Health and Care Bill

Debate between Baroness Walmsley and Lord Bethell

Committee stage
Friday 4th February 2022 Lords Chamber

[Lord Bethell (Con)]

I will also speak briefly in support of the register for social care workers, and I very much echo the words of my noble friend Lord Young. During the pandemic, we faced a huge challenge in identifying who social workers were. That meant that we struggled to distribute PPE, to get testing to the right people, to allocate and reallocate responsibilities when we tried to move away from itinerant service, and to create the vaccine prioritisation list. In the longer term, the question of the education of social care workers is absolutely essential, and a register is imperative to do that. In contrast with the NHS, the lack of a register of social care workers is a real impairment to the modernisation of social care working. For that reason, I ask the Minister to say a little more about his consultation and think very carefully about a mandatory register.

[Baroness Walmsley (LD)]

My Lords, last week, when we debated the call for a separate list of properly qualified cosmetic surgeons, I received a briefing from the GMC about the forthcoming new system of professional regulation. I asked the Minister when this would be forthcoming, but I fear that he was not able to give me a clear answer. This matter has been hanging around for a very long time, but, when I scrutinised Clause 142, I saw that there was another problem: in future, the regulation of healthcare professionals can be made through secondary legislation—and whether this would be agreed by the negative or affirmative procedure is not clear.

The Explanatory Notes make clear that subsection (2)(e) —the powers to remove certain professions from regulation—

“includes the currently unenacted provisions concerning social care workers”.

Like the noble Lord, Lord Young of Cookham, I want to ask the Minister about this, because many noble Lords, including me, have been asking that social care workers have the opportunity to obtain qualifications that would provide them with registration and a career path to better pay and conditions—but this sounds like the opposite to me. Perhaps the Minister can explain this and tell the House when the new regulatory system will be ready. The 2017 report of your Lordships’ House’s Select Committee on the long-term sustainability of the NHS said:

“The current regulatory landscape is not fit for purpose. In the short term, we urge the Government to bring forward legislation in this Parliament to modernise the system of regulation of health and social care professionals”—


I emphasise “social care professionals”—

“and place them under a single legal framework as envisaged by the 2014 draft Law Commission Bill.”

That was five years ago.

I have also received a briefing from the Health and Care Professions Council. It appears from this that the HCPC has a rather different view from the GMC: it wants the new professional regulation of health and care professionals to be collaborative and innovation focused. It believes that the current system is “siloed”, and it is looking for multiprofessional regulation, which, it believes, better reflects current working practices in the NHS. I am not an expert in this matter, so I express no opinion on that, but I am looking for some clarity from the Minister on which direction the new regulation system will take and the evidence that this will be better than before and contribute to better quality and safety of care for patients. I would also like to know when it will happen, because Clause 142 appears to me to open the door to a fight between different regulators, which would not be helpful.

Covid-19: Wuhan Institute of Virology

Debate between Baroness Walmsley and Lord Bethell

Wednesday 30th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have written to the commissioner for standards in response to that precise question and I should be glad to share that correspondence with the noble Lord.

[Baroness Walmsley (LD) [V]]

It is believed that given the slow rate of mutation of Covid viruses, Covid-19 would have taken around 35 years to evolve from its nearest known relative. What has been done to identify any intermediaries in which it may have lived during that period and any knowledge useful for preventing future pandemics that may arise from that knowledge?

[Lord Bethell (Con)]

I entirely agree with the noble Baroness. It is extremely frustrating that we do not know the steps of evolution that this virus went through. It has come to us completely out of the blue. That leaves us in a vulnerable state when we are preparing for the next pandemic. It is absolutely essential, as any epidemiologist will say, that one knows and understands where the virus came from—whether that is the water pump handle for an outbreak of cholera or a virus from China.

Folic Acid

Debate between Baroness Walmsley and Lord Bethell

Wednesday 23rd June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord. Can I just take a moment to bear testimony to his patient and determined campaigning on this issue? He has held the Government’s feet to the fire on it, and I am grateful for his focus. He is right that we are hopeful that there should not be any substantive delay with the industry. A huge amount of work has gone on in the consultations and the dialogue we have had, and I am grateful for that. However, the Senedd and Scottish parliamentary elections in May meant that new personnel were at the top of government. We hope that they are as supportive as the noble Lord so rightly pointed out, but there is a process to get the official endorsement that we need to take this forward and we are waiting for that paperwork to come through.

