PPE Expenditure

Lord Markham Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Harris of Haringey]

To ask His Majesty’s Government what is their latest estimate of expenditure incurred in purchasing faulty personal protective equipment (PPE) during the COVID-19 pandemic; how much had been recovered by 31 December 2022; and how much they forecast to recover by 31 December 2023.

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

The department’s Annual Report and Accounts 2020-21 confirm that 817 million items of PPE worth £673 million were not fit for any use. By December 2022, the department had reduced the number of contested PPE contracts from 176 to 60, with an associated recovery of value for the taxpayer of around £1 billion. Given commercial sensitivities, we cannot comment on our forecast for further recovery.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the Minister for that reply, but when I look at the National Audit Office report it produces some slightly different figures from those that he has given. It says that his department had identified 3.6 billion PPE items that were not suitable for use, at a cost of £2.9 billion. The point I want the Minister to comment on is that 53% of those suppliers who came through the VIP route provided materials which were not fit for use. Does that raise any questions about the procurement processes operated during the pandemic?

[Lord Markham (Con)]

I thank the noble Lord. Given the recent press, I want to start by setting out the position of Cignpost, the private sector Covid testing company in which, as many noble Lords will be aware, I own a stake. To be clear, Cignpost did not bid for any government PPE contracts and has only private sector clients. None the less, upon taking up the role as an unpaid Minister of Health, I resigned my directorships, made an undertaking to sell my stake, and in conjunction with the Permanent Secretary, ensured that I was not engaged in any areas where there could be perceived to be a conflict—I just wanted to make that clear.

Turning to the question, I was giving the most up-to-date figures. The £1 billion reflects the money that we have continued to recover. Right now, the only amount that has been written off is the £600-odd million that I have mentioned, and we are continuing to pursue the other amounts. When we close the accounts, we will have an update on where that will go. On the VIP lane, I think we accept that, given our time again, we would conduct that in a different way. I will check but I do not recognise those figures as to the level of faults.

[Lord Allan of Hallam (LD)]

My Lords, as well as the financial cost of failures in the PPE procurement process, does the Minister agree that it is important to remember the human cost paid by care workers who became ill when looking after vulnerable and elderly people without adequate PPE? Does he understand how frustrated care workers must now feel to see this level of wastage when their services are crying out for more investment? We could buy a lot of care packages for “£600-odd million”.

[Lord Markham (Con)]

In the circumstances at the time, I think we were all worried that we were going to run out of PPE. If the noble Lord remembers, it was the Wild West out there in terms of trying to purchase it, with planes gazumped literally on the runway and flying to other countries. That is why we stepped in. We bought to a worst-case projection, because we knew we could not afford for PPE to run out in our social care homes or our hospitals. We ended up buying 20% too much as a result, and that is what we are dealing with now. However, only 3% of everything that we bought ended up being faulty, which I think people will agree was a pretty good result.

[Lord Forsyth of Drumlean (Con)]

My Lords, will the Minister indicate how much we are paying for storage of PPE? Are the press reports that we paying for the storage of PPE on a substantial scale in China correct?

[Lord Markham (Con)]

Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.

[Baroness Finlay of Llandaff (CB)]

How many health and social care staff are now off long-term sick with long Covid? What correlation has there been between long Covid and their perception that they did not have adequate PPE for the job to be done?

[Lord Markham (Con)]

I will write to the noble Baroness with the statistics. I can be clear that the endeavours undertaken to buy the PPE were to make sure that we did not run out. Again, there is quite a bit of hindsight going on in saying, “Ah, we bought too much of it”, when at the time everyone was scrambling to say, “You need to buy more.” That was the result of the situation, and to try to apply hindsight now is quite wrong. They did a pretty good job regarding the amount that they bought; they got 97% of it right, which I think we would agree is a pretty good result.

[Lord Whitty (Lab)]

My Lords, the reference to hindsight is misplaced. The Minister accurately described the shambles and panic that happened at the beginning of the pandemic, but there had been several reports in the 10 years before it that indicated that one measure the Government could take for any pandemic was to have standby contracts whereby there were arrangements with companies to provide PPE and laboratory facilities. That was recommended by, among others, your Lordships’ own Science and Technology Committee. Do such contracts now exist so that, were another virus to hit us, we should not go through the same shambles and corruption that we did on that occasion?

[Lord Markham (Con)]

Absolutely. As ever, we want to learn the lessons. That is why we have set up the Covid inquiry. Yes, supply arrangements are in place. At the same time, as per the answer to the previous question, holding high levels of stock does not make sense. It is cheaper in this case to dispose of it while making sure that the supply lines are in place so that we can rapidly respond to any future event.

[Baroness Walmsley (LD)]

My Lords, I understand from the Minister that it is the department that paid the cost of this useless material, and for its storage. How many doctors, nurses and ambulance staff could be given a decent pay rise if that money had been given to the NHS?

[Lord Markham (Con)]

Again, I would take issue with the words “useless material”. It was bought based on a projection of how the pandemic could progress and what would be required. The fact that it did not progress that far was thanks a lot to the work we did in being the quickest country to vaccinate in the world. So, we did not need that level of PPE; that was a good thing. We bought for a worst-case scenario and, thank goodness, we did not require it because of the action we took to get on top of it all. Now, we are dealing with the surpluses bought for that worst-case scenario and quickly disposing of them.

[Baroness McIntosh of Pickering (Con)]

My Lords, can my noble friend tell us the amount of this stuff in UK warehouses, and how much that costs daily?

[Lord Markham (Con)]

As I mentioned before, the daily cost is roughly £700,000.

[Baroness Merron (Lab)]

My Lords, the National Audit Office found that during the pandemic one in 10 suppliers processed through the VIP lane were awarded contracts. This compared to less than one in 100 suppliers going through the ordinary lane. In view of this, could the Minister share with the House what particular qualities were required of suppliers to merit VIP status? Following up on his answer to my noble friend Lord Harris, in the event of a future emergency, was the Minister ruling out having a VIP lane?

[Lord Markham (Con)]

I think we all agree that, at the time, some mechanism was needed to sift the thousands upon thousands of offers of goodwill to help with PPE. A decision was made to take recommendations —the so-called VIP lane—and I think we all accept now that was not the right decision. Going forward, a different sifting mechanism would be set up in place of that. Now, of course, we have supply chains set up to do this, so we hope that occasion will not arise in future.

[Lord Lexden (Con)]

My Lords, my noble friend was right, was he not, to remind us of the context in which those decisions were taken three years ago? There was an overwhelming sense of crisis, to which the Government had to respond with extreme rapidity.

[Lord Markham (Con)]

Absolutely. I remember well, as I am sure do others, watching the news about planes being diverted to other countries and it being asked how come they were not coming to the UK and what the department was doing to get on top of it. I am sure there was criticism from this House—it was before my time—asking what we were doing as a Government to get a grip of it. Well, we did get a grip of it; we did buy the PPE and it did not run out. Yes, we ended up buying too much of it because, thankfully, the pandemic did not turn out to be as bad as we thought it would. I think we did a sensible thing at the time, and now we are going after all those people who did not keep to their supply agreements, and we are recovering the funds. By and large, with the benefit of hindsight, I think we did a fairly decent job—not perfect but pretty good.

[Lord Patel (CB)]

How long will we continue paying £700,000 a day to the Chinese?

[Lord Markham (Con)]

As I said, less than 1% of the stock is being held by the Chinese. Most of the money being spent on storage costs is in the UK. Notwithstanding that, we clearly want to get rid of it as quickly as possible. As soon as I came in, I said, “Let’s bite the bullet, write it off, get on with it and dispose of it.” That is absolutely what we are doing. We are accelerating that to the maximum extent. Those accelerations have already saved £200 million this year.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Lord Markham Excerpts

Wednesday 25th January 2023 Lords Chamber

Moved by

[Lord Markham]

That the draft Regulations laid before the House on 15 December 2022 be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

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

My Lords, to make sure that all noble Lords have the right version of this SI, I draw attention to the correction slip amending two points:

“Page 3, regulation 5(3)(a): omit ‘annual’; and Page 22 … paragraph 63(a): ‘…paragraph (b);’ should read ‘…paragraph (a);’.”


