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.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Balfe Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Balfe (Con)]

My Lords, I thank the noble Lord, Lord Patel, for his excellent report. It is a report I will not be getting rid of; it will stay on my shelf. That puts it in distinguished company, because it means that it is one that has been not only worth reading but worth keeping and referring to in future. The noble Baroness, Lady Young, said that this was the best old people’s home. When I came here, I was told it was the second best, but that there were no vacancies in Buckingham Palace.

I am very pleased that people are living beyond 80, particularly because I am now in my very late 70s and I look forward to joining them, but we need to remember that it is important to keep people alive, or to help them stay alive, in a way in which they can enjoy life, not as people struggling from day to day. We have the challenge not only of longevity but of helping people to contribute to society and to be able to be a useful part of it.

My first point is this: we are very lucky that we are in the House of Lords and have plenty to do. However, in the community in Cambridge that I live in, I see many people who could contribute a lot to society but somehow or other there is no structure for them to do so. Indeed, in many ways, there is almost a feeling that they are not quite wanted and are part of a generation that has gone. We must first look at changing our attitudes and realise that many people can contribute at many levels, and that that also helps to keep them healthy and on top of things.

I would distinguish between the changes that we have seen and which have contributed to the lengthening of people’s lives. Some of them are what I would call national changes, and some are individual ones. During my lifetime, we have seen the advent of the National Health Service, which has certainly helped a lot of people to live longer because those who cannot afford or do not see doctors have been able to access medical care.

We have also seen a number of incidental changes, which are now almost forgotten. For instance, I advise those noble Lords who have few weeks spare to read Chips Channon’s diaries. You will read about a London where fog was so dense that you could not see in front of you. Now, we have made marvellous steps in the reduction of pollution. You will read about a London where the amount of alcohol consumed—particularly in this place, incidentally—was prodigious. Nowadays that has gone down, which has contributed to change. You will read about a London where people bought each other a cigarette case for Christmas as a matter of course. How many cigarettes do you see now? Not many, quite rightly. We have made a lot of changes as a society. I say to the Minister that part of the department’s strategy must be to make it unacceptable for certain behaviours to take place at all. I am not going to start a debate on them, but there are areas where we need societal shifts to make it clear that certain types of behaviour are no longer accepted.

We also need to look at individual behaviour. One thing that has not been mentioned is class, although we have of course mentioned poverty. The fact of the matter is that the middle class is, and has always been, very good at looking after itself. One thing we have to spread is the inquiring nature of the middle class. Its ability to get the best out of society for itself must be extended. You cannot get hold of people and say, “Here is a social worker, we are going to make your life better”. Fundamentally, people have to change the way they look at society and make their own life better. For some years, I was the president of the British Dietetic Association. Dietitians will tell you that the biggest difficulty they have—or one of the biggest—is getting the intellectual case across. I hear what my good friend and doctor, the noble Lord, Lord McColl, has to say, but one of the biggest difficulties in persuading people not to put those calories into their mouths is persuading them that it is actually the wrong thing to do.

This is where the food and drink industries have a part to play. I am afraid that we have to get a bit tough with them. If any noble Lords wish to go across the road to Tesco and have a look at the meal deal on display, they will see that, if they have a Tesco card, they can get various commodities quite cheap. There are special offers and, of all those commodities—I went and had a look at them today before this debate—not a single one would be classified as healthy eating. They are all high in hydrogenated fats or are straightforward sweets, sugar and chocolate. The voluntary approach is not going to work. I think that the department would find that it had the country behind it if it took a tough line with the food and drink industry. Incidentally, I am a vice-president of the Food and Drink Forum, so I have some dealings with the industry. I listen carefully to all it says and believe about 5% of it—and I am a generous sort of person.

I also point out to the Minister the difficulty in getting things done. The noble Lord, Lord Rooker, and I have been campaigning for years—he has done most of the work, to give him his credit—for the addition of folic acid to bread. It has taken years and years. The Minister is going to have to be tough with the industry.

My final point is that there is a need for a better science of geriatrics. Most general practitioner services do not have a doctor who specialises in the elderly. They need it, but we also need more in the way of literature and publications that will help elderly people to know how to help themselves—in particular to tackle the polypharmacy case, because it could be tackled much better if people knew that they needed some help.