[Baroness Walmsley (LD) [V]]

My Lords, is the Minister aware that 50% of pregnancies are not planned? Therefore, while the Government consult and procrastinate, what communication is being planned with women of childbearing age to tell them that they need to take a folic acid supplement before they start a pregnancy to avoid NTDs in their babies?

[Lord Bethell (Con)]

My Lords, this Minister is very aware—personally extremely aware—of the fact that 50% of pregnancies are not necessarily planned. As the noble Baroness knows very well, that is one of the reasons for this policy and that is why we are so supportive of it. The education that goes to new mums and dads on folic acid is done through GPs, and we are always looking at ways to enhance that. But I think there is no better of way of ensuring that folic acid gets to the right people at the right time than through this measure, and that is why we are supporting it as energetically as we are.

Care Homes: Insurance Indemnity

Debate between Baroness Walmsley and Lord Bethell

Wednesday 19th May 2021 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, the Minister will be aware that the financial viability of many homes has become precarious during the pandemic. What mechanism is in place to monitor the level of premiums and any homes in danger of closing because of this problem? What contingency measures are in place to care for the residents who might lose their homes as a consequence?

[Lord Bethell (Con)]

My Lords, in terms of monitoring, Care Quality Commission data indicates that pressures are being felt by the insurance industry, but these are not translating into reduced capacity, service closures or quality concerns. There is, in fact, a growth in the number of home care agencies since March 2020; for instance, in the east Midlands, there has been a growth in capacity of 9.4%. These are reassuring figures and we are monitoring the situation extremely closely.

Social Care: Person-centred Dementia Care

Debate between Baroness Walmsley and Lord Bethell

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?

Covid-19: Obesity

Debate between Baroness Walmsley and Lord Bethell

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.

Covid-19: Vaccination Programme

Debate between Baroness Walmsley and Lord Bethell

Wednesday 24th February 2021 Lords Chamber

[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

Debate between Baroness Walmsley and Lord Bethell

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

Debate between Baroness Walmsley and Lord Bethell

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.

Health: Eating Disorders

Debate between Baroness Walmsley and Lord Bethell

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I recognise the issue of regional disparities, but I reassure the noble Baroness that our ambition is to deliver swift access to treatment for 95% of children and young people with suspected eating disorders within one week. The good news is that in the second quarter of 2021, 83% of urgent cases were seen within one week and 89.6% of routine cases were seen within four weeks. Those figures can be improved but I think that they are impressive. They show that progress is being made and that we are taking this issue seriously.

[Baroness Walmsley (LD) [V]]

My Lords, the eating disorder faculty at the Royal College of Psychiatrists has recently reported that eating disorder teams are being asked to ignore the NICE guidelines for treatment as being unrealistic and too expensive. Will the Minister either justify this or condemn it?

[Lord Bethell (Con)]

The noble Baroness brings to my attention something concerning. I would be grateful if she would write to me with the details and will be very happy to look into it in more detail.

Cannabis Oil

Debate between Baroness Walmsley and Lord Bethell

Tuesday 12th January 2021 Lords Chamber

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

My Lords, we are on the case. I completely recognise the problems faced by Alfie Dingley and all the individuals reliant on the previous arrangements with the Dutch Government for the supply of Bedrocan oils. The department is working urgently with Dutch Minister Tamara van Ark to find a solution that will enable these patients adequately to access the medications they need, and we are committed to setting up clinical trials to inform future NHS commissioning of cannabis-related medicines.

[Baroness Walmsley (LD) [V]]

My Lords, I thank the Minister for that very encouraging response. He will know that time is of the essence because these medicines prevent children having severe fits, some of which are life-threatening. Can he go back to his department and educate some of his officials? Unfortunately, a lot of the families are very upset at being told that they can safely be switched to an alternative formulation. That is both ignorant and dangerous. All the expert clinicians who know about these issues say that that cannot be done safely. Even if it could, eventually putting these children back on to the original formulation sometimes does not work. Will he make sure that his officials listen to the clinicians who are expert in prescribing and in following the progress of people on these formulations?

[Lord Bethell (Con)]

My Lords, I am grateful for the noble Baroness’s kind words, and I will indeed take that patient feedback back to the department. I reassure her that this is an area where patients have undoubtedly led the way, and clinicians have to catch up. In doing so, there will need to be a meeting of minds and regulation in areas that are open to patient interpretation. In that period, there will undoubtedly need to be compromises on all sides.