These regulations are intended to transfer the statutory functions of the Health and Social Care Information Centre, which operates as NHS Digital, to NHS England, and to abolish NHS Digital. This will create a central authority responsible for all elements of digital technology, data and transformation for the NHS, which was a key recommendation of the review by Laura Wade-Gery into how we can improve the digital transformation of the NHS. The recommendations were accepted by the Government in November 2021; we announced that we would merge NHS Digital into NHS England as soon as legislation allowed.

I know that noble Lords had concerns about this transfer during the passage of the Health and Care Bill last year, which we have sought to address. I will also seek to address the points raised by the report of the Secondary Legislation Scrutiny Committee, which are echoed in the regret amendment tabled by the noble Lord, Lord Hunt.

First, I reassure this House that the transfer will not weaken the existing protections of people’s data and that the protection of data remains a priority for NHS England, which at senior levels takes these new responsibilities very seriously. All statutory functions of NHS Digital relating to the protection of data are being transferred, including the rules and safeguards required by law. This has been a guiding principle. NHS England will be subject to the same rules on collecting and disseminating data as are applied to NHS Digital.

NHS England can establish an information system only when directed by the Secretary of State or in response to a request from another body. All directions and requests that NHS England complies with must be published, so there is full transparency on what is being collected and for what purposes, and a clear upfront control. It cannot exceed the requirements of the direction or request. It must also publish its procedures for receiving and considering requests to establish information systems and for requests to access data. NHS England will report annually on how effectively it has discharged its transferred data functions, seeking independent advice to inform this report and consulting with the National Data Guardian for their views.

Concerns were raised during the passage of the Bill that we would lose the excellent practice that NHS Digital has followed in protecting people’s data and the crucial separation between those responsible for collecting and de-identifying data and those in NHS England analysing it. We therefore committed to place further requirements on NHS England, alongside the transfer of statutory functions, to ensure it would be a safe haven for data via statutory guidance. This is a new requirement.

This statutory guidance sets out measures that we expect NHS England to protect confidential information. There was some disquiet that the guidance did not seem to go far enough and that we had not added new duties to the regulations. This was not considered necessary; this is a straightforward transfer of functions under a legal framework which goes back to 2012 and has stood the test of time. That framework includes duties under the 2012 Act to have regard to various matters such as the need to respect people and promote the privacy of service users.

Additionally, we will issue statutory guidance, and I will come on to its contents in a moment. NHS England must have regard to this guidance; that means that it would have to demonstrate that it had justification for any decision not to follow it. Case law has shown that clear and cogent reasons would be needed to depart from guidance which is subject to a statutory duty to have regard. However, we have added strength here, as there is also a new power of direction, introduced in the Health and Care Act 2022, which could be used in cases of non-compliance with the guidance—namely, in Section 13ZC of the NHS Act 2006. Together, these mechanisms create a strong, binding commitment on NHS England to maintain the highest levels of data protection and safeguards.

NHSE is a long-established public authority which is experienced in processing personal data, including that of patients and employees. It does so in accordance with a robust legal framework which includes UK GPDR and the Data Protection Act. The lawful and proper treatment of personal data by NHS England is extremely important to maintain the confidence of service users and employees, and NHS England is well versed in processing personal data lawfully and correctly. It is aware of the importance of seeking independent advice and will be able to do so where necessary, including on the recommendation of staff transferring from NHS Digital. NHS England will also be able to approach the Information Commissioner’s Office as the independent regulatory body if it needs an independent view on particular matters.

I also reassure noble Lords that this statutory guidance covers all confidential information as defined in Section 263(2) of the 2012 Act. Therefore, it covers all data identifying an individual and all data identifying an individual which is subsequently identified or pseudonymised where an organisation, including NHS England, holds both the de-identified data and other data which would enable reidentification.

The guidance requires NHS England to obtain independent expert advice on its data access processes and procedures and, where appropriate, on individual decisions around data access. This will enable these experts to provide advice and assurance for both external and internal requests for access to data for purposes other than direct care. NHS England will be required to secure this independent advice or have a very good reason for not doing so. It is not optional or a case of doing so only when convenient.

Central to this should be a data advisory group, comprising appropriate experts and lay members, including one or more members with expertise in social care. This last point is not currently spelled out by the draft guidance, which we will amend. It would be appropriate for some internal representation to support this group to add expert knowledge and insight, such as the organisation’s Caldicott Guardian and data protection officer. However, the majority of members should be independent advisers. Minutes of the data advisory group meetings should also be published.

I know that some noble Lords have been concerned that NHS England will receive data which is still identifiable and which NHS Digital would previously have de-identified before sharing. The statutory guidance requires that the organisation will de-identify data before its internal analysis and use—the same role which NHS Digital undertook previously will be done internally, by a team separate from those who need to use the data. It explicitly states that responsibilities and accountabilities for using the data should be organisationally separate from the functions providing assurance and advice on this, such as information governance and Caldicott Guardian functions, to ensure that there are no conflicts of interest.

NHS England must ensure that there is the right governance for considering internal requests to access data, based on the same principles of risk-based assessment as for external requests for data, and drawing on the same independent scrutiny and advice. Furthermore, the Secretary of State will issue a direction in relation to NHS England’s internal use of data, which will be published. This will make clear the legal responsibility for NHS England to de-identify data before analysis, so that an individual cannot be directly identified either from the data to be accessed or analysed from the results of the analysis carried out. The guidance also calls for NHS England to develop a register of internal data uses mirroring that which currently exists for external data uses.

In response to the concerns of the Secondary Legislation Scrutiny Committee, although we are moving at pace, we are doing so because we are keen to see the benefits of creating a single statutory body responsible for data and digital technology for the NHS delivered quickly. The statutory guidance has been neither rushed nor piecemeal in development. The guidance has been in development for a number of months; a version was shared with some noble Lords and stakeholders before Christmas, and we have been discussing it with stakeholders—including the National Data Guardian, the Information Commissioner’s Office, NHS Digital and NHS England—revising it to reflect their comments and strengthening the requirements on internal use of data, which was a predominant concern.

We have now published the second draft, which we have drawn to the attention of noble Lords. This was also shared with the Secondary Legislation Scrutiny Committee and the British Medical Association and other professional organisations, to seek their feedback. I am sorry that we did not share the guidance before with the BMA.

--- Later in debate ---

I have one last question: after the regulation moves the powers to NHS England, will the new arrangements allow a patient to log into the NHS app and see whether data about them has been accessed? There are, as I am sure the Minister has heard, many questions. I hope that he and his team will take them in the spirit in which they are intended, because this debate and the contributions today are all about getting it right for the NHS and for patients.

[Lord Markham (Con)]

I thank noble Lords for their contributions and agree that we are all trying to achieve the same thing: to ensure the digital benefits come from this system and maybe—who knows?—create a UTOPIA, but also, vitally, maintain confidence. I take all these comments in the helpful spirit in which they are intended, and I hope that noble Lords will like my replies. At the same time, anything that I do not properly cover now—I suspect there will be some things I am not able to cover—I will, as ever, follow up on in detail in writing. Such is the importance of this that I am happy to meet again as well. The various meetings that we have had have been very productive, so I will make sure that those written answers come out quickly. I invite noble Lords to please come back if they feel there are some bits that still need further clarification. I will definitely set that up quickly and ensure that the officials are there as well. I have had various bits of feedback from the officials—I have tried to be engaged all the way through this. As the noble Baroness, Lady Merron, said, we have tried to get this right. I accept that we have not always done it perfectly, but I hope noble Lords can see that the good will is there.

