Social Care: Person-centred Dementia Care

Baroness Walmsley Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely acknowledge the pressure the pandemic put on both formal and unpaid carers. That is why we put £6 billion into local authorities, to help support them in the care they gave to carers. However, I acknowledge the concerns of the noble Baroness about the pressure of the last year and reassure her that the full spectrum of social care will be considered in the forthcoming review.

[Baroness Walmsley (LD) [V]]

My Lords, Alzheimer’s disease has been described as a future epidemic. Without a known cure, research into causes of and treatments for Alzheimer’s and other dementias is vital. At the last election, the Government committed to a dementia moonshot, which would double research funding to over £160 million a year. Can the Minister say when this funding will become available?

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Walmsley Excerpts

Monday 17th May 2021 Grand Committee

[Baroness Walmsley (LD) [V]]

My Lords, it is of great concern that we are moving today not to step 2 but to step 3 of the road map, while the more transmissible Indian variant is spreading—Professor Whitty expects it to become predominant in the UK. I make no apology for repeating the concerns of other noble Lords. While the vaccine will provide a high level of protection to those who have received it, unvaccinated people could now be at high risk of serious disease and the NHS again of being overwhelmed.

The Prime Minister finally put India on the red list on 19 April, a few days before he was due to fly to India to discuss the trade deal he so desperately needed after Brexit. Many commentators believe the two facts are linked. Will the Minister give a clear answer to the following questions about India?

Why was India not put on the red list on 2 April, at the point when it had the same level of incidence as Pakistan and Bangladesh? By 9 April, cases in India were four times higher than in Pakistan, yet the Government waited another 10 days to act. During those three weeks’ delay, around 20,000 people came here from amber-listed India. Do the Government know whether they all quarantined for 10 days, as required, and had the necessary tests?

When red-list powers were announced in mid-February, the Government said they could be implemented in hours. Why, then, did they wait four days before implementation, allowing 900 people per day to come in from India without red-list restrictions? Why, when travellers arrived from India, were they forced to mingle at immigration with hundreds of people coming in on flights from other countries? Why have the Government not insisted on dedicated arrival facilities for passengers arriving from red-list countries? What support is being given to those people arriving from India who find it difficult to quarantine?

Why have the Government not learned that the characteristics of variants of concern are not the only reason to put countries on the red list? The cases in India had been rising exponentially for weeks before 19 April. There were more than 100,000 cases a day in India on 5 April, and the cemeteries were overflowing. Why did the Government not act when that level of cases was being reported?

The BMA and several scientists are seriously concerned about the further lifting of restrictions while this highly transmissible variant is spreading. It is one of the Government’s own tests. In Scotland, the First Minister has postponed the easing of restrictions in the south of Glasgow and in Moray, where cases of the Indian variant are growing. Will the UK Government do the same?

Alcohol Harm Commission: Report 2020

Baroness Walmsley Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Walmsley (LD) [V]]

My Lords, alcohol harm requires a cross-departmental response because of the range of harms that alcohol can cause. That is why I support the call of the noble Baroness, Lady Finlay, for a coherent, cross-government strategy.

The commission says, “It’s everywhere”, and it is. Drama can often explore complex issues in real life. The writers of Radio 4’s “The Archers” know that, hence their recent storyline about Alice’s struggles with alcoholism.

There are parallels with the obesity crisis, and there the Government have at last recognised that regulation has a part to play. The same goes for alcohol. We live in an obesogenic and alcogenic environment, and regulation can help. For example, people often do not know how much they are drinking or how strong a drink is. I have been asking for two decades for all alcohol to have its calories and alcohol units clearly labelled, but that still does not happen. I hope that will change now.

Services are thin on the ground. When police are called to an event of domestic violence, they should be able to link the perpetrator to therapeutic services and the children to social services. But this does not happen because the services are not there. This is crazy because, putting aside the human cost, money could be saved if they were. Are GPs and antenatal clinics confident to ask questions and refer people to alcohol services, where appropriate? Probably not.

