Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Bethell

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Lord, Lord Alton. I join him and the right reverend Prelate the Bishop of Durham in paying tribute to my noble friend Lady Sugg for her work on women’s issues—work that I support in every way I possibly can. I think that this amendment is a useful amendment to this Bill. My noble friend Lady Sugg is right that the world is changing: science raced ahead during the pandemic, and many things that had not been tried before were tried. Clinical tools have become more sophisticated, practices are undoubtedly evolving and there are definitely lessons from the pandemic that are worth our consideration.

That is why I very much welcome an opportunity to stand back and reflect on what has changed since 1967, which the noble Lord, Lord Alton, referred to, when the current settlement on abortion was agreed. That was an incredibly important moment, when those with different views engaged with public opinion, clinical judgment, ethical analysis and spiritual leaders. I accept that that settlement made in 1967 will not last for ever. In fact, I agree with my noble friend Lady Sugg that the arrangements that have been in place for many years definitely need a second look. If we agree that the moment is right, I emphasise that any reconsideration of these issues should be done in a thoughtful, considered fashion and that we should engage the large number of people who have strong feelings, as well as expert opinion.

We need to do this because these issues are extremely complex and the evidence is conflicted, and they engage so many different strands of our emotional, spiritual and intellectual life. If this this debate this evening is a starting gun for that process, I would recognise its significance and ask the Minister to reflect on the moment in his comments.

However, if this amendment is a realistic attempt to bring about a significant long-term change to the clinical pathways of our health system, I would be extremely alarmed. Regarding the point made by the noble Lord, Lord Alton, on procedure, I have serious concerns. There is no value in blowing up the long-term arrangements that were agreed in 1967 in a late-night Report debate on an amendment introduced at the last minute to a Bill that is about the integration of our healthcare system. It would be a travesty if the easements that were brought in to cope with a global pandemic were used as a pretext for a long-term rewriting of our abortion laws. We were promised that that would not be the case, and it would be regrettable if this Government went back on those reassurances.

I draw to the attention of noble Lords the report by Gynuity Health Projects, published in March 2021, on its study of the efficacy of telemedicine abortion. It found that 5% of participants using the medical abortion treatment at home needed surgical intervention to complete the procedure. These are worrying numbers and are worthy of further investigation before the current situation passes into legislation.

My hope is that this amendment is regarded for what it should be: a testing amendment to stimulate debate and not a serious effort to overturn arrangements that need to be reformed, not overturned. That is why I call on the Minister to explain why this amendment should not stand, and on my noble friend Lady Sugg to confirm that she will not be moving her amendment.

[Baroness Finlay of Llandaff (CB)]

My Lords, I find myself conflicted over this amendment. I am probably the only person in this Chamber who has consulted women over abortions, signed forms for abortions and performed abortions and I have been with women during late abortions for foetal abnormality. It is a complex area. I have also had women say to me, in the privacy of the consulting room, just before they go, “I have never told anybody else this before”—they have then told me about the serious abuse that they have suffered.

My worry with the first part of the amendment, on remote consultation, is that you do not know who is on the other side of camera or who is standing in the room with the woman. You do not know whether the man is using fertility and sex as a form of abuse and is standing there threatening the woman to proceed in one way or another. We know that men refusing to use condoms is a common form of coercive control of women.

The abortifacient tablets, to which my noble friend Baroness Watkins referred, are a separate step. It is inhumane to expect women to take those and then travel on a bus or even go in a taxi. Knowing what has happened before, I cannot help feeling that there is another step. Yes, let the women have their tablets and take them in the privacy of their own home. It is not pleasant to undergo an abortion—nobody should think that it is—but those women also need support and contraceptive advice as part of the package. I am concerned that I do not see that in this amendment and I have been concerned that during the pandemic the ability of women to access contraception may have become more difficult.

This is a complex issue. It is about a pathway with many steps in it. I wonder whether we should return to it at Third Reading, rather than trying to take a yes or no decision tonight on something that has some merits but also some problems. We are not adequately going into them by having a short debate now.

Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Bethell

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I support Amendment 266 in the name of the noble Baroness, Lady Merron, and Amendment 293 in the name of my noble friend Lord Lansley for all the reasons that my noble friend just articulated. I will not repeat them as he put them so very well. However, I would say to the Minister that, coming from the innovation space, I can see that the technologies for both cosmetic surgery and non-surgical cosmetic interventions are improving all the time. There is an incredibly rapid pace of change. They are set to continue to get better and better, so the marketplace is getting more sophisticated and their popularity is also exploding. We have been briefed on evidence about the role of social media in promoting non-surgical cosmetic interventions in particular. This is exciting, because it is great that people have access to these interesting products, but also extremely worrying, because not all the surgeries and non-surgical interventions are successful. It is the right time for the Government to intervene, so that we have a register of cosmetic surgical practitioners and a much clearer regulatory regime for non-surgical interventions.

I am pro cosmetic surgery. As a young boy, I had an inherited condition of having very big, sticking-out ears, which my father had and my cousins and aunts have, and it was miserable. I had them pinned back and I am very grateful that that happened. It meant that I could be a much more confident person as I grew up. I am pro cosmetic interventions; if people want to use the benefits of medicine to improve their confidence in the way they look, I applaud that. However, standing next to my noble friend Lady Cumberlege, I am also aware of Bruce Keogh’s extremely good report and the very large number of interventions that have not gone well. I know that the Minister’s instincts are not to intervene unless absolutely required and my suggestion to him is that we have hit that moment. The marketplace is exploding and now is the right time to intervene.

[Baroness Finlay of Llandaff (CB)]

My Lords, as I address Amendment 266, I should declare that I am a vice-president of the Chartered Institute of Environmental Health. I stress that this amendment has been supported by the Beauty Industry Group, which represents 10 industry organisations—two voluntary registers for cosmetic practitioners, the Mental Health Foundation and others.

There are currently significant gaps in our regulatory system. Environmental health and licensing professionals work at a local authority level. They inspect, register and license premises for a very limited set of procedures, such as acupuncture, tattoos and piercing. Even for these procedures, however, there are no nationally set training programmes or qualification requirements for somebody to practise. For the riskier beauty procedures, such as the injectables, there are only voluntary registers of accredited practitioners. They have some approved education and training but that is not mandatory.

That means that there are many unaccredited practitioners on the high street providing services to people directly with no checks. A licensing scheme, as outlined in the amendment, would provide appropriate qualification and competency standards for practitioners wishing to practise, which is key to improving safety. The amendment as drafted is an open power for the Secretary of State, so it is easily amended as new procedures come online and on to the marketplace. The weakness of existing legislation in the area is that it fails to cover many of the newer treatments that are now popular.

When things go wrong, it is the NHS that has to pick up the pieces. Infections, injuries, scarring, burns and allergic reactions from a range of procedures often all end up in the NHS, sometimes with people being hospitalised and disfigured. Injection of fillers—or botulinum toxins—into blood vessels can cause dying back of tissues as well as blindness when administered by people who really are not adequately trained and certainly not registered. That means that there is no recompense for people damaged by these practitioners, who have no medical insurance or qualifications. In addition, there are unauthorised advertisements that breach advertising standards. There are strict laws around prescription-only medicines such as botulinum toxin, but these advertisements seem to bypass those.

Among members of the public who have had cosmetic procedures, alarmingly, three-quarters were given no information about the product, volume, brand or batch number of whatever was being used and just under three-quarters were not asked anything at all about their psychosocial or mental health or any body image issues. It is a vast and complex area and there are gaps in regulations. We need a national framework of standards with qualifications that can be recognised, so that there is a clear badge for members of the public.

To briefly address Amendment 297, I suggest that it is not needed because dermatological surgery and plastic surgery are subsections of medical practice and already registered with the General Medical Council. This gets nearer to credentialling than to requiring a separate qualification. These are doctors. They are highly trained, they have gone through a recognised training programme and they have been often examined as part of their exit from their training in whatever procedure they are undertaking.

I remind the Committee that, in a recent letter from the right honourable Michael Gove, he said that he is considering a licensing scheme. I hope the Government will see that this amendment would allow such a scheme without tying the Government down, and I hope that they will accept it, as well as Amendment 264 from the noble Lord, Lord Hunt, for which I should declare that I am an honorary fellow of the of the Royal College of Physicians of Edinburgh and the Royal College of Emergency Medicine. I think the contents of the amendment would go wider than simply surgical procedures. The Royal College of Emergency Medicine was established as a separate medical college in 2008, but the guidance and regulations were written prior to that, so they are completely out of date for what is now emerging as a major specialty across medicine. That amendment would rectify a lacuna.

Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Bethell

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, from the perspective of a clinician, I support this amendment very strongly. If it is not adopted, I can see it being imperative, in any doctor’s consultation, to warn the patient that their data could be accessible and to be very careful about what is recorded in the clinical record. Very often, patients come to see a doctor, possibly at a very early stage of slightly disordered thinking or because they have undertaken a potentially high-risk activity, often in the sexual domain, and are worried that they may have contracted some condition or other. If you inhibit that ability to see a doctor early, you will further drive people into whatever condition is beginning to emerge, so it will not be known about until later. That applies particularly in mental health, where early intervention might prevent a condition from escalating.

I can see that, without an amendment such as the one proposed by the noble Lord, Lord Hunt of Kings Heath, every clinical consultation will have to be conducted with extreme caution, because of potential access to data.

[Lord Bethell (Con)]

My Lords, I an enormously grateful for this debate, because this clause and related clauses are critical both to achieving the digital transformation aims of the NHS, referred to by the noble Lord, Lord Clement-Jones, and to getting the healthcare system to work better together.

I am also grateful for the humanity and testimony of several noble Lords, exemplified by the noble Baroness, Lady Finlay, who spoke movingly about the practicalities of patients going to see their doctors. I know from my own life and from my family how important it is to protect those relationships.

That is why I would like to hear a little from the Minister about what protections there are, because health data is and should be treated as a special category of data. What additional protections are there in the use of health data, including in the common law duty of confidentiality, the role of the National Data Guardian, the way the Caldicott principles will be used and the national data opt-out? What reassurances do we have that those special considerations will apply to this clause and its related components?

