Women’s Health Outcomes

Baroness Bull Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Bull (CB)]

My Lords, I congratulate the noble Baroness, Lady Jenkin of Kennington, on securing this debate, which feels particularly timely as we mark the 73rd birthday of the NHS this week. Women were undoubtedly among its most immediate beneficiaries, as the expansion of maternity care put an end to many of the horror stories of obstetric disasters, post-delivery haemorrhage and infections needlessly killing mothers after childbirth, for want of sterile surroundings. We have come a long way since then, but there is still some way to go.

The Library’s helpful briefing makes clear a range of healthcare areas in which women experience worse outcomes than men, including mental health. The Mental Health Foundation reports a strong relationship between women’s physical and mental health, with 85% of its surveyed members reporting that menstruation, menopause, pregnancy, fertility pressures and contraception impacted negatively on their mental health.

I will focus on eating disorders—serious mental health disorders that can affect anyone, but which are much more prevalent in women than men. A recent Finnish study found that one in six female adolescents and young adults met the criteria for an eating disorder, compared with one in 40 males. The pandemic has seen eating disorders spike, with demand for services up 200% in some areas and waiting lists at record highs. Those with high-BMI eating disorders cannot access treatment, since clinical pathways for binge eating are currently closed, as the NHS struggles to cope with the increase in low-weight disorders.

This is nothing short of a public health crisis, yet it receives neither the attention nor the funding it warrants. The best-known eating disorder, anorexia nervosa, has the highest mortality rate of any psychiatric disorder in the UK, yet the last available dataset comparing all mental health related research grants from major UK funders revealed that eating disorders received just 1% of the near £500 million available over the four-year period surveyed.

It is hard not to conclude that eating disorders suffer a triple whammy of perception and misperception: first, they are seen as a niche problem largely affecting a middle-class elite, which is not true; secondly, they are mental health conditions and, despite claims to the contrary, we have yet to live up to our promise to give mental and physical health parity of esteem; and finally, above all, they are seen as women’s issues.

Earlier this year, in the other place, the Minister Nadine Dorries said,

“for generations women have lived with a healthcare system that is designed by men, for men.”—[Official Report, Commons, 8/3/21; col. 535.]

Women continue to suffer as a result. I look forward to the forthcoming women’s health strategy and hope that it has some effect in redressing this age-old imbalance.

Covid-19 Update

Baroness Bull Excerpts

Tuesday 18th May 2021 Lords Chamber

[Baroness Bull (CB)]

My Lords, I declare my interests as set out in the register. With the move to stage 3 of the road map, university students can now return to campus. Most of them are too young to have received vaccines so students around the country will form a significant cohort of young people undertaking regular and frequent testing as a matter of course. What consideration has been given to the benefits of sustaining PCR testing and sequencing at scale in universities as a way of rapidly identifying and understanding new variants? Will the Government consider providing funding to support that in future?

[Lord Bethell (Con)]

My Lords, I pay tribute to the vice-chancellors and to the universities and colleges of Britain for the way in which they have embraced campus testing. It has been a salutary lesson in what can be done, and it has helped to keep infection rates down on campuses where there has been a small number of returning students to date. That is done mainly through LFD testing. Positive tests then have a complementary PCR test, and the PCR test is automatically sequenced if it is positive. The combination of LFD, PCR and sequencing is the right one for keeping infection rates down, but we tweak the formula as and when best advice comes in.

Eating Disorder Services: Referrals

Baroness Bull Excerpts

Monday 17th May 2021 Lords Chamber

Asked by

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the change in referrals to eating disorder services since April 2020.

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

My Lords, eating disorders are serious, life-threatening conditions. We recognise eating disorder services are facing increased demand from children and young people, with 719 urgent cases starting treatment in the fourth quarter of 2020-21. That is why we made £10.2 million of additional funding available to mental health charities, including those that address anorexia, at the beginning of the pandemic, we convened a cross-government ministerial group to publish a mental health recovery plan and we are holding a ministerial round table on eating disorders.