On the specific questions asked by the noble Lord, Lord Hunt, I agree not only to publish the review but, happily, to brief Parliament on that. On the idea of including the LGA in the composition, I am very happy to do that. Regarding the points made by the noble Baroness, Lady Brinton, on the ability to use Palantir outside of the agreed research, the intent is absolutely that it can be used only for the agreed purposes and it cannot be used or sold elsewhere without suitable agreement. Again, the annual report will address how well it is working in practice.

I hope that the merger will not be like the PHE closure. I think they have been working on the new timing, in terms of February, since October, when it was announced, and have been working with the staff on that timing. I know that the plans that I have seen have taken into account the ability or need to retain people, which is obviously crucial to this, as we know that you need additional skills in this space and the importance of retaining them.

On the questions asked by the noble Baroness, Lady Finlay, my understanding regarding Wales—and I will make sure that this is followed up properly in writing—is that it has consented to the transfer arrangements in this. Generally, NHS England will continue to play the same role it has currently; that has been agreed. I entirely take and accept her point about the hacking risk, that the more attractive you make the data pool, for want of a better word, obviously the more essential it is to make sure that security and protections are in place.

As ever, I enjoyed the points made by the noble Lord, Lord Allan. He was talking about UTOPIA. He mentioned the geeks, and I am sure he is aware that that word came out of the Second World War, when they were looking for general engineering and electrical knowledge in their recruitment of soldiers, so that is one for him. Going forward, those extra forms of transparency and the quadruple lock all sound very sensible to me. I had a quick note from my team, saying that they also thought that it sounded sensible. Again, I think that we will probably need to put some detail around that, but I thank the noble Lord for those suggestions. Let us try to make sure that we work with those.

I absolutely take all the points made by the noble Baroness, Lady Merron, again, in the spirit in which they are intended. I do not think that I have a good answer to the “marking their own homework” point, to be fair. I hope that the noble Baroness knows me well enough to know that I will never try to argue that black is white from where we are. I think that is, quite rightly, the concern that all noble Lords have raised tonight, and it is obviously these protections, such as the quadruple lock and the other things that we need to put in place, that we need to make sure are there.

On the kind of things mentioned, the advice and the minutes from the meetings and the advice given by the independent groups—absolutely. I spent a bit of time today on how we would involve the ICSs, and my understanding—again, I freely admit my understanding is probably at GCSE level right now, so I need to do a bit more work on this—is that a lot of this is around the data standards that the ICSs are starting to deploy to make sure that the formatting of the data is correct so that everything can be kept in this common data warehouse. That is something that they are working on already, in terms of establishing those standards. A number of trusts have worked towards that, accepting that it cannot be completely finalised until we know who is going to win the tender for it.

National Health Service (Primary Dental Services) (Amendment) Regulations 2022

Lord Markham Excerpts

Tuesday 24th January 2023 Lords Chamber

I hope that the Minister can address all these points, because I am afraid that NHS dentistry in this country is going in the wrong direction. We need to see it provided so that people can be assured of their health in all ways.

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

My Lords, I start by declaring an interest: as I have mentioned before, my wife is a dentist, and so interested in this. She has been able to join us here, as part of a celebration for my father’s 80th birthday. Who knows why they would want to come and listen to me on such a night?

I thank the noble Lord, Lord Hunt, for securing the debate on this important matter and thank noble Lords for their contributions. We all agree that dentistry is a vitally important area. On the points made by the noble Baroness, Lady Bennett, I agree that health and oral health are indivisible. This is a key part of levelling up. I agree with the premise that these SIs are a start, not a finish—a point made by the noble Lord Allan.

I will try to address the points made by the noble Baroness, Lady Merron, about the defects of the SI. I am not defending some of the other things but I would like to think that this regret Motion and the one that we had the other day are more about having a debate because we think that we can do better, rather than disagreeing with the SIs themselves. If that is the case, I agree that they are the start and not the finish; there is definitely more that we want and need to do in this space. These regulations are a sensible first move. Some changes have been mentioned already tonight but the UDA changes—to put the minimum value in place and ensure that it more fairly reflects the complexities of some of the treatments—are steps that we worked with the BDA on. I think we would all agree that they are sensible steps.

I have also heard various variants on some dentists, for want of a better word, gaming NHS contracts. I have definitely seen some of that behaviour. I will need to take away some details on the points that the noble Lord, Lord Hunt, made about pension qualifications, but we generally recognise that that is going on. At the same time, the provisions within the SI to give more support, 110% or even more, to those who are properly contributing to the system are welcome. I hope that that would be generally agreed.

I hope that we would all agree that the other measures, such as using teams to get a better skill mix and DCPs to do more of that work, are sensible. I agree that we need to reduce those obstacles. I did not realise that we had the Tim Berners-Lee of the dentist directory among us today, but I hope that we would all agree that moves on dentistry website information are sensible, modest though they are. I know that water fluoridation is a great favourite of the noble Lord, Lord Hunt. We are making moves on it. On the changes we were discussing the other day on GDC international recruitment, the mutual recognition of qualifications is a good first step and should definitely be a way forward in easing access. There clearly has to be a better way forward on intelligent use of recalls, rather than those people who are already lucky enough to be with an NHS dentist automatically getting a six-monthly reminder. We all know that, in many cases, those appointments could be better used elsewhere.

As mentioned, we all agree that these measures are just the start and definitely not the finish. The steps we need to introduce have to centre around supply and workforce. On when the workforce strategy will be published, fairly advanced drafts are being circulated, as I mentioned the other day. A lot of work has been and is being done in that space. While I cannot give a precise date, I think it will be in the not-too-distant future—let me put it that way. We recognise that more needs to be done on it. As the House has heard me say before, a lot of that is around the flexibility between qualifications and having much more of a modular, escalator-type approach. For instance, it surely makes sense for a dentist to be qualified as a nurse along the way, two years in, and then to be able to start work in the dentistry profession and hone their skills, rather than supplementing their income down at Wetherspoon’s as they finish the rest of the course. I think we all agree that those have to be sensible measures, and I know this is very much the direction of travel being worked on.

The critical element is dental deserts. We all know this is the nut that we have to crack. When I have conversations with colleagues normally, having a bit of knowledge can sometimes be a dangerous thing. In this instance, I try to describe it. I ask them to think about a situation where we want a dentist who has probably been there for about 10 years and is in their mid-30s. We might say, “We would now like you to set up your own practice.” The dentist says, “Great, I’d like that. I’m up for that.” We say, “And in an NHS dental desert, because that’s where we need it.” The dentist says, “That’s good, I really want that. What do I have to do?” We say, “Well, raise 400 grand to set up a practice; set up payroll so you can employ six to eight people; start marketing yourselves; fit it all out, get the chairs, and off you go.” They say, “Hang on a moment, I’m a dentist. I’m good at being a dentist. I’ve done it for 10 years, and I think that qualifies me. I’m not in a position to go out there and set up a dental practice like that.” So, I think there is recognition that, if we are really going to move the dial in that area, we have to give them far more help and support: the know-how, some of the funding, the whole package. Clearly, if you are going to get that support, you need to be committed to doing it in that area, but that is the kind of direction of travel that I know colleagues are working on. So while I portray a personal view in terms of my feelings towards it, I know that is very much recognised by colleagues in the House.

Respiratory Syncytial Virus

Lord Markham Excerpts

Thursday 19th January 2023 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government whether they have plans to introduce PCR testing and an annual vaccination programme for young infants, children and older adults in relation to seasonal Respiratory Syncytial Virus (RSV).

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

PCRs test are already in use to diagnose RSV and monitor its prevalence. Current RSV immunisation is targeted at infants at high risk of severe complications. New immunisation products, including vaccines, have been developed and are being reviewed by the Joint Committee on Vaccination and Immunisation, JCVI, which will potentially provide advice later this year. His Majesty’s Government will decide on future vaccination programmes once they have received that advice.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as the Minister will know, RSV-related hospitalisations in the under-fives cost £48.2 million in the UK annually. At a time when the NHS is facing increasing pressures, both financially and through capacity, will the Minister clarify how the Government plan to reduce the infant burden associated with it to ensure that the NHS does not experience the same situation next season? If there are plans, will they publish them? If there are no plans, why not?