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 9th September 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have some supplementary questions. I am most grateful to the Minister for the update and for yet again appearing before the House. I will pose short questions about three areas.

First, on the public health messaging over asymptomatic carriers, we seem to have had a complete drop-off of mask wearing and of being distance aware. Neither of those impedes the economic viability of any business at all; they are simply social behaviours. People seem to have gone back to the most inappropriate social hugging, which is unnecessary. Yet I do not see any public health messages coming out just to maintain the control measures we had in place before. Could the Minister tell me what the plans are for that?

Secondly, does the noble Lord plan to widen the list of eligible children to ensure that those who have a family member, whether a sibling or parent, who is particularly vulnerable are offered vaccination—this would not be forced but would be an offer to them—rather than being excluded, as they are at the moment, because they themselves are not ill? They may carry quite a large emotional burden, knowing that someone at home could become very ill, despite being double vaccinated.

Thirdly, on preparing for the winter, does the Minister recognise this week’s notice from the Royal College of Emergency Medicine showing that 80% of respondents are not confident in their ability to cope safely in their departments as we go into winter, and that half of the emergency departments are reporting delays of transfer from ambulances into their departments? That compares with a quarter of such departments reporting these delays in October 2020, which would suggest that the whole backlog and silting up has got worse. Can the Minister explain what provision there is to expand bed provision, so that people who arrive in emergency departments and need admission can be moved rapidly into beds to be looked after, rather than having this backlog, which also stops ambulances going to other emergencies while they are stuck outside an emergency department?

[Lord Bethell (Con)]

I thank the noble Baroness for three extremely thoughtful questions. I will dwell on them, if I may, because they are a good opportunity to answer some of the concerns that I know many noble Lords have.

On public health messaging and behaviours, there is a question of perception. If we look closely at the analysis done by our behaviours team, we see that the public remain extremely conservative and restrained. While the noble Baroness’s perception may be that mask wearing and distancing have been given up and that hugging is not where she would like it to be, from the data it appears that the public remain extremely concerned about public transport, going to the shops and attending major events. Therefore, we are in a moment of transition, but roughly speaking we are where we would want to be.

Let us be clear: we are keen to get back to the life we once had, and vaccines are going to be the way that we do that. We want to return to intimacy and to the way in which our community likes to live. Testing, social distancing and the panoply of virus control play a role in that—but we are seeking to step back from those days and, so long as the vaccines work in the way they are working at the moment, we are keen not to disrupt people’s lives as much as we can.

On eligible children, that ball is with the CMO at the moment. I completely hear the noble Baroness; she is entirely right about the emotional burden. I also emphasise the importance of making sure that children get the education they need, while at the same time empathising with their concerns for their loved ones and those with whom they live. It is an awful position for those children and families to be in. That is why the CMO is looking at vaccination for 12 to 16 year-olds and possibly beyond.

On winter preparations, I hear the noble Baroness’s comments about the Royal College of Emergency Medicine. The statistics she gave are a matter of concern, but the medical director of the NHS monitors these questions extremely carefully. We think we are in the position we need to be in to get through this winter. We are on the balls of our feet in case there is either an uptick in the current delta variant or a new variant. A huge amount of investment has gone into the redeployment of NHS beds. The NHS has never had a bigger capacity in terms of its workforce and the number of beds available. The use of ICUs and the management of Covid patients have become much more efficient and productive than they used to be, and we believe that we are in good shape.

Covid-19

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, following the G7 we pulled together a joint task force with USA colleagues to address the precise point that the noble Baroness alludes to. That joint task force is working extremely hard to resolve the various practical, epidemiological and virological arrangements for the kind of green-list corridor that we would like to have between our two friendly countries. I am hopeful we will be able to make announcements on that shortly.

[Baroness Finlay of Llandaff (CB) [V]]

I would be most grateful if the Minister could follow on from the question of the noble Baroness, Lady Tyler, and tell us when these plans will be published. The statement says

“we do not believe that infection rates will put unsustainable pressure on the NHS”,

yet we know that the lambda variant, if it should come into the UK and spread, is probably antibody resistant. We know that already, last weekend, some emergency departments had waiting times of around eight hours because they were under such pressure from patients plus staff sickness. We know that it is completely inhumane to expect parents of a sick baby to go into work if the child has RSV during the winter, so those members of staff will inevitably take unpaid leave if they are not allowed to take leave to look after their child.

[Lord Bethell (Con)]

The challenge presented by workforce illness in the NHS is acute at the moment. It is one we are very conscious of, and the noble Baroness is entirely right that parents who have a sick child must stay at home. Not only is that humane; it is also infection control wisdom. That puts the pressure on. That is why we have prioritised vaccination among healthcare staff, and we are prioritising the boosters for staff.

In terms of managing emergency services, we are conducting a huge marketing campaign around the use of NHS 111 so that people can book their slot and be directed to the right kinds of services because, as the noble Baroness knows, many people who turn up in emergency departments are not necessarily in the right place for the conditions they present.

In terms of variants of concern, we are keeping an eye on lambda, beta and all those that may present a vaccine escape risk. We will take whatever steps necessary to address their threat.

Folic Acid

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 13th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am looking forward to outlining the draft timetable, but I will not be able to do so before the Recess.

[Baroness Finlay of Llandaff (CB)]

My Lords, following on from the Minister’s answers, can he tell us whether a provisional target date has been set with the devolved nations for the implementation? Given that we know that 90% of women aged 16 to 49 currently have folate levels below that required to reduce the risk of neural tube defects and that 70% of adults—that includes men—have folate levels so low that they are at risk of anaemia, this is an urgent problem.

[Lord Bethell (Con)]

My Lords, I share the sense of urgency expressed by the noble Baroness in her articulation of those statistics. They are both worrying and entirely accurate. We very engaged with the devolved assemblies. Welsh and Scottish Ministers have expressed their support, but with Northern Ireland it is important that we consider all the implications of the Northern Ireland protocol. I am therefore not able to lay out the precise timetable now, but I reassure the noble Baroness that we are moving as quickly as we can.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I understand the question put by my noble friend but I am afraid that I do not recognise the anecdote to which she refers in terms of hospitals’ treatment of individuals. Nor do I particularly recognise the generalisation that males and females are affected by the disease differently, but I would be very happy to look into this matter and write to her if I can find more details.

[Baroness Finlay of Llandaff (CB)]

I thank the Minister for his responses and for the meetings he has set up. Using his words, given the challenges of “getting the NHS back to speed”, as well as the predicted rise in seriously ill patients with infections— both from influenza and Covid variants such as beta, lambda and others that may emerge—what contingency plans are being developed and activated now? What is being done to increase bed capacity for the autumn and winter and to recruit, train and upskill staff who have currently stepped back from or retired from clinical care, to increase overall capacity?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to make the connection between Covid and flu. We regard the winter as presenting two pandemics, and we will treat them with equal energy. Flu and Covid have the same net effect on the healthcare system, which is to be a huge drain on resources. So we are putting a huge amount of effort into the vaccine and boosters for Covid and the vaccination against flu. They can be taken together, and the advertising and promotion distribution to identify priority groups will be extremely energetic. That is the most important thing we can do to protect the NHS. Our second priority, though, is getting the beds to which the noble Baroness referred used for elective surgery. We do not want to see the NHS heaving under the pressure of Covid and flu. We want to see it addressing the backlog.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend refers to humility and he is right: we have all had to develop a stronger sense of humility in the face of this awful virus and this dreadful pandemic. It has taught us that, despite all our 21st-century healthcare systems, we are all vulnerable to its awful effects. His words are absolutely spot on. I repeat the statistic that 69.4% of adults across the UK have had the vaccine, because the overall story of the vaccine rollout has been one of incredible participation by the British public. Not only have I never been involved in anything quite so successful in my life but there are very few national projects anywhere in the world that have been as successful. I really applaud all communities in every part of Britain for the way in which they have stepped up to the vaccine. My noble friend is right that there are some communities in which those levels are not as high as they should be. That has led to higher transmission among younger people, and in a few cases that has led to severe disease among older people who, frankly, should have taken their vaccine. I urge everyone to step up to their opportunity.

[Baroness Finlay of Llandaff (CB)]

As the Minister, who has worked tirelessly during Covid, knows only too well, an outbreak anywhere can become an outbreak everywhere. Can he tell us how the UK plans to increase vaccine distribution globally through COVAX to control the pandemic and decrease the risk of further variants arising in countries with high rates of infection, particularly as the risk of vaccine-resistant variants will remain high for at least a decade?

[Lord Bethell (Con)]

My Lords, the Tedros principle of us being safe only when we are all safe remains the most profound insight. The noble Baroness is entirely right: we must do more to try to help those in the developing world. The frustrating truth is that the world simply does not have enough capacity for the manufacture of these very complex and tricky substances. We are straining every sinew to try to deliver the 9 billion vaccines we need to deliver worldwide vaccination, but the rate of manufacturing is not as high as any of us would like. I take my hat off in particular to AstraZeneca, which has provided licences for the vaccine worldwide on a no-profit basis, but I also pay tribute to the other vaccine companies, which, despite what one might read in the press, are trying all they can to set up manufacturing sites all around the world. Progress is being made.

Folic Acid

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I think my noble friend alludes to the rollout of the vaccine, which has been the consummate preventive medicine programme that the country has ever seen. It is, I hope, an inflection point in the whole country’s approach to its healthcare. We have for too long emphasised late-stage, heavy- duty interventions, and we have not focused enough on preventive early-stage interventions. Folic acid is a really good example, as are the vaccine and fluoridation, and the kinds of population health measures we hope to bring in will address all of those.

[Baroness Finlay of Llandaff (CB) [V]]

I too commend the noble Lord, Lord Rooker, for his tenacity on this important aspect. Do the Government recognise that 90% of women of childbearing age have low folate levels? If these were corrected by the dietary addition of folate to flour, we could see up to a 58% decrease in neural tube defects. These are massive numbers and cannot be ignored. The clock is still ticking and there are women getting pregnant today who have low folate levels.