[Baroness Bull (CB)]

My Lords, Q4 data on waiting times released last week showed, as the Minister said, 719 patients starting treatment for urgent cases of eating disorders, but this compares to 353 at this time last year. At this point in 2020, 18 people awaited urgent treatment, and 543 awaited routine treatment; those numbers are now 130 and 1,404. While much has been said about the pandemic’s role in driving this spike, most studies into young people’s mental health over the last year were not designed to detect eating disorders so, beyond anecdote, the reason for this increase, and therefore the best way to address it, is not clear. What will Government do to better understand this sharp increase? Does it represent broader and lasting behavioural changes among young people? Will the Government closely monitor the impact of their obesity strategy on referral rates, given that some of the planned measures—calorie labelling on menus, for instance—are shown to exacerbate existing eating disorders and increase the risk of their development in the general public?

[Lord Bethell (Con)]

My Lords, undoubtedly, the increase in referrals is something of concern. It is something we are monitoring closely, with the round table and the ministerial group dedicated to looking at this. That shows the seriousness with which we regard it. The reduction in the impact of community services, which is the best way of addressing these kinds of issues, has undoubtedly had an effect on urgent needs. During this period, there has also been a large increase in the number of young people who have started treatment, which is encouraging. If the noble Baroness has evidence that measures such as nutrition information on packaging has an effect on anorexia, I would welcome correspondence from her.

Office for Health Promotion

Baroness Bull Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, consultations are there to have an honest conversation. It would be wrong for me to try to pre-empt the outcome of that consultation from the Dispatch Box.

[Baroness Bull (CB)]

My Lords, the Government have pointed to Singapore’s health promotion board as a model, citing its digital public health schemes such as the national steps challenge or the “Eat, Drink, Shop Healthy” challenge. Is the Minister aware of the risks that gamification and incentivisation of what for many of us are healthy behaviours present to people living with eating disorders? With its responsibility for both obesity and mental health, will the office ensure that eating disorder experts are always involved in planning obesity interventions so that the complex relationship between the two is taken into account?

[Lord Bethell (Con)]

I completely take the point of the noble Baroness. We are extremely conscious of the challenge presented by social media in particular to identity and sense of body image. I know that there is much liaison between Public Health England and obesity and anorexia charities about its marketing to ensure that it hits the right note. We are investing in digital technology to try to get people moving and change their lifestyles; I pay tribute to the team behind Couch to 5K, who have used apps and digital engagement to encourage millions of people to take important steps towards a more active lifestyle.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Baroness Bull Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Baroness Bull (CB)]

My Lords, I too congratulate the noble Baroness, Lady Wyld, on bringing the Bill to the House and on her excellent introduction.

Restricting the use of Botox and cosmetic fillers in young people seems to me such an unarguable proposition that I could resume my seat at this point. However, I would like to take a moment to set this legislation in the wider context of body image and, in particular, the causes and impact of body image negativity in children.

The term “body image” describes our relationship with our body—how we think and feel about it and how much other people’s opinions affect that view. The recent report from the Women and Equalities Committee in the other place reveals that 66% of children feel negative about their body image, with body dissatisfaction identified in children as young as five.

Poor body image matters because of where it leads: low self-esteem, depression, anxiety, body dysmorphic disorder and eating disorders. Poor body image prevents young people from taking exercise, joining clubs, visiting their GP or even speaking up in the classroom. It increases risky behaviours, reduces quality of life and, at the extreme, can lead to self-harm and suicide ideation. It does not go away: poor body image lasts a lifetime. It is not surprising that Professor Chambers of the Nuffield Council on Bioethics describes body image as nothing short of a public health issue.

The factors acting on our sense of our bodies are manifold and unrelenting. From early childhood, we are bombarded with images of unrealistic bodies on screen, in print and online—ideals that young people internalise and then pursue, with social media the perfect platform to idealise and compare. The Commons inquiry highlights the damaging impact of digitally altered or filtered images in advertising across social media, with image editing apps readily available to change our shape or our appearance—apps regularly used by 45% of 11 to 16 year-olds.