Finally, the report says that, in Scotland, deprived groups are six times more likely to be admitted to acute hospitals and 13 times more likely to be admitted to psychiatric hospitals for alcohol problems than the least deprived groups. So the matter is often related to poverty. However, poor people can afford alcohol—because it seems to make things better; it is an escape from the misery of people’s lives. If we banish poverty, introduce minimum pricing and provide services, we can go a very long way to solving alcohol harms.

Covid-19: Obesity

Baroness Walmsley Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the correlation pointed out by the noble Baroness. We must acknowledge and address the fact that areas of deprivation undoubtedly have higher levels of obesity. However, we have to be careful about taking away people’s sense of agency. It is possible to buy affordable healthy foods at any price point. Food has never been cheaper than it is today. We must put into people’s hands the knowledge and inspiration to take the steps necessary to shed the pounds that need to be shed.

[Baroness Walmsley (LD) [V]]

My Lords, can the Minister assure me that the Government will not renege on their promise to ban the advertising of high-fat, high-sugar and high-salt foods online? Will he ignore the objections of junk food producers and advertisers, and remind them of the similar ban on Transport for London when the amount of advertising actually went up? Reformulated and low-calorie options generate revenue too.

[Lord Bethell (Con)]

My Lords, the Government take the advertising of unhealthy foods seriously, which is why we have commissioned this consultation. It has not finished yet so it is not possible for me to pronounce on its findings, but I assure the noble Baroness that we are looking at this issue extremely carefully indeed.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Baroness Walmsley Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, I thank the noble Baroness, Lady Wyld, for bringing us the Bill, and I support it as far as it goes. However, I would like assurances that, using the powers to make regulations in Clause 5, the Government will ensure that, for the most part, botulinum toxin procedures on under-18s do not take place at all, even by a clinician.

We live in a world where young people, particularly girls, are under great peer pressure about their appearance and their weight. Undertaking a dangerous procedure such as this is not necessarily the answer. If the matter affects the mental health of the young person, it should be treated as a mental health issue, not with Botox.

The charity Changing Faces has provided us with the voices of young girls affected by “visible difference”. One said, “Everywhere I looked, clear-skinned models told me the same thing. I never saw a public figure that looked like me and I felt totally alone. I spent hours researching various scar removal surgeries and extreme treatments and started saving for them.” These young people require support, information, the attention of professionals and the protection of the law.

When the Bill was debated in another place, amendments were tabled to ensure that medical practitioners could provide non-surgical cosmetic procedures to a person under 18 only if it was medically necessary. I agree with this. There may be situations where facial disfigurement from whatever cause is causing physical or mental distress to the patient and for which botulinum toxin is considered by a doctor to be the appropriate treatment, rather than more intrusive cosmetic surgery. In such cases, regulations could be used to lay down those matters which should be considered before a clinical decision is reached.

Laura Trott MP, the sponsor of the Bill, argued that it already had safeguards to ensure that under-18s would receive these procedures only where medically necessary. The Minister, Nadine Dorries, agreed that there would be a review of the regulations to assess any unintended consequences. I would like an assurance that this review will consider regulations to restrict the use of this procedure except in certain clearly defined conditions of medical need.

I am aware that GMC guidance says that doctors performing cosmetic interventions can provide treatment to children only when it is deemed to be medically in the best interests of the patient. However, I would like to see the Government making their intentions clear in regulations that under-18s should not receive this treatment except where strictly medically necessary. I would also like the Minister’s assurance that mental health support will be provided to patients in this situation where appropriate.

Covid-19: One Year Report

Baroness Walmsley Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, I support the regret Motion from my noble friend Lady Brinton and echo the thanks that she gave. She highlighted how the Government have failed, which is why we should not trust them by giving them a blank cheque on our civil liberties. I also agree with points made in the Motion of the noble Baroness, Lady Thornton.

The issue underlying both regret Motions is the incompetence of this Government in their handling of the pandemic. That is why it is the Government themselves who should be amending this Act, since we are unable to do so. There has been a failure to plan and prepare, decisions have been taken at the wrong level, there has been an overreliance on private sector providers at enormous cost and there have been failures of transparency and providing for democratic scrutiny.