[Lord Bethell (Con)]

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

World Health Organization: Pandemics

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s passion for international travel. Like him, I cannot wait for global travel to restart. I also see the connection between the promise of a vaccine certificate of some kind and taking up the vaccine itself. Plans for vaccine certificates for global travel are emerging as we speak. We have a Cabinet Office programme which is co-ordinating across government initiatives on vaccine certification, and a review is in progress which will pronounce shortly.

[Baroness Finlay of Llandaff (CB) [V]]

[Inaudible]—excellent record in research, are the Government able to work through the WHO to promote research into recyclable PPE to avoid the environmental hazard of an enormous pile-up of plastics and discarded PPE? Can the Government work on a public education programme of basic hygiene, with clean water and soap available across the world, so that the very basic principles of hygiene can be maintained?

[Lord Bethell (Con)]

My Lords, the environmental consequences of the pandemic are indeed severe, as the noble Baroness rightly points out. We are working with colleagues in Defra to try to figure out answers to this tricky problem of the legacy of all this PPE. With regards to hygiene education around the world, we have a number of programmes in place, through ODA and our various international development plans, and hygiene is very much at the centre of those.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to my noble friend for his question and I echo his comments on Kate Bingham. However, my Lords, we are not post-vaccine; we are, at best, mid-vaccine. Vaccinating 20 million people is an enormous achievement but there is a hell of a long way to go. There is still an enormous amount of infection in this country; nearly half a million people, or thereabouts, have the disease. There are variants of concern being generated in this country, such as the Kent virus, and overseas, such as the Manaus virus. Until we are truly through this, we have to show restraint and make uncomfortable decisions, and we must ensure that the NHS is preserved and we save lives. That, I am afraid, remains our priority.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, British science is indeed to be celebrated, as is government support of it, in vaccine development, genome sequencing and disease-specific registries such as UK Biobank. Will the Government use that experience to establish a national Covid registry to bring together the four main groups of data referred to by the Minister in his reply to the noble Lord, Lord Taylor, to inform long-term planning to reveal links between new variants found on sequencing, different long-term complications, including long Covid, the risk factors behind it and other matters such as body-mass index, vaccine history and any associated other contagious diseases? Such a registry could act as a long-term public health research tool.

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

Covid-19: Brazilian Variant

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to the noble Lord for flagging the Brazilian connection with Ireland, which I did not know about. I reassure him that there is an enormous amount of collaboration between Whitehall and Dublin on this matter. There are strong links on the managed quarantine programme within Ireland in order to close the “Dublin backdoor”, as it is sometimes called. I pay tribute to colleagues in Dublin for their collaborative approach. We do not currently have a five nations unified approach, but it is of interest. We are definitely keen to ensure that there is no backdoor entrance for VOCs through Dublin, or in the other direction.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, given the inevitability of variants and that some will evade antibody responses, what plans do the Government have for unified messaging, across the whole of the UK, that long-term distancing, mask-wearing and other measures are essential, and to tell the public that this is not like flu and we need to live differently?

[Lord Bethell (Con)]

The noble Baroness is entirely right, which is why the Prime Minister struck such a cautious tone when he unveiled the road map. We are not through this yet. A substantial proportion of the country is vaccinated, but we have to protect the vaccine. For those who have not been vaccinated, there are risks, and that is why we still have in force a “do not travel” alert and why we are maintaining marketing and communications at every level on the restrictions that are still in place.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay immense tribute to the test and trace system, which, at 11 am, published remarkable performance figures, as the noble Lord probably knows; 92% of tests were turned around before the next day, and 86% of contacts were traced. This is an incredible performance. On his specific point, the creation of a variant-of-concern tracing group that is targeted at those rare appearances of VOCs in the community is the important development that we have put in place in reaction to the mutant variants. I pay tribute to Steve McManus, who is running that programme, for the impact that he has already made on the problem.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, with the emergence of new variants, questions over vaccine-induced antibody response to these and the risk of children as asymptomatic carriers, will the Government ensure that schools’ policies are flexible, adapted to each child’s needs, so that children shielding a very sick parent or sibling at home will be able to continue with home schooling and not be forced back through punitive threats on parents; while children needing the security of school can continue to access school as at present and when the majority have the benefit of being able to return?

[Lord Bethell (Con)]

I reassure the noble Baroness that we are absolutely putting the arrangements for pupils in the hands of schools themselves, because they know best how to look after their pupils and their teachers. The role of test and trace is to provide testing facilities and the resources to make schools safe, but it is up to the Department for Education, the local authorities and the schools themselves to protect those who need special arrangements, either because they are shielding or because they have other needs.

International Year of Health and Care Workers

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the Minister for Vaccines has been clear on this: the Government are not currently undertaking work on vaccine certification. However, the noble Baroness makes the case well. Certainly, those who have had the vaccine are very anxious to ensure that they have the correct documentation, and we will ensure that that is in place.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my roles at Cardiff University. Will the Government create a range of funding streams as overseas aid to ensure that UK universities’ successful distance learning programmes in practical health and care specialities and generalist care are affordable and supported in those countries? Will they work with me and others to invest in better provision of public health, infectious disease control, maternity services, dermatology, palliative care and other services around the globe?

[Lord Bethell (Con)]

My Lords, I pay tribute to the work of the noble Baroness in this important area. Her implied insight is exactly correct. We cannot be healthy and safe here in Britain if there are diseases raging around the world. It is both in our pragmatic self-interest and aligned with our values of partnership with other countries that we should indeed invest in the kind of training and support to which the noble Baroness alluded. I will definitely look into how we could do this better.

Covid-19: Variant

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, PHE weekly seroprevalence data suggests that antibody prevalence among blood donors aged 16-plus in England is 6.9%, which is consistent with other data that we have. The MHRA has considered this and has decided that vaccinating is just as important for those who have had Covid-19 as it is for those who have not.

[Baroness Finlay of Llandaff (CB) [V]]

How are demographic and NHS outcome data and test results from patients across the UK being collated to identify patterns suggesting further new variants, reinfections, changes in risk factors to severe disease, such as malnutrition, and planning for managing long Covid and modelling ICU provision?

[Lord Bethell (Con)]

The noble Baroness alludes to a world of analytical complexity, which is very much what we have to look forward to. The way in which this new variant has popped up and has been dramatically more transmissible presents a wholly different level of threat compared with the one that we were dealing with just six weeks ago. It is a matter of grave concern to all of us that this mutation has happened. However, I reassure noble Lords that we have very strong genomic capability in this country. Roughly 5% of all tests are analysed. It is only 5% but that is more than in most other countries, and we are putting in the analytical muscle to be able to process that data.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 15th December 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum. I ask the Minister to express thanks to staff in his department as they continue to work with us and the Ministry of Justice to run a rapid-response webinar on Friday, requested from primary care leads yesterday, following their pilot, to support primary care as vaccination is rolled out to care homes, where many residents have seriously impaired capacity. We aim to disseminate the latest guidance and ensure appropriate information to support understanding for consent to vaccination, including easy-read and pictorial versions of information.

[Lord Bethell (Con) [V]]

I am enormously grateful for the work that the noble Baroness, Lady Finlay, and the National Mental Capacity Forum have done during the pandemic. The issue of mental capacity and consent has been addressed in official guidance that the NHS and others have issued to medical professionals who will administer the Covid vaccine in care homes. I understand that officials at the DHSE and the MoJ are supporting the forum with the webinar planned for this Friday, and I am absolutely delighted to reaffirm the Government’s support for the forum’s work on these important areas.

Care Quality Commission Report

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, my noble friend makes an extremely important point. The role of families and communities in the social care provided to those with autism and learning difficulties is extremely important and will be at the centre of every recommendation that we make in response to this report.

[Baroness Finlay of Llandaff (CB) [V]]

I declare my role as chair of the National Mental Capacity Forum. Are the Government considering the separation of learning disabilities from within the Mental Health Act to drive training in early crisis recognition and de-escalation in the community, learn from good practice and pilot alternative ways of providing places of safety in a crisis? The underlying social problems need social care solutions and are not always appropriate for, or amenable to, medical intervention.

[Lord Bethell (Con) [V]]

The noble Baroness makes her point extremely well. These are exactly the kinds of questions that have been considered by Sir Simon Wessely’s review of the Act. As I said earlier, we are looking forward to publishing a White Paper on the Mental Health Act 1983 shortly, and those are exactly the kinds of issues that it will seek to address.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 30th November 2020 Lords Chamber

[Lord Bethell (Con)]

I welcome my noble friend’s challenge. I reassure him that the testing and vaccination programmes will absolutely run alongside each other and that this has already been happening. They are collaborating very closely. The resources being provided for both are generous enough to ensure full delivery of the vaccine. The rollout of the community testing programme is a sign of the success of test and trace, but it will in no way have a negative impact on the deployment of the vaccine programme, which remains a number one priority for the Government.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, given that some people need to go to visit a relative who is dying or otherwise very distressed, will the Government instigate a system whereby these people can register that they will need to travel across boundaries? They may even need to stay over to provide care for some time, to enable a person to be cared for in their own home. Under the current situation, they risk being given a criminal record for breaching rules, and then they may have to try to defend themselves in retrospect after the person has died.

[Lord Bethell (Con)]

I thank the noble Baroness for her characteristically compassionate question. I can reassure her that there are exceptions for essential travel. The kind of scenarios that she just described would seem to me to fit into the definition of exceptional travel. I am happy to look into whether some form of registration process is necessary but, as far as I understand, that has not proved to be the case.

Covid-19: Vaccination Prioritisation

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 25th November 2020 Lords Chamber

[Lord Bethell (Con)]

My noble friend has made the case for rough sleepers extremely well. It is one that we are deeply concerned about. When it comes to the prioritisation list, what has been published so far is an interim and indicative list. It will be reviewed, and a more detailed list will be published in time.

[Baroness Finlay of Llandaff (CB) [V]]

As the Government keep the priority list under review, will they also look at the results of the New York vaccine rollout prioritisation? Younger adults who have been shielding are often already on a list, are at high risk and have children at school or college who are also their carers. These children are already stressed, if they attend education, knowing that they risk being asymptomatic virus carriers into the home and that Covid could kill their parent or sibling.