Covid-19: Restrictions

Debate between Baroness Walmsley and Lord Bethell

Thursday 7th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness analyses the situation extremely well and has laid out exactly the Government’s plan for rolling out the vaccine. She is entirely right that we are using lockdowns to bridge the gap until herd immunity is achieved through the vaccine. We have mobilised an enormous amount of the NHS, and are very grateful to the volunteers who have stepped up and are making an enormous difference. We are trying to get as much of the vaccine as possible out of the factories and warehouses, with batch control, and into the country’s surgeries and hospitals to vaccinate millions of people before the spring.

[Baroness Walmsley (LD) [V]]

My Lords, a weak link in the measures to suppress the virus has been the small percentage of people not self-isolating when they should. This is often because they cannot afford to do so. Dozens of times my Lib Dem colleagues and I have asked the Government to provide adequate financial support for self-isolators. So I ask the Minister again: in order to suppress the virus, will the Government pay the wages of poor people who need to self-isolate?

[Lord Bethell (Con)]

My Lords, I pay tribute to the advocacy of the noble Baroness and her colleagues on this important point. I acknowledge the financial pressures on those of limited means who are required to isolate. We have put in provisions for statutory sick pay and the £500 Covid bonus to help to support those people, and there are local authority funds and provisions to provide additional support. The point that she makes is made well and we completely acknowledge the challenge.

Obesity

Debate between Baroness Walmsley and Lord Bethell

Tuesday 5th January 2021 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what assessment they made of the report by the All-Party Parliamentary Group on Obesity The Future of Obesity Services, published on 25 November 2020.

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

My Lords, we welcome the ongoing work and support of the All-Party Parliamentary Group on Obesity and its report The Future of Obesity Services, which continues to make a valuable contribution to the debate. We published Tackling Obesity: Empowering Adults and Children to Live Healthier Lives last July, which demonstrates an overarching campaign to reduce obesity, takes forward actions from previous chapters of the childhood obesity plan and sets out measures to get the nation fit and healthy.

[Baroness Walmsley (LD) [V]]

I thank the Minister for his reply, but he will know that we have had several obesity strategies before. What steps are the Government taking to ensure that this latest strategy is implemented in full without delay? Can he provide an update on the timelines for implementation? One of the main concerns of our witnesses was that the full range of services should be provided everywhere in the country, with easier access at any stage of the pathway. Will the Government take this on board?

Coronavirus Vaccine

Debate between Baroness Walmsley and Lord Bethell

Thursday 3rd December 2020 Lords Chamber

[Lord Bethell (Con)]

I am slightly surprised by the tone of the noble Lord’s question. If there were ever a moment when my right honourable friend the Secretary of State for Health deserved a bit of praise and a thank you, today would be that day. That ad hominem attack was beside the point. On his serious point about trust in the vaccine, it would not be helpful for politicians to lead the charge. Our approach is to put science and the NHS at the forefront of our communications. They are truly engaged with both the expertise and the communities that need to take the vaccine.

[Baroness Walmsley (LD) [V]]

My Lords, the rollout will require many people, in addition to those giving the injection. Are there any plans to use the thousands of NHS volunteers who signed up during the first lockdown to act as marshals, drivers, identity checkers, or whatever else is required? In planning the appropriate use of the military, have the Government recognised the concerns of certain community leaders that their presence at testing sites would not reassure members of their communities who are hesitant about taking the vaccine because they do not trust authority?

[Lord Bethell (Con)]

The noble Baroness is right about the NHS volunteers. We would very much like to work with those who stepped forward. Their move was extremely welcome and kindly meant. However, the deployment of the vaccine is a precise affair. We are relying on people having to put in long hours—often not at their own discretion or convenience. Volunteers may well play a role, but the backbone and functional aspect of the deployment will rely on professional staff.

I appreciate her conundrum about the military. It is a delicate dilemma. I do not want to live in the kind of country where we turn our back on the military because some people might feel uncomfortable at the sight of uniforms on the streets. We need to build trust with communities. I want to use this moment of the vaccine to build a bridge of trust between those whom the noble Baroness reasonably described and the military. We must not make the mistake of disrespecting the military by turning them away from this important task.