It is incompetent for Governments not to plan properly. This involves horizon scanning and putting measures in place to adequately respond to identified risks. The horizon scanning by the national security risk assessment happened and still does, but a recent study by the Centre for the Study of Existential Risk made several criticisms and recommendations. One criticism was that there is no process, body of expertise or oversight mechanism in place to ensure that departments’ risk plans are adequate. That had fatal results in the case of this pandemic.

The study also concluded that the UK’s pandemic influenza strategy, which was fairly detailed, did not make any plans for a lockdown, despite this being one of the dominant response strategies for Covid-19. Can the Minister give the Government’s response to this serious analysis and say how they plan to learn lessons about planning our risk identification and response in future? Simple mistakes were made, such as failing to ensure that stocks of PPE were in date and fit for purpose.

It is incompetent not to provide adequate basic resources for worst-case scenarios. We started this pandemic with 11,000 too few hospital beds, 5,000 too few doctors and 40,000 too few nurses. We had a fraction of the number of ICU beds and ventilators of other European countries, which is probably why our death rate is one of the highest in the world. Do the Government plan to provide the resources to correct this?

It is incompetent not to care for the most vulnerable in society, for whom the consequences are most serious. For example, it is extraordinary that the DHSC did not realise that sending older people back to care homes to clear hospital beds without first testing them for the virus was catastrophically dangerous. Many deaths occurred in the closed environments of care homes at the beginning of the pandemic that have never even been recorded as Covid deaths—people did not have a test, even when they fell ill. The death rate in care homes was double the rate in the wider community. It was incompetent not to provide care homes with PPE at the start and it was not true to say that care homes were safe—they were not.

The so-called NHS app was incompetent from start to finish. The first system did not work and was replaced. The second system did not pass on information about Covid hotspots to the authorities. People were advised by the app to isolate because of contact with a positive case, but they were not entitled to the £500 support at first, unless they also had a call from another authority —people did not know that because of incompetent communication.

Then there is test and trace—an exemplar of the biggest incompetence of all, which is making decisions at the wrong level. The Government relied on central decision-making and provision, aided by expensive management consultants and private companies, instead of devolving responsibility and decision authority to local government, where the skills and experience could do the job better. Indeed, in the end, when they started to get the necessary information, resources and authority, local authorities proved this very decisively. As the noble Baroness, Lady Bennett of Manor Castle, mentioned, management consultants have been marking their own homework and are being paid to do tasks that should be undertaken by civil servants as part of their job. We need answers about this. It was incompetent to delay taking action when advised to do so by scientific advisers. That was probably the most fatal incompetence of all.

Finally, it is incompetent not to understand your own Act of Parliament. It is not true that failure to renew this Act would remove good things such as the furlough scheme and measures to keep us safe, as some government spokesmen have suggested. That is not what this is about. It is about a blank cheque to control our civil liberties and reduce democratic scrutiny. We will not give that to anyone, especially not this incompetent Government.

Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021

Baroness Walmsley Excerpts

Monday 22nd March 2021 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, the noble Baroness, Lady Thornton, raises several serious issues. She is right to criticise the delay in acting following scientific advice. Sadly, slowness to react has been a feature of this Government’s handling of the pandemic and has probably contributed to the fact that we have almost the highest death rate of any country in the world. The fact that the regulations failed to prevent the Brazilian variant coming in indicates that they are ineffective, unmonitored and not supported.

It is illogical to force travellers coming directly from red-list countries to isolate in a hotel while allowing those from the same countries, via a short stop in a third country, to isolate at home. I have to accept that the only way to ensure that people do isolate is to ensure that they go into suitable accommodation, with proper support. Since the Government have not provided that, the very least that they should be doing is monitoring that those who are supposed to isolate at home are doing so—but microscopically little of that has been done. Why?

There is also the issue of support. No amount of pre-travel testing will get over the fact that many travellers, like others who are asked to self-isolate for other reasons, are not able to do so. The reasons are usually financial but may be caring responsibilities. These Benches have been calling for many months for paying people their wages to enable them to isolate, but our appeals have fallen on deaf ears. To get the benefit of the NHS vaccination programme, we must do more to prevent variants coming in. Will the Government now look carefully at the evidence from other countries that have put all travellers from abroad into isolation accommodation? It worked at the beginning of the pandemic, when passengers from a cruise ship with an outbreak were isolated in vacant nurses’ accommodation on the Wirral. It could work now.