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness for suggesting the New York precedent. It is not one that I was aware of and I will look into it. I reassure her that we are liaising with all our international partners over the vaccine rollout to ensure that we put in the best possible practice that we can.

Medicines and Medical Devices Bill

Debate between Baroness Finlay of Llandaff and Lord Bethell

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[Lord Bethell (Con)]

I can give a couple of illustrative examples if that would be helpful, but to run through the whole philosophy and system is probably beyond my ability or the time afforded by this Committee. In essence, the challenge identified by my noble friend Lady Cumberlege is that individual reports of adverse signals are not easily connected, unless those reports are somehow sent to a central registry and analysed by the kinds of experts who can spot mistakes and the connections made between those signals. This is how any problem identification system works. To do that process, you do not have to share personal details. You do not need the telephone numbers or personal identities of those concerned, but you need the clinical details and the full context in which signals have occurred. This pattern identification is often missing in the instances on which my noble friend reported. Having this information system, and analysis connected to it, will enable us to spot problems at a much earlier stage. Necessary interventions based on analysis and understanding will be much prompter and the connections made much more emphatic.

[Baroness Finlay of Llandaff (CB)[V]]

I am incredibly grateful to all noble Lords who have spoken in this debate. It has been very important and illuminating. We will all need to read the Minister’s words with care because there was an awful lot in them. I am most grateful to the noble Lord, Lord Ribeiro, for asking about the private sector, because if procedures are done in the private sector for patients who pay for themselves and those procedures are outsourced more and more, it will be important to make sure that this safety data is collected.

I am surprised that the word “must” is not being picked up. A supermarket will know how many tubs of mayonnaise it has ordered and which factory they came from. If there is glass in jam, a supermarket can track it back to the factory where the glass was. If we do not have complete data collection systems, we will find that all the places that are functioning above average will do really well. They will collect the data properly, and so on. But 50% of places are below the average line—that is the nature of an average. All patients need to be protected and standards need to be driven up. I was grateful to the noble Baronesses, Lady Walmsley, Lady Redfern and Lady Jolly, for elaborating on aspects of points that I have made, and particularly grateful to the noble Baroness, Lady Thornton, for giving us the history of the amendment and asking again how this would work in practice.

Consent is critical. Patients going into a hospital expect all the equipment to be safe and to be known about. They expect the fire alarms to work and that the oxygen pipes to anaesthetic machines are correctly positioned and known about, and that full servicing data is available. It is important. Here I should declare that I was a very junior doctor in a hospital, but on the periphery, when an anaesthetic accident happened many years ago. It was critical that things could be traced back urgently. Unfortunately, there are tragedies, even when it is possible to do that.

We need to be able to look right across the whole system. There is the safety aspect—the tracking and quality control—that goes along with all the routine procedures. If something faulty is used in 15 hospitals around the country, that needs to be known rapidly and safely. I, too, worry about relying on clinicians to report if there is a problem, and I rather felt that the Minister’s answer underlined the call for a distinct commissioner for safety. The noble Baroness, Lady Cumberlege, has been calling for that because we need somebody who can interrogate and analyse the data, and look at it carefully. She explained consent for patient details extremely well. The Montgomery test of consent is that you should be given the information that other reasonable people would expect. It is almost the Clapham omnibus test of what patients should be told.

This is not about what the clinicians want or do not want to tell patients. They might feel it unnecessary to tell them something, but most patients would want to know about it and therefore it should be disclosed to patients. A doctor might say, “This can happen, but it has never happened to me”, but they still have a duty to disclose. Linked to that consent, I would like us to have routine processes in clinical practice for consent data to be entered into a registry. Patients could opt out and say that they did not want it to be entered, so that box would not be ticked; their scanned-in data would then not be sent on with the additional information.

This debate has been incredibly important. It gets right to the nub of patient safety. I hope that the Minister will meet me and the noble Baroness, Lady Cumberlege. I have to say to the Committee that I am pretty convinced that we will return to this on Report because there is a lot more to do. However, we have another group of amendments to move on to, and that debate will be interesting and informative, so I beg leave to withdraw the amendment.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, Amendment 91A seeks to replicate the innovative medicines fund with a comparable fund for medical devices called the innovative medical devices fund. We have had a terrific debate on this. The ideas and insights shared by noble Lords have been extremely powerful, but perhaps I may address the points in turn.

The goal that is shared wholeheartedly by the Government is that we recognise the huge benefits that medical devices can deliver. My noble friend Lord Lansley and the noble Lord, Lord Hunt, put that particularly well. We recognise the astonishing pace of innovation and development that is creating new healthcare options for patients across the UK. In fact, that is one of the reasons we are considering this Bill. We are extremely ambitious and are determined to capitalise on the opportunities presented by new medical technologies to ensure that the best innovations are adopted and spread across the NHS.

Devices, like medicines, are key to ensuring patient health, but they are different and it is not necessarily helpful to use a system that was developed for medicines to be used for devices. For example, the primary purpose of the innovative medicines fund is to cover the cost of managed access agreements where NICE feels that there is insufficient evidence to give a positive opinion and asks for further evidence to be collected before the product is re-evaluated.

Devices are not assessed by NICE in the same way and we do not consider that mirroring the provisions for medicines would necessarily be beneficial. In particular, unlike medicines where, once licensed, they do not change, medical devices are constantly evolving. New iterations of medical devices are developed quickly, their impact on patients changes, often rendering earlier iterations completely obsolete within relatively short periods of time. That gives rise to the potential for funding mandates to be in place for devices that are no longer the best or most cost-effective in their category. Requiring the mandatory purchase of all but the most innovative devices by commissioners would not be a sensible use of NHS funds. We therefore need to find different systems of process to ensure that innovative and effective devices, along with other medical technologies such as digital, find their way to the NHS and to patients.

That is why we have boosted the remit of the Accelerated Access Collaborative. It will bring together leaders from across Government, the NHS, regulators and industry to address the underlying challenges that delay patient access and uptake.

As chairman of the AAC, the noble Lord, Lord Darzi, has been able to bring his world-leading expertise to bear to deliver a host of successes in recent years. Indeed, almost 750,000 patients have benefited from access to AAC-supported innovations in recent years, including more than 315,000 patients who have accessed new technologies supported through the innovative technology payment programme. The AAC is going further to deliver the commitment in the NHS Long Term Plan to accelerate the uptake of proven, affordable innovations with the introduction of a new medtech funding mandate. The mandate will ensure that all patients have faster access to selected cost-saving devices, diagnostics and digital products approved by NICE, via medical technologies guidance and, when available, NICE diagnostic guidance for innovations.

The final criteria to be used in the mandate will be announced in the consultation response to be published in December this year, and the mandate will take effect from April 2021. Additional steps are being taken to ensure that the mandate translates to front-line improvements in patient access. The NHS standard contract has already been updated to state that the relevant parties must comply with their obligations under the mandate guidance, and technologies receiving the mandate will benefit from dedicated support via the regional academic health sciences network to help drive local adoption and spread.

NICE also recognises the need to ensure its methods for assessing innovative medical technologies continue to support our ambition for the NHS to provide world-leading care that delivers value to patients and the NHS. The NICE methods review is therefore under way, with extensive input from industry and patient representative groups. The consultation on the case for change to existing NICE methodology is open until 18 December, and I encourage all those interested to submit their views.

Finally, it is also important to note that in her amendment the noble Baroness, Lady Finlay, stated that moneys should be paid to the Secretary of State under Section 261(9) of the National Health Service Act 2006 in order to support an innovative medical devices fund scheme. However, Section 261 of the National Health Service Act relates only to voluntary schemes agreed with pharmaceutical manufacturers which control the prices charged, or profits accrued, by manufacturers and suppliers of health service medicines. The vast majority of medical devices would not therefore be within the scope of such a scheme.

I trust that I have been able to reassure the noble Baroness that the funding of medical device technology in the NHS in England is of great importance to the Government and that we are actively putting in place mechanisms to support it. On this basis, I hope very much that the noble Baroness, Lady Finlay, will feel able to withdraw her amendment.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I thank noble Lords for contributing to this debate. There were a couple of comments that I would like to come back on.

The noble Lord, Lord Lansley, asked whether there was evidence of the slow adoption of innovation. I have a series of different case studies that I will happily share with him. I shall highlight one. Cytosponge had a 19-year journey from when it was thought of to when it was adopted. It is estimated that it saves 7,190 QALYs having now gone through NICE. Companies do not feel incentivised to develop low-cost devices in this country.

Another example is the CoMICs study on conventional versus minimally invasive extra-corporeal circulation in patients undergoing cardiac surgery, which compared two types of bypass machines. The difficulties there resulted in most of the study going abroad and being conducted elsewhere. Our development of robotics has been impressive, but we have huge competition from the US market, in particular in device development.

So I suggest that we need to look at a way of making sure that we can develop devices. I accept that this amendment as worded may not be right for this Bill at this time, but I hope that we will not lose sight of the need to innovate. I would like to come back on Report to the concept of provisional licensing as a way of getting new and innovative devices through the system rapidly, possibly without burdening the NHS with the financial bureaucracy that this amendment might cause. I beg leave to withdraw the amendment.

Covid-19: Dental Services

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend is right to allude to the confusion around the closure of dental practices. We have made it crystal clear that in the second lockdown all dental practices—both NHS and private—should remain open; that is part of our commitment to try to clear the backlog. I also acknowledge her concerns about the diagnosis of cancers. I do not have the figures for which she asked, but we certainly appreciate the role that the dental sector plays in detecting many cancers, including oral cancers. Dental services are open to those seeking urgent care and we hope that those urgent care clinics to which I referred earlier can provide some diagnostic analysis in urgent cases.

[Baroness Finlay of Llandaff (CB) [V.]]

My Lords, I declare my role as chair of the National Mental Capacity Forum. Following on from the question of the noble Baroness, Lady Uddin, will the Minister say how the urgent care pathway is being evaluated, particularly for children and young people with learning difficulties who might need a general anaesthetic for dental work? They are at a particularly high risk of sepsis from dental abscess, which can be avoided by preventive dentistry, yet they are often part of the increasing backlog and have difficulty registering with a dentist locally because they need even more time for their care than other patients and will therefore decrease the number of other patients whom the dentist can see.

