. For whatever reason, they are not going to them. We need to do a lot of work, and in the community as well, to break down that resistance and some of the reasons that they do not go there, because those early support hubs are a key part of any prevention.

I will directly address the points about how, where there is that circumstance of solitary treatment, we can try to minimise it and really respond. The first thing that came to me, from the noble Baroness, Lady Hollins, and others, is that we really need to increase the barriers to entry, for want of a better phrase, and make them as high as possible, so that it really is a last resort. I personally like the idea of the Secretary of State’s approval. There are some logistical issues there, such as if it is out of hours or whatever. The suggestion was made of the Secretary of State’s approval being needed if it is beyond 48 hours, at which point I can see practically and logistically that you could make that work a bit better. Having the Secretary of State’s approval before someone goes in could be hard logistically, but having it beyond 48 hours allows for that planning.

I was toing and froing with the team during the debate, and I think we can have a productive conversation around it, particularly on the point that the noble Lord, Lord Allan, made. I have had some personal experience of this: in the department, I sign off all consultancy agreements on the use of consultants, contractors and everything else. I normally sign nearly all of them off, but the main point is that a lot of them probably never come to my door, because the DGs and managers who are putting them up know that they must be absolutely watertight in their cases to do it. I believe that this would be a similar mechanism of prevention, so I will definitely take it away.

On the reviews and the CQC, we want to have it all up and running next year, obviously as early in the year as possible. I will come back to be more specific on that timing. The funding, as mentioned, is for two years, but I like the suggestion that we all know that, as long as solitary confinement is happening, we will need something like this. First, we need to increase the barriers to entry but, secondly, where solitary confinement is needed, we need to increase the review process. That is the role of the CQC and the ICETRs, but it is also about the use of the data, as suggested. I do not know how much the FDP can be used in this, but I saw an example this morning of it being used quite well in the discharge space, where it is linking in with social care and the local authorities. There are some good grounds there, and I will definitely pose the question.

There is acceptance that people sometimes need to be treated in solitary confinement. If they do, it is all about reviewing and accountability, as the noble Baroness, Lady Hollins, said. On that, as my noble friend Lady Browning and the noble Baroness, Lady Wheeler, said, it is about making sure that the CQC is notified within 48 hours, so that it is on the case and reviewing it. That is another vital cog in accountability.

I was told that they plan to enter into a consultation on that as quickly as possible. I was told that they thought the timing for that was January 2025. Quite honestly, I have gone back and said two things: do we really need to consult and, if we do, does it really need to be as long as January 2025? Again, I will come back on both of those things and maybe these are some of the things we can talk some more about in the round table.

Thirdly, if we are in the circumstance whereby solitary confinement is deemed to be the right treatment method, obviously we come on to quality, and the point was made there about making sure that the quality is right, in that circumstance. Obviously, the CQC has a role in that and the Health Services Safety Investigations Body, or HSSIB, clearly has a vital role to play in all of that. We do understand that there was a feeling that the Government were not acting quickly enough in our response to the paper written by the noble Baroness, Lady Hollins, so, again, we will come back further on that.

I hope that reassures noble Lords to some extent that there are things that we can do, and plan to do, in the meantime—absent the mental health Bill—and, again, I want to use the round table to talk about that, explore it and make sure it is as actionable as possible. As I said, as ever, I will write to make sure that I have picked up all the points made in detail. I would like to end by again thanking the noble Baroness, Lady Hollins, and all other noble Lords for their contributions to what I found was another very good debate.

Mental Health: Children and Young People

Lord Markham Excerpts

Thursday 23rd November 2023 Lords Chamber

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

I thank all noble Lords for their contributions to this debate. Before replying, I add my congratulations to the noble and learned Baroness, Lady Hale, on her maiden speech. I am sorry that no one was able to add to the Yorkshire hat trick and, speaking as a Brighton boy, I cannot get much further away than that. I found the reasons for the delay fascinating; it was an education for me, as I did not quite realise her involvement in so many things. For me, it was well worth the wait, and it is a personal honour to be able to reply after such a distinguished and accomplished speaker. I invite her, along with all other speakers, to join—as the noble Baroness, Lady Wheeler, mentioned—the round table that I have organised with the Minister, Maria Caulfield, where we can follow up some of the themes brought out today in more detail. I would be delighted if the noble and learned Baroness were able to add her experience to that round table.

I also thank the noble Earl, Lord Russell, for enabling us to have this debate. He has heartfelt and personal reasons for the debate; as many noble Lords will know, I have my own personal experience and reasons. As the noble Lord, Lord Allan, said, it is normal. I had the misfortune of going to a funeral last week of one of my school friends, whose brother had mental health issues. As we were talking on the way down in the car, we were updating each other on all our families, and we realised that every single one of our families had one of their children or someone in the household with mental health issues.

Is the reason for that Covid, as the noble Lord, Lord Laming, mentioned? Is it some of the online reasons, as mentioned by the noble Baroness, Lady Hollins, and the noble Lord, Lord Allan? Is it gambling? I have to say to the right reverend Prelate the Bishop of St Albans that the gambling aspect of it all was something that I had not probably thought through enough, but I found that fascinating as well. Is it the cost of living, as mentioned by the noble Baroness, Lady Tyler? Is it the increase in the number of ghost children—I apologise for using that phrase, but it is the easiest way to sum it up—as mentioned by the noble Lords, Lord Storey and Lord Laming? Is it eating disorders?

I always like these debates to result in substantive action rather than being a talking shop, so that really led me to take away an action point. I was proud to be titled the Minister of Follow-through by the noble Lord, Lord Allan, yesterday, so I will follow that up. I would like to see whether we have done any research, through the NIHR, to really understand what factors and causes are behind what is a massive increase in the number of young people requiring mental health support, as the noble Earl, Lord Russell, says and we all acknowledge. I have seen various figures; the one I was cited was that it had gone from one in nine to one in six. Whichever way you look at it, it is a massive increase. We really need to understand those reasons, because it is often only when you understand the causes that you can look at how to address them. I will do some personal work, but if the research is not there I propose—and I will speak to people about this—that this is something that the NIHR should do, because it is vital that we understand those reasons. As all noble Lords have said, prevention is of course key to this.

Obviously, I hope that many of the reasons are transitory—maybe many were caused by Covid so we are seeing a big jump up now but will see a reduction afterwards. But the reason for needing to understand it is that it goes to the long-term funding we might need. If they are not just transitory reasons, and this is now the new normal, so to speak, then we need to do exactly as the noble Lord, Lord Allan, said, and think about a whole provision of child services in the mental health space, in the same way we do in the physical health space. I think we all agree that we need to do that to a degree regardless, but it is the level of that. That goes again to the points made by the noble Baronesses, Lady Wheeler and Lady Tyler, about the long-term workforce plan and understanding how many mental health staff we need to make sure we are training and equipping. Specifically, while I mention that, I will write to noble Lords on the mental health dashboard and when that is being updated.

I think we are absolutely united on the need for early detection in all this. The noble Baroness, Lady Hollins, gave the example of Emma, in the autism space, but we have all said it in various guises. We have made good progress on mental health provision and identification in schools, which has gone up from about a quarter to over a third of schools, with a target of over 50% in the next year to 18 months. However, I think we all agree that we need to go further and that it needs to be 100% of schools.

Also on early detection, I have been interested in some of the pilots in Bradford, which are starting to look at children’s school results and how they respond to the SATs and other things to see whether that could be an early indicator of some of the issues. I recently saw a fantastic example in the Boston children’s hospital, where they look at how children play online, digitally, on their iPads. With dyslexia, for example, the problem is often that it is only when children are five or six and have been taught to read that such things show up, but there they have started to see how children of two or three interact through pattern recognition, with blocks and other games devised for that. They look at their playing patterns to see whether those can be good early indicators.

I have personal experience of this. I am fortunate that my wife was an early years special needs schoolteacher, and she was able to identify very early on and make sure that our son had that early support. I firmly believe that that stood him in good stead in later life. So early detection starts with the parents. If I had not been so fortunate, 25 years ago, to have a wife who understood these sorts of things, I would not have known. As the noble Baroness, Lady Hollins, said, it starts with parenting programmes and making sure that the early support hubs are a good way into that. I echo and support our commitment to early detection.

You also need early support, as all speakers have said. The ICSs are the right place to do that because they look system-wide. As we know, schools are also a vital part of this, and the £2.3 billion of funding that we put into this space is designed specifically for 350,000 extra places for young people in the community—and I think we all agree that the community is the right place. Obviously, in the next debate, tabled by the noble Baroness, Lady Hollins, we will talk about some of the issues around in-patient treatment, but I think we all absolutely agree about the need for community treatment. My understanding is that these early support hubs are very much like mental health drop-in centres, as the noble Lord, Lord Allan, mentioned, and that is what they are designed to do. As the noble Baroness, Lady Tyler, said, the innovation programme looks promising, but we need to make sure that this is rolled out. ICB early support hubs are very much part of the first line of defence, for want of a better phrase. To me, the 350,000 extra spaces and the funding we are trying to put in are a very important part of that.

