NHS: End-of-life Care

Lord Balfe Excerpts

Thursday 8th September 2022 Lords Chamber

Asked by

[Lord Balfe]

To ask Her Majesty’s Government what assessment they have made of the provision of end-of-life care by the NHS, particularly in respect of Archie Battersbee.

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

The Government are committed to providing high-quality end-of-life care, working closely with the NHS and other stakeholders. The Government are commissioning an independent review into the causes of disputes between those with parental responsibility and those responsible for the care or medical treatment of critically ill children such as Archie Battersbee. The requirement was specified in Section 177 of the Health and Care Act 2022 to lay a report before Parliament by 1 October 2023.

[Lord Balfe (Con)]

I thank the Minister for his Answer and for our meeting earlier this week. I stress that what I am looking for is a review, not an inquiry. We are not trying to pin blame and I hope that the review will have a wide range of disciplines and not be dominated by doctors and lawyers. Because although they say they acted in the best interests of the child—I am prepared to agree that—the parental grief will last for the next 50 years, for the rest of their lives, and we need to get this right. I hope the Minister will be able to reassure me that this will be a wide-ranging review that will involve all the disciplines involved in care.

[Lord Kamall (Con)]

I return the favour by thanking my noble friend for the meeting, but also for the frequent conversations we have had about mediation, for example. I know my noble friend is a qualified and experienced mediator. We are quite clear that the review has to attach no blame. We want to hear from as many people as possible. It will investigate the causes of disagreements in the cases of critically ill children between providers of care and persons with parental responsibility. It will look at whether and how these disagreements can be avoided, how we can sensitively handle their resolution, provide strong evidence and inform future recommendations to support end-of-life healthcare environments in the NHS. As much as possible, it will promote collaborative relationships between families, carers and healthcare. We can see it from both sides: as a parent, just put yourself in the shoes of someone who has to make these difficult decisions. Sometimes they feel that the medical profession acts like God; on the other side, there are medical professionals who believe that the parents do not really understand all the details. Let us make sure that we get this right.

Health and Care Bill

Lord Balfe Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I will speak very briefly to Motion Q: Amendments 105 and 105A. I declare my health interests as in the register, particularly my role as a trustee for the Centre for Mental Health.

I was disappointed that the Government did not accept my Amendment 105, which was passed in this House on Report, regarding mental health membership on integrated care boards. I repeat my thanks for the support I received for the amendment from Labour and Liberal Back-Benchers, particularly the noble Baroness, Lady Walmsley, some Cross-Benchers, and from my own Front Bench, my noble friends Lady Wheeler, Lady Merron and especially Lady Thornton, who has been tremendously supportive throughout. I am also extremely grateful for the continuing and unstinting support of organisations outside Parliament, such as the Centre for Mental Health and the Mental Health Foundation.

However, I am satisfied that the Government’s amendment in lieu, Amendment 105A, captures the essence of my amendment: that the voice of mental health should be at the board table at the inception of the 42 ICBs, and play a crucial part from the start in determining service priorities, budget and resource allocation, workforce growth and development, and commissioning arrangements, among other things. The chairs of ICBs will now have responsibility for the appointment of mental health representation and will be held accountable for their decisions. This House, the other place, external bodies, the public and I will all scrutinise these appointments very carefully.

The Government’s amendment, devised by the noble Baroness, Lady Walmsley, and passed on Report, will put a double lock on mental health representation because of its intention to review the skill mix and expertise of ICB membership in the future. We had further assurance in the Minister’s letter to all noble Lords, which said:

“We strongly agree with the principle underpinning Lord Bradley’s amendment and with his view that ICBs will be strengthened by having at least one member with knowledge of Mental Health on the Board. As it stands, however, the current drafting would create significant legal ambiguity, which is why we tabled an amendment in lieu in the Commons to ensure that the principle is maintained in a legally robust way”.


I am grateful to the Minister for this assurance, and I believe that in taking it together with the two amendments, the ambition for parity of esteem between physical and mental health will, as a result, take a further significant step forward.

The Government’s amendment in lieu of my amendment should ensure that the voice of mental health is heard clearly on ICBs and in the wider integrated care system, and that the mental health and well-being services needed and demanded by the public are at the heart of integrated health policy in the future.