[Lord Bethell (Con)]

My Lords, the concern about children is particularly acute. We are especially keen to encourage parents, to ensure that they are still bringing children forward. That is why we have the Help Us to Help You campaign to encourage public access to NHS services. She is entirely right that acute situations—involving, for instance, some form of anaesthetic—provide a particular challenge. We have a prioritisation process in place, and I understand that that is working well to ensure that those who have the greatest need are put at the front of the queue. However, as I said to the noble Baroness, Lady Uddin, I would welcome any feedback from those who think that the system is not working well enough.

Covid-19: Contracts and Mass Testing Programme

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 4th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do not accept the assumption that we are going into a second lockdown because of the failure of tracing. The tracing system has led to the isolation of more than 1 million individuals, which has done an enormous amount to break the chain of transmission. However, there is more that we could do. I completely acknowledge that the Government are focused on improving performance in tracing, and we will use the opportunity of the next month to ensure that that performance gets better.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my interests in medicine. Given that 55% of GPs, 35% of physicians and 11% of surgeons recently reported that they lack confidence in adequate PPE being available during the ongoing pandemic, when will the Government issue revised guidance to all NHS managers insisting on a duty of care to all front-line staff to ensure that staff are supplied with quality-certified appropriate PPE that is in date and fit tested under a risk assessment for the well-being of the clinical workforce? Have the Government commissioned research into reusable UK-manufactured PPE?

[Lord Bethell (Con)]

My Lords, we take the duty of care to our staff and patients extremely seriously, and that is already well documented by the NHS. I reassure the noble Baroness that purchase orders have been raised for 32 billion items of PPE in anticipation of a second wave; 18.6 billion items have already been delivered, 2.2 billion are with our delivery partners, and a further 16 billion are on their way. This is a massive investment in PPE and I reassure her that it will be made available to healthcare staff in abundance.

Cancer Task Force

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

My noble friend is entirely right. The impact on cancer from Covid is extremely concerning. However, the backlog is being dealt with more quickly than the immediate figures perhaps suggest. The investment in radiotherapy is incredibly important; we have new treatments coming in all the time, and I reassure my noble friend that we will be retiring redundant machines as soon as they reach the end of their natural lifespan. I want to mention in particular stereotactic ablative body radiotherapy for small cell lung cancer and oligometastatic indications: I am told that this is a particularly exciting radiotherapy treatment

[Baroness Finlay of Llandaff (CB) [V]]

Following on from that, does the Minister recognise that about half the machines in the country are currently beyond their 10-year lifespan and urgently need replacing—including upgrading to provide stereotactic radiotherapy, which has lower side effects and better outcomes—and that there therefore needs to be at least £230 million ring-fenced for innovation in radiotherapy, quite apart from the other investments?

[Lord Bethell (Con)]

The noble Baroness puts her case extremely well. We have a massive investment in the NHS that spans physical infrastructure and staff, hospitals and investment in nurses. This will have a big impact on the diagnosis of cancer, which we are committed to getting as early as possible, as well as on treatment for cancer. Treatment with radiotherapy will form an important part of that.

Covid-19: Local Restrictions

Debate between Baroness Finlay of Llandaff and Lord Bethell

Friday 9th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely recognise the importance of stakeholder engagement, building alliances and collaboration. I emphasise our commitment to the partnership between local and national government. When it comes to Parliament’s engagement in these measures, I can only repeat what I said earlier: my right honourable friend has made it very clear that for significant national measures with effect in the whole of England or UK-wide, we will consult Parliament and, wherever possible, hold votes before such regulations come into force. Until then, it is through the usual channels that the schedule of the House of Lords will be arranged.

[Baroness Finlay of Llandaff (CB)]

Building on the Minister’s commitment to locally led decision-making, will the Government confirm that they will now consult daily with the devolved Administrations and share evidence prior to any press release, as confused messages have undermined public confidence? That way, they may avoid some of the debacles that have happened when local authority decisions have been undermined by leaks to the press.

[Lord Bethell (Con)]

I completely defer to the noble Baroness’s expertise in matters to do with the devolved Administrations, but I reassure her that there are numerous calls every day between Whitehall and the DAs on Covid. We very much celebrate the achievement of a four-nations approach. There are divergences in some procedural matters between the different countries; that is entirely to be expected—indeed, celebrated—as it enhances the effectiveness of our measures. But I completely take on board the noble Baroness’s points and we will endeavour to ensure that communication between Whitehall and the DAs remains firm and solid.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My noble friend puts it all very well. It is my birthday today, so I am feeling a little bit older and thoughtful on these subjects. On a serious point, living wills have enormous benefits and give peace of mind to those who enter nursing homes and hospitals, and their loved ones. We will look carefully at this important point and I will share my correspondence with the noble Baroness, Lady Wheatcroft, with my noble friend.

[Baroness Finlay of Llandaff (CB) [V]]

Happy birthday to the Minister. Given the dangers of the shortcut abbreviation of DNR, which can result in essential care decreasing, has the Department of Health considered adopting NHS Wales’s concept of a natural, anticipated and accepted death—NAAD? In five years, this has had no problems reported and gently and sensitively leads to DNACPR conversations with patients and those who love them.

[Lord Bethell (Con)]

My Lords, I welcome the testimony of the noble Baroness. We often keep track of Wales’s use of innovative health measures and, while I am not aware of this concept in particular, I will be glad to take the advice back to the department, recommend it and return to the noble Baroness with a response on how we are going to take it forward.

Covid-19: Tracking

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 30th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are looking carefully at the Apple express system. It does not contain the substantial investment in the algorithm from the Alan Turing Institute that gives our own app the sensitivity and protection that phone users are seeking from such a device. We have looked carefully and worked extremely intensely with Apple on the battery and our understanding is that the app does not have a large impact on battery use.

[Baroness Finlay of Llandaff (CB) [V]]

When will the equality impact assessment be published for the trial in Newham of the test and trace app that uses the Google-Apple technology?

[Lord Bethell (Con)]

The results of the Newham trial are analytical rather than about the privacy assessment, which has already been published. What we learned from Newham was that security concerns among that community were profound and, therefore, we shaped our marketing in order to address those concerns.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 23rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have said on other occasions that we publish a lot of data, and I would be glad to share a full list of our data sources with my noble friend. To put a different perspective on the point she makes, the biggest challenge we have is to persuade people that their personal health is not a private matter that affects only them; it is a public matter that affects the people they love, the people they are standing next to and everyone else. This is particularly challenging for young people, quite understandably. Young people may have very few symptoms or none at all. They may carry the disease without any personal implications whatever but are vectors of disease who carry it to the vulnerable, ill or elderly. Persuading the country that their health is a public matter is our number one priority. My belief is that we are making great progress, but there is some way to go.

[Baroness Finlay of Llandaff (CB) [V]]

To break the chain of transmission, people must isolate if carrying the virus. Therefore, people have to understand that a negative test means only that they were not carrying the virus at the time the test was taken. The new contact tracing app being launched tomorrow has the potential to interrupt the transmission of the virus, but in order for it to work, a large proportion of the population will need to download and use it. Is it true that only just over half the mobile phones currently in circulation in the UK are compatible with the new app?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that a test today only proves that you have not got it this morning; it does not necessarily prove that you might not have it in a couple of days’ time, when you go and see your loved ones. However, she is not correct on two points concerning the app. First, all the epidemiological data suggests that even small numbers of downloads—even two people, but certainly 10% of the population—can make a difference. Our aspiration is much higher than that, but it is not true that a large proportion of the population needs to use it for it to be effective. Nor is it true that that it works on only half the phones: our belief is that it will work on a very large majority of phones.

If I may take a moment, I shall use it to advertise the “Distance Aware” badge sponsored by the noble Baroness. It is a really good device for encouraging people who are near those who are shielding to respect the social distancing rules.

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord’s sentiments. The economy and education are critical. I reiterate the Government’s commitment to ensuring that the economy survives in the best possible way and that our children get the education they need. However, it is not quite as binary as he describes. If the public abide by the behaviours recommended in the guidelines, we can enjoy a far greater range of activities than would be the case under a major lockdown. Either way, we are committed to protecting the most vulnerable. I point to the substantial financial investment in protecting those who are shielded and in social care.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare my role in the Distance Aware programme in Wales, intended to help people coming out of shielding. We must focus on breaking the chain of transmission. Oxford University reports that the Isle of Wight Test and Trace pilot with the NHSX app broke transmission rates from among the worst in the UK to zero in three weeks. That app was withdrawn. Now the Google/Apple app trial on the island and in Newham is failing to stop R rising after five weeks. As the NHSX app is the only intervention shown to break the chain of transmission, will the Government now urgently roll it out nationwide?

[Lord Bethell (Con)]

My Lords, the noble Baroness is correct inasmuch as the statistics published for the original app would suggest. However, new statistics about the new app will be published after its launch on Thursday. I reassure her that the circumstances between then and now have changed considerably. The impact of an app that is widely downloaded and implemented across the country can be profound. We are extremely optimistic about its impact.

Health Care: Guidance

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I reiterate the point I made earlier in response to my noble friend’s quite reasonable remarks on the importance of fairness when it comes to age: blanket age restrictions play no role in the NHS and are overtly against the constitution.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum and am an elected member of the BMA ethics committee. All treatment decisions must be individualised based on the likelihood of benefit to the person, considering their wishes and feelings, without prejudice of age, disability or other pre-existing conditions. Will the Government continue to work with the forum to ensure this is known and understood properly across health and social care in all sectors?

Covid-19 Update

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 14th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I thank the noble Baroness and the noble Lord for their perceptive and thoughtful questions. On the noble Baroness’s questions about the level of alert, to my knowledge it has not changed. It was reduced from four to three on 19 June; it remains subject to review on a weekly basis, but we are not in a position to raise it at the moment.

The noble Baroness asked about the rule of six and why we had committed to six as opposed to anything else. The short answer is that we are seeking to have rules that are simple to understand and straightforward to apply. We accept that during the last few months the guidelines have grown increasingly complex and difficult to understand in all their detail. Across the board, with “Hands, Face, Space”, the rule of six and other measures that we are seeking to publish, there is a genuine effort to engage the public in a really simple lexicon of how we can beat the coronavirus.