As the right reverend Prelate the Bishop of St Albans said, we have set up gambling clinics to try to address this from some of those angles. However—and this goes back to the research—we need to look at some of the wider angles. My noble friend Lord Evans was just saying that AFC Wimbledon has tried to get football clubs to remove the sponsorship of gambling companies, which a load of Premier League clubs have. Straightaway, that normalises gambling from a very young age. Those are some of the wider society solutions that we need to look at in all of this.

We have 70 eating disorder teams, and we need to look at whether we need to expand that, given what we know about the issues involved in a lot of eating disorders. This all comes back to the long-term workforce plan, which many Members mentioned, and making sure that we have the support there.

A couple of noble Lords mentioned the Major Conditions Strategy. My understanding is that it is not supposed to be seen as an either/or. It is about trying to understand that, because a lot of people have more than one major condition, instead of us approaching things as silos we have to look at a whole-person solution, and so we would look at their mental health as much as their physical health. I accept the perception that any major conditions strategy generally focuses more on the elderly, so I will take back that we need to make sure that it is not delivered in that way and does not prevent the sorts of things we need to do for young people.

The noble Baroness, Lady Tyler, asked about CAMHS. A lot of the funding I was speaking about and the 350,000 extra spaces are all about trying to make sure that we meet that four-week target. It is recognised that the sooner you can get people mental health support, the better; that is obviously even more important for a young person in that context. I will look into the points raised about support into adulthood, to make sure that that handover happens properly.

I hope I have given a flavour of what we are trying to do. As the noble Earl, Lord Russell, said right at the beginning, it starts with recognising that there has been a fundamental change. That needs to be reflected in our response. As I was saying earlier, I am attempting to try and understand what is behind that so we can get to some of the root causes.

I encourage all speakers to join the round table with the Minister, so I will invite people to that. I know I am never able to respond to all the points in my speech, so I will write to all the speakers, covering all the points raised in the questions. I thank the noble and learned Baroness, Lady Hale, for making her maiden speech, the noble Earl, Lord Russell, in particular for his words, and all noble Lords for their contributions. I have learned a lot from the debate and thoroughly enjoyed it.

My understanding is that we are going straight into the next debate, so I hope noble Lords will excuse me for taking a quick bathroom break beforehand.

Adult Social Care

Lord Markham Excerpts

Wednesday 22nd November 2023 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the financial situation facing adult social care leaders and providers, following information published by the Association of Directors of Adult Social Care Services that 83 per cent of councils expect to overspend by an average of 3.5 per cent on adult social care in 2023-24.

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

The department carries out regular assessments of the financial pressures facing adult social care. Since the spending review, the Government have made available up to £8.1 billion in additional funding over two years to support adult social care and discharge. This includes an additional £570 million announced in July. This will put the adult social care system on a stronger financial footing and improve the quality of and access to care.

[The Lord Bishop of London]

The autumn survey of the Association of Directors of Adult Social Services paints a worrying picture of the state of adult social care: a third of directors of adult social care services said that they have been asked to make additional savings to their budgets, on top of the £1 billion of savings that they are expected to make by 2024-25. The Homecare Association’s deficit report, published on the same day, states that providers are being paid less than the work costs and cannot pay their employees a competitive salary. In this context, can the Minister explain what outcomes social care users can expect to see as a result of the investments he spoke of?

[Lord Markham (Con)]

I thank ADASS for its report. The outcomes we are seeing show a number of things: as well as the £8.1 billion investment we put in, we have brought down waiting lists for assessment by 13% since the peak level. We are seeing high levels of satisfaction with a lot of the work we are doing; 83% of people say that they are satisfied with the services they are receiving. Yes, there is a lot more to be done, but there is a lot of good progress as well.

[Lord Forsyth of Drumlean (Con)]

My Lords, in July 2019, the Government promised that they would fix the crisis in social care. When does my noble friend think that that will be redeemed?

[Lord Markham (Con)]

Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

[Baroness Pitkeathley (Lab)]

My Lords, according to the same survey cited by the right reverend Prelate, 68% of directors reported unpaid carers having break- downs because of burnout from stress, and half a million home care hours had not been delivered because of a lack of staff. Carers UK published a survey showing that 25% of unpaid carers are going without food and heating because of the demands of caring. When will the Government commit to a national strategy for carers to address some of these problems?

[Lord Markham (Con)]

We realise that they are the hidden army, and they are tremendously valued. I think noble Lords know that I have some personal experience of this. We have tried to put some measures in place for payments; I perfectly accept that it is not the same as a full wage, but payments have been put in place. We are also introducing respite care, so we are taking steps in that direction to recognise the vital service they all provide.

[Lord Allan of Hallam (LD)]

My Lords, I know the Minister is keen to ensure that people who are fit to leave hospital can do so quickly, but is he concerned that local government spending restrictions, imposed because of the state of the finances highlighted in the Question from the right reverend Prelate, may lead to more delayed discharges this coming winter? What steps are the Government taking to ensure that that does not happen—a hospital saying that a patient should leave, but the local authority saying that there is nowhere to go?

[Lord Markham (Con)]

The noble Lord is absolutely correct that the flow through the hospital is vital to A&E and other wait times. That is why we have announced things such as the virtual ward: the 10,000 beds are designed to get people out of the hospital and into a care environment where they still feel supported, thereby using technology to help take the strain. The point about this year, and the whole reason why we announced the £600 million extra investment over the summer, is that we learned the lessons of the previous year, recognising that the earlier we can get this money to the local authorities, the better they can spend it to put the provision in place.

[Baroness Blackwood of North Oxford (Con)]

My Lords, investment is welcome but reform is also vital. The NAO’s autumn report noted that my noble friend’s department ended its charging reform programme board and

“has not established an overarching programme to coordinate”

reform activity. It is instead delivering reform

“through a series of 27 projects which report to the director-general … via nine separate programme boards”.

Can my noble friend investigate this to see if there could be better co-ordination of reform to ensure that it is delivered more effectively?

[Lord Markham (Con)]

My noble friend is correct, in that having so many local authority and private sector providers means it is a confusing space in which to bring all this together. The People at the Heart of Care White Paper is trying to co-ordinate that and at the same time provide a career structure, because we know that the bedrock of all this is the staffing, and this needs to be an attractive space for people to work in. Therefore, giving them that recognised, transferable qualification which they can take into nursing and other areas as needed is vital in ensuring that we have the workforce to underpin this.

[Baroness Wheeler (Lab)]

My Lords, the NAO’s recent figures show that so far, only 7.5% of the much-vaunted £265 million allocated by government to addressing social care staffing shortages and recruitment for 2023-25 has been spent due to the DHSC staff recruitment freeze; and the training workforce development programme has also stalled because the department has not managed to set up the necessary systems to administer provider payments. What is the Minister’s response to this and the ADASS survey finding that government investment in social care so far has just stopped the ship sinking and has not moved local authorities out of the storm they are trying to navigate?

--- Later in debate ---

[Lord Markham (Con)]

As I say, we are seeing staff increases. I accept that there is a lot to do in this space, but there has been a 1% increase this year, so we have turned things round quite substantially. Overall, the number of patients being cared for in this way went up by 15,000 in the last year. As the ADASS survey showed, there has been a decrease in the waiting lists, down 13% from the peak, so we have turned a corner and we will see further improvements.

[Lord Watts (Lab)]

My Lords, the Minister said that waiting lists have gone down by 13%. Can he tell us by how much they went up over the previous 12 years?

[Lord Markham (Con)]

I do not have the figures for those 12 years, but I will happily send them to the noble Lord.

[Lord Young of Cookham (Con)]

My Lords, further to the original Question from the right reverend Prelate, is not the real problem facing the care sector that of recruiting and retaining care workers, who can often earn much more in a local supermarket than in a nursing or residential home? What action are the Government taking to make this a more attractive profession for people to go into?

[Lord Markham (Con)]

My noble friend is correct; they are the bedrock and are valued, and it is important that we make them feel valued. As I said, we are reforming the process in order to give them a qualification, which means that that work in the social care setting will be transferable between positions. In addition, if they want to go further into the medical service, be it nursing or other areas, a modular qualification system will enable them to build towards that, so that they not only feel valued but are in a long-term career structure.

[Lord Weir of Ballyholme (DUP)]

My Lords, many families seeking adult social care can find that availability and quality are patchy; and particularly for those living in rural areas, the help they receive can effectively be a postcode lottery. What steps are the Government taking to drive consistency and equality throughout the system, so that every family can receive the level of adult social care that is needed for their loved ones?

[Lord Markham (Con)]

That is a good point. We have given the CQC responsibility for measuring local authority provision of care. Overall, we are seeing a high satisfaction rate—89%—and the number of complaints went down by 16% in the last year, so these things are making a difference.

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Lord agree that if we are truly going to fix the problem, as the noble Lord, Lord Forsyth, said and as Prime Minister Johnson promised, we have to deal with the issue of self-funders, who are having to pay thousands of pounds over years without any support from the state above a very limited means-test level? When will the Government come forward with proper proposals to deal with this?