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[Lord Markham (Con)]

I thank the noble Baroness for her question. I am pleased to say that there are promising new vaccinations. The current vaccination unfortunately requires monthly injections, which is why it is not very effective, and costs £2,000, so it is not an effective way ahead. A new injection, nirsevimab, has just been licensed which is showing in tests to be 75% to 80% effective and immunises people for six months, so we are hopeful that it is the way ahead. The JCVI is currently conducting a study on it, and we are hoping its recommendations will suggest a good way forward.

[Lord Patel (CB)]

My Lords, two days ago Moderna from the United States announced that it had used messenger RNA technology to develop a vaccine for RSV. The report was of a late-stage trial and the vaccine has an efficacy of 84% for adults. There are similar results from both GSK and Pfizer, with an efficacy of 66%, but we already have antibody prevention treatment developed by AstraZeneca and Sanofi for prevention of RSV in children and young infants. That has been approved by the European Medicines Agency, and the Moderna vaccine is seeking FDA approval. Why does none of these have market authorisation in the United Kingdom?

[Lord Markham (Con)]

I can report best on nirsevimab, which has just been licensed, is shown to be 75% to 80% effective in the trials and has the approach of immunising people for six months. I am aware of Pfizer developing a maternal vaccination for whooping cough, which will give the baby immunisation through the mother. The House will also be aware of the recent announcement we made with Moderna on the investment in new R&D facilities here, so that we are at the forefront. I hope the noble Lord can see that we are looking at all these new innovations and will roll them out.

[Baroness Buscombe (Con)]

My Lords, have we not learned some lessons, from Covid and long Covid, of the need for children, babies and all of us to build our immune systems? Long Covid is proving that we have a real problem. I caught this virus from my granddaughter, a baby. I am told that the more she catches these wretched things now, the healthier she will be and the better she will be at putting off some serious diseases later in life. While accepting that high-risk babies obviously need particular regard, is it not right that we should be mindful of continually looking for a vaccine every time a new virus is discovered?

[Lord Markham (Con)]

My noble friend is correct in that, for the vast majority of people—infants in this case—it is mild, flu-like symptoms at most. At the same time, it is responsible for 35,000 hospitalisations and 20 to 30 deaths a year, so it is a serious thing that we need to get on top of. We are looking for the best of both worlds. That 90% of two year-olds will have had RSV and so will have that natural protection is a good thing. But in the most serious cases—the risk groups are those with congenital lung or heart disease or spinal muscular problems—these new treatments really will help and are very important.

[Baroness Walmsley (LD)]

My Lords, the innovative vaccines and treatments mentioned by the noble Lord, Lord Patel, all require UK clinical trials. The number of clinical trials initiated in the UK declined by 4% between 2017 and 2021. What are the Government doing to reverse this decline so as to bring valuable industry money back into the NHS and cutting-edge treatments, such as RSV vaccines and treatments, to patients?

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

[Baroness Wheeler (Lab)]

My Lords, we know that older adults are at greater risk of serious complications from RSV infections in children, because our immune systems weaken as we get older, which can lead to exacerbations of underlying lung and cardiac disease. What action is being taken to address the serious underestimation of older adult RSV infections and to improve testing, reporting and treatment for this key group?

[Lord Markham (Con)]

I thank the noble Baroness. The key risk groups in the elderly as well are, as I mentioned earlier, those with congenital lung or heart disease or spinal muscular atrophy. The problem is that the current vaccination needs monthly immunisation to be effective, and I think most people will agree that it can be used in only the most severe cases because it is not a very practical way forward and is very expensive. That is why I am really excited by the new treatments, particularly nirsevimab, which is 75% to 80% effective, versus palivizumab, which is more around 50%. I think we have a good way forward.

[Baroness Wyld (Con)]

My Lords, has the Department of Health done any assessment of how many children may have missed their routine vaccinations during the pandemic lockdown? Is the department doing anything to follow up with these children? If so, can the Minister say what?

[Lord Markham (Con)]

I know that this, like all those areas that were unfortunately missed out during the pandemic, is something the department is working on. There are catch-up activities. I have seen it personally with my four year-old, who of course was two and three during this time. I will happily provide the detail in writing.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that it is wise for the UK to maintain a good level of baseline PCR testing so that we can ramp it up when confronted with novel viruses such as Covid-19? In that respect, does he agree that it is important to consider this resiliency benefit when looking at the business case for PCR testing for other viruses, such as RSV?

[Lord Markham (Con)]

Yes. I should probably declare an interest, having set up a PCR business—in the private sector, I might add. I know at first hand from that how versatile these PCR machines are. They can be used to diagnose all these sorts of treatments, so we absolutely have to make sure we keep that strategic capacity alive.

[Lord Turnberg (Lab)]

My Lords, we were obviously ill prepared for the Covid outbreak. How prepared does the Minister think we are now for track and trace and delivery of PCR tests? What resources do we have in place to cover that?

[Lord Markham (Con)]

We have the PCR capacity in place. Clearly, as responsible Ministers spending-wise, we are ramping some of that down because we do not need the sort of capacity we had before. From personal knowledge, I can promise that there are a lot of these PCR machines knocking around, so that capacity really is there. There was a Question a few days ago about how prepared we are for the next epidemic. Clearly, we will get the findings of the Covid inquiry, but the whole purpose of setting up the UKHSA was to make sure we have the proper preparations around for next time.

Osteoporosis: Early Detection

Lord Markham Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare my interest as co-chairman of the APPG on Osteoporosis and Bone Health.

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

The Government are committed to improving outcomes for those living with osteoporosis. NHS England, through its Getting It Right First Time programme, is exploring how best to support integrated care systems in the detection and management of osteoporosis. This includes a focus on improving provision of and equity of access to high-quality secondary fracture prevention services, such as fracture liaison services that help to identify those most at risk and offer preventive support.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis affects half of women and a fifth of men over the age of 50, but all too frequently its late diagnosis means broken bones, pain, reduced independence and, sometimes, life-changing disability. Yet there is no excuse for that, because we have it in our power to identify those most at risk. Is my noble friend aware that almost two-thirds of people with one of three major risk factors have never received a bone health assessment, while a simple and cheap assessment tool proven to prevent hip fractures can be used in five minutes in a GP’s surgery? As the costs of helping people recover from fractures are far higher than the costs of identifying and treating those at risk, should the National Screening Committee not urgently reconsider the case for a targeted national screening programme, so that as a country we invest just millions of pounds in preventing harm rather than billions in managing failure?

[Lord Markham (Con)]

I agree with my noble friend that prevention is always better than cure. The beauty of these processes is that I get to swot up, and I learned that the second largest bed-intake cause is actually a fractured femur from osteoporosis, so he is correct. We have a target that 95% of patients will get a check within six weeks by March 2025. It is good that musculoskeletal services are now part of the national improvement programme, but we clearly need to make sure we are on top of that.

[Lord Rennard (LD)]

My Lords, a year ago the Minister’s predecessor said to the House that he hoped NHS England would ensure that effective fracture services were universal. However, unlike in Scotland and Wales, that is not the case in England. Is not part of the problem with healthcare in this country that the Government struggle to resource treatment and pay for those who provide it while failing to invest in prevention and public health initiatives? What action are they taking to ensure that osteoporosis is given sufficient priority by recognising that it needs to be considered in parity with other long-term conditions?

[Lord Markham (Con)]

The noble Lord refers to the fracture liaison services. It is the responsibility of all ICBs to roll out those services or their equivalent. Regarding the numbers that he cited, I should say that 51% of ICBs have a fracture liaison service in that shape or form and the others have different versions of it, and they are all responsible for rolling those out. At the same time, they are also responsible for musculoskeletal services, to make sure that we have nationwide provision for it.