Sir Mark Walport, the head of UKRI, was right in his warning that the jeopardy is enormous. If we do not get this communications challenge right, and if people think they are confused and think they have a way out because it is in some way complicated, we will fail, the disease will come back and we will have tens of thousands of deaths; we will have an NHS that is challenged; we will have an economy that is shut down; and we will have a generation that is lost to education. Those are the stakes, so we are determined to get it right. I am happy to stand here for as long as it takes and be pub-quizzed on “What about this? What about that?” if it means that we get it right.

However, the public seem to understand these simpler rules. The response from the public in our planning focus groups and in the response since their publication has been extremely positive, and we think we are on the right track. This is advice that was informed by SAGE and we went through its models in great detail.

The noble Baroness and the noble Lord, Lord Scriven, asked why children are included. The bottom line is that we want to keep it simple. Children are vectors of infection; they can pass the disease from one generation to the next. Time and again, in city after city, we have seen an infection that starts with a young person, moves to mum and dad, then to grandma and grandpa. It takes weeks or sometimes months for that progress to take place but, as I have said at this Dispatch Box before, as night follows day, the infection moves through the generations unless we take steps to break the chain of transmission. The rule of six is a critical, unambiguous step in the Government’s strategy for doing just that.

The noble Baroness and the noble Lord, Lord Scriven, asked about marshalls, so let me just say a word about that. This measure came from our engagement with local authorities. Local authorities are looking for ways in which they can implement the right measures to disrupt crowds forming and, as the noble Lord, Lord Scriven, said, mingling—a concept which, frankly, I do not think needs much description and nor do members of the public. In order to break things up, they are looking for ways in which they can have both the authority and the personnel to do that, and we have responded by putting in the right regulations to do that and by providing the right resources. But it will be up to local authorities to implement that in detail.

The noble Baroness asked about shooting and hunting. My understanding is that guidelines on all sorts of sports and activities where the rule of six is in any way ambiguous will be issued in the coming days.

The noble Baroness asked about Hammersmith, and I am extremely grateful for the tip-off. I will look into it, as I have done when other noble Lords have alerted me to concerns they might have. I am extremely concerned that there might be a breakdown in the asylum centre in Hammersmith. However, I reassure the noble Baroness and the House that directors of public health are responsible for this kind of implementation, and the benefit of directors of public health is that they work across all departments. Some directors of public health have a health background, some have a police background and some come from a leisure background, but they all hold the ring when it comes to local implementation of local measures, and therefore they are the best-placed people to ensure that situations like this are not overlooked.

The noble Baroness asked whether we should be reviewing the current measures for pubs, clubs and workplaces. The simple answer to that is yes, absolutely; we should be reviewing it—and we do review it every single week. We are on tenterhooks because, if we get this wrong, the jeopardy is enormous. We are working as hard as we can, with regulatory measures such as the rule of six, marketing measures such as “Hands, Face, Space” and containment measures such as the test and trace programme, in order to keep the economy open, to keep our educational institutions open and to keep life as normal as we possibly can. If we do not—if we fail—it will go back to where we were before, and I hope memories are not so short that people do not remember quite how imposing and draconian the former lockdown was.

On test and trace, the noble Baroness quite reasonably asked about the capacity and about demand. I can reassure her that the capacity has literally never been higher. We are up 7% week on week and—if I can provide the right figures here—we will have a capacity of 500,000 by the end of October. We have 500 centres, including five major laboratories, 236 mobile testing units, 72 walk-through testing sites, and more sites opening all the time. For every 1,000 people in this country, we test 2.43 a day; that compares with Germany at 1.15, Spain at one and France at 1.15.

We are throwing everything we can at the test and trace system, but it is true that demand has gone up. Part of that demand is through children returning to school. I welcome enormously the return of children to school, but it is an un unambiguous fact that this has led to a very large increase in the number of children being sent to testing centres—often bringing their parents and other household members with them—and that has put an enormous pressure on the system.

Another feature is asymptomatic testing. Estimates are that between 20% and 25% of those turning up for a test are currently asymptomatic. If we had all the tests in the world, that would not be a problem and I would welcome it, but right now we are building the system, we are under pressure and we need to communicate more clearly to the public that asymptomatic testing is not supported by our current testing system.

The noble Baroness asked about social care—quite rightly, as this is a major feature; we are concerned about it, and I know that noble Lords are concerned about it. I reassure the noble Baroness and the House that care homes are absolutely our number one priority. This was reiterated in meetings with the Prime Minister last week. Some of the capacity challenges in places such as walk-in and drive-in centres are because we have put care homes front of the queue and because those tests are taking priority.

The noble Lord, Lord Scriven, asked a number of extremely detailed questions, some of which I have touched on. He asked why we have included children. He is entirely right that, in Scotland, they have not included all children and in some other countries they do not do so either. We have taken a different view. Partly, that is on the epidemiological advice from SAGE; partly, that is on the marketing advice from our communications department, which is insistent that we are clear and unambiguous with the population; and, partly, that is the CMO’s advice—he rightly identifies children as potential vectors of infection, particularly in intergenerational households.

The noble Lord, Lord Scriven, asked for consistency. Well, we are consistent in that we are determined to break these chains of transmission. The science is not simple; if it were, the disease would have been beaten. It bounces around, and we are doing our best to fight it. We are communicating as best we can on all the science we have.

In terms of collaboration, I pay a massive tribute to all my colleagues at the department, in other departments, in local authorities, at PHE and in the NHS. It is difficult for me to explain in great detail in a short amount of time the immense amount of cross-departmental, inter-agency collaboration that has sprung up around Covid. The amount of data that is shared, the number of Zoom calls and the working together are absolutely phenomenal. The noble Lord cited that the LGA did not know about the marshalls plan until the last minute; I am afraid to say that it must have been the last one on the list.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief, so that I can call the maximum number of speakers.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, policymakers around the world are facing exactly the same dilemma. We are determined to have the schools back, because the long-term effects on young people—particularly the least advantaged—will be profound if we shut the schools. The noble Baroness is entirely right to say that parents are naturally concerned that the safety of children, and other generations that they may come into contact with, is at risk. That is why we are massively prioritising the return of schools and introducing measures such as the rule of six to break the chain of transmission and thereby protect the schools from closure.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

I apologise to the noble Baroness, Lady Verma, who I should call now.

Smoking

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 20th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, I believe that the annual cost is £2.3 billion. It is far too much and we must do more to get it down. Huge progress has been made but we are still committed to a smoke-free 2030.

[Baroness Finlay of Llandaff (CB) [V]]

Do the Government recognise the particularly high addictive potential of tobacco among the young and that two-thirds of 100,000 youngsters who took up smoking last year went on to become long-term smokers? Without banning passive smoking in open areas, all the public health gains to date will be lost. There is strong evidence that smoking bans have been most effective in improving health.

[Lord Bethell [V]]

My Lords, I completely recognise the power of the smoking bans, as well as the threat of young people taking up smoking and sticking with the habit for a long time. We are on track to meet our national ambition of reducing under-15 smoking from 5.3% in 2018 to 3% or less by 2022. However, even that seems too high and we will continue to work on our efforts.

Independent Medicines and Medical Devices Safety Review

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 15th July 2020 Lords Chamber

[Lord Bethell]

I completely agree with the noble Lord, Lord Greaves, that this is an important report. I pay tribute to my predecessor my noble friend Lord O’Shaughnessy, who commissioned it. We take it extremely seriously. No one could possibly read about the hardships suffered by the women described in this report without wanting to move swiftly on it. It has only been a few days so I cannot announce a strict timetable for every measure, but I assure the noble Lord that it is taken seriously and we will be moving on it in the very near future.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, this important report must become core in every curriculum, because patients must be listened to. It is correct to say that there must be a culture change, but I would like to focus on the third recommendation about establishing a redress agency. How quickly will the Government progress that? Without that, and without changing the whole culture of compensation and complaints, we will not get the openness and listening whereby if somebody comes forward with something they should expect the answer, “Thank you for telling us,” not “Oh well, we’ll look into it.” Until that changes and every comment is welcomed and patient- reported and family-reported outcomes are used to move services forward, we will not get the culture change that is needed.

[Lord Bethell]

The noble Baroness is right about culture change, but we are aware that having a big, clunking fist of financial threat hanging over individuals who are considering the admission of mistakes is not the right combination to create a culture of self-awareness and acknowledgement. We have to move extremely delicately to encourage people and make them feel safe enough to acknowledge the mistakes that might have happened and to embrace the kind of dialogue with patients that is necessary to deal with these results. That delicate balance is one of the most important things to get right in our reaction to this report.

Covid-19: Test and Trace App

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, in all aspects of our battle against Covid, we have sought a four-nations approach. We hope to work together for one solution. I am aware that other nations are looking at their own options, but it is our hope that, in time, they will all come together for one solution.

[Baroness Finlay of Llandaff (CB) [V]]

What were the governance processes behind the decision to abandon rather than complete the last stages of development of the NHSX app and where are they published, given that the NHSX app had MHRA and security clearance and was days away from being finalised?

[Lord Bethell]

My Lords, the decision to change strategy was taken ultimately on operational grounds. The regulatory environment was not necessarily relevant for that. We cannot avoid the fact that there have been technical issues with both the Apple and the NHS apps. We are still some way from resolving those issues, but we hope to overcome them, in partnership with Apple, and the House will be updated when we do.

Social Distancing: Two-metre Rule

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 16th June 2020 Lords Chamber

[Lord Bethell [V]]

No, I do not accept my noble friend’s analysis. In fact, social distancing, which is central to our strategy, has had an incredible impact on saving lives and protecting the NHS. You have only to look at the spike that is occurring in places such as Texas, Florida and, according to today’s news, Beijing to see what happens if you do not tackle the underlying prevalence of the disease and you allow the lockdown to end too early.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, do the Government recognise that if the blanket rule is relaxed for some, such as most primary school children, who appear to have a lower rate of infecting others, people who are shielding someone will be terrified that reducing the distance will endanger the life of the person they are protecting? Their need to maintain a greater physical distance will need to be clearly signalled—for example, through an officially issued lapel badge or lanyard, as I suggested yesterday—and they will need to have antibody testing.

