(2 days, 15 hours ago)
Lords ChamberThe policy for lighting is shared across a number of departments—not just the Department for Health and Social Care but the Department for Transport, as my noble friend says, as well as the Department for Energy Security and Net Zero, the Department for Business, Innovation, Science and Trade, and a number of arm’s-length bodies. We do all indeed co-ordinate and, as I mentioned earlier, work internationally, particularly with the UN Economic Commission for Europe, because we need to ensure that we update international vehicle lighting to meet the point that my noble friend is concerned about.
My Lords, the Minister referred to blue light and its effect on children, which is correct, but a similar biological effect occurs in the retina of children based on the amount of time they spend on screen usage, particularly at night, because, as mentioned already, it disrupts melatonin production, which disrupts sleep. The same effect happens based on the length of time children use screens as for LED lighting, particularly higher-wavelength LED lighting. I thank the Minister for commenting on that.
The noble Lord is quite right and highlights exactly the point I was making earlier on the first question about cars and lighting. There are a number of factors. Screen use can indeed be harmful, particularly where it replaces sleep, physical activity or leisure time. As the noble Lord will know, we advise families with under-fives to limit screens around bedtime and to ensure that content is age appropriate. I know that our department and the Department for Education will be publishing wider guidance for five to 18 year-olds in January.
(2 days, 15 hours ago)
Lords ChamberI should advise the Committee that if this amendment were agreed to, I would not be able to call Amendments 7 to 15 for reasons of pre-emption.
My Lords, we are entering the phase of debate on the Bill which I personally consider to be the most crucial part. Why do I consider it to be the most crucial part? It is because tackling health inequality is central to the revival, if not the survival, of the NHS and the broader economy.
I will speak mainly to my Amendments 7, 13 and 19, but before I do so, I want to say something because I feel strongly about it. I regret that consultants have decided to go on strike. No doctor should ever, under any circumstances, withdraw their services from the sick and the vulnerable. I think any doctor, and I hope every doctor in this House, would support that idea. They might have grievances, but they could settle those without going on strike, and they should not withdraw services. I hope the professional bodies, including the royal colleges, will align with that comment.
Having said that, my amendments about reducing inequalities are there because what we have in the Bill is a direct transfer of the issue of reducing inequalities from what was part of NHS England’s duties and was already in the duties of ICBs. There is nothing new in the Bill about reducing inequalities. It is a great pity that an opportunity is being missed by this Government to put a mark on how to reduce inequality. Why do I say “this Government”? It is because in the last 30 years, it was only once that we succeeded in reducing health inequalities, and that was from 2000 to 2010. An academic review, which was a proper assessment, demonstrated that, in mortality, infant mortality and ill health, the strategy devised by the then Labour Government managed to reduce health inequalities. But we have now come to a point where they are all rising for all kinds of reasons.
Who were the people who were responsible at the time? Their names were Alan Milburn; John Reid, now the noble Lord, Lord Reid; Yvette Cooper, now Secretary of State for Health; the noble Lord, Lord Darzi of Denham, who produced a report on the NHS; and Andy Burnham, the last Secretary of State for Health in that Government, and now the Prime Minister. Surely the present Government can find people of same calibre who can tackle health inequalities—or maybe not.
The strategy was a cross-governmental public service agreement—PSA—which was a legally binding framework used by the Treasury in the spending review process. It was as simple as that. It could be argued that my amendment is too strong. It would make the Secretary of State responsible, and I might be told that cannot be, because it removes the Secretary of State’s autonomy and flexibility, and therefore putting that in the Bill is not appropriate. If it is not, it does not make the policy of inequality strategy development inappropriate. As demonstrated between 2000 and 2010, the then Government found a way—cross-governmental ministerial responsibility—where, although the strategy was based on ill health, all the other Ministers were responsible for making sure that their ministries contributed to that improvement in reducing health inequality.
Therefore, if the Minister does not like my Amendment 19, there might be other ways for the Government to decide how the same could be achieved through another strategy; for instance, the same kind of agreement that Government did in 2000-10 or through Cabinet Secretary responsibility, as the Cabinet Secretary is responsible for making sure that all the Ministers and different government departments contribute and are mindful of a strategy that reduces health inequality.
