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.

Covid-19 Update

Lord Balfe Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely understand the noble Baroness’s concerns about those in social care. In the provisions that we have put in place for the vaccine, I reassure her that we have those who are elderly and vulnerable absolutely at the top of our minds. As she knows, we are putting in place arrangements for a third shot for those who were early on the prioritisation lists, and we are working on booster shots, should those prove to be necessary. The vaccine is our absolute front line in the battle against the virus. We are seeking to protect most those who are in social care, the elderly and the vulnerable, which is why the vaccine arrangements have been prioritised in that way.

[Lord Balfe (Con)]

My Lords, I welcome the Minister’s conversion to living with the disease, which I have said for some time that we have to do. In answer to my noble friend Lady Altmann’s question, he mentioned that there was a winter plan. I would also welcome a copy of that and an assurance from him that plans will come forward to tackle the waiting lists, both regionally and by specialisation, so that we can deal with the huge backlog that the NHS now has to face.

[Lord Bethell (Con)]

My Lords, I remind my noble friend that we have awarded £1 billion to kickstart elective recovery, supporting providers to address backlogs and tackle long waiting lists. We have also awarded a further £6.6 billion to recover health services from March to September. These are substantial investments and will go a long way to address this considerable challenge.

Hospital Waiting Lists

Lord Balfe Excerpts

Tuesday 29th June 2021 Lords Chamber

Asked by

[Lord Balfe]

To ask Her Majesty’s Government what assessment they have made of the time needed for waiting lists for hospital treatment to reduce to the levels they stood at on 1 March 2020; and what plans they have regularly to publish data on waiting times for each (1) medical speciality, and (2) geographical region.

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

My Lords, the horrible dividend of this awful pandemic has been the impact on the wider healthcare service. That is, I am afraid, what epidemics do, but we recognised the threat from the beginning and have worked hard to keep open essential NHS services. We have financed the biggest surge in healthcare spending in NHS history, including £1 billion this year to tackle head on the waiting lists and diagnostic backlog so that we can get back as soon as possible.

[Lord Balfe (Con)]

My Lords, that was an interesting statement but it did not answer any of the Question, which is: what is the Government’s estimate of the time needed to get waiting lists back to the state of a year ago and, secondly, what plans do they have to regularly publish data on waiting times for each medical speciality and geographical region? That is the question; would the Minister like to answer?

[Lord Bethell (Con)]

My Lords, waiting lists are published throughout the NHS and I would be very happy to write to my noble friend with details of the web locations for that data. We are working on the forecasts at the moment. It is not possible to forecast precisely when we can back to where we were, but I reassure my noble friend that a huge amount of work is going on to get there as quickly as possible, including 1.8 million diagnostic tests and treatment for 1.1 million patients since April 2021.

Covid-19: Care Homes

Lord Balfe Excerpts

Thursday 17th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are in the middle of a consultation on mandatory vaccinations for care home staff. One thing I would remind the noble Baroness of is that the vast majority of infections in care homes last year were through staff, not through discharge.

[Lord Balfe (Con)]

I think the question the public want the answer to is why so many people died in care homes. Will there be an inquiry which will try to get to the bottom of that simple fact?

[Lord Bethell (Con)]

My Lords, PHE has published a report on that. It calculates that around 1.6% of the deaths in care homes were directly attributable to discharge. That number is very sad, but it is a relatively low proportion. This will, of course, be a subject covered in the government inquiry that the Prime Minister has already announced.

Covid-19 Update

Lord Balfe Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Balfe (Con)]

My Lords, could the Government try to get back the initiative so that we are talking about a health service and not constantly talking about Covid? I have some numbers: 114 people are in hospital with the delta variant. Of those, 83 are unvaccinated, 28 have had one dose and just three have had two doses—114 in total. This morning, the cancer support unit released some new figures: referrals are down by 350,000 over the year, there is a backlog of 40,000 new patients, and the survival rate is back to 2010 levels. We have this completely out of kilter, and it is largely because the Opposition are obsessed with it. I ask the Minister to go back to the department and try to reclaim the huge tragedy of unmet need in the National Health Service that has built up because we have done nothing but prosecute Covid. We have to learn to live with it.

[Lord Bethell (Con)]

My Lords, I completely understand my noble friend’s concerns, but I do not accept that we have done nothing. It is quite wrong to suggest that the NHS has done nothing but Covid. In fact, I am incredibly impressed by how well services have been maintained during an extremely difficult period. Were he to join clinicians in the NHS or the department, he would know that there is a laser-like focus on catching up. I remind him that there were 1.86 million urgent referrals and over 470,000 people receiving cancer treatment between March 2020 and January 2021—that is not doing nothing. An extra £1 billion is being used to boost diagnosis and treatment across all areas of elective care. On 25 March, NHS England published its 2021-22 priorities and operational planning guidance, and there is a Minister-led group under Minister Ed Argar, which is absolutely focused on the restart in cancer care in particular. I reassure my noble friend that there is a focus on this, and we are doing everything we can to get through the incredibly important backlog of work that needs to be done.

Covid-19: Poverty

Lord Balfe Excerpts

Thursday 27th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the vaccine race is being contested right across the country, and I take my hats off to all those who are delivering the programme so effectively. We are not too proud to learn from each other. In fact, I pay tribute to, for instance, those in Scotland who have programmes around alcohol and drug use, which are pioneering on a worldwide level. We have to work on this all together, and we will absolutely use the best case studies to apply the best programmes on a countrywide basis.

[Lord Balfe (Con)]

My Lords, I draw attention to my position as a fellow of the Royal Statistical Society. There is an old adage that correlation does not necessarily indicate causation. While it is easy to talk about levels of poverty, there are other factors such as lifestyle and ethnicity, and there will be a need for some multiple regression when studying the consequences. When the committees are inevitably set up to look at the causes and how to deal with those matters, will the Minister make it a priority that a good, well-qualified statistician is included among the members of any committee that is set up?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s warning very clearly and he is absolutely right. We must not be confused between statistical correlation and causation. However, one thing that has become clear is that in Covid personal health status, particularly obesity, has been a driver of severe illness and mortality. The environments in which people live and work have been a driver of infection. Those two are probably inescapable conclusions and will be central to our levelling-up agenda.