--- Later in debate ---

[Lord Markham (Con)]

I think we all accept the points made by the noble Lord and my noble friend. By way of context, after 2019, the huge disruption of Covid came right in the middle of this, with all that that meant for the dislocation of the health service. We have to accept that that is a factor. The market sustainability and improvement fund tried to ensure that the amount local authorities pay for fees is fairer, as there is cross-subsidisation of those who pay privately. I accept that, in terms of the overall objectives set in 2019, there is more work to do, but that is still the Government’s ambition.

Mental Health Act 1983

Lord Markham Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Bradley]

To ask His Majesty’s Government what plans they have to reform the Mental Health Act 1983.

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

We are committed to improving the care and treatment of people detained under the Mental Health Act, including taking forward non-legislative commitments such as culturally appropriate advocacy, as well as continuing to expand and transform NHS mental health services. I am grateful to the noble Lord and his colleagues on the Joint Committee for their work on the Bill to date, and I assure him that it remains our intention to bring forward a Bill when parliamentary time allows.

[Lord Bradley (Lab)]

My Lords, for over six years, the Government have promised to reform the 1983 Act, from manifesto commitments to the Wessely report, draft Bills and consultations, and now the Joint Committee which reported to this House in January of this year— 11 months ago. Then, to the astonishment and no little anger of thousands of people with mental ill health, autism and learning disabilities, who have been supported by their tremendous advocates, there has been deafening silence from the Government. Now the proposed Bill has been completely dropped from the legislative programme. There is a real feeling of frustration across the country about this situation. Will the Minister now give a real explanation so that we can try and restore the breakdown of trust that has come about from this situation?

[Lord Markham (Con)]

I understand the frustration and disappointment about the fact that the Bill has not been brought forward. I am keen to focus on what we can do in the meantime. Of course the Bill is trying to decrease the rate of detention and, within that, decrease the racial disparities, such as the fact that a black person is four times more likely to be detained than a white person. There are a number of things that I hope we will be able to discuss more, particularly in the debates on Thursday as well, such as the things we have introduced in pilots, like the culturally appropriate advocacy. That really can make a difference here and now.

[Baroness Buscombe (Con)]

As the chairman of the inquiry, I reassure noble Lords that my noble friend the Minister is very aware of our frustration. However, I am pleased to hear—I am sure others are too—that, along with others in the department, he is looking to see what we can achieve without primary legislation. Could he and his officials focus on the further development and implementation of, for example, advanced choice documents, which would really make a difference to the dignity and choice that people with mental health issues thoroughly deserve? Could he also, as he touched on, really research and respond to why a highly disproportionate number of black men are unfairly detained?

[Lord Markham (Con)]

I thank my noble friend for her question and for her work on this. The advanced choice documents are a perfect example, like a birth plan, of where people can put in place what their hopes are for the future. There are good examples at King’s College and at South London and Maudsley of what they are doing in this direction, and I am really keen to learn from those and expand them further. I am also keen to invite all the participants to a round table that Mental Health Minister Caulfield has agreed as well, where we can really talk about the action that we can take on the ground to implement as many things as we can to rectify the problems in this space.

[Baroness Hollins (CB)]

My Lords, 40 years ago, as a young consultant psychiatrist, I argued against the inclusion of learning disabilities and autism in the 1983 Act—it is out of date; these are not mental disorders. Does the Minister agree that it is time to take this Bill forward seriously?

[Lord Markham (Con)]

We are all agreed on the intent behind what we were trying to do with the Bill. On learning difficulties and autism, the most important thing we are trying to do is to make sure that the CQC, within 48 hours of a person being put into segregation, is investigating and doing an independent review on whether that is the best place for them. Like the noble Baroness, I share the feeling—we all think it—that it is much better that they are treated in the community, where they can be.

[Baroness Barker (LD)]

My Lords, mental health legislation relies on good data; we do not have good enough data about the detention of people from different groups. Does the Minister agree with the committee that a step forward that could be taken now is the appointment of a responsible person in each organisation with a duty to record not only the detention of people under the Mental Health Act but the demographic data surrounding it?

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

[Baroness Merron (Lab)]

My Lords, the provisions of the Mental Health Act have no clear definition of a safe place in which a sectioned patient may be taken while awaiting medical assessment. That often results in vulnerable people being taken to police stations and forcibly detained by the police. What assessment have the Government made of the frequency of this continuing due to the Government’s failure to reform the Mental Health Act—something that Labour, if we win the next election, will put right? How will the Government ensure that patients are no longer detained in such inappropriate and punitive environments?

[Lord Markham (Con)]

I appreciate the feeling that our response on minimal standards—in our reply, I think, to the report by the noble Baroness, Lady Hollins —did not go far enough to make sure that those patients are in the right quality setting for them, so the noble Baroness, Lady Merron, has made an important point. I was going through with the team what we can do to make sure that that is right. As I mentioned before, the fact that the CQC now has responsibility for those independent reviews will mean that it will look not only at whether it is right that the patients are in those in-patient environments but at whether it is the right environment as an actual place.

[Baroness Berridge (Con)]

My Lords, the committee heard about disproportionality, particularly with community treatment orders, which are about 11 times more likely to be imposed on someone from an ethnic-minority background. Can my noble friend the Minister look at that, and maybe meet with colleagues in other departments to see whether there is a legislative opportunity to sort that out by putting that provision into a different piece of legislation?

[Lord Markham (Con)]

Yes. I have tried to get into this further, and my understanding is that lot of the trouble is that there is often a fear from black and ethnic-minority people of the existing institutions that can help people early on. As we all know, with mental health difficulties, we have to act quickly. A lot of this is about getting everyone in society open to the idea that the earlier they can go to these sorts of places, instead of trying to brave their way through, the better. That is one of the key things to do to make sure that we do not then see problems down the pipeline, including the disparity whereby a black person is 11 times more likely to have community reviews and the disparity in detentions.

[Baroness Watkins of Tavistock (CB)]

My Lords, I think that other noble Lords will welcome the idea of sitting down at a round table to look at the future. In particular, what do the Government intend to do to invest in children’s and adolescents’ mental health services to make them accessible in schools? Early intervention will prevent a high proportion of people needing to be sectioned later on.

[Lord Markham (Con)]

The noble Baroness is absolutely correct. With the mental health units to detect problems early, we are now at around 35%; last year it was only 25% but in the next 18 months or so we should be at 50%, which is higher than ever before. I freely accept that 50% is not 100% but it is clearly a step in the right direction. The £2.3 billion investment we are putting in means 350,000 extra places for young people as well.

[Lord Allan of Hallam (LD)]

The Government keep telling us that they plan to take other measures to improve mental health outcomes in the absence of the legislation. I hope the Minister will understand why, having been let down on the promised Bill, we want to see the colour of the Government’s money. Can he go back to his department and ask it to produce a list, with details and dates, of all the measures it intends to take to improve mental health practices via statutory instrument and new guidance in this parliamentary Session?

[Lord Markham (Con)]

Yes. I am happy for the noble Lord to come to the round table and put those points himself as well.

[Baroness Browning (Con)]

My noble friend will be aware that autism is not a mental health condition but a communication disorder. However, of course like everybody else, people on the autistic spectrum can develop mental health problems as well. What assessment has the department made or could it make, quite urgently, of just how able and experienced psychiatrists around the country are at disaggregating between an autistic person having a meltdown and a mental health condition? If they get it wrong, as often happens, the consequences of the treatment that follows are devastating.

[Lord Markham (Con)]

My noble friend is absolutely correct, and from personal experience I know the importance of getting that early diagnosis right. I am quite happy to write in detail exactly what we are doing in this space.

Black and Minority Ethnic Babies: Mortality Rates

Lord Markham Excerpts

Wednesday 15th November 2023 Lords Chamber

[Baroness Thornton]

To ask His Majesty’s Government what steps they are taking to reduce the mortality rates of black and minority ethnic babies, following the publication of research from the National Child Mortality Database.

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

The Government are committed to tackling disparities for parents and babies. We are addressing this through the National Health Service three-year delivery plan for maternity and neonatal services, which sets out how care will be made more equitable for women, babies and families. Support is also provided through the universal public health programmes and programmes that target vulnerable families.

[Baroness Thornton (Lab)]

My Lords, what is very worrying in a rich country such as the UK, with a universal, mature healthcare system, is that this figure of infant mortality rates for babies and children from black and minority ethnic backgrounds is going up and not down. What does the Minister believe the drivers of this data show and how will the Government reverse it? For example, the Apgar score for testing the health of babies, which is a skin tone test, does not work for black and brown babies.

[Lord Markham (Con)]

I thank the noble Baroness for her Question and for her work in this space. I have tried to delve into the numbers. It seems that roughly half the reasons why black and ethnic minority people have higher death rates are to do with socioeconomic and lifestyle factors: where they live, levels of obesity, drinking, smoking and those sorts of factors. Clearly, behind that there is a lot that needs to be done in terms of education and support, folic acid in bread and folic acid generally. The other half is more to do with racial factors. English as a second language is a key thing behind that. I hate to make generalisations, but the fact that black and ethnic minority mothers can often be less assertive means that clearly there you need training of staff to take more time, listen more, make sure that they are understanding and asking the questions to find out whether the issues are there.