[Lord Balfe (Con)]

My Lords, I rise to speak to Motions L and L1. Where we have got to today is a good example of what the House of Lords is for. When this Bill came to the Lords it had nothing in this area—but by working together, particularly with my friend, the noble Baroness, Lady Finlay, we have produced an acceptable clause. I would have liked more, but it is acceptable.

My skill, so to speak, was mediation, not health. What I hoped to do was to alter subtly but importantly the power relations in the hospital setting. The aim of compulsory mediation is that the patient would be given some power, although only the power to ask for mediation, which is, after all, a system whereby both sides have to agree. None the less, it would give them a way of articulating an issue. One of the jobs of a mediator is to make sure that both sides of any case are understood not only by the other side but by the side presenting it. I did the odd mediation in my time, and when we got down to it, it was clear that the people asking for it were not quite sure what they were asking for. So mediation is a way in which to calm things down, and that is what I was hoping to do. In the middle of all this, the Ministry of Justice came forward and said that it would cover certain legal costs. My aim was actually to reduce costs on the NHS by producing a rather cheaper way—but I am sure that that is something to be welcomed.

I will make just two or three small points. First, when this review is done, it is important that the mediation system that comes out is capable of being enforced. There are basically two types of mediation—what in lay man’s terms we used to call family mediation, and commercial mediation. The weakness with family mediation was that it was non-binding. I never did family mediation, but I belonged to a group with both sides in it, and one of the most distressing things was the huge amount of time that could be put in, and then the mediation agreement was just renounced and set aside. That has to be avoided; we cannot be in a situation where there is an NHS mediation and, let us say, the senior consultant says, “I’m not having that—I refuse to agree.” There has to be something equivalent to what in commercial mediation is known as the Tomlin order, which is the order whereby the court underwrites the mediation; it does not intervene in it but it gives it the force of law so that it can be enforced.

The detailed points that I would like to make to the Minister are as follows. First, in the clause that he has tabled, the department refers to

“the carrying out of a review into the causes of disputes”.

It needs to go a bit wider than the causes; it needs to be a review into the causes and the ways of solving disputes. It is no good having a catalogue saying, “This is where there are disputes.” It has to actually provide a solution to the disputes.

My second point is about where the provision refers to

“a report on the outcome of the review, within one year beginning with the date on which this section comes into force.”

It is a very simple question here: when does the Minister envisage that the section will come into force? There are things in Acts that have been around for years and which have never actually come into force. When will this come into force? I also hope that he will be able to give us a favourable answer on Motion L1, and the additional amendment, tabled by the noble Baroness, Lady Finlay. It adds a couple of very important points to this amendment, and I hope that it will be accepted.

NHS: Pre-pandemic Facility Levels

Lord Balfe Excerpts

Tuesday 29th March 2022 Lords Chamber

Asked by

[Lord Balfe]

To ask Her Majesty’s Government when they expect the full range of NHS facilities, such as hospital visiting and booking GP appointments, to return to pre-pandemic levels.

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

My Lords, NHS services are open to patients and numbers of general practice appointments have returned, or are returning, to pre-pandemic levels. As before the pandemic, hospital visiting is currently at the discretion of NHS trusts. Hospitals are expected to accommodate at least one hour of visiting per day, and preferably more. The department is working closely with the NHS to tackle the Covid-19 backlog and restore pre-pandemic activity and performance as soon as possible.

[Lord Balfe (Con)]

I thank the Minister for that Answer, but in our local hospital there are very big signs saying that visiting is still not permitted, while it seems to be quite in order for staff who are unvaccinated to go in and out of the hospital at will. What steps are being taken to test unvaccinated staff to ensure that they are not carrying Covid, and can the Minister remind me whether we have repealed the bit of legislation that restricted the number of people who can be in a GP’s surgery?

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer as many of them as I can. We are aware that this idea of returning to normal is patchy in different parts of the country. Some people have told me that visiting their GP or a hospital is fine, while others have had real trouble. Therefore, when these issues come up, I hope that noble Lords and others make us aware, so that we can ask the NHS what is happening. It is clearly an issue of capacity, but also, some people are trying to get face-to-face appointments with their GPs, while some practices are trying to move towards a technology-based service offering. I am aware of that. GP appointments are up to 60% of what they were pre-pandemic, but we understand that there is progress to be made in other areas.