GPs: In-person Appointments

Lord Balfe Excerpts

Tuesday 19th October 2021 Lords Chamber

Asked by

[Lord Balfe]

To ask Her Majesty’s Government what steps they are taking to ensure all patients can choose to have a telephone or in-person appointment with their GP; and what assessment they have made of the impact of appointments not being in person on the late diagnosis of conditions.

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

We have published a comprehensive new plan to support GPs and make it easier for patients to see or speak to GPs and their teams, based on their choice. The plan is backed up by a new £250 million winter access fund, which will help patients with urgent care needs. As part of this, practices should ensure that they are providing the right proportion of appointments for their registered population that is clinically warranted and takes account of patient preferences.

[Lord Balfe (Con)]

I thank the Minister for his reply but point out that one of the fundamentals of the NHS has been that the patient has decided when they wish to see the doctor. Under Covid, that has been breached many times, with doctors having far more power not to see patients. Can he assure me that the aim of the department will be to get back to a system where the patient decides whether they need to see the doctor?

[Lord Kamall (Con)]

My Lords, I am happy to agree with the sentiment in the question from my noble friend, but it is important to make sure that we are not overly prescriptive. Patients sometimes want face-to-face consultation, but they may also be happy with a telephone call or an online consultation. At the heart of this should be patient choice.

Commonwealth Fund Report: NHS Ranking

Lord Balfe Excerpts

Tuesday 14th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have not studied the report’s comments on mental health but, in the broad terms in which the noble Lord describes the issue, I agree. We are very committed to improving access to mental health in this country—we have invested in it, but there is more to be done. It is an area of our health system that requires more investment, which is why we have committed more money to it.

[Lord Balfe (Con)]

My Lords, reference has been made to healthcare outcomes, where we are nearly at the bottom. It is rather like saying, “Everything went well but the patient died.” One of the functions of the NHS is to provide care but, because it is such a bureaucracy, there is very little competition. Can the Minister look at ways to preserve the NHS which include some sort of built-in incentive to innovate?

[Lord Bethell (Con)]

My Lords, I remind my noble friend that the report looks at 10 countries, so although we are at the bottom, it is bottom of a very small list. There is competition within the NHS—the 2012 Act organised that. My experience of working in healthcare, which has only been for one and a half years, is that collaboration, rather than competition, is the key to productivity. Getting diagnosis and the patient journey right requires a huge number of experts to work together and huge expertise, often in many different organisations. We are keen to use technology and modern techniques to make sure that collaboration is at the heart of the way in which the NHS works.

NHS Update

Lord Balfe Excerpts

Thursday 22nd July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

The noble Lord is right: we are concerned about the pay, conditions, career prospects and retention of care workers. I have spoken about this in detail in debates on social care, and I share the sentiments of the noble Lord. When we come to social care reform, the correct provisions for social care workers will form an intrinsic part of those reforms. I do not wish to be obtuse, but this is about the NHS. The NHS is a direct employment body, whereas social care has a different employment system and is therefore not covered by this particular settlement.

[Lord Balfe (Con)]

My Lords, while I am sure that we appreciate the work done by NHS staff, I remind noble Lords that it was NHS staff in the Radcliffe Infirmary in Oxford who put a “Do not resuscitate” notice on my good friend Caroline Jackson’s bed without her knowledge—she found out about it only much later. I have asked the Minister about this. The last Written Answer I got said that a report would be produced “in due course”. Can the Minister ensure that these notices are rigorously reviewed before they are put on people’s beds and certainly not, as in the case of Mrs Jackson, put on the bed without her or her husband or anyone close to her knowing that it had been put there? Not all NHS staff are perfect.

[Lord Bethell (Con) [V]]

As my noble friend will know, I know Dr Jackson extremely well from the old days and heard her story with great regret. I took the story back to the department and played it into the system, as I told him I would do. A report is being drafted and I can reassure my noble friend that it is being taken seriously. The clarification of guidelines has been sent to all wards and there has been additional training for staff put in the position of needing to consider and engage with loved ones on this issue. However, may I push back against my noble friend? It is not right to try to generalise about staff on this point. I have the highest regard for NHS staff. In the very large majority of cases, they have worked extremely well in difficult circumstances in these situations and they are owed our respect for that.