[Lord Sewell of Sanderstead (Con)]

My Lords, to what extent is the research programme of the Office for Health Improvement and Disparities looking into this area of health disparities in childbirth and death in childbirth?

[Lord Markham (Con)]

The database from which all the evidence and data have come has just been published. That is exactly why we are publishing the database: so that we can understand the reasons behind it. We are also tying that to the NIHR to see what research is needed in those areas.

[Lord Allan of Hallam (LD)]

My Lords, behind every figure in the national child mortality database lies a personal family tragedy, which we all need to try to understand and reduce as far as we can, as the Minister said. The regional breakdown of the figures shows that there is much less variation between different ethnicities in London than in other English regions. Will the Minister look into that to see whether there are things we can learn from London—perhaps there the staff follow procedures where they are more responsive to people from varied cultural and ethnic backgrounds —so that those lessons can be applied in the rest of England?

[Lord Markham (Con)]

Yes, absolutely. One main reason for that is that in London there is generally a more ethnically representative mix of staff, who are better placed to understand and work in that way. Clearly, we need to increase training as well as recruitment across the rest of the country to make sure that they achieve the same levels.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister will know how highly regarded he is in this place as one of the most caring members of the Government, but what does he say to the comments of the president of the Royal College of Paediatrics and Child Health about how troubling these figures are in a wealthy nation such as ours and about child poverty in this country being a driver of child mortality? What will the Government do about that?

[Lord Markham (Con)]

That is specifically what the Best Start for Life programme is all about. It is a joint Department of Health and DfE £300 million initiative focused on the 75 most deprived areas and local authorities. As the noble Baroness might be aware, the whole reason Andrea Leadsom wanted to come back as a Minister—I was talking to her about this yesterday—was to drive this programme, which she is passionately behind. That work is being done through family hubs, making sure that the whole family is involved and bringing in the dads. That sort of action is very much focused on making sure we tackle this.

[Baroness Blackwood of North Oxford (Con)]

My Lords, every year 4,000 babies die due to pregnancy-specific conditions such as pre-term birth and pre-eclampsia, but 73% of drugs given to pregnant women do not have any safety information and only one drug has been developed specifically for use in pregnancy over the last 30 years. During that time, 600 drugs have been developed for cardiac conditions. Will the Minister look at the report Safe and Effective Medicines for Use in Pregnancy: A Call to Action from the University of Birmingham, which offers sensible and effective ways to put this right and reduce deaths in pregnancy?

[Lord Markham (Con)]

Yes, I would be very happy to take up my noble friend’s suggestion and will make sure that the regulators, NICE and the MHRA, are linked into that as well.

[Baroness Whitaker (Lab)]

My Lords, research has shown that the mortality rate among Gypsy, Roma and Traveller children is far higher than among any other minority-ethnic group, yet this is hardly ever reflected in any account of the situation. Will the Minister get his department to recognise more explicitly the disproportionate mortality rate in this often unrepresented ethnic-minority group?

[Lord Markham (Con)]

Yes. Obviously, we want to find every group and then understand the targeted action around them. Noble Lords will have often heard me say that one of the most effective bits of joined-up government I have ever seen was the Troubled Families initiative, led by the noble Baroness, Lady Casey, and I am interested in the 13 local authority pilots that are using wraparound services to identify community groups and troubled families in particular and provide them with cross-government help.

[Baroness Manzoor (Con)]

My Lords, my noble friend will know that over the last four years the NHS workforce has grown by over 14%, but in the workforce for midwives there is a shortage of 2,500, according to the Royal College of Midwives. Can the Minister say what the Government are doing to ensure that we have sufficient midwives on the wards and, more particularly, a diverse workforce from ethnic minorities who will become midwives and health visitors? The numbers do not look great and of course this plugs in to the prevention strategy the Government have in place.

[Lord Markham (Con)]

Yes, it absolutely does fit into it. We have increased the number of maternity staff by about 14% since 2010, and the long-term workforce plan is all about making spaces for 1,000 extra students and having many routes into it. Noble Lords have often heard me talk about how my mother got into nursing as an older mum—she got into maternity services. There are apprenticeships and later-life opportunities. You should not only be a graduate; you often know much more about life when you are that bit older, especially if you are a mum.

[Lord Scriven (LD)]

My Lords, child mortality rates in all high-income countries, apart from this one, are improving. What is it about this country that is causing this, and what evidence do the Government have to show that there is a specific problem here? What measures will be used to tackle this, and by what dates will this be done?

[Lord Markham (Con)]

I have specifically investigated infant mortality rates. If you look at it, you see the increase is in pre-24-week term cases. Post 24 weeks, the number of cases has remained stable, the data has shown. I have been trying to drill down to understand why it happens within less than 24 weeks. Clearly, more work needs to be done. We are also changing the way this is being measured. We are looking for more indications of whether there are early signs of life, and if there are no early signs of life, that is not recorded as a death. Now there is a lot more investigation to understand those early signs of life, so the change in measurement could be increasing the numbers. I am happy to go into more detail on that.

[Baroness Lister of Burtersett (Lab)]

My Lords, further to the question from my noble friend Lady Chakrabarti, the recent Joseph Rowntree Foundation report on destitution found that minority ethnic groups are disproportionately affected by destitution. What steps are the Government taking directly to reduce destitution among this group?

[Lord Markham (Con)]

Again, noble Lords will know that housing, to my mind, is key to so much of that, and the whole building programmes and the million extra houses are a key part of that. If you look into health across the board, you see that the homeless, for instance, use and need A&E services more than ever. Clearly, it is a root cause we need to tackle.

Autism: In-patient Care in Mental Health Hospitals

Lord Markham Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Touhig (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as a vice-president of the National Autistic Society.

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

My Lords, this year we are investing £121 million in community support for autistic people and people with a learning disability. This will support reductions in the numbers of autistic in-patients in mental health hospitals in line with the NHS long-term plan commitments. To ensure that autistic people receive quality care in these settings, we are rolling out a National Autism Trainer Programme and have published guidance on sensory adaptations in health environments.

[Lord Touhig (Lab)]

The King’s Speech was an opportunity for the Government to introduce the mental health Bill, ending the scandal of autistic people being locked up in mental health hospitals, sometimes for decades. By shelving the Bill, the Government have failed thousands of autistic people and their families, who are devastated that there continues to be no legal protection against unnecessary detentions; I believe that is an attack on their human rights. The Minister is well respected across this House as a caring and compassionate individual, but I must press him on this. Will he please explain why His Majesty’s Government do not see the Bill as a priority, and as an opportunity to end a most evil practice?

[Lord Markham (Con)]

I thank the noble Lord for his kind words about me; I understand the situation. The Government are committed to implementing those changes and we are looking for opportunities to introduce them. I understand his disappointment that the Bill is not in the current programme of legislation. What I am committed to doing is making sure that as many features as possible from the Bill are implemented through action on the ground; the care and treatment reviews are a vital part of that today. Following the report from the noble Baroness, Lady Hollins, we are also making sure that we have regular CQC reviews over the next few years. We are delivering good action in this space, but I understand his feelings.

[Baroness Browning (Con)]

My Lords, like the noble Lord, Lord Touhig, I am a vice-president of the National Autistic Society. I also remind the House of my interests in the register and my family interest in this subject. The reason why a lot of autistic people become in-patients in mental health hospitals is the lack of real understanding and training of healthcare professionals in that field. It is a lot better in the big conurbations than in the countryside. Autism is not a mental health condition but, as my noble friend the Minister will know, one of the problems that the Government will face if they are to help to get people out of these institutions is that, like the rest of us, people with autism can develop mental health conditions; autistic-related anxiety is a very common one. Psychologists—one finds more of them than psychiatrists out in the community—cannot prescribe; it has to be a psychiatrist who prescribes. Until you get the right number of trained professionals out in the community—namely, psychiatrists with a specialism in autism; it is no good having just your average jobbing psychiatrist—those people are doomed to stay. I urge my noble friend to look at the levels of availability for the right professionals, to release these people from the incarceration they should never have suffered in the first place.

[Lord Markham (Con)]

I and the whole House would agree with my noble friend that having the right people making the right assessments on the right place for those people to be treated is key to all this. We are rolling out training through the National Autism Trainer Programme, in which we have invested £20 million to ensure improvements in autistic diagnostic pathways and people’s capability to achieve them. We are now rolling out the Oliver McGowan training to over 1 million people and looking at rolling out stage 2. However, I agree with her that these actions are vital.

[Baroness Hollins (CB)]

My Lords, the tragedy is that so many admissions are due to failings in adult social care. Mencap’s analysis of the latest NHS Digital statistics shows that only 45% of ICSs have met the adult in-patient rate promised by March 2020 and that 26% of ICSs are going in the wrong direction. Can the Minister update the House on future plans for building the right support after March 2024? In the absence of mental health and adult social care Bills in the gracious Speech, what plans are there to fully implement the recommendations in my report, which he kindly mentioned, published by the Department of Health on 8 November? So many of those recommendations were dependent on a code of practice to the current Mental Health Act being reopened.