In my view, if we do not do this, and there is no strategy coming forward, nothing will change. We will be talking about the same things that we have been talking about for the last 15 years, quoting the same statistics that have already been given about life expectancy being reduced in disadvantaged populations, how the time people spend being unhealthy will increase, how infant mortality will go up, how maternal mortality will go up, as it is doing now, and all the other things.
I thank the noble Baroness, Lady Cass, who might speak after me on children’s issues, and the noble Baroness, Lady Manzoor, who added her name to my amendment. I hope the Minister might agree to four things that I will ask her. I am not asking questions but asking her to agree that health equality and health outcomes are key to the overall welfare of the NHS and the broader economy; that now, after two decades, there has not been any improvement; that the improvement that previously occurred was as a result of a cross-government strategy; and that the increase in health inequality is being driven by rising ill health in England, but the Bill does not have a plan for the Secretary of State, a Minister of the Crown or Ministers in other Governments to demonstrate how they will reduce inequalities.
Baroness Cass (CB)
My Lords, I will be very brief. I support the amendments from the noble Lords, Lord Patel and Lord Hunt, and the noble Baroness, Lady Tyler. It will not surprise noble Lords to hear that I plan to focus on children yet again, but, as my amendments on inequalities in children come much later in the Bill, I will defer to other noble Lords to speak on this group. However, I will give noble Lords a spoiler alert: the Royal College of Paediatrics and Child Health’s State of Child Health report shows that inequalities are widening, particularly in marginalised groups, such as those living in deprived circumstances, or minority ethnic groups. There will be more of that anon; meanwhile, I defer to my colleagues.
I am sorry to hear that it is cold, but I am glad the noble Baroness is here. I appreciated the useful distinction that she drew regarding what we are talking about when we talk about inequalities.
Amendments 18 and 19, tabled respectively by the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, have regard to new strategies for tackling health inequalities. I know that your Lordships’ Committee is aware, but it is worth saying again that we remain absolutely committed to our comprehensive 10-year health plan. It was drawn up with a very wide range of input and, importantly—as has been referred to on this group and elsewhere—it was underpinned by the independent investigation of the NHS by the noble Lord, Lord Darzi. Tackling inequalities is at the very core of the 10-year health plan, which dictates everything that we do. It is therefore important that we focus on practical action rather than diverting towards developing new strategies. To assure noble Lords, I repeat that tackling inequalities is what I call core business; it is not an add-on or a sidecar—it is absolutely key.
The noble Lord, Lord Patel, put a number of observations to me and asked whether I agreed with them. My answer is that I appreciate them all and agree with most. I particularly welcome the acknowledgement by the noble Lord, Lord Patel, the noble Baroness, Lady Manzoor, and a number of my noble friends, of the achievement of the last Labour Government—which was somewhat exceptional in the period we have been talking about. The only point I would make to the noble Lord, Lord Patel, is that when he was running off a list of Ministers at the time, I hoped he might mention me—but I am doing so.
I was very proud to have been part of that as Public Health Minister, working with Andy Burnham. But it is not enough to just rest or delight on one’s memories; we must take what worked and bring it into the current time.
I agree with the noble Lord, Lord Patel, that tackling health inequalities is key to not just the NHS but the broader economy—and, of course, the well-being of people. I agree with all noble Lords who said that a cross-government approach is crucial. That is why we are taking that approach, underpinned by the 10-year health plan. Tackling inequalities, for example, informs the key initiatives of the 10-year health plan, such as neighbourhood health centres. On that, we are starting in the most deprived communities. We are not going to the communities that are easier to work with; we are starting where there is the most challenge. I welcome that radical approach.
I believe accountability is extremely important. I assure noble Lords that the department will continue to report on action taken to address health inequalities as part of its annual report, alongside a whole range of published metrics, including the health inequalities dashboard. The dashboard’s measures cover 20 indicators, including—I will give noble Lords a couple of examples —the prevalence of adult and childhood obesity, and healthy life expectancy at birth.