[Lord Bethell [V]]

The noble Baroness is entirely right. The kind of differential shielding that she suggests may well play an important role in what we do going ahead. We must do our utmost to protect those who are shielded. However, we are also aware of the challenge of having confusing regulations. That is why we are currently holding the line. We are aware of the effects on the economy, and that is why a review is on the horizon, but until then we are focused on reducing the prevalence rate and protecting those who are most vulnerable.

Covid-19: Cancelled Medical Operations

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 10th June 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is entirely right to focus on those who are the most vulnerable. Data for March 2020 shows that cancer referrals began to drop although treatment levels did remain high, with 15,363 patients starting treatment following an urgent referral. That is the highest figure on record in a single month. So, although some treatments may have been cancelled, as she rightly describes, what I would like to convey is that a large number of treatments did continue, and we will be working hard to address any backlog.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, following on from a previous question about bed capacity, I declare an interest in that my son was involved in setting up the Nightingale Hospital Excel. What assessment has been made of bed requirements to keep non-surgical care completely separate from surgical care that needs to happen in Covid-light or Covid-free areas, and to ensure the frequent testing of staff, in particular highly skilled trauma surgical staff who may be moving between these two zones, so that they do not themselves become a cause of transmitting infection?

Exercise Cygnus

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 9th June 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, after operation Cygnus were estimates of the requirements for PPE checked against the 2006 influenza pandemic stockpile, given that this store was found to contain no gowns or visors, and 21 million protective FFP3 masks were missing when the store was opened for the current pandemic?

[Lord Bethell [V]]

The noble Baroness is right—if I understand her correctly—that the needs of PPE for a flu pandemic were quite different from those for Covid. It is also true that the planning did not anticipate a breakdown in global trade and a failure of the business-as-usual supply of PPE. No one could have imagined that flights would be grounded and factories shut and that the global supply chains for these key and vital products would have ground to a halt in the way that they did.

Covid-19: Care Homes

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.

The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.

Covid-19: BAME NHS Staff

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 19th May 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?

[Lord Bethell]

I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.

Covid-19: Testing

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 14th May 2020 Lords Chamber

[Lord Bethell]

My Lords, workplace testing for not just Peers but all workers is an important part of our return-to-work strategy. We need to work with employers of all kinds and the diagnostics industry to put in solutions so that people can go back to work with confidence that they are not infectious and that the person sitting next to them is not infected.

[Baroness Finlay of Llandaff (CB)]

My Lords, what national policy control mechanisms will be used to monitor and report on false negatives and false positives as testing is rolled out to complement a contact tracing app?

[Lord Bethell]

I did not hear all the question, but I think I understand what the noble Baroness is asking. The truth is that, however strong the sensitivity of the machines, false negatives and false positives are an inevitable part of the testing process. However, PHE conducts extremely thorough validation processes so that these are kept to a minimum and we will use algorithms to ensure that rogue test results are picked up as soon as possible.

Covid-19: Vulnerable Populations

Debate between Baroness Finlay of Llandaff and Lord Bethell

Tuesday 12th May 2020 Lords Chamber

[Lord Bethell]

My Lords, mental health advice is very clearly available, most of all from GOV.UK/coronavirus, where there is a huge amount of practical and pastoral advice, and access to resources.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am an honorary fellow of the Royal College of Emergency Medicine. How will the Government ensure that emergency departments never again become the crowded places that they were, which act as a source of nosocomial infection—hospital-acquired infection—for the vulnerable and those caring for them, especially child carers, who might present with acute injuries, particularly once they are out and undertaking more activities?

[Lord Bethell]

My Lords, a strange and peculiar feature of the epidemic has been that accident and emergency wards are, surprisingly, below normal capacity since people have sought to avoid them because of the obvious threat of the disease. That said, nosocomial infection is of grave concern. It is an inevitable and frequent feature of any epidemic, but we are applying new ways of working and seeking to section off those with the disease to ensure that the infection does not spread in our hospitals and from there into the community.

Covid-19

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

I entirely agree with the sentiments and intent of my noble friend’s point. It occurs to me that we should perhaps set up some kind of advertising or promotion of this. I will take that point back to the department.

[The Deputy Speaker]

Baroness Wheatcroft. No? We will move on to Lord Balfe.

[Lord Balfe (Con)]

In the Statement, the Minister referred to the need for people who have other medical needs to still contact their GP. In Cambridge, where I live, the opticians, chiropodists, dentists and surgeries are all closed, with different fierce notices on their doors. When the isolation requirements are lifted, could the Government make it a priority to get these vital medical services open again and get doctors back into surgeries, not at the end of the telephone? Perhaps we could at least teach them that Zoom exists.

[Lord Bethell]

I reassure my noble friend Lord Balfe that the amount of video treatment being given by doctors has gone through the roof. During this epidemic, we have seen the medical trade and patients embrace a huge amount of digital technology. We are working with the colleges to try to get all the services of the medical profession open at this time and the response has been largely positive.

[The Deputy Speaker]

Lord Woolf. No? Lord Dobbs.

--- Later in debate ---

[The Deputy Speaker]

Minister, if you could be very brief, we might be able to fit in the noble and learned Lord, Lord Woolf.

[Lord Bethell]

I am very grateful for my noble friend’s helpful update, but I remind him that these arrangements are conducted by local authorities. The question that he asks is best answered by those local authorities.

[Lord Bethell]

I thank the noble and learned Lord. Will he please express my and the Government’s profound thanks to his secretary for their contribution? I hope it is proving to be rewarding to him or her personally and impactful to the causes in which he or she serves.

[The Deputy Speaker]

My Lords, the time allotted for the Statement is now up. I thank all noble Lords for being concise, in particular the Minister for his very concise answers.

Covid-19: Extent of Infection

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

My noble friend is entirely right. Fitness and the Covid epidemic are closely connected. The Secretary of State for Health has made it clear that a daily walk should be part of everyone’s lockdown arrangements and we are ambitious to make fitness and diet part of the agenda as we leave the Covid lockdown.

[Baroness Finlay of Llandaff (CB)]

I thank the Minister for being open to communicating with us during the period before Parliament resumed. What assessment have the Government made of combining repeat virus detection with those risk factors that the Intensive Care National Audit & Research Centre’s contemporaneous data has shown are associated with particularly poor outcomes—I refer particularly to high body mass index, indicating obesity—and how will this inform the lockdown exit strategy?

[Lord Bethell]

The noble Baroness speaks of anecdotes of which we are very aware. We are conscious of the stories coming particularly from America about a seeming correlation, if not a causation, between obesity and Covid mortality. Clinical trials and data on this are in short supply. The CMO has not made a declaration on it. But I share her instinct that there is a strong connection. As the noble Lord, Lord Moynihan, suggested, fitness and diet will be important parts of our post-lockdown experience.

Health Protection (Coronavirus) Regulations 2020

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 9th March 2020 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, first, I apologise to the Committee that I came in late. The business proceeded slightly faster than I realised, but I am most grateful to noble Lords for allowing me to intervene briefly.

The comments made by the noble Lord, Lord Campbell-Savours, clearly illustrated the need for messaging out to the public. One of the difficulties is that the answers to many of his questions are just not known scientifically. It is a range of probabilities only; the way the virus behaves on different surfaces and with different substances is different. The infectivity may vary with the viral load to the individual as well as the individual’s own immune system. That makes it really complicated in terms of defining. You cannot give a false sense of security to people by saying, “Well, you are fit and well, and your immune system is okay”, because those people may become very ill, particularly if they have a large viral load. We saw that with the Chinese doctor who initially highlighted the problem. Tragically, he died.

I take this opportunity to ask a few questions. This order refers to Public Health England but we have devolved Administrations, and Public Health Wales and Public Health Scotland operate differently. Some aspects of this statutory instrument concern the police and justice, yet the Ministry of Justice and its overarching responsibilities are not devolved, so there is a difficult interface between the devolved and non-devolved competencies. Can the Minister provide some reassurance on the daily round-table consultations that are going on to make sure that decision-making is absolutely seamless and that the devolved Governments are taking forward—and, I hope, mirroring—such legislation so that we do not end up with different systems operating across what are effectively artificial borders? In areas such as Shropshire, there is a huge amount of cross-border flow between England and Wales. Linked to that, can the Minister clarify that equipment, and its distribution to where it is needed, is also part of the consideration of the protection of the public so that we do not have an outcry if one part of the country cannot access equipment as well as another?

Testing is difficult: it is a complex and finite resource, and it takes some hours to run the test. A lot of the public do not understand that it is not like a pregnancy test; it is not a quick dip and a quick answer. With such a finite resource, will the Minister clarify where the governance sits for the management of negative results? One of my anxieties is that people may have a false sense of security from a negative result, because they may get the infection the day after it and subsequently become positive. Although it is helpful to confirm positive cases, a negative result does not mean that you are not going to get the coronavirus infection further down the road.

Linked to the cross-border issues, can the Minister also confirm that the use of beds and the availability of things such as ITU beds and ECMO are being considered across the whole country? I worry that difficult decisions are going to have to be made and it will be very important to have clear standards against which to make them. If it looks as if we are becoming like Italy, that will certainly more than stretch services to the limit; it will take them beyond it.

Will we need additional statutory instruments for the reregistration of people with healthcare professional qualifications of any sort? If so, when will we see them? I was rather hoping that it might be today. This relates to my earlier question about registration on specialist registers. Is the GMC working to find alternative ways of putting those who have completed training on the specialist register without bringing them all together in an exam hall, which seems to be an unwise move when their competencies have already been assessed through training?

That concludes my questions, but I thank the Minister for his clarity, for explaining things really well, for answering questions on the Floor of the House and for answering unanswerable questions with such honesty. It is terribly important that he and those advising him try to be very clear and open about the things that we do not know.