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Baroness for her report and the meeting that we had to follow it up. Probably the best way forward on this is that a lot of things we are doing and can do can be done absent the Bill. I should be happy to sit down with her and talk through what we can do and where we can go further to make sure that everything that we were trying to put into legislation we can effectively make happen anyway, because we are all agreed as a House absolutely on the direction of travel in which we want to go.

[Baroness Barker (LD)]

My Lords, what is being done to change the commissioning systems and contracts that currently incentivise providers of medium and long- term secure accommodation to keep people in hospital, rather than equip them to go back into the community?

[Lord Markham (Con)]

I will come back in more detail on the contractual arrangements, but the point that the noble Baroness raises on making sure that there are no perverse incentives to do that has to be right. The now CQC-led reviews that we have agreed to put in place as part of continuing the recommendations of the noble Baroness, Lady Hollins, happen frequently. In the case of adults, there is a review every six months, if appropriate, and, in the case of children, every three months to make sure that every step of the way we ask whether this is really the right place for them to be.

[Lord Sahota (Lab)]

My Lords, these days, more and more parents would like to have purpose-built accommodation for their autistic children. At this moment, they are unable to have that because they cannot access an adaptation grant, also known as a disability facility grant. That needs to change so that parents can build independent self-contained accommodation for their autistic children, which can be done only through legislation and extra funding. Will the Government look into this?

[Lord Markham (Con)]

I am aware of the point that the noble Lord makes. About 48% of the reasons why people are not discharged are because of a lack of suitable housing. It is something on which we are working closely with Homes England and DLUHC, to make sure that we can utilise as much of the affordable housing grant as possible. I was not aware that legislation needed to be changed but I will happily look into that to see if it is the case.

[Baroness Meacher (CB)]

My Lords, is the Minister aware of the critical importance of early intensive education for severely autistic children? I hope so. I was involved in such an initiative some years ago and it is remarkable how a child with no speech and tremendous deficits can ultimately go to a normal school, and the prospects to then lead a reasonably normal life are enhanced enormously.

[Lord Markham (Con)]

Yes, I have some personal experience here and I know how vital it is to find out early, so you can put together the tools. I have seen some really interesting things. The Bradford pilot looked at children’s scores and whether that was an early indicator. I was at Boston Children’s Hospital a few weeks ago, which is looking at the way that children play on apps and whether that can give indications of whether there is some neurodiversity. There is absolutely the intention of early diagnosis.

[Baroness Wheeler (Lab)]

Thankfully, my Lords, understanding of and support for autism have changed substantially since the now 40 year-old Mental Health Act, especially about being clear on what an autism-friendly environment looks like and should be, although sadly that is not often found in mental health settings and ATUs. Did the Government’s decision to abandon the new mental health Bill this Session include an assessment of the impact this would have on patients? This is particularly urgent now that changes to the code of practice, recommended by the excellent report on long-term segregation by the noble Baroness, Lady Hollins, will not be considered until we deal with the Bill. How and when will the Government deliver the significant changes needed?

[Lord Markham (Con)]

I think we are all agreed on the action; there was was an intensive and involved process by the whole House when it came to agreeing the action. That is why I am keen to ensure that we implement as much of it as possible that does not require legislation, which we are doing. I am happy for the noble Baroness to join me at the meeting with the noble Baroness, Lady Hollins, when we can look at the practical steps to see what is possible.

Children’s Hospices: Funding

Lord Markham Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government whether they are on target to provide £25 million for children’s hospices for 2023-24; and whether they intend to repeat this on an annual basis uprated in line with inflation and allocated directly to each children’s hospice.

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

The Government and NHS England recognise the vital role that hospices play in delivering high-quality, personalised palliative and end-of-life care for all ages. The children and young people’s hospice grant plays an important role in enabling that to happen. As such, grant allocations of £25 million have been paid in full to hospices in 2023-24. A further £25 million has been announced for 2024-25, with the funding allocation mechanism currently being worked through by NHS England.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister. He will be aware that 80% of the income that goes to children’s hospices comes from fundraising. With the cost of living problems we have at the moment, that is increasingly difficult, so the £25 million grant is a lifeline. Do the Government accept that making this grant permanent, so that hospices know about it going forward, and uprating it by the rate of inflation will give enormous help in stabilising the finances of children’s hospices?

[Lord Markham (Con)]

First, I absolutely recognise the noble Lord’s point that 80% of hospices’ funding comes through charities, so they represent an excellent resource for us. That is why we are pleased to confirm the £25 million for next year. The debate, which I am sure we will get into more later, is about making it a direct grant. We generally think that ICBs are best placed to take control of health services in their area, and it is about trying to get the right balance between making direct grants for the provision of places and saying that ICBs know what is best for their area and should cater for them in that way. I would be happy to talk further about that balance with the noble Lord.

[Lord Patel (CB)]

My Lords, should we not be ashamed that care for children at the end of their short lives is funded by village fetes, cake shops and elderly marathon runners instead of by central government? The total cost of 34 children’s hospices is £130 million and the totality of it should be funded centrally, not as unguaranteed £25 million grants every year. We should be ashamed of this.

[Lord Markham (Con)]

To put this into context again, only about 6% of children’s deaths occur in hospices, so 94% happen in other settings. I want to get that right for the context of all this. There are many parts to this; hospices are quite close to my heart and I want to donate to them charitably. There are many parts of society where we think there is a role for charities to add value and enhance the system, rather than their being crowded out by government-funded sources all the time.

[The Lord Bishop of Worcester]

My Lords, I am grateful for this announcement. We have a wonderful hospice in Worcester, the Acorns Children’s Hospice, which does extraordinary work with young people. Does the Minister accept that, although a minority of children die in hospices, the number of children cared for by them greatly exceeds that. Their work is invaluable.

[Lord Markham (Con)]

Yes, it is. I was surprised to find out that, for instance, the number of young people living with life-limiting conditions was 33,000 in 2001-02 and is over 90,000 today. That is the case because we generally have much better treatments for those children. That is obviously good news, but it means that lots more people with such conditions have to be cared for and we need to make sure that they are.

[Lord Wigley (PC)]

My Lords, as a former trustee of Hope House Children’s Hospices, I draw the Minister’s attention to the clinical guidance published by NICE, which showed that for every £1 spent by the public sector in supporting end-of-life care for infants, children and young people, non-cash savings worth almost £3 would be released back into the NHS. Will the Government commit to provide, ongoing, the necessary funding to sustain hospices and maximise the benefit for the NHS and, most of all, for the dependent families?

[Lord Markham (Con)]

As I said, we absolutely agree on the vital role of it all. The amount of funding that we placed there a few years ago was £15 million, so it has gone up by about 67%. It is excellent value for money, and it is excellent that we managed to get the care and energy of the voluntary sector into it. That is the model that I think we all believe in.

[Lord Balfe (Con)]

My Lords, I declare an interest as the joint chair of the all-party group whose secretariat is Together for Short Lives. The thing that is of great difficulty in this sector is uncertainty. In the interests of permanence and certainty, will the Minister include a dedicated long-term strategy in the Government’s mandate to NHS England that addresses the palliative care needed for children and young people so that the sector can have an assured future?

[Lord Markham (Con)]

My noble friend is correct; it is a long-term part of the statutory requirements of all ICBs to provide palliative care, so it is written into that NHSE mandate. It has to review all 42 ICB arrangements, and we make sure that in each setting they have the 24/7 care set-up required of them.

[Lord Allan of Hallam (LD)]

My Lords, following on from the Minister’s answer to the noble Lord’s supplementary question, most integrated care boards will have only a very small number of residents who need services from local children’s hospices. Given that, it raises concerns that spending on those services will not be prioritised at that very local level. Does the Minister accept that there is a case for integrated care boards to band together at the regional level and fund hospice services that way?

[Lord Markham (Con)]

Yes, absolutely. Again, there is a balance we are trying to get over here, because we are all agreed on the importance of what they are trying to do. At the same time, we believe that ICBs, generally, are the right people make provision at a local level, because they know best what is required in their area. Clearly, where it makes sense for them to band together, that has to be sensible.

[Baroness Wheeler (Lab)]

My Lords, most of us will have the amazing work of our own local children’s hospice in mind today in response to this Question. Ours in Surrey is the care and support that the Shooting Star Children’s Hospices provide for babies, children and young people with life-limiting conditions, and their families. We fully support the children’s hospice grant going directly to a hospice. It is the most cost-effective way; it overcomes the patchy performance of many ICBs and their CCG predecessors on hospice funding, and it avoids hospices having to engage with multiple ICSs when their services go across areas. What actions are the Government taking to ensure that ICBs meet the NICE standards in supporting children’s hospice care and against ICBs that have made no attempt to access the current grant arrangements?