Covid-19: Vaccination Programme

Baroness Walmsley Excerpts

Wednesday 24th February 2021 Lords Chamber

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government what assessment they have made of the progress of the COVID-19 vaccination programme towards meeting its (1) delivery targets, and (2) objectives.

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

My Lords, the vaccine deployment programme is proceeding at pace, for which I give profound thanks on behalf of all noble Lords. We have offered a Covid vaccine to 15 million of the top four priority cohorts, hitting our 15 February delivery target. We remain on track to achieve our objective of offering a vaccine to all priority cohorts by 15 April and all adults by the end of July.

[Baroness Walmsley (LD) [V]]

My Lords, the vaccine programme certainly is going well, but there is evidence that some groups are being left behind. One such group is housebound people. Although they cannot leave their homes, carers and family come in, which opens them up to infection. Why does NHS England not record the number of housebound patients who have received the vaccination? What is being done to speed up their vaccination? The other group is people in poor areas and demographics. What is being done to correct this?

[Lord Bethell (Con)]

My Lords, we were alert to the issue of housebound priority cohorts from the very beginning, which is why we have put in place mobile vaccine units. We work closely with community pharmacists and GPs in order to take the vaccine to housebound individuals. While we do not report on them publicly, I understand from the front line that the progress of that has gone extremely well.

The issue of areas of deprivation is really troubling. It is often those areas where the disease is most prevalent and where the vaccine rollout has been the slowest. We are working extremely hard with local community groups, faith groups, marketing experts and influencers to get the message through to the right people and to take the vaccine delivery into the right contexts.

Dentists: Covid-19

Baroness Walmsley Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

I join the noble Baroness in paying tribute to dentists. As of 18 December, 88% of NHS dental practices were open, and that is a huge tribute to the hard work, determination and skills of dentists. She is right that they offer a spread of services; more triaging is going on, and that has successfully made a big contribution to getting through the lists. As of 13 January, 6.9 million dental patients have been triaged on the AAA service—advice, analgesics and antibiotics—but urgent dental care centres, of which there are 695, have picked up the difficult and time-consuming work for those who have an emergency need.

[Baroness Walmsley (LD) [V]]

My Lords, do the Government plan to continue to enforce activity targets in the next financial year? The new contract is only seven weeks away, and those in the profession has heard nothing about the basis on which they will be paid next year. When do the Government plan, at last, to deliver wider NHS dental contract reform, which they committed to in 2010? The issue keeps being kicked into the long grass.

[Lord Bethell (Con)]

My Lords, I would like to reassure the noble Baroness that officials are working extremely closely with the dental profession on the arrangements for the new practice. It will not be a complete renegotiation of the full contract, but we are looking at what arrangements should be in place for 2021-22. And as I said before, I pay tribute to the hard work of dentists. Activity targets are a useful way of getting a focus on increasing the throughput of dentistry. We have a big backlog, and that is one way we can try to increase the velocity of dental appointments.

Covid-19: Self-Isolation

Baroness Walmsley Excerpts

Wednesday 10th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do not accept the accusation of slackness. Testing should happen before the flight, not at the airport. All those who seek to avoid the red list protocols will be interviewed by the police, and the kinds of fines ascribed to that offence have been made crystal clear in the Statement by my right honourable friend the Secretary of State for Health.

[Baroness Walmsley (LD) [V]]

Does the noble Lord the Minister dispute the figure quoted by my noble friend Lord Scriven about the number cutting short their isolation, or is he just planning to ignore it? Does he accept the figure from local authorities that two-thirds of applicants for the £500 do not receive it? Does he therefore agree with me that most of those who apply for it actually need it to help them do the right thing?

[Lord Bethell (Con)]

My Lords, I do question the figure supplied by the noble Lord on isolation adherence because, I am afraid, he does not know, nor is there any questionnaire that can prove exactly, who is isolating, when they are isolating, for how long and under what circumstances. However, I agree with the noble Baroness that the issue of economic support is very important. We have put a large number of protocols in place. The isolation payment of £500 is substantial. I acknowledge that there have been procedural issues with that payment, but a lot of them have been ironed out and take-up of the money has increased.