My noble friend Lady Nargund supported the call for a cross-government strategy, which we are already working on. Recent cross-government action in this area includes the warm homes plan, the Keep Britain Working review and the homelessness strategy—all of which speak to the points that noble Lords are calling for. That is one of the reasons why I caution against putting in the Bill a duty to develop some independent strategy, when in fact it is core to what we are already doing.
Amendments 13 and 14 were tabled respectively by the noble Lords, Lord Patel and Lord Patel of Bradford. My noble friend Lord Hunt asked whether I would meet the noble Lord, Lord Patel of Bradford; I would be very pleased to do so, and I open that meeting up to other noble Lords who are interested in coastal and rural areas. Amendment 20 was tabled by the noble Baroness, Lady Pidgeon. These amendments are concerned with tackling health determinants and inequalities in coastal and other areas.
Health is determined not just by our health and care system but by our wider environment. We know that geographical variation has grown over a number of years, and this Government seek to tackle it. That variation runs from housing and employment to education and our local high streets, to name just some. It has informed the content of our 10-year health plan and the overall guiding aim that we pursue: to halve the gap in healthy life expectancy between the richest and the poorest—to which noble Lords referred. That is why we are introducing the neighbourhood health centres, to which I referred, where they are needed most. We are now going further by devolving power to local communities so that those who know their areas best can make sure that the services are there for them. I remind noble Lords that ICB funding allocations, for example, are already adjusted for health inequalities and take account of factors such as an ageing population and deprivation. The Core20PLUS5 approach gives ICBs a range of tools to tackle inequalities, and we will—and do—hold ICBs to account for their progress.
I am grateful to my noble friend Lord Hunt for tabling Amendment 11 on accessing GP services—an area raised by other noble Lords, including the noble Baroness, Lady Gerada. I agree that equitable distribution of GPs is crucial to ensuring that people in all areas get timely access to care. When I say that, I mean not that every area should have exactly the same number but that the distribution should be sensitive to the needs of an area. Progress is being made: there are 2,600 more GPs than in July 2024—the highest figure since 2015; the average number of patients per GP practice is improving; and we continue to boost recruitment through the practice-level GP reimbursement scheme in 2026-27. Because GPs—like other professions —are more likely to practise where they trained, we are delivering 1,000 more GP training practices by 2028, targeted towards the areas of greatest need. We are also reviewing the Carr-Hill funding formula because, to reduce health need, we have to ensure that resources are allocated much more accurately—as noble Lords expect.
The noble Baroness, Lady Hodgson, also commented on this area. We are uplifting the GP contract by £601 million for 2026-27, which builds on last year’s £1.1 billion of additional investment. In the year to August 2026, 15.8 million additional appointments—including Covid vaccinations—were delivered, compared with the previous 12 months. This is the way we are going. When I make these points, I am not saying that the job is done, but I am showing movement and improvement.
The Minister did what I thought she would do: point to areas in the legislation that might help reduce inequalities in health and in outcome, and therefore inequalities in healthcare provision. She mentioned the 10-year health plan, but she was not able to point to where it says the gap is, which is around cross-government action. Neither did she mention examples in the Bill that demonstrate that there is cross-government action. She said she did not agree with me in one area—maybe it was that one.
Oh, no—I agree with the noble Lord about the need for cross-government action. I simply part company with the idea that it needs to go into primary legislation. That would not be usual, because that is a process. I also referred to examples of where we already have cross-government action to deal with health inequalities, as distinct from healthcare inequalities—the noble Baroness, Lady Gerada, referred to that.
Why not, when, as she mentioned, the Minister was previously so successful as part of the Government who demonstrated how they could implement cross-government action and reduce inequality?
I am not sure we are that far apart on this. I am just picking up the point about primary legislation, rather than the intent of the noble Lord, which I agree with.
(3 days, 15 hours ago)
Lords ChamberMy noble friend is right to identify that there is a higher incidence of osteoporosis in women than men; it is more common. Some 80% of osteoporotic vertebral fractures are not identified and not managed appropriately, which again is unacceptable. That is why NIHR research has investigated the use of a new questionnaire to improve the diagnosis of these fractures in women. If it is successful—I hope it will be—it will reduce fracture risk and change clinical practice, particularly for older women with back pain.