[Lord Markham (Con)]

As I mentioned, it is a statutory requirement for every ICB. NHS England is responsible and is reviewing those arrangements in all 42 trusts. At the same time, this is an element which the CQC follows up to ensure that care is in place. I echo the House’s feelings that the results of the voluntary sector and the hospices are excellent. We need to ensure they get the proper support.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as having set up training in paediatric palliative medicine in the UK and internationally. Together for Short Lives data shows that about £15,000 per annum is spent on children and young people in the active caseload, which is probably almost 10,000 young people having care from hospices, some of them for many years. Given that there are service specifications and guidelines, can the Minister be a bit more explicit as to how those are monitored to ensure that service specifications really do meet the needs of the children and that hospice services are integrated with local paediatric services, given that such children often have multiple and complex needs?

[Lord Markham (Con)]

As I said, it is a responsibility for all of them, but I will happily give the noble Baroness a detailed reply so that it is very clear exactly what they are doing to make sure that happens.

[Lord Forsyth of Drumlean (Con)]

My Lords, a bazillion years ago when I was the Scottish Health Minister pre-devolution, we introduced a pound-for-pound match-funding system for hospices. That worked brilliantly because it meant that hospices could raise more cash and the Government provided support for organisations that depend on being voluntary. Would my noble friend consider doing that, not just for children’s hospices but for the movement as a whole, which does such fantastic work?

[Lord Markham (Con)]

My noble friend makes an excellent point. My understanding is exactly in this vein: £7 million was paid in match funding to children’s hospices in exactly the way he mentioned. As to whether we should be doing that more widely, it is a good idea, and I am happy to take it away and come back on it.

King’s Speech

Lord Markham Excerpts

Thursday 9th November 2023 Lords Chamber

[Lord McInnes of Kilwinning]

That an humble Address be presented to His Majesty as follows:

“Most Gracious Sovereign—We, Your Majesty’s most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty has addressed to both Houses of Parliament”.

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

My Lords, on behalf of all noble Lords, I thank His Majesty for his gracious Speech. I am truly honoured to be a Minister in his Government and to open this debate.

I always said that I wanted to be a different kind of Minister, and today is no different. Over the past few days, I have thought a lot about the sort of speech that I wanted to give. I could not quite make up my mind, but it finally clicked late last night, as I leaned over my five year-old son, Xavi, as he slept in his bed. I thought that, if I am making a speech about the long-term changes that this Government want to make in health, education, housing and welfare, I need to explain what kind of country we want to build for Xavi and his generation—so forgive me if this is a bit unconventional.

As I have told Xavi when he asks me about work, the National Health Service is probably our country’s most beloved institution. It represents how we think of ourselves as a nation: caring, compassionate, and a place where everyone will have their needs cared for at no cost, according only to need. It touches so many lives every day. It saved Xavi’s brother, Sam, when he was born more than 20 years ago and, more recently, it saved Xavi’s grandfather with an emergency operation.

However, it is a health service that faces huge challenges. It is a health service that must care for an ageing population that is growing rapidly and has rapidly growing needs, where it costs five times more to care for 70 year-olds than for 20 year-olds. It is a health service that is still recovering from a once-in-a-generation pandemic, which stretched it more than ever before and created health needs both physical and mental, which even now we are only just beginning to understand. So it is a health service where we need to make decisions for the long-term, to change how it operates and how we approach it, so that it is there for Xavi’s generation and the one after, just as it has been for ours.

That means we will all have to have to take more responsibility over our health, and that government must empower us all to make long-term decisions that benefit our health. That means diagnosing and treating conditions faster, but it must start with prevention. The single biggest thing that Xavi and his generation can do to protect their health is to never start smoking, and this Government are going to help them do that. We are making it illegal for Xavi and his friends, and anyone who is 14 or younger, to ever be sold tobacco. This will save thousands of lives and prevent thousands more people suffering from cancer. Vaping is, of course, much safer than smoking, and it helps many smokers to quit for good, but that does not mean that Xavi and his friends should ever take up vaping. That is why, following a consultation, we will bring forward measures to restrict the availability of vapes to our children, targeting sweet flavours, colourful packaging, eye-catching displays and disposable vapes, making sure that we do not replace a generation of nicotine addicts who smoke with another who vape.

We are not only taking steps to prevent Xavi’s generation suffering major illnesses but steps that will allow them to take more responsibility for their health. Just as we use apps and technology to manage our finances, retail preferences and social lives, they will be able to manage their health using technology, through the NHS app. As we speak, we are loading more features which will allow patients to understand their health needs through accessing their health records, and to navigate and decide whether they are best served by seeing a pharmacist through our Pharmacy First programme, seeing a nurse or a doctor, or referring themselves straight to a specialist at one of our 160 new community diagnostics centres. Patients will be able to make appointments from the app and then get their results directly to their phones. If they need follow-up treatment with a specialist, at a hospital or at a CDC, they will be able to exercise choice to find an appointment that suits them, whether that is seeing a particular doctor, getting care closer to home, or getting a shorter waiting time.

Artificial intelligence and technology are already allowing us to do great things. AI is allowing us to halve the time that it takes to treat people with strokes, making it more likely to recover completely. It is allowing radiologists to read lung and breast scans to detect cancers more quickly and more accurately than ever before. For Xavi’s generation, AI can do so much more. It could help us to discover medicines and cures that have defeated us so far, and it could analyse health records, helping us to join the dots between what links different generations and different conditions, to allow scientists to develop medicines and treatments to target the causes of major diseases.

All the work that we are doing to improve the nation’s health is underpinned by our long-term workforce plan—ground-breaking in its purpose—ensuring that we have the right numbers of nurses, doctors and specialists, and the right training and pathways into the profession, whether that is by expanding degrees, apprenticeships, or more on-the-job development. Underlying all our work is the need to focus our most precious resource, our people, on getting upstream of the problem. Rather than just focusing on hospital treatment centres and primary care, we are focusing resources on prevention and increasing the use of technology.

At this stage, I want to emphasise the Government’s commitment to creating parity between mental and physical heath and to introducing the mental health Bill in the future, when parliamentary time allows. In the meantime, we are taking decisive action. We are eliminating dormitory accommodation, so that people with mental health conditions are treated where they can be best cared for—in the community. We are making sure we have mental health ambulances available to answer 999 calls where we need a mental health response. We are also investing an additional £2.3 billion to support 2 million more people to receive mental health treatment.

As well as building a sustainable future for the NHS for our children, we are making sure it is ready for winter. Average category 2 ambulance response times were over 10 minutes faster in September than in the same month last year—and we are going further. This year, we are investing an additional £600 million into our discharge fund, supporting hospitals to discharge patients when they are ready, with the right support, and stopping patients who do not medically need to be in hospital from taking up important beds and delaying ambulance handovers. We are also providing 5,000 additional permanent staffed beds, introducing 800 new ambulances and using our 10,000 hospital-at-home beds to keep thousands of patients out of hospital.

As well as protecting the health of Xavi and the next generation, we are getting them ready for their futures. We are proud of our education record to date. Xavi and his friends are far more likely to go to a school rated good or outstanding. When we took office, just 70% of schools met this standard; today, that figure is 90%. Our nine and 10 year-olds lead the western world in reading, and our 15 year-olds perform significantly above the OECD average for reading, maths and sciences. However, the parallel nature of A-levels and technical qualifications limits the breadth of young people’s education, stops progression in maths and English far too early and prevents parity of esteem between academic and technical qualifications. Furthermore, we are an international outlier from 16 to 19 in terms of subjects taken and the number of hours taught. The advanced British standard will ensure that, when Xavi and his friends turn 16, they will face a world-class system, placing equal value on technical and academic knowledge, giving them depth and breadth of knowledge to succeed in further study and the world of work.

I now turn to housing and the world that we want to create for Xavi’s generation and those that follow. First, we understand the vital role of housing supply. Since 2010, we have delivered nearly 2.3 million homes, realising dreams of home ownership and delivering decent rented accommodation. We are on track to deliver our manifesto commitment of building 1 million more homes over this Parliament. At some point, all of us, including Xavi, are likely to rent their home, maybe as a stepping stone to home ownership, or maybe for the long term. Whatever the circumstance, we have acted to make renting better and fairer by cracking down on those 400,000 non-decent homes and banning tenant fees. With the Renters (Reform) Bill, we are going further. We will ban no-fault evictions that carry just two months’ notice, empower tenants to raise concerns about the quality of their property and give them greater security. At the same time, we want to be fair to landlords, making it easier for them to evict tenants who display anti-social behaviour or wilfully do not pay their rent.

We also want to help people like Xavi and young people today into home ownership. For some of us, that will mean buying a leasehold property. This Government are committed to improving the experience of the owners of the 5 million leasehold dwellings in England and Wales. We have already capped ground rents in most new leases at very low rates and we will deliver further leasehold reform with the leasehold and freehold reform Bill, which will ban the sale of new leasehold houses. Where leaseholds are required for practical purposes, such as in flats and apartments, we will extend their lease to 990 years and cap new ground rents, with the intention of giving future leaseholders the equivalent experience as if they owned the freehold on their home. We will also launch a consultation to see how we can further improve leaseholder rights. This legislation will fundamentally reform the leaseholder system, ensuring that families have the right fully to enjoy their homes and giving them increased opportunities to pass them on to their children.