Health and Care Bill

Lord Balfe Excerpts

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

As she said she would, the noble Baroness, Lady Finlay, has listened to all those who raised legitimate questions in Committee and has changed the amendment to address their concerns. I sincerely hope that my noble friend the Minister feels able to accept it.

[Lord Balfe (Con)]

My Lords, my only previous intervention on the Bill came about when I read the proposed clause, and in my capacity as a trained mediator I thought that the original proposed clause was not very sound. The proposed new clause is a huge improvement on that, and I hope it will be looked on with favour. As the noble Baroness said, it is about evening up the power relations.

If you are in a hospital and dealing with anyone who is ill, but particularly small babies, it can be a very difficult experience. My daughter-in-law had two very small twin babies. Gathered around the incubator were one PhD and three decent BScs, and we did not know what to do. We felt quite powerless, but we also felt that it was very difficult to get the doctors to tell us what the prognosis was. In fact, the prognosis was quite good—they recovered and are now both in the school football team—but at the time there was on our part a great sense of powerlessness and a feeling that the doctors did not feel they really needed to communicate with us. That level of powerlessness is what this aims to address.

It is about early access to independent mediation. The first qualification of a mediator is that independence. They will not get a result, and nor should they, unless they have the trust of both sides and unless both sides enter into it in a good spirit, looking for a solution. Finally, if they get a solution, it has to be one that sticks. That is why the amendment refers to

“the senior doctor with overall clinical responsibility.”

This cannot be a mediation where a junior member of the medical staff is sent along, where it has no binding effect and where the senior doctor looks at it and says, “I don’t like that; we’re not going to do that.” There has to be some sort of legislative backing.

However, as noble Lords will have seen, the amendment states:

“Where the authorities … become aware of the difference of opinion they must take … reasonable steps.”


It is all about getting consensus; it is about releasing medical data to both sides, and it is about ensuring that the doctors responsible for treatment are at least obliged to listen to any alternatives that the parents might wish to put forward.

When we last debated this issue, I advised—and indeed this has been done—that we knock out the financial provisions, because we thought that the Government would object and say, “We can’t sign a blank cheque.” However, clearly not all the people listened, because this very morning the Ministry of Justice released its Legal Aid Means Test Review, which states:

“We are proposing to increase significantly both the income and capital thresholds for legal aid eligibility, and remove the means test entirely for some civil cases. These include legal representation for children, and legal representation for parents whose children are facing proceedings in relation to the withholding or withdrawal of life-sustaining treatment.”


It rather shoots the government fox that was running around, does it not? It was said that mediation would encourage litigation, whereas now mediation will discourage litigation, because it will be in the interests of both the health service and the medical profession to make mediation work. In making it work, they will not have days and days in court, but they will have a chance of putting the case to a mediator—having been one, I can tell you that it is a lot cheaper than a barrister—and coming to an agreement without needing the great generosity of our Deputy Prime Minister, Dominic Raab, in offering to pay all these costs. I must say that I was surprised by that statement, but if anyone wants to read it, there are multiple copies in the Printed Paper Office, which is where I got mine.

I hope that the Minister will be able complement his colleagues in the Ministry of Justice by taking a positive attitude to curing this particular result. Otherwise, we will be in a position where the Department of Health and Social Care is saying no to mediation, but where we are now going to get free access to the law courts to run up huge bills. What the Ministry of Justice does not say is which departmental budget will pay for this concession. I would not mind placing a little bet as to which one it has in mind.