Covid-19 Update

Debate between Baroness Walmsley and Lord Bethell

Monday 30th November 2020 Lords Chamber

[Lord Bethell (Con)]

I share completely the noble Lord’s ambition for collaboration and a sense of national unity. I am grateful to the devolved Assemblies and the leaders of the nations for their collaborative approach, and to the leader of the Opposition for his support on a large number of matters. However, right now we need clear, simple, strong government, which is best supplied by the voted-in majority.

[Baroness Walmsley (LD) [V]]

My Lords, at the beginning of the first lockdown in Wales, we were forbidden from going out of our borough or travelling more than five miles for exercise. It worked. Now some Government Back-Benchers are demanding more granularity in the tier areas, with restrictions being eased in boroughs with lower case numbers. If this is to be done, it must be—as the Minister just mentioned—without risking the virus spreading from adjacent high-incidence areas, as it did before. If the Government are inclined to give in to this pressure, will they at least consider imposing travel restrictions in high-incidence areas?

[Lord Bethell (Con)]

The noble Baroness is entirely right. I share her sentiments. We are not inclined to give in to the pressure. There is a temptation for greater granularity, but we have learned the lesson on that one.

Covid-19: Dental Services

Debate between Baroness Walmsley and Lord Bethell

Tuesday 10th November 2020 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what measures they are taking to ensure the continued provision of dental services during the COVID-19 pandemic.

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

My Lords, the challenge presented to the dental profession by Covid is severe. We are grateful for the hard work of 10,000 NHS and private practices in introducing PPE and infection-control arrangements to keep patients and staff safe, and to the 600 urgent care centres that are providing services for the most severe cases. However, the impact on the nation’s health remains something that we are working hard to mitigate.

[Baroness Walmsley (LD) [V]]

My Lords, I thank the Minister for that reply, but 60% of dentists can now see only a quarter of their usual number of patients, particularly because of the measures needed for carrying out aerosol-generating procedures. There is a backlog of 15 million treatments, and many dentists are in danger of going out of business. They cannot afford ventilation equipment, which would enable them to see more patients in a day. Will the Government provide funding for this, so that the backlog of patients can be cleared?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the challenge that the noble Baroness has described. Many dentists can see only 20% of their normal cases, and around half can see about 50%. The backlog is, as she describes it, severe, and the impact, particularly on private dentists, has been very hurtful for their businesses. I cannot make a commitment to fund ventilation arrangements, but we acknowledge the scale of this challenge and are looking at ways to mitigate it, including bringing in testing, which we hope would help provide a safe environment for both staff and patients.

Social Care Workers

Debate between Baroness Walmsley and Lord Bethell

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay tribute to all those who contribute to the care of loved ones, neighbours and people in their community. The noble Baroness is entirely right to acknowledge the enormous contribution, born of civic duty and personal love, that people put into caring for those in need. I acknowledge the 10 extra hours that she mentioned; I have no doubt that many have had to put in extra work during the pandemic. That is why we have put in significant financial support for the charity sector, and these are the considerations that we will put into future social care reform.

[Baroness Walmsley (LD) [V]]

My Lords, health and care workers can now be reimbursed for the immigration health surcharge. While this is unlikely to fill the gap identified by the noble Lord, Lord Dubs, it is welcome. How are the Government ensuring that all care workers who do not work in large hospitals are aware of their right to the refund, and how are they monitoring what percentage of those eligible are making the claim and what sort of establishment they work in?

[Lord Bethell (Con)]

This is a very important piece of communication. We have sought to work through the colleges and through the CQC system in order to make sure that employers make knowledge of these funds available to those in social care. I will look at the department to see what we are monitoring and what the take-up rates have been, and if I have any further information I will be glad to write to the noble Baroness with that data.

Covid-19: People with Learning Difficulties and Autism

Debate between Baroness Walmsley and Lord Bethell

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the guidance for day centres in particular is not something I know the specific date for, but I would be glad to take my noble friend’s question back to the department and seek a date, as he asks. We all wish for day centres to be open, but keeping infection control in day centres for those with learning disabilities and autism is extremely challenging, and our primary concern is the safety and protection of children. Therefore, we have to weigh those considerations with the natural pastoral concerns and the contribution of day centres to the care of children.