While this Government are committed to supporting our society in health, education, housing and living and working independently, I want Xavi to know that we take care of those who need our support—now more than ever with the heightened cost of living. We spend £31 billion on supporting renters with housing costs and £276 billion in total through the welfare system in 2023-24, including providing more than 8 million low-income households with cost of living payments totalling up to £900. For those who need it most, we have increased benefits and the state pension by 10%, in line with inflation. We have made strong progress towards halving inflation by the end of the year, thereby reducing cost of living pressures. I am proud to say there are 1.7 million fewer people in absolute poverty than in 2010, including 200,000 fewer pensioners and 400,000 fewer children.

While we must support people who cannot work, it is vital that we give a leg up to those who can. As well as bringing economic benefits to a person, work boosts their confidence and well-being. The Government have made work pay with the introduction of a national living wage and by ensuring that those earning £12,570 or less pay no income tax or national insurance. These steps led to record employment rates before the pandemic and, last year, the lowest level of unemployment for 50 years. At the same time, there are 2.6 million people who are economically inactive due to disability or long-term sickness. Over a quarter of those who are long-term sick want to work, to the benefit of themselves and the economy. With flexible working and the ability to work from home, we want to help these people into the types of work that they can do, while understanding their conditions. That is why we have launched a consultation to change the work capacity assessment to come into force by 2025 and to provide tailored support for people to safely move into employment, to benefit them, their health, well-being and confidence and, of course, our economy.

I finish by addressing an issue of utmost importance, given the ongoing events in the Middle East. The aftermath of Hamas’s attack on Israel on 7 October demonstrates a clear link between anti-Israel sentiment and anti-Semitism. In the 21 days following this attack, the Community Security Trust recorded more than 800 anti-Semitic incidents—the highest ever recorded in a 21-day period. We know that boycotts and sanctions are divisive and undermine community cohesion. Many target Israel, under the banner of the Boycott, Divestment and Sanctions—or BDS—movement. There is evidence that this movement has contributed to the horrific rise of anti-Semitism in the UK. Yet we have seen taxpayer-funded bodies attempt such boycotts. In 2014, Leicester City Council passed a BDS motion on boycotting goods from Israeli settlements; that same year, Gwynedd Council passed a BDS motion calling for a trade embargo with Israeli settlements; and, in 2021, Lancaster City Council passed a motion in support of the BDS movement.

Taxpayer-funded public bodies should never interfere in foreign policy. That is why this Government have carried over the Economic Activity of Public Bodies (Overseas Matters) Bill into this parliamentary Session. It will deliver on our 2019 manifesto commitment to ban public bodies from imposing boycotts, divestments or sanction campaigns against foreign countries. It will prevent them pursuing divisive policies that undermine community cohesion and stoke anti-Semitism, ensure that the UK speaks with one voice internationally and guarantee that taxpayers only pay for foreign policy once.

Across housing, welfare, health and employment, this Government are taking the long-term decisions to help give Xavi and young people across the country a brighter future. We will create a health system that puts patients first, give more families a quality home, get more people into work and grow our economy. My noble friend Lord Younger and I look forward to hearing noble Lords’ valuable reflections on the measures that I have outlined today on how we can all take the long-term decisions needed to create brighter future for Xavi and all our young people.

Suicide Prevention Strategy

Lord Markham Excerpts

Thursday 26th October 2023 Lords Chamber

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

The actions in the new suicide prevention strategy for England are informed by the existing and emerging evidence, by engagement with people with expertise in suicide prevention, including people with lived experience, and by the mental health call for evidence. This strategy is population-wide and the actions within it aim to support as many people as possible, including those on out-of-work disability benefits.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer, but I am not sure that clarifies this issue. This issue concerns one bit of government not heeding the research of another bit. NHS Digital’s Adult Psychiatric Morbidity Survey clearly shows that more than 43% of ESA claimants—that is employment and support allowance out-of-work disability benefit claimants—have considered suicide, compared with 7% of non-ESA claimants. The argument that this group should be included in the NHS suicide prevention strategy was made five years ago, and it was not included with no explanation. We now have the new suicide prevention strategy, and they are omitted again. I would like the Minister to clarify whether this group will be included in the Government’s—actually rather good—suicide prevention strategy or not, and if not, why not?

[Lord Markham (Con)]

What the strategy is trying to do is to look at those high risk groups and the risk factors behind them. One of the biggest risk factors causing suicidal thoughts are financial difficulties, which of course out-of-work disability benefits come into. One of the highest groups in terms of priority are middle-aged men, who are often the people suffering in this space. There are other groups as well, such as children and young people, pregnant women, new mothers and autistic people. There is a range, and what we are trying to do in this strategy is hit those areas of highest risk. To put this into context, those people on all DWP benefits in the reviews done on suicide make up less than 1% of the population of suicides. What we are trying to do is hit the major risk groups.

[Lord Allan of Hallam (LD)]

My Lords, the suicide prevention strategy says that DWP staff will be trained to identify benefit claimants who express suicidal thoughts and escalate these appropriately. Can the Minister confirm that the DWP will collect data on out-of-work disability benefit claimants who are caught or flagged by the system, so that we can understand whether or not this new policy is as effective as we would all want it to be?

[Lord Markham (Con)]

Yes, and I had the opportunity, because I used to be the lead NED at DWP, to go along to a number of jobcentres and see the sorts of work that they do. They have two things. They have an independent review of each of these, and those are the stats I was using: they get about 50 cases a year in these categories. Where there is a serious case they have a serious case review, independently chaired with a Permanent Secretary on it as well.

[Baroness Browning (Con)]

I remind the House of my personal interest: I have family members claiming ESA. I advise my noble friend the Minister that I am awaiting an appointment with DWP Ministers following Questions that I tabled before the Summer Recess about the suicide rate among disabled benefits claimants—in fact, among all benefits claimants. My concern is not only around the way the DWP collects data but around the way it sometimes does not disseminates the information that it has. Will my noble friend pause in relying totally on the way in which the DWP produces data at present? For example, I am particularly concerned about how it collects information from coroners’ courts. This is something that I think is ongoing; I hope that my noble friend regards it in that way as well.

[Lord Markham (Con)]

We are definitely always looking to improve, get access to better data and learn lessons from that. I will make sure that that is understood and follow up with DWP Ministers accordingly.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interests in medicine. The new suicide prevention strategy is most welcome, but do the Government recognise that the ONS data shows that the time of diagnosis and first treatment of those with severe health conditions can be a high-risk time when they feel devastated and often do not have adequate support? The way in which news is communicated and bad news is given to them alters their risk of suicide, particularly in those who have been bereaved by suicide previously. Will the Government therefore put pressure on NHS England and the GMC to ensure that communication skills are included in revalidation and appraisal processes so that patients get better support and are steered towards the new SR1 benefit, which is designed specifically for people with poor prognoses and can play a really important role in relieving financial pressures?

[Lord Markham (Con)]

I thank the noble Baroness for her support for the suicide prevention strategy. It tries to look at the themes behind this issue, of which working to give effective support, communication and training is absolutely key—as is making sure that that is followed up on. The other thing that I want to pull out from the report is the real feeling, in terms of the seven key themes, that suicide prevention is everyone’s business and is something that we all need to be aware of and could learn more about.

[Baroness Brinton (LD)]

My Lords, the Minister has outlined how important it is to learn from the experience of people who have considered suicide. Last week, an Information Rights Tribunal asked the DWP to publish its secret report on suicide rates among vulnerable claimants; it has not yet been published despite the fact that it was written in 2019. Can the Minister explain why it still has not been published? If not—I appreciate that this falls under the DWP—can he write to me, because it is clear that we need to learn the lessons of what went wrong?

[Lord Markham (Con)]

Absolutely. I would be happy to write to the noble Baroness.

[Lord Davies of Brixton (Lab)]

My Lords, on the suicide prevention strategy more generally, does the Minister share my concern at the figures published today by the ONS showing that the suicide rate among offenders in the community is six times that of the general population and the suicide rate among female offenders in the community is 11 times that of the general population? Surely this points to the need for priority action.

[Lord Markham (Con)]

The noble Lord is absolutely correct. The priority groups identified include people in the justice system for exactly that reason; likewise, as I mentioned, middle-aged men, who are three times more likely to commit suicide. There is a strategy behind each priority group—people with poor mental health, people on the autistic spectrum, pregnant women, people who self-harm, children and young people, as well as people in the justice system—in terms of how we help and support them.

[The Lord Bishop of London]

My Lords, as we have heard, our financial situation has a serious impact on our health and mental well-being. This is supported by recent polling commissioned by Christians Against Poverty. This issue is not just about more disease; it also includes malnutrition, mental health and failing to take time off when sick due to financial insecurity. What assessment have the Government made of the impact of the cost of living crisis on people’s mental health, particularly in our most deprived and vulnerable communities? What steps are the Government taking to reduce health inequalities, specifically those related to suicide?