My Lords, in response to the question asked about the devolved Administrations, the Minister suggested we should interpret the data with caution. The caution is this: Scotland established one of the world’s first fracture liaison services, which is recognised globally as the most effective. Claims of a 50% reduction in repeat fractures might be exaggerated, but not by much. So what is the caution?
The caution—I am very happy to write to noble Lords with more details on this —is that it has been suggested that it has 100% coverage, but I am advised that that is not exactly the case.
(1 month, 2 weeks ago)
Lords ChamberTo ask His Majesty’s Government what assessment they have made of the use of patient data for research.
My Lords, after listening to the last debate, I am tempted to speak only about how health research data might help economic growth to alleviate all the debt that we were talking about, but I will not. I thank the noble Baroness, Lady Merron, for taking this debate and ,all noble Lords who signed up to take part, despite the brief time for which they are allowed to speak. I also thank the Library for its excellent brief and POST for the publication of its report on the subject of health data research.
I fully support the Government’s initiative to strengthen the collection and use of health data for research but I hope that the commitment from the Government will be longer term and that they will be prepared to do whatever is necessary to make the UK a world leader in health data research. The use of health data to improve healthcare is not new. In the 14th century, plague killed one-third of the population because they did not have the ability to use data and track the epidemic. By 1854, however, John Snow tracked the cholera outbreak in Soho and controlled the spread of the disease. There are many examples of the use of data and epidemiological studies leading to improvements in healthcare, such as the association made in 1954 between smoking and lung cancer and chronic lung disease and, later, the association between HPV and cervical cancer. Most recently and quite importantly, the UK Cystic Fibrosis Registry, kept by the Cystic Fibrosis Trust, identified genetic mutations that occur in some children and adults who suffer from cystic fibrosis, and identified an effective drug that improves their ventilatory function.
The advent of AI and machine learning, genomics and pharmacogenomics, and the linking of such data through machine learning and imaging technology will transform the research using health data for better healthcare and innovations. Better data means fewer deaths.
A strong, efficient health data platform that can be accessed for research is crucial for the success of the life sciences strategy and for economic growth. Currently, the life sciences sector has a turnover of £146.9 billion and employs over 360,000 people. Apart from delivering better healthcare, health data research is the fuel that will accelerate that by adding more than £10 billion annually in value added growth. The UK’s strands for health data curation have the ability to track longitudinal data from a diverse population of 63 million, but the current system is fragmented and scattered across thousands of GP practices, hospital trusts, community health clinics and others that deliver healthcare.
However, the UK health data environment is changing from a siloed system to a national framework. One hopes that the active phasing-out of data sharing, which often led to data breaches, will now stop that from happening. Data sharing will be replaced with the secure data environment, SDE, and the data stay-put model, where the data will stay on one platform and not be shared but rather acted upon. Researchers will be allowed to access only that data, and it will not be exported. The Five Safes model for data access and outputs will make the data secure. The launch of the HDRS, the Health Data Research Service, which is backed by £600 million of Government investment, keeps the promise going. That is all very good, but the verdict is that, while it is a great blueprint, delivery is the test. We have good plans, but let us hope that delivery will follow.
What are the challenges? Currently, regional secure data environments operate in silos in over 180 trusts. Often, they are written and uncoded, which means that using them is difficult. They are diverse, handwritten and uncoded, and they occur in 180 trusts and thousands of GP practices, and are therefore not connected. Data is currently written and collected in different hospitals and general practices but is not unified in any data models. The governance to access data for research is multi-layered, causing bottlenecks. One has to answer to so many different regulators just to be allowed to use the data. If the UK is to become a leader in clinical trials, health data needs to be coded and easily available in every hospital. To maintain public trust, there need to be clear, transparent, and legally binding arrangements as to how data can be accessed and used for the pharma and tech industries, and how the NHS will benefit from the benefits that accrue, both in healthcare improvement and money. I personally approve of the opt-out model rather than the opt-in model, because the latter will not work for health data research.