[Baroness Blackstone (Lab)]

My Lords, the Minister said that prevention is better than cure. That is obviously the case, yet we have severely failed to prevent the horrible development of this crippling disease, which mainly affects women, as has been said. He has talked about a 95% target. What is he going to do, as the Minister with some responsibility in this area, to ensure that the target is met, given the failures in the past? Will he find a way of reporting back to the House on progress in reaching that target?

[Lord Markham (Con)]

One of the many things for which I am responsible is NHS performance, as I think the House is aware, and these are exactly the sorts of issues that I am interested in, so I am happy to undertake to give an update on that. We all know that effective spend, which we need to make sure is always put to best use, involves identifying where these problems are, and 3 million people are affected every year. As I said earlier, a fractured femur is the second biggest reason for intake into hospitals, in terms of beds. That is something that I am happy to be measured by and report back on.

[Lord Lexden (Con)]

My Lords, following on from the question from the noble Lord, Lord Rennard, is it not the case that, while the Government accept that everyone over 50 should have equal access to fracture liaison services, insufficient progress is being made towards that crucial goal? Is there not a case for the appointment of a strong and determined national specialist adviser on osteoporosis to speed things up?

[Lord Markham (Con)]

As I mentioned earlier, this is the responsibility of all the ICBs. Part of my job is making sure that we as Ministers now regularly communicate with all the ICBs. There are a number of boards that I regularly speak to, check in with and visit on a frequent basis, and one of our checkpoints is making sure that they are on top of services such as these. I am delighted to say that every ICB has now set up a community base fall service, to make sure that if someone should fall in a case such as these, rather than an ambulance and two paramedics, we can have someone specially set up to right these people, put them on their feet and avoid an A&E visit.

[Baroness Merron (Lab)]

My Lords, the UK primary care base trial on screening for osteoporosis in older people examined a systematic approach to identifying older women for fracture prevention, leading to a 28% reduction in hip fracture risk, significantly reducing costs and seeing increased adherence to treatment. What plans are there to extend and learn from this important study?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to my attention. Clearly a 28% reduction is impressive and something that we should take seriously. If she can give me the reference, I will definitely take it up and write back.

[Lord Sandhurst (Con)]

My Lords, is not exercise when growing as an adolescent, particularly impact exercise, important for stimulating bone growth? Should more not be done to encourage impact exercise among children and teenagers, particularly among girls, who do not always want this—in other words, running, jumping on the spot and so on?

[Lord Markham (Con)]

As a player of rugby, which probably has far too many impacts, I agree with the sentiment that exercise is always a good thing, whatever stage of life one is at. Also, we all know that vitamin D is a vital part of helping against bone weaknesses. Things as simple as spending more time in the sun in summer or taking vitamin D supplements in the winter are vital prevention methods. I agree about exercise, but all these measures should be rewarded and promoted.

[Lord Turnberg (Lab)]

I am sorry to correct the Minister but vitamin D does not affect osteoporosis. It is helpful for osteomalacia, the softening of the bones due to vitamin D deficiency, but not very useful for osteoporosis. Exercise is valuable, and at any age it is the only thing that prevents osteoporosis. There are treatments available for osteoporosis but they are not very nice—they involve injections—and are quite expensive. Exercise is the thing.

[Lord Markham (Con)]

I thank the noble Lord. As I say, part of the beauty of this job is being educated. I will take that back to my officials and query them on my briefing.

[Baroness Watkins of Tavistock (CB)]

My Lords, could the Minister comment on whether the department of health is working with the department of energy to ensure that we can afford to heat our swimming pools? Swimming is a really good exercise and reduces the risk of falls, particularly in older people.

[Lord Markham (Con)]

As previously mentioned, prevention is always better. Exercise, as I have learned from my noble friend Lord Sandhurst, is a good way of preventing osteoporosis. Where we can find cost-effective ways of getting that exercise, such as swimming pools, we should be promoting them.

[Baroness Manzoor (Con)]

My Lords, having identified the causes of osteoporosis, could my noble friend say how the message is being communicated? He mentioned vitamin D, which could be an issue, but the reality is that some vulnerable women in communities do not get some of the messages regarding exercise or indeed have access to those facilities. I know walking and so forth can help, but what are the Government doing to put that preventive message across in a very firm and consistent way?

[Lord Markham (Con)]

My noble friend is correct that education and awareness are always the start point on any of these health issues. It was a key part of the women’s health strategy that came out in 2022. Osteoporosis is a key part of that, and promotion and awareness are a key part if it as well.

Times Health Commission

Lord Markham Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government what assessment they have made of the establishment by the Times of the Times Health Commission on 15 January.

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

My Lords—

[Noble Lords]

Hear, hear!

[Lord Markham (Con)]

I thank noble Lords. It is not quite the same as scoring a hat trick in football, but I will take the Order Paper home with pleasure.

We welcome the Times Health Commission’s contribution on how we can improve health and social care. We are always looking to build on good ideas, knowledge and experience, which this commission offers in bucketloads. I look forward to working with the commission and building on the best ideas.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that quite positive reply but, first, given our long history of political failure to tackle the increasingly serious care and health problems facing the country, will the Government set out in more detail what support they will give to this initiative? Secondly—this is perhaps more difficult for the Minister—will he seek support from his colleagues to enter into discussions with the opposition parties about the way in which we may create a new and entirely separate joint political mechanism whereby the recommendations that come forward from this commission may be amended or revised but in fact, on a joint basis, would then be implemented regardless of the political power held by any of the parties?

[Lord Markham (Con)]

I thank the noble Lord and firmly agree that we should look to implement anything that is a good idea. I know that there are many things we can learn and that I am still to set up the meeting I talked to him about. I apologise that it has taken a while but we have had a few things on. In a word, yes, I will always look to work on a cross-party basis. One thing that I want to bring to Parliament soon is the new hospital programme I am working on, which I believe needs to go on for ever in terms of the way we are going to build new hospitals. It is something I would like to take forward as a cross-party action. Most of the things in this space are not political; they are all about getting good and effective treatment to our population, so I am very happy to work in a collaborative fashion.

[Lord Fowler (CB)]

Should not the Minister go a little further than what he has said? Should not the Government follow the example of the Times and set up a full-scale royal commission, with adequate financial support and powers of investigation, so that it can take through an independent look at the state of the health service today? Surely the Minister will agree that no one can be happy with where we are at the moment.

[Lord Markham (Con)]

No, we are working very intensively. We have some very good minds involved in this. I know from my work with my colleagues that we work hard on developing our own plans, some of which were announced just last week. We are facing a challenge, as we all know, from the setbacks around Covid but we are tackling it. What I am saying is that there is an absolute openness to new ideas, which is why I welcome any ideas that come to the table—but, believe me, we are working on a lot of our own ideas.

[Lord Forsyth of Drumlean (Con)]

My Lords, if the Government or the editor of the Times want to find out what we need to do about social care or look at what has been agreed on an all-party basis, all they have to do is to read the report from the noble Baroness, Lady Andrews, and the Select Committee that was set up by this House, which sets it out clearly—or even the report that was done by the Economic Affairs Committee three years ago, which predicted the mess that we are now in. We do not need journalists doing reports; we need the Government to respond to what Parliament has demanded.

[Lord Markham (Con)]

I think we have responded and are responding. That is very evident in the plans and funding that we have recently put in place and from the work that we are doing, which the House will see far more about as we announce it over the coming weeks and months.

[Lord Allan of Hallam (LD)]

My Lords, when confronted with evidence of problems in our health system, the tendency of government is to play it down or to blame anyone but themselves while, candidly, the instinct of opposition is to say that everything is a catastrophe entirely of the Government’s own making, even when the facts are more complex. Does the Minister agree that it is essential to have the data for us, the Times and others to come to firm conclusions? The critical piece of data that we are still missing is the workforce strategy for health, social care and public health. When are we going to see that data in order to be able to have a better informed debate?