[Lord Markham (Con)]

It is understood that people’s financial well-being—or lack thereof—is one of the key causes here. Interestingly, as I looked at the statistics, there was a big jump up in the suicide rate from 2008 onwards, following the financial crisis. It is about making the point that, when people feel under more stress, they are, unfortunately, more likely to commit suicide. However, if you look at the statistics over the past five years, the rate has been pretty flat; so far, there is no evidence to show that, in the past year or so, the cost of living crisis has caused more suicides. None the less, it is something that we absolutely need to stay on top of and ensure that we are monitoring closely, as the right reverend Prelate the Bishop of London mentioned.

[Lord Kamall (Con)]

My noble friend the Minister rightly said earlier that suicide prevention is all our responsibility—or something like that—and that we need more awareness. Can he enlighten us on some programmes to increase awareness of suicide prevention so that we recognise that it is the responsibility of someone’s wider family, wider community and others and so that they are aware of the signs to look for?

[Lord Markham (Con)]

Yes. Effective bereavement support comes into this in a similar way. There are a number of communication methods, which I will happily share in writing so that noble Lords can see them, but there is also a full marketing and support plan around them.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister assure us that DWP staff are being trained properly in recognising the suicide risk of such claimants? One of the most important things is that people largely want to work and getting rejected following job interviews is a huge risk for that particular population.

[Lord Markham (Con)]

Absolutely. It is my understanding that all front-line DWP staff have two days of mental health training in precisely this area. Also, their stated objective is to support people in what they can do and support them into work based on their abilities. We all know that work gives people a big feeling of self-worth and confidence and is a key to both physical and mental health.

Ultra-processed Food

Lord Markham Excerpts

Thursday 26th October 2023 Lords Chamber

[Baroness Bennett of Manor Castle]

To ask His Majesty’s Government what is their assessment of the impact on public health of ultra processed food; and what steps if any they will take to reduce the amount of ultra processed food consumed.

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

Observed associations between ultra-processed food and health are concerning, but it is unclear whether these foods are inherently unhealthy due to processing or their nutritional content. A diet high in processed food is often high in calories, salt, saturated fat and sugar, which are associated with an increased risk of obesity and chronic diseases. This continues to be the basis of our dietary guidelines and policies to tackle obesity and poor diets.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for his Answer, which reflects what he said yesterday in our debate, that the House did not agree on whether processed food per se is bad for you. Common sense has long suggested that food that, to quote the Washington Post, is

“refined, pounded, heated, melted, shaped, extruded and packed with additives”

is bad for you. These dreadful food-like substances do not just contain a terrible balance of nutrients; there is also a problem with the process. The science increasingly demonstrates that. Yesterday I referred to a study based on the French NutriNet-Santé study by Chantal Julia et al; I supplied the Minister with the link. Will he commit to asking the department to look closely at that study, which demonstrates that nutritional quality and ultra-processing are correlated but distinct issues in diet? Will the department provide a substantive response to the study?

[Lord Markham (Con)]

Obviously, I am always happy to look at all the research because this is a vital area. This is the fifth time we have discussed it in the last three and a half months, so I apologise for any repetition. We are ever vigilant on this area but, as the contributors to yesterday’s debate showed, the research is mixed. The key things to get behind are the bad features of ultra-processed foods that are high in sugar, salt and saturated fat.

[Lord Deben (Con)]

My Lords, I will ask a very simple question. Was it not true that, before we had the link between smoking and lung cancer, we did have evidence of an epidemiological connection? The problem here is that we have no direct link, but it does seem that there is a connection that we do not yet know is causal. Will the department be very careful not to ignore that evidence simply because it is very inconvenient for scientists if their whole history of understanding nutrition is undermined by it?

[Lord Markham (Con)]

Absolutely—we have to be understanding of the latest research in cause and effect. The evidence I have been shown so far is that it is about the features within those ultra-processed foods—are they high in fat, sugar or salt? Those are the things that are causing the harm. If we find links to the processing itself, we will act on that.

[Baroness Boycott (CB)]

My Lords, a few years ago the Government introduced very good obesity policies on stopping the sale of “two for the price of one” on junk food and limiting junk food advertising during children’s television. These have been delayed until 2025. What was the Government’s reasoning? Can the Minister assure the House that it was not based on any lobbying from the food industry?

[Lord Markham (Con)]

The rationale was very clear. The measures that we introduced by the modelling showed that in what we were trying to do we were attacking the things that cause 95% of the reduction in calories—namely, the product positioning, which has the support of 78% of people to reduce the so-called pester power. Early evidence shows that it is working, because foods that are not high in the bad stuff have gone up by 16% and those with high sugar, salt and fat content have gone down by 6%, all through the product positioning. It is working, but the most important thing is that we have gone after the big numbers, those that effect 95% reductions in calorific intake.

[Lord Allan of Hallam (LD)]

My Lords, to follow on from the questions asked by the noble Baroness, Lady Boycott, there is a public expectation that the delayed junk food advertising regulations will mean that children will be less likely to see ads for products from companies such as KFC and McDonald’s. But my understanding from the Minister’s previous comments is that the Government’s expectation now is that the advertising will carry on as before and children will continue to see just as many ads, albeit with the products reformulated to get around the ad ban. Is that correct?

[Lord Markham (Con)]

I have said many times that the prize is reformulation. I do not think that any of us should have a problem per se with the food if the bad stuff is taken out. Diet Coke is a perfect example. It is not particularly good for you but not bad for you either, so why should Coca-Cola not be able to advertise Diet Coke? If you take out the bad stuff, we should encourage industry because advertising works. It wants to advertise, so if it is encouraged to take out the bad stuff, that is a big incentive.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, as far as I recall, it was said that we should keep it simple and that the focus should be on sugar. When will the Government look at children’s school meals, review the regulations and reduce the sugar in children’s free school meals?

[Lord Markham (Con)]

The noble Lord makes a very good point. A healthy start to life is vital, which is why I am very pleased to say that we have the highest level of free school meals ever, with every infant school kid and a third of children overall having a free school meal. On the composition of those foods, I know that this was planned but was stopped due to Covid. The timing is now being reviewed again, because things move on in terms of the content and healthy foods.

[Lord Kirkhope of Harrogate (Con)]

My Lords, most people would be very concerned to know what ultra-processed food means. People who rely on staples such as bread, cereals, sausages, gravy, fruit juice, baked beans and biscuits would be very surprised to hear us talking about those as ultra-processed food and how bad it is for you. Some people say that five ingredients or more puts food into this category. While we should encourage vegetables, fruit and fresh food of various kinds being eaten, does my noble friend not agree that we are alarming the public too much if we deny them the staples that they are used to?

[Lord Markham (Con)]

That is absolutely correct. My understanding is that ultra-processed foods make up, on average, 60% of a person’s diet. If you were to try a blanket ban, it would have a massive impact. I think we all agree that it is important that we try to discourage things that are bad in ultra-processed food, not ultra-processed food per se. As I have said many times, there are many types of ultra-processed food that we encourage, such as wholemeal bread and many of the cereals.

[Lord Hannan of Kingsclere (Con)]

My Lords, ultra-processed food rests on the weirdly unscientific definition of containing stuff that we do not normally find in our kitchens. My noble friend the Minister has rightly said that the advice is to cut down on salt, sugar and fat. I suggest that almost all of us have plenty of salt, sugar and fat in our kitchens, so will my noble friend the Minister join me in urging people to stick to advice that is based on science and the empirical and reasoned method, rather than going for a basically primitive fear of things that we are unfamiliar with?

[Lord Markham (Con)]

That is absolutely right. We should always base this on the science. I thank my noble friend for that comment.

[Baroness Merron (Lab)]

My Lords, nearly half of baby snacks and up to three-quarters of baby biscuits and rusks are categorised as ultra-processed. Many of them are high in fat, sugar and salt and if overconsumed, reports suggest, can lead to weight gain, unhealthy eating habits and a wider negative impact on development. Have the Government made any consideration of measures to help parents to be more informed of these risks? What discussions have taken place with industry to address information and formulation?

[Lord Markham (Con)]

To take the second question first, the industry has worked with a lot of comments on reformulation across the board—for younger children and older ones. Noble Lords will remember me saying that foods such as Mars, Galaxy, Bounty and Snickers bars have all been reformulated, as have Mr Kipling’s “exceedingly good” cakes. Clearly, we need to look across the board at it all. I know that the industry is working in the area of young people. I am happy to follow that up in writing with the precise details.

[The Earl of Effingham (Con)]

My Lords, in yesterday’s QSD on ultra-processed foods, the Minister spoke of how he had recently made a sound choice due to calorie labelling. What will the Government do to help and encourage SMEs with fewer than 250 employees to show calorie labelling on food and drinks that are not pre-packed?

[Lord Markham (Con)]

My noble friend makes a good point. I gave an example of where it had affected my own behaviour. I am sure we all have examples of when we have looked at the menu and thought, “Oh, do I really want that choice? Is it worth the extra calories?”. We want to get it proportionate, so while we want to encourage as many companies as possible to take it up, we appreciate that for small companies it is quite a bit harder. We are working with them to introduce it voluntarily if they can.