So I am asking the Department of Health and Social Care to save itself some money, thanks to the beneficent amendment proposed by the four noble Baronesses and supported by me. We are out to save the Government some money, to make it much easier and to build into the system a right for parents to have a more evenly balanced say in what happens to their child at what is a very difficult and distressing time for many of them.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I did not contribute to the debate on this amendment in Committee, but I did sit and listen to the contributions from around the House. What struck me was that in his characteristically sympathetic response, the Minister had not quite understood the purpose of the amendment and the problems it would solve. He stated that the amendment would place the views of parents and guardians above those of clinicians. I do not see that this is the case, especially with the revised amendment that we have before us. Unfortunately, it is a reality that parent-doctor conflict happens. I declare an interest as chief executive of Cerebral Palsy Scotland, and I have seen far too often the views of parents dismissed by clinicians. No matter how qualified parents may be, or what their role in life outside the hospital may be, they are consistently referred to only as “mum” or “dad”. Too often there is an imbalance of power with doctors, and too often parents are labelled as “difficult” or “sharp-elbowed”, as if wanting to do the best for your child is an irritant, and such parents should be grateful for what they get.

By the time a family is faced with palliative care, they will undoubtedly have been through the care of many clinicians: specialist, community, hospital and, potentially, hospice teams. The parents are therefore often the one consistent factor, and they are especially important when the child is too young or too ill, or unable to voice their own views. It is when parents feel they have not been listened to by clinicians that they resort to formal complaints or litigation. It is a last resort, but too often it is the only resort that is open to them. This amendment seeks to address this by giving them space for a formal coming together of all interested parties at an earlier stage, and so preventing costly and lengthy legal disputes. It does not place one party’s views above others; it does not, as outlined in proposed subsection (3), require the provision of resources for any treatment or require a doctor to provide treatment not in the best interests of the child. It simply ensures that there is a clear framework in these tragic, difficult cases to guide what happens next.

This amendment is designed to solve a problem currently faced by families and clinicians at moments of crisis. I urge the Government to consider it, and I will listen carefully to the response of the Minister tonight.

Health and Care Bill

Lord Balfe Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Stowell of Beeston (Con)]

My Lords, I do not very often become involved in health matters, so I hope that your Lordships will indulge me on this occasion.

Five years ago, when Charlie Gard’s parents were doing everything they could to fight for his life, I, like everyone else, was moved by their determination. Even so, my instincts were to accept what the Great Ormond Street hospital doctors were advising and what the judge decided was in Charlie’s best interests. I fall into the camp which believes that, in such an unimaginable, heartbreaking situation, the objective and dispassionate professionals are best placed to make a decision that no parent would ever want to have to make for themselves. When Charlie sadly died, I was moved by his parents’ dignity in coping with their heartbreak in the midst of a legal battle and in the full glare of publicity. Probably like many others who felt so sorry for their loss, I soon moved on and thought little more about this tragic case.

Then, just over a year ago, during the Christmas lockdown, when I was out on my daily walk, I heard an interview that Charlie’s mother, Connie Yates, gave to Andy Coulson on his podcast, “Crisis What Crisis?” For well over an hour, I listened to Connie tell her story. She spoke clearly, intelligently and reasonably about their experience as a family during the year in which Charlie lived, and about all that she and her partner, Chris, went through in their fight to be heard and taken seriously by doctors and lawyers. From listening to Connie, I learned that their expectations were well-informed and reasonable but that as the dispute continued, the situation became increasingly fraught and distressing —to the point where their efforts to be heard as parents made them feel that others believed they were guilty of not wanting the best for their baby. Even so, she was at pains to praise all the medical staff who had cared for Charlie at Great Ormond Street.

Towards the end of the interview, Connie told Andy Coulson that a Private Member’s Bill was being sponsored by the noble Baroness, Lady Finlay, that would bring to life what she called “Charlie’s law”. The noble Baroness has described this law. When Connie talked about it, I was struck by how modest and reasonable it is to create a legal framework to allow for resolution, without the added stress and trauma that they had faced during the time when they were fighting for Charlie. It also struck me very powerfully that, in developing this framework, Connie had taken the time to contact and listen to the doctors who had opposed her, so that she could better understand them and their position. That is worth emphasising again: this young woman is so reasonable that she wanted to create a law that would work for the benefit of the medical profession, not just parents.

As I finished listening to Connie, I vowed that I would support that Bill whenever it appeared. But as we know, Amendment 287 is here in lieu of that Private Member’s Bill, and arguably is a better way to introduce this measure, rather than having to battle with the usual procedural risks that are associated with private Members’ legislation. I am delighted to lend my support to this amendment. I am sure there are technical matters within the amendment which might require discussion between the noble Baroness and the Minister, but I urge my noble friend to take this seriously.