[Lord Markham (Con)]

I agree with the noble Lord that data has to be the basis of any decision-making. I know that early drafts of the workforce strategy have already been formed so he and the House will see that before too long.

[Baroness Butler-Sloss (CB)]

My Lords, the noble Lord, Lord Fowler, suggested a royal commission; the Minister did not respond to that. What is the Government’s view about a royal commission?

[Lord Markham (Con)]

My experience of royal commissions is that they take a couple of years to report. I do not want to wait a couple of years. I want to get on with it now. We have some very good minds in the department working on it, with access to all of this. I am always willing to take on new ideas from new minds but we do not need a two-year report; we need action now.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that, in any investigation of health and social care, the voices of patients and users must be loud and strong? How are the Government going to ensure that this happens?

[Lord Markham (Con)]

Clearly, the patient has to be at the centre of everything. That is what the plan for patients is about. It is also what patient choice is about; we are using other ways to make sure that people can get treatment quickly when they need to. It involves using the independent sector, as pioneered by colleagues in this House, and learning lessons from that so that we can get on top of waiting lists, which we all agree we need to do.

[Baroness Berridge (Con)]

My Lords, on the day when the Joint Committee on the draft Mental Health Bill has published its report, can my noble friend the Minister assure us that, while we hear a lot of talk about health, when the ideas are in the department, mental health and the situation in secure units are taken into account—we have the same problems of delay and discharge in those units—so that mental health is given the parity with physical health it deserves?

[Lord Markham (Con)]

Yes. Unfortunately, one of the results of Covid was our understanding a lot more about the cases of mental health caused by it. We have put more investment into that as a result; it will be key to this issue as well.

[Lord Patel (CB)]

My Lords, the Minister mentioned different reports and said that the Government will be willing to implement good advice. The House of Lords Select Committee on the Long-term Sustainability of the NHS also published a report, with clear recommendations. Will the Government implement some of those recommendations, even now?

[Lord Markham (Con)]

As I mentioned, we are working on and taking good ideas from there. I know that it is one of the inputs being considered in all this.

[Lord Scriven (LD)]

My Lords, the Government do not need a Times Health Commission to know that there are 165,000 social care staff vacancies and a 29% turnover of staff in that sector, while 542,000 people are waiting in the community for an assessment of their social care needs. Short-term funding as a sticking plaster is not going to work, so when are the Government going to bring forward a strategic plan, with funding, for social care?

[Lord Markham (Con)]

As I said, we have already announced big increases in funding, with more than 20% over the next two years. Two years is not the short term. Minister Whately is working very hard on this because we know that the flow in social care is a key element of the whole solution.

[Baroness Wheeler (Lab)]

My Lords, I welcome the Times setting up the commission. So far, it seems to have a clear and coherent view on the scale of the crisis facing the NHS and what needs to be done, which seems to be sadly lacking from the Government. In the light of all the Times research in articles this week on the resuscitation that the NHS needs, the waning faith people have that they will be cared for and the rising billions that levels of ill health are costing the country, does the Minister agree that the Government’s ABCD policy for addressing the crisis needs a complete rethink?

[Lord Markham (Con)]

No, not at all. In fact, the things I have read in the Times are about what we are implementing. The House has heard me talk about virtual wards; I saw an article on how important those are in helping with the step-down care that is needed in some social care. I have seen that in many places already and it is a way forward. It has also talked about the need for AI and robotic surgery; again, I have seen examples of that in different hospitals. The commission is taking a lot of the good ideas that are already in place throughout the health service and, as I want to do, looking at the ways in which we implement that across the board.

United Kingdom: Future Pandemics

Lord Markham Excerpts

Monday 16th January 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the United Kingdom’s readiness for any future pandemics.

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

My Lords, we cannot perfectly predict the characteristics of a new pandemic pathogen, and therefore pandemic preparedness is an area kept under review. The UK has flexible and well-tested pandemic response capabilities. We are continuously enhancing our preparedness using the latest scientific information, lessons learned from exercises and our response to emergencies, including Covid-19. The UK Health Security Agency maintains constant vigilance on emerging infectious disease threats. This includes co-operating globally to detect and counter future pandemics.

[Baroness Merron (Lab)]

My Lords, Dame Kate Bingham, former chair of the UK Vaccine Taskforce, told the health and science committees in the other place that many of the initiatives set up by the taskforce have been dismantled, that key recommendations have not been acted on, and that the clinical research environment has deteriorated. Does the Minister acknowledge the pressing need to go further than the Government’s targeted spend on research and development, and can he say why the Government have been so reluctant to act on the taskforce’s conclusions from the last pandemic?

[Lord Markham (Con)]

Our approach to this has been led by the science. As the House is aware, we set up the UK Health Security Agency precisely to make sure that we have a team of experts in place ready to answer what is needed, in any eventuality. We also set up the 100 Days Mission to make sure that we have the ability to deploy effective diagnostics, therapeutics and vaccines within 100 days, which is pretty good.

[Lord Hannay of Chiswick (CB)]

My Lords, could the Minister report to the House what progress is being made in giving the World Health Organization better access to new virus discoveries, and setting up schemes that will enable the better distribution of vaccines at an earlier stage in any further pandemic?

[Lord Markham (Con)]

We have deployed our sequencing capability to the benefit of the whole world. Some 50% of the variants were discovered on these shores using our capability, and we were the first to announce them to make sure that the whole world could benefit. We have also been leading on vaccine distribution, so we have a good story to tell.

[Lord Robathan (Con)]

Will the Minister reassure the British people that, when the report of the noble and learned Baroness, Lady Hallett, and her excellent commission is finally published, they will have looked carefully at the efficiency and effectiveness of lockdowns and other restrictions that came into place after March 2020? At the moment, they do not appear to be looking at this, but the British people deserve an answer on whether they worked.

[Lord Markham (Con)]

They will absolutely look at the use of lockdowns. The House will see that, even during Covid itself, we evolved our approach significantly, as we learned more about some of the wider consequences. We were far more hesitant in the case of omicron not to lock down, quite rightly, whereas other countries went ahead. That proved that our judgment was correct and we will learn those lessons going forward.

[Lord Allan of Hallam (LD)]

My Lords, for many people, the most effective tools for contact tracing during the pandemic were messaging services such as WhatsApp, as family and friends kept each other informed about test results and infections. But you were often left in the absurd position of someone calling from the official track and trace system about a contact who had let you know about their infection several days earlier—including, sometimes, people who lived in your own home. Can the Minister assure the House that the Government’s plans for future pandemics will look at how best to work with these local, informal, peer-to-peer networks, rather than think that the solution always lies in centralised, expensive systems?

[Lord Markham (Con)]

I agree. There are many examples of where centrally run initiatives did not work so well, test and trace being one. That is what the inquiry is all about. There are many examples of things that worked very well, such as our vaccine preparation and our creating the first test for Covid, through the PCR process. There are many lessons to learn, including from many of these centrally run initiatives.

[The Lord Bishop of Carlisle]

My Lords, can the Minister tell us whether His Majesty’s Government have yet put in place a revised system to purchase PPE during a pandemic?

[Lord Markham (Con)]

PPE is an example of where we all agree that we could have done better, to say the least. At this stage, I should declare an interest in that I set up a Covid testing company—not PPE—which never supplied the Government. I want to be clear about that, so that the House is fully aware of it in terms of my replies, now we are talking about PPE and related areas. Yes, we can learn a lot about PPE. At the same time, we did buy 35 billion items, 97% of which worked very well. It is important that we keep all this in context; we got 97% of things right.

[Noble Lords]

My Lords—

--- Later in debate ---

[Lord Browne of Ladyton (Lab)]

My Lords, I am sure that the Minister is aware that it took repeated FoI requests from an NHS doctor to get the Government in 2021 to reveal that they had carried out Exercise Alice in 2016, which was designed to recognise the challenges should a coronavirus hit our shores. The report, redacted when published, revealed shortages of PPE, no plans for pandemic-related travel restrictions, and a failure to have a working contact-tracing system—all of which we had to improvise when it actually happened. Is the department carrying out similar exercises? Is it producing solutions, not just identifying problems? Will the Government publish these reports, so that the public can see what needs to be done to prepare this country?