I stress all this today because body image dissatisfaction is understood to be a motivator for the pursuit of cosmetic medical interventions. Preventing these procedures for young people who do not have the maturity to give informed consent at least addresses the supply side of the equation, but can the Minister say what we can do to address the demand side? What steps will government take to reduce the image editing, ban altered images and encourage use of a greater diversity of body types in advertising? Will the Government ensure that the forthcoming online harms Bill covers harms related to body image, and will they reconsider the potential harms inherent in the obesity strategy, particularly those relating to calorie labelling, which the Minister has been good enough to discuss with me?

The Bill is important, I support it and its provisions are welcome, but it addresses only part of the problem. Unless we create an environment in which children are supported to accept and enjoy their bodies as they are, they are likely to carry on chasing the fairy tale dream of a skin-deep perfection that does not in reality exist.

Covid-19 Update

Baroness Bull Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to my noble friend for looking forward. She is entirely right: the experience of this vaccination programme cannot stop when we have finished the initial rollout and we have to look to the future. As I said in my opening remarks, I am extremely hopeful that this can be an inflection point where we double-up on our commitment to rid the country of as much contagious disease as we possibly can. That will include booster shots, to which my noble friend alluded. It will also include a greater commitment to flu shots, and we very much hope that we can increase dramatically the take-up of flu shots at all ages, to stop not only illness itself but transmission.

[Baroness Bull (CB)]

Following on from the noble Baroness’s question and the importance of overall and ongoing vaccination coverage, can the Minister say how many people living in the UK are not registered with an NHS GP and therefore cannot be contacted for vaccination? We know that socially excluded groups, such as rough sleepers, Gypsy, Roma and Traveller communities and vulnerable migrants, are less likely to be registered, and there will be people registered only with a private GP. What assessment have the Government made of the scale of this challenge—how many people are affected—and what efforts are under way to find them and offer them vaccination?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes her point extremely well. It is an area that we have looked at extremely carefully. The proportion of people who are not registered is remarkably small, but the phenomenon does exist. For this particular vaccination round, we have put in procedures so that those who turn up at a GP or vaccination centre who are not registered can be registered on the spot, and I thank colleagues at NHS D, who have put the necessary arrangements into the NIMS programme to make that possible. There are also others who do not know their NHS number—well, an enormous number of them now do know it. That is one of the blessings of this vaccination programme. We are also working extremely hard to reach out to the people the noble Baroness alludes to—the homeless, the Roma community and those who are recent arrivals in the UK—to make sure that the vaccination is offered to absolutely everyone in the UK, whatever their immigration status, whatever their living arrangements and whatever their medical history.

Osteoporosis: Treatment

Baroness Bull Excerpts

Tuesday 9th February 2021 Lords Chamber

[Baroness Bull (CB)]

My Lords, the Minister has rightly pointed to fracture liaison services and the vital role they play, but only half of the population in England currently has access to an FLS, compared to 100% in Scotland and Northern Ireland. Is the Minister aware of the recent economic analysis that suggested that upscaling provision to cover all over-50s in the UK could prevent an estimated 5,686 fragility fractures every year, with net cost savings of £1.2 million? Will the Government commit to 100% coverage for fracture liaison services and if not, why not?

[Lord Bethell (Con)]

The noble Baroness is entirely right. There is significant regional variation in the rates of fragility fractures within the older population with the lowest incidence observed in London, the east of England and the south-east and the highest in the south-west of England, Northern Ireland and Scotland. To reduce variation in osteoporosis services in 2017, NHS England’s RightCare programme published cases studies and pathways for the management of osteoporosis and fragility fractures. The noble Baroness is right that we should have high aspirations in this matter. I am not sure that I can commit to 100%, but I will return to the department and see if we could be doing more.

Covid-19 Update

Baroness Bull Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

I am afraid to say that the noble Lord’s point makes no sense to me whatever. We are not going to go around the country asking people whether they refused to take the vaccine. We have a dialogue with the whole country, and we wait patiently for people to step forward. I cannot give statistics on people who have refused because it would make no sense at all to ask people whether they are in that category.