Given the ordeal that Charlie’s family faced a few years ago, when no one in authority listened to them, I am sure it would bring them a huge amount of comfort to know that they are being heard now. That is my main point and motivation today. Of all the things we must do if we are to level up this country, listening and taking seriously people who feel ignored or misunderstood is the most important aspect of that agenda, and in this context it costs us nothing.

I also say to Connie Yates, should she be listening today or read the record subsequently, that she is one impressive woman. When I heard her speak, and listened to what she had to say, she changed my mind and made me realise I had been wrong not to listen more carefully a few years ago.

[Lord Balfe (Con)]

My Lords, I welcome the amendment put forward by the noble Baroness, Lady Finlay, and will make what have been described as technical points. While I think this is a very good base, there are some things that I think need looking at.

I trained as a commercial mediator some years ago, and practiced for a couple of years, before I was signed up by David Cameron to do a different job. The first point I make is that there is a difference between commercial and family mediation. It is important to realise that. I notice that the amendment says

“where the authorities consider that the difference of opinion is unlikely to be resolved entirely informally”.

I suggest that it cannot be the authorities that decide; it has to be offered equally to both sides. That is why it will not be appropriate for the authorities to provide the mediation service. There are a couple of good, independent mediation services, including the Centre for Effective Dispute Resolution and the Alternative Dispute Resolution Services, but if it is to be a system which has the confidence of both sides, it must be independent of the authorities.

The next point I would like to make is this. There is a big difference between family and commercial mediation, and the difference is fundamental. Commercial mediation produces a legal, enforceable result; family mediation produces an agreement which has no legal force. One of the points which must be addressed if this is to be brought to fruition is what is to be the status of the mediation agreement. That is fundamental.

I was a commercial meditator and in East Anglia, where I was, we had a practice of commercial mediators going out also with family mediators to get an experience of the full area. One of the most distressing points about family mediation was the way in which families would bicker, eventually reach some sort of compromise, and, before you were through the door, decide they were not going through with it. If mediation is to work, it will have to have some sort of resolution at the end where the medical profession and the family can say, “This is settled”—not where one side can say, “Well, I don’t really like the outcome”. This could be the case, particularly in a complex medical situation, where you have a number of doctors involved and maybe two or three of them are part of the mediation but there is then someone further up the line who says, “No, I just don’t accept this”. There has to be a dispute resolution which has a legality about it.

New Hospitals

Lord Balfe Excerpts

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness will recognise that we need not only to build new hospitals but to upgrade existing infrastructure and this is all part of the capital programme. The decisions on individual hospitals and upgrades will be taken in local communities in consultation with clinicians and local ICSs.

[Lord Balfe (Con)]

My Lords, will the Minister avoid getting caught in a numbers game? We need an adequate number of beds in a good geographical spread to deal with the needs of the whole population. I hope that he will see this as part of an integrated expansion of the health service and that we will not get tied up with the numbers, as we did years ago—how many hospitals, how many this, how many that. We need an improved health service. This is a vital part of it, but it is only a part.

[Lord Kamall (Con)]

I completely agree with the sentiments expressed by my noble friend. Surely what we should focus on is output; surely what we need is the best healthcare system across the country. We need up-to-date healthcare with the best information from patients to make sure that we can diagnose and give them appropriate treatment, working with the very latest technology such as artificial intelligence to spot patterns, to make sure that we can also build in prevention when we look at tackling health issues in the future. I welcome my noble friend saying that we have to focus on output—modern digital infrastructure and modern digital hospitals fit for the future.

Social Care

Lord Balfe Excerpts

Thursday 28th October 2021 Grand Committee

[Lord Balfe (Con)]

My Lords, I thank the noble Lord, Lord Lipsey, for initiating this debate. We have gone round and round on this subject for many years; as the noble Lord said, he was on a royal commission long before I ever got anywhere near this House—indeed, before I ever thought I would.