[Lord Markham (Con)]

As previously mentioned, there were many things that we did not get right. The whole reason that we set up the UK Health Security Agency was because we were not happy with the response in some areas. That agency was set up with a team of experts to make sure that, learning from those lessons, we are properly prepared for all eventualities next time around. There are lessons to learn but, as the Covid inquiry will show, there were also many things that we did right. It is important that we have that balance.

[Lord Patel (CB)]

My Lords, the Minister is absolutely right that we led the world in sequencing the genomes of Covid-19, particularly identifying the variants worldwide. But since we have now closed down many of our sequencing facilities, how can we surveil internationally, particularly for emerging variants? For example, XBB1.5 is now emerging as the variant causing most of the infection, probably including in England. What is our surveillance mechanism for sequencing?

[Lord Markham (Con)]

Given the detailed nature of the question on sequencing, it probably deserves a detailed response. I will happily write on that. The 100 Days Mission—to deploy effective diagnostics, therapeutics and vaccines within 100 days—is all about having UKHSA ensure that we have a preserved capability to act when we need to.

[Lord Farmer (Con)]

My Lords, in any future global health emergency, legitimate concerns—such as effects on mental health, education, aspects of healthcare, and the psychological side-effects of terrifying people into self-isolation—about measures must not be silenced. They will be extensively aired anyway, in online echo chambers, and amplified, typically with much ignorance of the facts and inadequate nuance. Will the Government ensure that concerns are debated in public and by senior leaders in society and government?

[Lord Markham (Con)]

I agree with my noble friend that some of the lessons learned from all this are around consequences of lockdown that we had not quite imagined. Clearly, the impacts on mental health are impacting us to this day. We need to make sure that we are learning all those lessons, so that we do not walk into situations in the future where we put in lockdowns without fully considering the impact on the whole of society, including the mental health consequences. That is what the inquiry is about.

[Baroness Brinton (LD)]

My Lords, the Minister said in his earlier response that the Government were flexible and well tested, had learned the lessons of the pandemic and were using the experience of response to emergencies. Can he explain why there are over 9,000 patients currently in hospital with Covid, over half of whom have acquired it in hospital? Could he ask the Secretary of State to reinstate the mask mandate in hospital for these very vulnerable patients?

[Lord Markham (Con)]

I know that the use of masks in hospital is being debated as we speak, to make sure that we are prepared for any new eventuality. As we are aware, 9,000 beds being taken up by Covid is a response to our seeing more waves: this is something that we see each time. Thankfully, due to the vaccines and our treatments, the death rate from those waves is very much reduced, but there is still a big impact. The House is aware of the impact that it is having on us all right now: 9,000 is a big number.

Social Care: Integrated Care Systems

Lord Markham Excerpts

Wednesday 11th January 2023 Lords Chamber

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

ICSs need to include social care fully in planning and strategic decision-making. Local authorities are responsible for social care and have a clearly defined role within ICSs. The Health and Care Act 2022 includes local authorities in its minimum membership requirements for ICBs, giving local government a greater voice in NHS decision-making than ever before. In July 2022, we also published guidance on how ICPs and adult social care providers should work together.

[Baroness Wheeler (Lab)]

I thank the Minister for his response but ICBs and ICSs have been fully operational only since last July—less than six months. The Minister is quite right that, when they were being set up, we argued strongly for the need for effective social care representation in both bodies to ensure that health and social care are integrated and fully embedded in both. However, this just is not happening. The ADASS spring survey found 73% of directors reporting that ICS management has had little impact on local investment in adult social care to date; some even said that ICSs were reducing investment. How does this help ICSs play a key role in their respective areas in, for example, tackling the staffing crisis in both services, prioritising adult social care and producing the urgently needed ICP integrated care strategies, which are due in June?

[Lord Markham (Con)]

First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, I believe that six integrated care boards have been selected as national front-runners on innovations that will help move patients from hospital to their home. Can my noble friend the Minister confirm that these are going ahead, give examples and reassure us that they will be properly monitored, with data being collected? I have just realised that I called the Minister “my noble friend” but, due to my new role, all noble Lords are now my noble friends.

[Lord Markham (Con)]

Replying on behalf of all noble friends, let me say that I am particularly pleased to see this scheme go ahead. Just yesterday, Members of the House were talking about whether we should have full-time contracted dom care people because they know their patients best. That is exactly what these front-runner pilots are designed to do: to try out these new ways of working and heavily invest in areas, which you probably cannot justify on a national level until you know that it really works. Leeds, for instance, is developing a transfer of care hub, while the Northern Care Alliance is focusing on dementia. This is all about seeing what works and then, when we know what works, scaling it up very quickly.

[Lord Laming (CB)]

My Lords, I hope the Minister can assure the House that he has had an opportunity to read the Adult Social Care Committee’s report, which was published in December. The report makes it abundantly clear that the NHS will not achieve its objectives—some might even say its survival—unless social care is integrated at every level and includes the voice of unpaid carers. Can the Minister assure the House that these matters will be taken seriously?

[Lord Markham (Con)]

Absolutely. It strikes me—again, I mentioned this yesterday—that less than 10% of the 13,000 so-called blocked beds contain people who will need to be in social care full-time in future. Most of them need short-term support and, once they have it, will be able to go back to living in their home, which is the best place for them to be.

[Lord Allan of Hallam (LD)]

My Lords, as the Minister has recognised, social care provision is largely in the domain of local authorities. The level of local authority representation on integrated care boards is therefore likely to have an impact on how powerful the social care voice is in integrated care system decision-making. Does the Minister have any information to share with the House about local authority representation across the 42 integrated care boards, including whether it goes beyond the statutory minimum, so that we can understand whether it is sufficient and likely to lead to the step change that I think we all want to see?

[Lord Markham (Con)]

It is, as the noble Lord says, a statutory requirement that the local authorities are represented on the ICBs. In the last few months, I and other Ministers have met and had discussions with all the ICBs. Every ICB is asked to put up a few people. I have had the local authority representative there as one of only three or four people in the meeting—that is key to all of this. They have been critical participants. They are very involved, and it is vital that they remain so.

[Lord Touhig (Lab)]

My Lords, the Government are to be congratulated on amending the Health and Care Act to ensure that responsibility for integrated care systems addresses the needs of children and young people under the age of 25. However, children with special educational needs or disabilities have lifelong problems. How will providers ensure that there will be integrated health and social care for disabled children and their families?

[Lord Markham (Con)]

This is the whole point and the way that we are moving; the real decision-makers running their local areas should be the ICBs. They know their areas and the needs of the people—including people with special needs and learning disabilities—more than anyone. It is absolutely their responsibility to understand the needs in their areas and to ensure that they are provided for under the commissions.

[Lord Polak (Con)]

My Lords, unpaid carers throughout the country are, more than often, working 24/7. The Care Act 2014 requires local authorities to deliver this high-quality care, including support for unpaid carers. How confident are my noble friend the Minister and his department that local authorities will undertake carers’ assessments for unpaid carers?

[Lord Markham (Con)]

From my experience I understand that this is a very important part of their remit and role. As we are all aware, the unpaid carer role is vital and historically has probably not been recognised as much as it should have been.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, following on from the question asked by the noble Lord, Lord Laming, what plans has the Minister to encourage ICSs to embed co-production in the design and delivery of adult social care at the local level?

[Lord Markham (Con)]

Each ICB has a slightly different approach to ensuring that it is there and ensuring the kind of co-production with these front-runners that I talked about earlier. It is about trying to see whether there are new and better ways of doing it. Maybe at another time I can talk to the House in more detail about what those six different pilots are doing. It is about taking the comments that I have heard here over the last few weeks about what works and trying to scale them up.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Is the Minister content that the current approach to institutional and professional regulation will foster effective integrated care across institutional boundaries, secondary care, primary care and the broader community?