What are the consequences of not addressing these challenges? If we do not address them, it will affect the NHS; it will affect patients, because they will not receive modern care; and it will affect the UK economy. I therefore have four key questions for the Minister. First, what specific legal mandate will be needed for longitudinal data streams that link GP and hospital data? Secondly, what effective plans will be put in place to end the fragmented secure data environment? Thirdly, on public trust, will the Government legislate that any benefits from the use of and access to NHS data by commercial companies flow back to the NHS? Fourthly, are there plans for trusts to have a workforce, such as data engineers, to clean up the data and produce the appropriate codes that will be used by AI and machine learning to national standards and, if so, how will they be funded? I look forward to the Minister’s answers.
(1 month, 3 weeks ago)
Lords ChamberIn the not-too-distant future, the mental health strategy will pull together all of the strands that the noble Baroness and her colleague are concerned with, and she is right to be concerned about them. In all these areas, patient safety comes first. That is the driver as to why we are reducing the use of agency. I agree that the end game in all of this is to increase the numbers of permanent staff, and the forthcoming workforce plan will support us in that.
My Lords, can the Minister say in the spring of which year the workforce plan will be published?
On the basis we have moved beyond spring of this year, I can say that, to ensure the workforce plan reflects the new Government we have, the Secretary of State and my colleague, Minister Karin Smyth MP, the responsible Minister, are working to ensure the workforce plan properly reflects the priorities —so I hope we will not be keeping your Lordships’ House or the noble Lord waiting for too long.
(3 months, 1 week ago)
Lords ChamberYes, I am very pleased to do that. I point to the National Healthtech Access Programme, which is exactly what the noble Baroness is seeking. It is a route for cost-effective and clinically effective technologies, such as the one the noble Baroness describes, so that we can see the best benefit to patients and the best value, and that supports more equitable access. NICE is currently assessing three projects, including using AI in histopathology for the diagnosis of prostate cancer and breast cancer, to give two examples, and we will shortly see the publication of those results.
My Lords, the Minister quite rightly alluded to the clinical entrepreneur programmes, and she might want to say a bit more about how successful they have been. Does she agree that, for these programmes to succeed in making clinical departments more innovative, we need strong academic departments working together with universities and teaching hospitals?
I certainly agree with that, because there are many aspects to this. On the successes of the clinical entrepreneur programme—some of which I have mentioned—we now know that, as of June, that over 10,500 occurrences of innovation are being adopted by organisations. That has resulted in the creation of over 5,100 jobs, and 448 NHS staff have been retained by, or have returned to, the NHS to be part of the programme. This is an extremely active area that will greatly contribute to services for patients: better care and safety, as well as tackling waiting times.
(3 months, 3 weeks ago)
Lords ChamberI absolutely agree with what my noble friend said about kindness; when we had the Statement last week, we discussed compassion as well. It is disappointing to have to talk about it, because it should be a given, but we have found that it is not. I totally agree that pregnancy is not an illness—I was once quoted as very sharply telling an interviewer that. I am not aware that it is, and it is not, but it is worth restating, in my view. On the role of men, I am very careful to speak about women and families; that is the right thing. I also clarify that, in this Statement, I do not believe anybody is suggesting that one form of birth is preferable to another. I think we would probably all agree that it is about the form that is safest and the right one for the circumstance.
My Lords, I thank the Minister for the Statement today and the noble Baroness, Lady Amos, for her excellent report. We have many reports now describing the tragedies occurring in maternity services. I hope this report will be the final one before we go back to delivering the best maternity care, as we used to. It was world leading.
I am privileged to have been an obstetrician for nearly 40 years of my life, delivering many thousands of babies—normally, as people refer to it, and by caesarean sections, which are done when there is an indication to do so. We expect the mothers to enjoy normal deliveries, but also to enjoy the delivery when they must have a caesarean section. The greatest privilege I had was to hand a baby to a mother and see the first look on the mother’s face, which is unbelievable; I had the privilege to witness that first-hand, long before partners would see it. It is important that we deliver world-class maternity services and, therefore, that what the task force comes up with has the standards to be delivered. I hope it will be mandatory for those standards to be followed, monitored and audited against. It should be possible, at the mother’s first visit to the antenatal clinic, to have a plan for how her pregnancy will be managed by midwives and obstetricians. It should also be possible to have every maternity unit audited, as used to happen, when things go wrong involving the mother and the families—and to have a plan for how that will be tackled. I hope that will be the answer.