[Baroness Walmsley (LD) [V]]

My Lords, the lockdown has led to distress for many autistic children due to different routines and limited social interaction outside the family. Many have found returning to school difficult. The National Autistic Society has recommended that schools provide all autistic children with a personalised transition plan to help with their return to school. Has this been happening?

[Lord Bethell (Con)]

The noble Baroness puts the plight of those with autism extremely well. Who could not feel sympathy for those with special needs and autistic sensibilities, with the distress and trauma of changes and the unfamiliarity of the Covid regime? I do not know the precise status of a personal plan for all those transitioning back to school, but I would be glad to inquire back at the department and write to the noble Baroness with a reply.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Debate between Baroness Walmsley and Lord Bethell

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, NHSE&I is currently engaged with stakeholders, including people with lived experience, to develop better information for patients and to understand whether procedures need to be changed. I reassure the noble Baroness that DNRs are not issued, they are agreed with families and relevant loved ones. On no account should DNRs be unilaterally issued. They are for a joint decision; that kind of blanket application is something that we are extremely concerned about and seeking to avoid.

[Baroness Walmsley (LD) [V]]

My Lords, when someone who has a DNACPR is well enough to leave hospital, can the Minister assure me that the notice will be reviewed as a matter of course after consultation with the patient and their carers?

[Lord Bethell (Con)]

The noble Baroness makes a fair point. Of course, someone who walks healthy from a hospital need not have such a notice left on their clinical records. I will admit that I do not know the precise arrangements for how that is conducted but I will be happy to write to the noble Baroness and explain the procedure.

Covid-19: Tracking

Debate between Baroness Walmsley and Lord Bethell

Wednesday 30th September 2020 Lords Chamber

[Lord Bethell (Con)]

Perhaps I may reassure the noble Lord that the NHS app is usable by nine out of 10 smartphones. On average, 87% of Apple and Android phones can download the NHS app. The Apple express service uses a smaller segment of the population because it requires more modern software in the phones.

[Baroness Walmsley (LD) [V]]

My Lords, what have the Government done to ensure that the new NHS app can read only official QR codes at venues and not scams that have the potential to corrupt a person’s phone or grab their data and cause privacy issues? How can users recognise whether a QR code is genuine and is any guidance available to help them to be cautious?

[Lord Bethell (Con)]

I reassure the noble Baroness that the use of non-official QR codes is rejected by the app. I have had personal experience of this. We have had downloaded 600,000 of the official QR codes—an astonishing figure. The use of those codes seems to have been embraced and adopted. I have one at my office and it works extremely well.

Covid-19: Medical and Funeral Expenses

Debate between Baroness Walmsley and Lord Bethell

Monday 28th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure the statistics that the noble Lord describes are at my disposal. However, the phenomenon he describes is both heart-breaking and of deep concern. Payments have been made to charities that have an interest in bereavement support to address this exact problem. Our thoughts and prayers go to all those who have lost a spouse or loved one to Covid.

[Baroness Walmsley (LD) [V]]

My Lords, I ask about eligibility for the funeral expenses payment. It looks to be less about those who do qualify and more about those who do not. For example, somebody on benefits, who is responsible for a funeral and makes an application, will be turned down if a close member of the family is not on benefits. How many people have applied for this payment since the pandemic began and what proportion have been successful in receiving it?

[Lord Bethell (Con)]

My Lords, the noble Baroness is correct that the calculation is dependent on close relatives being on social benefit. It is a sliding scale, but it is applied in an open-hearted and generous-minded way, and there are relatively discretionary payments, of up to £1,000 for ancillary costs that go beyond the funeral parlour costs, to try to create the kind of funeral that marks the passing of a loved one. We are keeping this payment under very close review, given its sensitivity, and will review it if there are concerns.

Health Care: Guidance

Debate between Baroness Walmsley and Lord Bethell

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, there are no blanket DNR notices. These are completely abhorrent and against the NHS constitution. We are not supporting them at all. The noble Lord is entirely right that families should be consulted before any such measures are put in place. The social care plan published earlier this month makes that absolutely clear.

[Baroness Walmsley (LD) [V]]

My Lords, young people have been hit hard by Covid-19, if not physically, then mentally and emotionally. They may be caring for someone who is either sick or vulnerable and therefore isolating. What is being done to ensure that young carers continue to get support during the pandemic—especially in the light of further restrictions—both for their caring duties and for their own mental health and well-being?