[Lord Markham (Con)]

Clearly, it is early days. These were set up last summer and we must ensure that they bed in properly and learn. I am confident that that is the right approach, but, as the noble Lord mentioned, we must make sure that regulators in this space ensure that that is the case. It is probably a question for a few months’ time, when we can be sure.

[Baroness Finlay of Llandaff (CB)]

My Lords, according to Hospice UK, of which I am a vice-president, up to half a million people last year had a palliative care phase before they died. In many of those cases, a failure of social care resulted in a breakdown of care in the community and hospital admission. Following on from the question asked by the noble Lord, Lord Touhig, when these patients are seriously ill or disabled children, they need access to respite care during their illness, as well as at the end, with rapidly responsive care. How are the Government monitoring whether the needs of these people are being met and that the timeframe to put in place the social care that they need does not just slip to the point of becoming a meaningless exercise?

[Lord Markham (Con)]

Those monitoring processes are in place, but to give sufficient detail, it is best that I write.

Care Homes: Staffing

Lord Markham Excerpts

Wednesday 11th January 2023 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government how they will ensure that care homes where they block-buy places to assist with hospital discharges are adequately staffed.

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

On Monday, this Government announced an additional £200 million of funding for short-term NHS step-down care packages to help ease the pressure on local hospital beds. ICBs will work closely with local authorities to purchase places in care homes and other settings. Using their knowledge, they will commission appropriate beds where there is sufficient capacity, including workforce capacity, to meet patient needs.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that response, although it seems a bit more knee-jerk than it does a coherent strategy and it poses as many questions as it answers. For example, are the Government planning to pay care homes directly to pay recruited staff or to work through ICBs and local authorities only? What rates are to be paid? Will it be more than care workers currently earn, so as to compete with the retail sector? Given that there are 160,000 vacancies in the care workforce currently, where are those workers to come from, without pulling staff away from an already understaffed NHS?

[Lord Markham (Con)]

Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.

[Lord Bellingham (Con)]

My Lords, is the Minister aware that a lot of homes across Norfolk are complaining that they cannot sponsor more overseas members of staff? At a time when there are not enough locally trained and motivated staff, surely there should be more flexibility for those quality homes that want to sponsor more overseas members of staff.

[Lord Markham (Con)]

Yes, this is absolutely something that we talk to our Home Office colleagues about all the time. I believe that 15,000 people have already come through on this route in the last nine months or so; we are seeing a rate of about 1,500 a month. It is very important and something on which we are focused.

[Lord Watts (Lab)]

My Lords, rather than bringing in people from abroad, would it not be more effective to pay our own people proper wages with proper conditions, so that they want to work in this sector?

--- Later in debate ---

[Lord Markham (Con)]

We absolutely need both. For years, ever since the NHS was founded, we have had international workers. It is a very important part of it now. Of the funding going in—up to £2.8 billion next year and up to £4.7 billion the year after—70% will translate into wages, because this is a staff-based business. That is a huge injection of money into the sector, and it will go into staff, salaries and welfare.

[Lord Allan of Hallam (LD)]

My Lords, we know from surveys by the Association of Directors of Adult Social Services that there is already a shortfall in domiciliary care capacity, such that people are not getting the services they need at home. While additional, funded care home places are welcome, we need to ensure that this does not worsen the domiciliary care situation by drawing staff away from other vital roles. I raised this question on yesterday’s Statement, but I think it important enough to come back to. Will the Government monitor workforce changes to ensure that both residential and domiciliary care capacity benefit from any new funding?

[Lord Markham (Con)]

Since the question yesterday, I have had a chance to talk to colleagues further about domiciliary care and understand its vital role. I talked to one ICB today, which has its own arm’s-length body, set up by the local authority, which does exactly what was suggested by employing domiciliary care staff full-time. They know the patient best and are ready to take them back out of hospital and put them in place. This is central to what we are doing.

[Baroness Browning (Con)]

When people are transferred, either to home or residential care places, part of the delay is caused by the need, quite rightly, for a proper and appropriate assessment of their needs before a transfer is made. What work have the Government done to assess who is going to carry out those proper assessments, either at the hospital or the care home end, and what the likely delay at that stage will be? It is delaying a lot of people now and no doubt will continue to do so.

[Lord Markham (Con)]

That is absolutely right. In our weekly meetings as Ministers, we look at the reason for the delays in terms of the 13,000 beds. That assessment of delay is one of the key criteria that we monitor each week. The best ICBs that I have seen have teams on this—they are absolutely SWAT teams—who make sure that they do it, and measure the time in which they can do it; for example, they have got to have that assessment within 24 hours. When the patient goes in, they have an estimate of the day that they are leaving, which they will target and work towards. The best do that, and the task force is set up to make sure that it is rolled out to all the other places.

[Baroness Andrews (Lab)]

My Lords, the question has been put to the Minister already, but I want to put it again. Has he read the report of the Adult Social Care Select Committee, published in December, which has a raft of challenges and very good ideas on social care? I look forward to discussing it with the Minister. Specifically, does he agree that as long as we characterise adult social care workers as unskilled and pay them, quite often, below the minimum wage, we are never going to build the capacity that we need? That is a huge challenge. If he were to read the report, he would find that what we recommend is so evidently simple: we need a national workforce plan for adult social care, to raise standards, incentives, status and pay.

[Lord Markham (Con)]

I thank the noble Baroness. I think that the House will recall that I have mentioned on a number of occasions that this is a critical part of the workforce plan. What has become clear, even in the short time that I have been at this box, is that social care is a vital cog in the whole chain, so to speak, which goes right back to ambulance wait times and A&E, because if we do not get the flow going out of the system, we have got problems there. So I can assure the noble Baroness that it is key to my thinking, and to all our thinking.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a future member of the NHSE board. I want to ask how we are going to monitor the advancement from care homes back into domiciliary care, in order to ensure that we do not just move the problem from the hospital to care homes so that, very quickly, there are no beds left in care homes to continue this transfer system. In particular, who is going to pay for the residents in those care homes, and for how long?

[Lord Markham (Con)]

The question is absolutely correct: as I said earlier, less than 10% of these 13,000 people need to be in care homes full-time. The danger is often that once you put them there, they remain. That is why the package is focused on stays of up to four weeks, and absolutely making sure that they are monitored through, because it is vital. It is a step-down situation to help people ease from the acute—where they need a bit of extra support—so that, most importantly, they can get back home as soon as possible.

[Lord Young of Norwood Green (Lab)]

My Lords, does the Minister agree that some of the best examples of care are provided by charities and faith-based organisations which pay more than the minimum wage? Is that not an example to be encouraged if we really want to improve the recognition of carers in the care sector?

[Lord Markham (Con)]

Yes, absolutely. I find—and I talk as a businessman of 30-odd years—that by paying people well, you attract and retain the most motivated staff. It is the best way to run an organisation.

[Baroness Tyler of Enfield (LD)]

My Lords, is it not the case that there will be sufficient staff in the social care sector—both care homes and domiciliary care—only when we have a truly integrated approach to workforce planning across both health and social care? Yes, pay will be absolutely critical, but so will progression and career development opportunities, and opportunities for things like joint posts and rotational arrangements between the two sectors. What plans do the Government have to look seriously at this critical workforce issue?

--- Later in debate ---

[Lord Markham (Con)]

Absolutely; it is an integration issue. Noble Lords will have heard me say just yesterday that our plan is for a modular system of development, so that someone in social care has the modules to go on to become a nurse. It is integrated in that way so that it is seen as a career path for all those people. It is fundamental to all our thinking.

Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Lord Markham Excerpts

Wednesday 11th January 2023 Lords Chamber

Moved by

[Lord Markham]

That the draft Order and Regulations laid before the House on 11 October and 16 November 2022 be approved.

Relevant document: 15th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 9 January.

Motions agreed.