One of the difficulties is that there is a wide range of social care. Some people who are in need of residential care, which they pay for, are not that far away from people who are in need of care through the NHS or some other public body where it is not even thought that they will pay. There is a penumbra in between. The wide range of social care is also reflected in the demographics of the country. My generation is living longer than any previous one. No member of the previous generation of my family ever lived as long as I have now, so there is a general tendency to live longer.

However, there is also a general tendency to wish not to face facts. It exists in our household, where we cheerfully say to each other, “Well, of course, all our family died of strokes. They haven’t lasted very long. They’re unlikely to need anything other than an ambulance to take them off to the hospital, and they probably won’t come back.” This is a factor when people look at whether they should make any advance provisions for social care. I stress “advance” because, if you are going to ask people to take out insurance policies, the policy will be meaningless for many of them; they will never draw on the policy because they will die in a way that means them not needing its benefit.

I have a limited example of equity release. I must say, there must be a lot of money in it. Two years ago, in an idle fit on a Sunday night, on my computer, I filled in one of those forms that says, “How much could you get for your house if you sign up to our equity release?” I thought, “That’s interesting. I wonder how much I would get.” I filled in the online form; it is the only form I have ever filled in but, since then, I have had a regular stream of offers of equity release on my house—and not only from the people whose form I filled in. It is fairly obvious that the information has been sold off around the industry. Every couple of months, I get an invitation to take up equity release. Clearly there is a lot of money there. I also think that there is a lot of capacity for mis-selling in the equity release market; we probably need to look at that.

Next, the Conservative Party’s proposals are interesting. I am pleased to say that the Conservative Party is a party that looks after the wealth of people like me. In other words, what we are talking about is wealth preservation. When we talk about the cost of care for the elderly, we are actually asking whether we can preserve our wealth, particularly in our house, to pass it on to the next generation. Putting it crudely, that is what this is all about. Of course, for many ordinary people who live in council flats or rented accommodation, there is no pool of wealth; that is the big challenge that we face.

I am afraid that my solution to help individuals to pay for social care is that they should probably pay a sum of money towards it, and that most of the fancy systems devised will prove to have flaws in one way or another; they all have weaknesses. It is the fairest way of all. It may be hard luck on the children but, frankly, if you have built up a sum of capital it is not unreasonable that you should spend it on looking after yourself. After all, you would not say, “I need to save money for my children, so I won’t eat or pay the rates.” If you are unfortunate enough to need some form of care, that should be paid for by the person utilising that care.

I noted the noble Lord’s point about the housing association remedy. That is fine if you are a single person, but it is no good if you have a partner living at home—let alone dependants of that partner—because they will need to carry on living there. You cannot give the house to a housing association and draw money. My not very happy conclusion is that we probably have to carry on not far away from where we are at the moment. It may produce its anomalies, but the anomaly of getting people who have money to use it for their care is not unacceptable. It is not as bad as some of the anomalies that would occur if you tried to tilt the system so that the owners of capital were somehow exempt from using it for their care. It is a rather gloomy prognostication, but it is my conclusion.

I hope that the Minister and the department will be very cautious before they come forward with plans. I warn them that there has been a problem in some continental countries, in northern Europe. Where you go down this slope of free care, you will face enormous bills. Take a day trip to Denmark, and ask about the cost of care for the elderly. They are not only tremendous but unceasing. At the last election in Denmark, part of the debate was about how many baths per week should be provided by the local services that cared for people in their own homes. That is because Denmark has the universal system, but that system will run out of money every time more money is put into it. It will make the National Health Service look a relatively tame organisation. You will find that there will be huge debt if you go down that path. I caution the Minister: he should be very careful.

Health Incentives Scheme

Lord Balfe Excerpts

Thursday 28th October 2021 Lords Chamber

[Lord Balfe (Con)]

My Lords, perhaps I may first apologise to the Opposition Front Bench for my confusing an Urgent Question with an Oral Statement. I thought that we had only 10 minutes for all of us.

My reaction is that this system will be quite easy to game. One cannot measure fruit and vegetables, and size of portions, by wearing a wristwatch; one can only use it to input data. That is the same for step counting, which, on a wrist counter, is well known as being not as accurate as elsewhere. I hope that the Minister and his officials will look carefully at the possibilities for gaming the system. If they are collecting the data remotely, they should be able to tell whether it is being gamed.