[Lord Bethell (Con)]

The noble Baroness is entirely right to focus on the plight of young carers, who play an incredibly important role in society at any time, and who are under profound pressure, particularly when isolating during this epidemic. Substantial financial support has been given to local authorities to provide their social care services with the additional funds necessary to support such cases, and we continue to work through our charity partners to ensure that young carers are supported.

Covid-19 Update

Debate between Baroness Walmsley and Lord Bethell

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are introducing a new scheme for bringing testing capacity straight to the desks of general practice, and the results from that initiative are promising.

[Baroness Walmsley (LD) [V]]

My Lords, I welcome the further £2.7 billion for the NHS to prepare for winter and the further £150 million to expand emergency departments in England. However, as a resident of Wales, where health is devolved, I ask the Minister whether the Government have provided a proportionate sum to the devolved Administrations, to ensure that their residents can benefit from these improvements too? Furthermore, will the changes to NHS 111 be available in Wales, Scotland and Northern Ireland?

[Lord Bethell (Con)]

My Lords, the noble Baroness raises an important point about the rollout in the devolved Administrations. I do not have the details in my brief but I would be glad to write to her with them.

Covid-19 Update

Debate between Baroness Walmsley and Lord Bethell

Thursday 10th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely and utterly reject the noble Lord’s suggestions. I remember well the nay-sayers, the sofa epidemiologists and the sceptics who, when we had testing at the level of 5,000, poured cold water on the idea we would get to 100,000. We hit that target. We have made amazing progress since and we will continue to push for more testing.

[Baroness Walmsley (LD) [V]]

My Lords, the Secretary of State has blamed the recent failure of laboratories to process tests in a timely way on members of the public who are not eligible—as he calls it—seeking to take a test. Is this not another example of Ministers blaming someone else for their failures? How do people know if they are not eligible? If they are concerned about something, what system is in place to enable testing centres to know who is eligible, so that they can refuse to test those who are not?

[Lord Bethell (Con)]

The noble Baroness is right, but it is sometimes difficult to know whether you have the symptoms of Covid, the flu or something else. That is why it is a complicated matter. What we have seen through our engagement with the public in the last few weeks is people who show no symptoms of anything but who seek a test to provide themselves with reassurance. It is not a question of blame, but rather of clarification: we simply do not have the national resources to support that kind of activity.

Covid-19: Response

Debate between Baroness Walmsley and Lord Bethell

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness invites speculation; I wish that I knew the precise answer to that key question. We are extremely vigilant in a large number of areas, including the measures to release a degree of social distancing and on foreign travel, as she knows. We know that if the country remains committed to the basic principles—hand washing and hygiene; social distance; and isolation when necessary—those three principal pillars will be the ones that defend us from the spread of the disease. We are doing everything we can to shore up those pillars, and that is particularly true in social care, where we have massively boosted testing for both staff and patients and brought in hygiene control, particularly around PPE. We will continue to support the sector financially to ensure that agency workers can be used as little as possible.

[Baroness Walmsley (LD) [V]]

My Lords, there are still issues about the length of time it takes for test results to be returned and contacts traced. Is the Minister aware that a four-week pilot scheme for the OptiGene saliva test in Southampton was completed a week ago? This test takes only 20 minutes to process. Since it does not rely on throat and nose swabs, there are less likely to be false negatives because of faulty swabbing. Can the Minister give the House the results of the pilot, which was referred to by a witness to the Science and Technology Committee as a potential game-changer? Are there plans to make the new test more widely available? In light of the latest news about travellers from Spain, will the test be given at the airport to all passengers returning from non-exempt countries so that they can be followed up quickly at the address they have given on the passenger locator form, and should they not have another test a few days later?

[Lord Bethell [V]]

My Lords, I pay tribute to colleagues at Southampton, who have been managing this exciting trial of saliva-based LAMP testing. The LAMP process is extremely exciting, as it removes the time-consuming RNA extraction process from the testing; turnaround times are therefore dramatically reduced. Saliva is a much more accessible vector for the virus than swabbing and therefore has potential for mass appeal. We are extremely interested in the pilot of the OptiGene technology. It is, though, at an early stage. I would not want to raise expectations too quickly on this, but it remains one of a great many similar exciting technologies that our innovations and partnership team is looking at. I am extremely optimistic about the speed and scale of innovation in our test and trace programme, and I believe that we can move more quickly, at bigger scale and with more accuracy than we ever have before in the very near term.