[Baroness Bull (CB)]

My Lords, can the Minister tell the House what assessment the Government have made of the risks presented by aerosols, which, unlike droplets, are small enough to remain suspended in the air for hours and which expose individuals at distances beyond 2 metres? New evidence is emerging all the time, the latest just this week from the University of Bristol. Does he agree that we need a clearer position and stronger messaging on the risk of aerosol transmission indoors and the importance of ventilation, particularly as the vaccination programme rolls out, which will inevitably lead to calls to release restrictions and to reduce the 2-metre rule? We may need to add a fourth word, “ventilate”, to the mantra “hands, face, space”.

[Lord Bethell (Con)]

The noble Baroness is entirely right that understanding of the role of aerosols is growing. Frankly, I find it quite terrifying. She is right that we need to look particularly at the way our office spaces are ventilated. The statistics I have seen on the potential cost of rebooting the ventilation of the UK’s workspaces in order to make them Covid-friendly are that it would cost tens of billions of pounds. Our focus is therefore on vaccine deployment, but work is going on to reimagine and envisage how workspaces could be made safer, not just for this pandemic but for the future. I can imagine a world where ventilation is given greater hygienic priority in future.

Health: Eating Disorders

Baroness Bull Excerpts

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we recognise the contribution of charities to this mental health challenge, and £10.2 million of additional funding has been allocated to mental health charities. We also recognise the importance of keeping schools open: no Government could have tried harder to keep schools open than this one. However, the allocation of the vaccine is based on morbidity—we have to protect those whose lives are most threatened and that is why the JCVI has put the prioritisation list in the form it has.

[Baroness Bull (CB)]

My Lords, a recent literature review found that many GPs feel unequipped to identify and manage eating disorders, meaning that patients who could benefit from primary care are often passed on to specialist services and face long waiting lists. Given the importance of early intervention, can the Minister say what is being done to train and support primary care professionals in diagnosing and treating people with eating disorders, and to improve shared care across the primary and secondary care interface?

[Lord Bethell (Con)]

My Lords, NHS England is working with Health Education England to procure training courses that will increase the capacity of the existing workforce, to allow them to understand these challenging issues better and allocate people to the right course of treatment. It is a problem that we recognise, and resources in training are being put in place to address it.

Care Quality Commission Report

Baroness Bull Excerpts

Tuesday 15th December 2020 Lords Chamber

Asked by

[Baroness Bull]

To ask Her Majesty’s Government what steps they are taking in response to the report by the Care Quality Commission Out of Sight—Who Cares?, published on 22 October.

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

My Lords, the Government are clear that in-patient care should be high quality, therapeutic and for the shortest time possible, and that any kind of restraint should be used only as a last resort and in line with strict protocols. That is why the evidence in the CQC report of poor care and excessive use of restrictive practices is so unacceptable. Our response to the report from the Joint Committee on Human Rights in October outlines many of the measures that we are already taking. We will respond formally to the specific recommendations in the CQC’s report at the earliest opportunity.

[Baroness Bull (CB)]

My Lords, this report details an horrific culture of restraint, seclusion and segregation in the care of people with learning disabilities and autism. NHS data seems to show around 3,400 in in-patient care, some in isolation for 13 years, with no meaningful activity, outdoor space, natural light, furniture or belongings—their food served through hatches and their only human contact via intercoms and screens. Does the Minister agree that, while that number is unacceptably high, it is low enough that the development of pathways individualised to support community living should be possible? The costs might be high, but the cost of hospitalisation is higher. When will government deliver those long-promised solutions and end these abuses of human rights and human dignity?

[Lord Bethell (Con) [V]]

I am not sure that I completely recognise the numbers given by the noble Baroness. In August, there were 365 instances of seclusion and 10 instances of segregation of those with autism and learning difficulties, but I would be glad to correspond with the noble Baroness to clarify those things.

I reassure the noble Baroness that the progress that we are making to create the pathways to which she rightly alludes is very much the focus of the department. Earlier this morning, the Minister for Social Care chaired the first Building the Right Support delivery board, in which she brought together representatives of the NHS, LGA, ADS, DfE and MHCLG to make progress on exactly what the noble Baroness is talking about. I reassure her that funds of £74 million have been put in place to help those with autism and learning difficulties who are being discharged into the community.