[Lord Bethell]

My Lords, I will start by talking about two matters that are not central to the regulations but which are important pieces of context. I thank the noble Lord, Lord Campbell-Savours, for his incredibly candid and heartfelt comments, which none of us here could help but be moved by. I would also like to express sympathy for his personal situation. We all know friends, relatives and people who are in a vulnerable position. While the CMO’s advice is that for a lot of us the virus does not present a huge risk, for some people it does. That cannot but be on their mind and we think about them a lot, so I am grateful to the noble Lord for bringing that message of seriousness and his personal testimony.

I will also address directly the noble Lord’s questions. I am afraid that I cannot answer the important technical questions he asked; I am grateful for his appreciation of that fact. However, I reassure the Committee that our approach is to seek to be as transparent as we possibly can be. In answer to the noble Lord’s question, there is a daily update on the PHE website, where all the figures that we know and can prove are published—they go up at 1.45 pm every afternoon. That is a serious matter, and we are looking at ways of making that a more easily accessible dashboard with a deeper set of numbers that you can look at locally; we could then publish as reasonable and proportionate an amount of figures as possible while keeping secure the anonymity of those involved.

The other part of our approach comes very much from the spirit of the CMO himself, whom many of your Lordships will have met. He is an enlightened character who is extremely committed to evidence-based policy recommendations. We all plague him with questions much along the same lines as those the noble Lord, Lord Campbell-Savours, asked, seeking from him reassurances about particular technical questions. He is able to speculate and to say, “Maybe this or maybe that, but I can’t give you any clear reassurance on that because there is no data on it”.

One of the things about trying to preserve the pact with the public that our decision-making is supported by evidence is to avoid going into the kind of tempting speculation that the situation draws you into. There is temptation there, but, as a cardinal rule, we have to apply a self-restraining ordinance on trying to give people the answers and the speculation that, emotionally, they naturally want. The questions of the noble Lord, Lord Campbell-Savours, are exactly right, and I reassure him that battalions of scientists are trying to get to the bottom of those answers. Lots of evidence is being worked up, and I believe that answers to many of those questions will be forthcoming. However, until they have the sign-off from the scientists, it is not right for us to indulge in speculation. That is the foundation of our approach, which I mentioned earlier. Although it is incredibly frustrating, from a public policy point of view it is the right approach. However, I will try to address just a couple of the questions that the noble Lord asked, without falling into my self-defined bear trap.

The noble Lord, Lord Campbell-Savours, asked about masks. Broadly speaking, except for the most comprehensive hazmat suits that cover you from head to toe, masks are mainly used to limit the number of germs that you emit rather than that you consume. I think we are all interested in the work going on in Taiwan, where all schoolchildren wear masks, not to protect them from the germs but to try to stop them infecting the people next to them. That is an interesting insight, but it is not the approach that the CMO has recommended.

On the delicate issue of mortality rates, I completely sympathise with the noble Lord’s point that there is wild speculation on these numbers, and it would be fantastic to have a more reliable set of figures. I will say only that it is extremely difficult to know mortality rates, because you simply do not know how many people have the virus in the first place. Large numbers of people are infected and infectious but completely asymptomatic and never go near a test kit, so we cannot know what the mortality rate is at any age. I recommend that the noble Lord treats all mortality rates data with great suspicion. It is not the way we are guiding ourselves.

--- Later in debate ---

[Lord Bethell]

I understand the point and will take it back to the department.

The noble Baroness, Lady Finlay, asked about testing. She is entirely right to focus on that, because we are at the stage of the cycle when questions about testing are very much on our minds. She asked where we were focusing our testing. The most important area for testing is those people who are most vulnerable but who might have the virus. She is entirely right that someone who tests negative today may well test positive tomorrow. Where that is most dangerous is within hospitals. Hospitals are centres of infection. It is one reason why, if you phone 111, they recommend that you do not go to your hospital or your GP. Therefore, testing within hospitals is where we are focusing our resources.

I reassure the noble Baroness, Lady Finlay, that we are moving incredibly quickly to increase capacity of ECMO beds. There will be a huge amount of pressure —we cannot hide that—but those most in need are being prioritised. Training is going on to support those with the technical knowledge of how to run the equipment and purchasing is going on to create new kit.

On reregistration of clinical professionals, all the concerns raised in Committee and in the Chamber about the provenance of people seeking to reregister are fully understood. Provision is being made to make sure that criminal record checks and competence checks are in place. However, these remain incredibly valuable and skilled people who can support us, so we are determined to mobilise them if possible.

[Baroness Finlay of Llandaff]

I referred to difficult decisions possibly being made. Can the Minister reassure the Committee that the Government are working with the heads of all the royal colleges—particularly their ethics committees—to make sure that unified guidance is going out to commissions across all the disciplines? Unfortunately, the different colleges have at times a tendency to work in their own silo, but this will be across all of them. It will have to go across the professions, rather than across the individual trusts and internal organisations. Therefore, a round table or regular consultation with them to make sure they all give the same messages is important, and it would reassure the public.

[Lord Bethell]

The noble Baroness, Lady Finlay, makes an important point. The CMO currently has a weekly call with all the presidents or relevant members of the royal colleges, and there is an incredibly energetic interface between officials at PHE and the colleges. New guidance is being drafted at the moment. As our understanding of the epidemic increases so the CMO’s certainty and confidence about the advice he is giving will be clearer. We are therefore seeking to publish really good guidance for employers, voluntary organisations and all the groups who need it. The CMO also works closely with the CMOs of the other three nations, and I understand that is an incredibly healthy and productive relationship. It has served very well to ensure that the devolved authorities are fully involved in decision-making and that there is transparency on key issues such as ethics, which the noble Baroness was right to mention.

Coronavirus

Debate between Baroness Finlay of Llandaff and Lord Bethell

Monday 9th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord is entirely right. The CMO’s effort is now to identify those groups who require the greatest priority of assistance. We are not sure, and the CMO has not declared, at exactly what age that should start. He is considering publication of the exact details of the priorities in future. It seems that it is not necessarily gender-specific but that the state of your immune system is the key driver. In some areas, of course, men have very bad habits when it comes to things such as drinking and smoking. The CMO has made it clear that if you want to do one thing to avoid getting the virus, it is giving up smoking.

[Baroness Finlay of Llandaff (CB)]

Will the Government give specific guidance on deferring or cancelling gatherings of clinicians and other healthcare professionals at conferences and examinations required for career progression, and specifically ask the regulators to allow alternative routes of registration and validation?

[Lord Bethell]

The noble Baroness asks an important question about trying to keep our clinical staff healthy and fit. That is one of the biggest priorities in an epidemic such as this, because the pressures on the NHS are made worse if clinical staff are themselves poorly. At this stage the CMO has not decided that the cancellation of conferences or major events is proportionate, but that remains one of the options laid out in our CV plan. If necessary, provisions for videoconferencing and alternative ways of attending training will be considered and put in place.

NHS: Doctor Retention

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 4th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord makes a very important point on the importance of medical research to the NHS’s achievements. For this Government, though, the focus of recruitment is on primary and front-line care. Our investment in research remains undiminished, but the new retention commitment is very much about delivering value and clinical delivery for patients.

[Baroness Finlay of Llandaff (CB)]

My Lords, I thank the Minister for his support for women in medicine—being one, I should declare that interest. Will he look actively, with NHS trusts and the GMC, at trying to dissuade people from retiring early and making it easier for them to come back part-time without having to jump through multiple hoops, so that we do not lose many years of wisdom from the NHS for those who no longer want to work full-time in their main specialty but have a great deal to contribute in teaching, research and clinical practice?

[Lord Bethell]

The noble Baroness makes a very important point. It is clear that the lifestyles of clinical professionals in the NHS are changing. Many choose to take time off after their studies before joining practice and many seek to return after taking time out from professional front-line work. It is 100% the responsibility of—and in the interests of—the NHS to make that journey as quick and easy as possible.

Wuhan Coronavirus

Debate between Baroness Finlay of Llandaff and Lord Bethell

Wednesday 26th February 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I add a note of congratulations to all the public health people, to Public Health England, Public Health Wales, staff across the UK and health board staff at every level. They have rapidly changed the way that they are working in order to undertake close planning. Can the Minister confirm that we are producing enough testing kits to be able to roll out more testing in the community across the whole of the UK? Has additional budget been put aside to ensure that health service personnel have all they need and to allow additional isolation facilities to be used, if necessary, for very sick patients who would be taken in isolation to NHS units?

[Lord Bethell]

I reassure the House that there is an enormously energetic effort being put into testing kits. The testing arrangements to date have worked well. There is a 24 to 48-hour turnaround for testing. Work is being put into a dramatic increase in the number of tests necessary. Energetic work is being conducted by commercial organisations into smaller, portable testing kits—the size of this Dispatch Box—that could be put in wards to have an immediate turnaround for testing. This will greatly facilitate the management of this epidemic. I salute those involved in the 24/7 race to produce new technology and large numbers of these testing kits. Like the noble Baroness, Lady Finlay, I have warm words for Public Health England, which has done a fantastic job. I cannot remember the third thing that she asked.

Hymen Surgery

Debate between Baroness Finlay of Llandaff and Lord Bethell

Thursday 23rd January 2020 Lords Chamber

[Lord Bethell]

The noble Lord touches on the key dilemma of this issue. Cosmetic surgery is appropriate in many circumstances. There are many women who wish to repair damage, for instance from childbirth. A blanket ban would not help them. The key issue here is consent. Are those undergoing this procedure truly consenting to it and what is the ethical climate in which that decision has been made? Important questions have been asked about that climate, and the Government are determined to look at it closely.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest as an elected member of the BMA ethics committee. What levers do the Government have to look at the ethical framework within which consent is sought for such procedures? Any woman coerced into consenting to surgery that distorts her genitalia is herself being distorted and abused, and made into an object of sexual gratification for a man. In fact, the outcomes do not support that it improves sexual function in the men, who may need counselling on sexual dysfunction.

[Lord Bethell]

There are three key frameworks. The GMC oversees how medical practitioners coach and deal with those applying for this procedure. The CQC looks at the premises and procedures of organisations that offer this and the ASA looks at how they are advertised. Looking at the advertising on the internet is a very gruelling experience: I would not recommend it to anyone after a meal. Clearly, a massive question needs to be asked about whether the advertising climate in which these procedures are presented really respects the advertising code and is the right kind of climate in which to bring up our children.