Smoking

Debate between Baroness Walmsley and Lord Bethell

Monday 20th July 2020 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, the Government propose that pubs should aim at two metres between smokers and non-smokers when outside. However, the Minister should know that social distancing is already being flouted when alcohol is involved. Is he concerned that this so-called compromise is supported by FOREST, which is funded by the tobacco industry, and will he answer the question of the noble Lord, Lord Faulkner, and ensure that the guidance will be issued by the Department of Health and Social Care rather than by MHCLG?

[Lord Bethell [V]]

I take a different view from the noble Baroness on the success of pubs’ efforts to introduce social distancing. I spent the weekend in a number of pubs and I was extremely impressed by the measures that publicans have put in place. That is why we support the role of local authorities in judging the right measures for the right pubs and why we will support the government amendment.

Medicinal Cannabis

Debate between Baroness Walmsley and Lord Bethell

Monday 6th July 2020 Lords Chamber

[Lord Bethell]

My Lords, I cannot comment in detail on the specific situation the noble Lord refers to. I recognise the high costs of medicinal cannabis, and we have done an enormous amount to bring those costs down and to regularise the transport and regulation of those drugs, but this is the way our medical arrangements are made in this country. Private prescriptions are an option for those who can seek them, and we are working hard to get more of these medical cannabis treatments on the NICE schedule, but they require clinical trials.

[Baroness Walmsley (LD) [V]]

My Lords, will the Minister accept that the existing protocols and regulatory mechanisms suitable for most pharmaceutical medicines are not capable of handling medical cannabis, which has multiple active ingredients and is therefore not suitable for the usual randomised control trials? Does he therefore agree that a new regulatory system is required for medical cannabis, as there is in many other countries?

[Lord Bethell]

I do not think the noble Baroness is right. There are always groups advocating that their medicines are different from every other type of medicine, but the processes of clinical trials have served medical science extremely well. I share her frustration that the process of medical trials around cannabis has not moved quickly enough. That is why NIHR is looking again at the way these trials are funded; I have spoken to it about how this can be accelerated.

Ultra-processed Foods

Debate between Baroness Walmsley and Lord Bethell

Thursday 2nd July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is entirely right to say that Covid has focused our minds on obesity and the role of diet. However, voluntary approaches are necessary. We have to take people, industry and government with us. That is the core of our approach and it will remain our approach.

[Baroness Walmsley (LD) [V]]

My Lords, will the Prime Minister’s proposed obesity strategy include the full range of obesity services up to tier 4 in all areas, plus ensuring prevention measures such as calorie labelling, portion size, reformulation and the restriction of price promotions of HFSS foods? Will there be independent evaluation of the measures to be proposed?

[Lord Bethell [V]]

My Lords, it is not my role to pre-empt the Prime Minister’s strategy formulation, but the noble Baroness has articulated a very reasonable list of the potential measures. We are closely focused on this area. We are measuring ourselves keenly and our objectives are clearly laid out. The focus is on getting movement on this important area.

Covid-19: Track and Trace System

Debate between Baroness Walmsley and Lord Bethell

Thursday 18th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, we are in regular contact with many of the countries that are working with apps. Two things are crystal clear. The opportunity of using automated technologies to create extra tracing contacts is enormous, and we are working extremely hard to chase down that opportunity, but the technical challenges are also enormous. We are working very closely with our tech partners and with other countries to develop the best possible app, particularly for a moment when the prevalence in society might increase, for that is when the mass automation delivers its unique advantage.

[Baroness Walmsley (LD) [V]]

My Lords, can I press the Minister on his answer to the noble Baroness, Lady Young? In the first week of “test and trace”, over 8,000 cases were referred, but the ONS said that there were 33,000 cases. If only a quarter of cases are being referred, how does the Minister think that we will ever stamp out this virus? When will we get more widespread asymptomatic testing and tracing?

[Lord Bethell [V]]

My Lords, the epidemiological maths is as the noble Baroness describes, but our focus on symptomatic cases does not mean that the system does not work. Taking out more than a quarter of infected cases is a massively important and impactful event. Asymptomatic testing has started in healthcare and social care workers. It is making a big difference in both those forums, where prevalence is higher than the community prevalence, and we will be learning lessons from those schemes.