Covid-19

Lord Balfe Excerpts

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I will be crystal clear on this matter. The noble Baroness is right: the wearing of masks is important—for yourself and other people— which is why the Government continue to recommend that people wear them. However, the question was about mandation, and, as I said earlier, it is not reasonable for the Government to mandate minute aspects of our life in perpetuity. We have made a decision on that and passed the responsibility to individuals, local leaders and those who do outbreak management. I completely understand and hear loud and clear people’s concerns, but, were we to mandate it, what is the option for the country? Are we going to issue tens of millions of fines to those who do not wear masks? If they do not wear them, will we lock them up in prison? We tried extremely hard on that policy, but I am not sure whether it had any further rope to run.

[Lord Balfe (Con)]

My Lords, I welcome the direction in which the Government are now proceeding. I quote from the Statement:

“To those who say, ‘Why take this step now?’, I say, ‘If not now, when?’”


There is regulation fatigue, and the Government are facing up to the need for, let us say, a managed process forward. I draw the Minister’s attention to this statement in the Statement:

“We are today publishing … details of a review that we will be conducting in September to assess our preparedness for autumn and winter.”


Could a copy of that review be placed in the Library so that we can all see what it has to say and, if necessary, offer our observations to the Minister to help the further development of what is turning into a policy that I can be fully behind?

[Lord Bethell (Con)]

My Lords, winter is a challenging time for the NHS, and, during an average winter, seasonal respiratory conditions drive an increased demand for hospital beds, as my noble friend knows. That will add to the already intense pressure that the NHS is under. Plans are being put in place. The circumstances are changeable. If there are any plans whatever that can be published, I will ensure that they are sent to the noble Lord and placed in the Library, as requested.

Folic Acid

Lord Balfe Excerpts

Tuesday 13th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely understand the frustration. I pay tribute to all noble Lords who have campaigned assiduously for this measure. It speaks extremely highly of this House that it is so focused on getting over the line an important and emblematic measure that puts preventive medicine at the heart of our healthcare system. Personally, I do not feel any disappointment or anger. I am completely committed to this measure, as are the British Government.

[Lord Balfe (Con)]

My Lords, I have been raising this matter since I became president of the British Dietetic Association, and my presidency ended a year ago. It seems that we go round and round in circles. Some 80 countries in the world have solved these questions. Why is it taking HMG so long? Can the Minister assure us that before we break up next week, he will have made a definitive statement on dates?

[Lord Bethell (Con)]

My Lords, I do not need to explain to a seasoned veteran such as my noble friend that the British Government have had a lot on their hands in the past 18 months and that getting right important measures such as this, that touch the lives of every single person in the country—at least, all those who have bred—is an extremely delicate matter. That is why we have to do it in a thoughtful, constructive way. There is no cutting corners on a measure such as this. I reassure my noble friend that we are going through it as quickly as we can. I am not able to give him the timetable that he asks for, but I would like to return in the new term with further details.

Covid-19 Update

Lord Balfe Excerpts

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am sympathetic to the noble Lord’s frustrations, but he is illustrating the delicacy of the inflection point we are currently at. Only 60% of people are in his fortunate position of having had two jabs for over two weeks. That is a huge reservoir of tens of millions of people who are unvaccinated. There is also a very large number of people—3.5 million in total—on the shielding list who have some kind of vulnerability. The noble Lord could be carrying the disease even though he has been double vaccinated. Of course I aspire to the destination the noble Lord described, but we cannot rush it. We are taking it in a proportionate and logical fashion, and we are absolutely keeping our eye on the kinds of down side risks the noble Baroness, Lady Thornton, described.

[Lord Balfe (Con)]

My Lords, I welcome the fact we are losing our obsession with Covid and learning to live with it. Earlier this week the Minister mentioned the NHS winter plan and said that it would be published. When will it be published and will there a be an arrangement for it to be debated and regularly reviewed so that we can see how we catch up with the huge backlog of health conditions that need dealing with?

[Lord Bethell (Con)]

I am grateful for my noble friend’s kind comments. On the NHS winter plan, he is right that I implied that it would be published. I have looked into this and my understanding now is that it is not a document due to be published imminently, as a winter plan was published in the autumn of last year. There are plans in place and I am working hard to try to provide my noble friend with whatever information I can.