I am sure we were all touched to hear what the noble Lord said. It must be a privilege to have done what he has done, and to have affected so many lives—those at their beginning but also the lives of the women themselves and their families. I am sure we are all grateful to him for that. The work of the task force, and of the expert reference groups—I am so grateful to the noble Lord, as well as my noble friend Lady Thornton, for taking part in one of them—will be to develop a plan of action, not just for how it will happen but for how it will be audited. Perhaps I should say that key to all this is accountability. The Secretary of State himself said in the Statement that what stuck with him from one of the bereaved mothers he spoke to was that accountability is what drives change. Certainly, when it comes to the regulators, that is why we are also taking action to improve.
(4 months ago)
Lords ChamberLooking to the future, obviously, one can only act on clinical guidance. Renal denervation, as I mentioned to my noble friend, is an emerging option for carefully selected patients at the moment, as the noble Lord said. What matters now is that evidence is emerging, and that is why it is being reassessed. We will not have to wait too long to see what the future will bring in this regard, but it certainly has a role to play.
My Lords, I will refine the previous questions. Resistant hypertension occurs when the blood pressure does not respond to standard treatment of two, three or even four drugs—hence we call it resistant hypertension. The reason why the renal system is involved is because the sympathetic nervous system acts between the kidneys and the brain. That controls vasodilatation and the production of hormones that raise the blood pressure. By denerving the renal system, which are nerves on the arteries of the kidneys, you can cut out one of the nervous system’s interactions between kidneys and the brain. What is important, therefore, is that people who suffer from resistant hypertension are treated by specialists at a specialist centre that considers denervation as one of the options, because it is not always the only answer. Therefore, does the Minister agree that people with resistant hypertension should be treated in a specialist centre?
I certainly would agree with that. Indeed, those who are diagnosed with resistant hypertension—and the noble Lord has, as ever, outlined how that is defined in a far better way than I could have done—can be referred by their GP to secondary care hospital hypertension services, so, to answer the point made by the noble Lords, Lord Patel and Lord Evans, that does mean in-depth investigations and expert management. The House can be assured of that.
(4 months, 1 week ago)
Lords ChamberYes, indeed. I am feeling positive about the way we are moving forward, about increasing research and about developing a frailty and dementia modern service framework by the end of this year, as the noble Baroness, Lady Casey, has called for. On the question of drugs, to which the noble Lord has referred, I can confirm that NICE is currently evaluating two licensed disease-modifying treatments for Alzheimer’s disease; it will meet to consider that on 8 July.
My Lords, if our intention is to increase the diagnosis rate of early dementia, normally what we would do is to find a screening test that would identify people at risk of any disease. There is one called Mini-Cog; it takes three minutes to administer and uses word registration and recall and a clock to diagnose early dementia. Why do we not use that as a screening test, easily implemented by trained people to increase the rate of diagnosis of dementia?
That will be considered. We have the Dame Barbara Windsor dementia goals programme, which very much aims to speed up the development of new treatments for dementia and neurodegenerative conditions by accelerating innovations, including in clinical trials. I agree that we need diagnosis that is effective and thorough, and the point that the noble Lord raises will of course be considered in all that.
(4 months, 1 week ago)
Lords ChamberMy Lords, several trials are assessing the use of AI for prostate cancer screening and diagnostics, as well as testing the accuracy of digital imaging and histological imaging of biopsies to understand better the progression of disease. Some of them are well funded. For instance, the screening programme has £42 million of funding. Similar trials are conducted for lung, ovarian, breast and pancreatic cancer. The common issue that comes out is that we need digital transformation throughout the NHS to deliver any of these uses of AI for cancer. We need a workforce that is trained to use it, and I hope that the workforce strategy that the Government are about to publish will specifically include how the workforce will be trained to use AI in healthcare.
As I said, your Lordships’ House will not be waiting too long for the workforce plan, but I certainly recognise the noble Lord’s points. He describes the transformed service set out in the 10-year health plan, and the workforce plan will support that.