Covid-19

Debate between Baroness Walmsley and Lord Bethell

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

My noble friend Lord Lucas is quite right about IP, although I bear testimony to the private companies and major corporations which have reacted incredibly generously and enthusiastically by supporting the Government during this crisis. Our supply chains absolutely need to be reviewed. Resilience is clearly more important now than it has ever been. When we look at the way in which our medical, pharmaceutical and device supply chains are put together, they will look quite different in years to come.

[Baroness Walmsley (LD)]

My Lords, the Secretary of State said that he would mention treatments, but he focused only on vaccinations, which are of course important. However, I would like to ask about progress on developing antiviral drugs and the use of serum treatments, about which I have heard encouraging reports. Can the Minister say whether there are any plans to ask recovered Covid-19 patients to donate blood after a suitable recovery period so that the serum could be used to treat very sick patients and help them recover?

[Lord Bethell]

The noble Baroness is entirely right. Serum offers an encouraging opportunity, not least because it is a proven technology. The national blood transfusion service has been asked to start investigating how to collect serum, and a grant for the purchase of new machines to help that has already been made.

Brexit: Medicines and Medical Devices

Debate between Baroness Walmsley and Lord Bethell

Wednesday 2nd October 2019 Lords Chamber

[Lord Bethell]

The noble Baroness makes a very fair point about concerns about easily diminished medicines such as vaccines and isotopes. I reassure her that plans are very well advanced to provide adequate stocks. The Government have procured a buffer stock of 400,000 adult vaccines, and a large number of measures have been put in place, including the use of air freight, the search for alternative vaccines where necessary and the central stockpiling of very large numbers of medical supplies.

On isotopes, the Government recognise the concerns raised over the transport of products with short lives such as radioisotopes, which is why we have put in place a range of measures. These plans are being developed in close collaboration with the relevant manufacturers, NHS experts and other relevant departments.

[Baroness Walmsley (LD)]

My Lords, in my local pharmacy there is a poster on the wall asking patients not to blame pharmacy staff for the current shortages of medicines and medical devices. While accepting that it is not the pharmacies’ fault, can the Minister say whose fault it is?

[Lord Bethell]

The noble Baroness makes a very fair point that touches on the challenge of medical supplies that we live with whatever the circumstances, whether Brexit exists or not. Medical shortages happen and are part of the life of the NHS. If anything, this preparation for a no-deal Brexit has shone a light on our arrangements for medical supplies, and they have never been in better shape. One of the advantages of the process that we have gone through is to improve the circumstances. However, as the noble Baroness pointed out, shortages do happen in every country in Europe, including Britain. But I predict that these will happen less and less because of the investment of time and resources into understanding our medical supplies.

Influenza: People with Learning Disabilities

Debate between Baroness Walmsley and Lord Bethell

Tuesday 1st October 2019 Lords Chamber

[Lord Bethell]

My Lords, I pay tribute to the extraordinary work of the noble Baroness, Lady Hollins, in this area, where she has worked so hard to improve the life chances of those with learning difficulties. The impact she has made is enormous. She is quite right that the life chances of those with learning disabilities are deeply hit by influenza. That is why the Minister of State for Care commissioned the mandatory training consultation. The response has been tremendous, with more than 5,000 submissions. It has taken longer than expected to work through this material, but publication is expected shortly. In the meantime, we are working with professional bodies and other stakeholders to reach agreement on the development of the core curriculum.

[Baroness Walmsley (LD)]

My Lords, is the Minister interested in the views of the pharmacist I consulted yesterday on this Question? He said that his difficulty was identifying the local people with learning difficulties, because unless they have a physical problem that keeps him and the local GP in contact with them, it is hard to get to know them and, therefore, to encourage them to have the flu vaccine. Does that not indicate the need for a major public information campaign in accessible terms to indicate the safety and efficacy of the flu vaccine and vaccines such as MMR?

[Lord Bethell]

The noble Baroness makes a very important point. The question of the learning difficulty register is undoubtedly one that affects this area enormously. Each GP should have a learning difficulty register where the names of those with learning difficulties are recorded, but it is recognised that those registers are not necessarily always up to date. At their board meeting on 27 June 2019, NHS England and NHS Improvement made a commitment to improve the quality of registers for people with learning disabilities for precisely that reason.