As a former president of the British Dietetic Association, I ask the department to look carefully particularly into the obese and overweight category. There is evidence that a BMI of around 26 does no harm to people, and I should like to see more medical evidence produced on that. I invite the Minister to ask the department to look at that.

Finally, will the department look at producing an app for all citizens, not with rewards attached but just an app of good practice that could be made available for free through the App Store so that we can all share in the wisdom of the department?

[Lord Kamall (Con)]

I thank my noble friend for those important questions, which are exactly those that I would have asked—and, in fact, did ask the briefing team when I was getting more details on this matter.

Of course, one of the most obvious things that we have to ask is: how do people game the system? Often, when one analyses a scheme, sometimes there are unintended consequences whereby people are able to game it. Someone asked me—I think and hope that it was in jest—“If I ate 75 cream cakes and blamed my metabolism, would I be able to get on to the scheme?” We have to make sure that our data is robust. The pilot will include robust anti-fraud measures in relation to users’ activity and access to incentives.

What is interesting about the scheme is that it is voluntary, but it will also make sure that the users input the data. There has been a lot of research around that, because it has seemed to be a potential weakness, if users were inputting the data, regarding whether they can game the system. We have been assured that measures have been put in place to avoid that sort of gaming but, once again, the evidence will tell. That is why the system is not national but is a pilot to test all these questions to the limit.

The noble Lord mentioned weight loss and obesity, which I shall come to. One of the things that we want to make clear is that the health incentives scheme is not a weight-loss programme; it is a programme for healthy living. It uses an innovative approach to rewards and incentives to help participants to adopt healthier behaviours for physical activity and diet. Of course, it will help those who are overweight. I have been on two diets in my life—no, really I have. What is interesting about this is that, when one looks at these issues, it is not just a question of consuming less but about burning off calories. That is why we want to encourage healthy living as opposed to purely tackling obesity. That is very important.

The other day, I met a young lady who was very slim. She said, “Why do you keep going on about obesity and type-2 diabetes? I am slim and I have type-2 diabetes”. So sometimes we have to make sure that we are clear about these connections.

Coronavirus Act 2020

Lord Balfe Excerpts

Tuesday 26th October 2021 Grand Committee

[Lord Balfe (Con)]

My Lords, I start with a quote from the front page of the regulations which I find quite over the top:

“These Regulations are made in response to the serious and imminent threat to public health which is posed by the incidence and spread of severe acute respiratory syndrome coronavirus”.


Presumably this threat arose in the week between Parliament rising for the Conference Recess—

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

My Lords, there is a Division in the Chamber. The Committee will adjourn temporarily.

--- Later in debate ---

[Lord Balfe (Con)]

I shall go back to the beginning because I cannot remember where I stopped.

I start with a quote from the regulations, which

“are made in response to the serious and imminent threat to public health which is posed by the incidence and spread of severe acute respiratory syndrome coronavirus”.

This could not have occurred in the week between the session we had in September and the Minister making this instrument on 22 September. The text carries on,

“the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House of Parliament.”

The first thing I ask the Minister is to get an agreement to discontinue this way of making legislation. It may be some time before the Government repeal all the Acts but they could certainly give an undertaking. I realise that the Minister cannot do that today, because he has to consult the department, but the department could give an undertaking that future regulations will be made after consultation with Parliament.

This pandemic has shown me something. The noble Baroness, Lady Foster, referred to her travels around the world. I have done a lot of lecturing on history, particularly the history of western Europe. I will not castigate any country in particular, but all countries have an undertow of authoritarianism in their public dimension. The pandemic has brought that out in this country. We have seen a level of authoritarianism in the way that people have used their power which is totally unacceptable. It can be seen in the way that the doctors have rewritten national health protocols, and the way that the police decided that they would or would not enforce parts of the law. Let me stress that “would not”; I sometimes wonder why we are here, when I look around and see how much of the law the police decide is not worth enforcing.

So we have an authoritarianism problem in this country but, as we move forward, we will have to learn to live with this. It will perhaps decline, as Spanish flu did in 1920-21, but it will not go away, and the possibility of further viral attacks is on the horizon. I echo the call made to the Minister that the Government should look at viral—and electronic—warfare and attacks as part of their defence capacity, because we could be liable to those sorts of attacks. It is important that we move forward from thinking that our defence consists of sailing a battleship round the Black Sea to a point where we accept that there is a much wider area in which public good can be interrupted for malicious reasons.

We have heard a fair bit about the number of people who have been vaccinated and the various plans that have come forward. I am an occasional subscriber to and regular reader of the Daily Sceptic, which I receive by email. It has put another view on some of the material that has been released about Covid. For instance, we hear very little about the Oxford group and a group of people who have looked carefully at all the evidence and concluded very similarly to the noble Viscount, Lord Ridley, on matters such as face masks. Not all the evidence is being presented; indeed, some outlets take great pride in saying that they are Covid-friendly and, basically, supply you only with government propaganda.

So I welcome the new Minister and the new Secretary of State, because they have an opportunity to move us forward towards a better situation. I have mentioned the problem of GPs in the past, but that situation also covers the rest of the National Health Service. I live in Cambridge, which could probably claim to be the medical capital of Britain. I live in a street that is packed full of doctors, because only doctors and former MEPs can afford the houses there. Some of my best friends are doctors, as they say, and some of their stories about what has been going on are, shall we say, not in line with what we have been led to believe is going on. One of them said to me, “I don’t know what the GPs are doing. We haven’t seen any of them in our hospital, I can tell you that”.

So we must get the health service and private hospitals back to work. Our local private hospital was bought out by the NHS and basically stood empty for the best part of a year, with the consultants doing their consultations at home. It was absolutely ridiculous. The way to get a consultation with your specialist relied on knowing their home phone number and getting on to them and going to see them at home. So they were finding a way round the regulations, and the hospitals were closed but still earning large amounts of money from the NHS.

So the Minister is going to find that there are a lot of themes to unravel. On the subject of vaccination, I counsel the Government not to take on battles that they are probably going to lose. If they take on this battle of trying to get vaccination certificates and vaccination approvals before people can do certain things, they will end up in a morass of bureaucracy and in the end they will lose. Leave it to the market. If a venue wishes to say it requires proof of vaccination to enter—as, for instance, some restaurants in France require—let it administer it and look at the certificate. All I would do is say, “Please put a notice on the door”. Do not get involved in what could turn out to be a terribly authoritarian effort.

There is one question I would like to ask the Minister. We are constantly urged to get lateral flow tests. How much do these cost? I was asked to get a lateral flow test before I went to David Amess’s memorial service. Why? I also question whether they should be free and whether it is our priority as a health service to carry on spending this amount of money. How much does it cost and, more importantly, what plans does the Minister have to wind it down or at least make it a paid-for service, which seems a quite reasonable thing to do?

My final words are that I am pleased that we are moving forward. I hope this will be the last SI we have to debate that is laid in this way, and I hope we will move forward, end this image of a terrified country and continue getting back to normal, so that we can start to get back to where we were some years ago, as normal human beings in a normal society.

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

My Lords, before the noble Baroness, Lady Brinton, joins us remotely, the noble Lord, Lord Naseby, will speak briefly in the gap.

NHS England Funding: Announcement to Media

Lord Balfe Excerpts

Tuesday 26th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for that question. It is important that we recognise that this is a public/private partnership and that we make sure that we can rely on expertise and investment from the private sector. On the specific question, I will write to the noble Lord.

[Lord Balfe (Con)]

My Lords, I point out that the NHS has an insatiable capacity to spend money. I put it to the Minister that political control must be re-exerted over the NHS. Nye Bevan did not found the NHS by asking civil servants to do it. I encourage the Minister to bring a Bill to this House PDQ to get political control back into the NHS and into running it.

[Lord Kamall (Con)]

I thank my noble friend for the very important point he has raised. A friend of mine with completely different politics from me—probably closer to that of noble Lords on the Benches opposite—once said to me, “The thing about working in the NHS is that we always want more money and we are always looking at how to balance that when we get more money”. I think it is important for the public, but also for workers, staff and patients, that we remember value for money and ensure that we spend as productively as possible.