Commonwealth Fund Report: NHS Ranking

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

Tuesday 29th June 2021 Lords Chamber

[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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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

Debate between Lord Balfe and Lord Bethell

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.

COVID-19 Variant: Travel Guidance for Local Authorities

Debate between Lord Balfe and Lord Bethell

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am conscious of having been asked questions about the vaccine, testing and lockdowns in Bedford before. However, I absolutely reassure the noble Baroness that we approach all areas on an absolutely equitable basis, and in fact I pay tribute to the people of Bedford and the local authorities there for their energetic response to this pandemic. We are working extremely hard with all local authorities to give them the effective powers and resources to deal with the pandemic on a local basis. That means that national co-ordination comes second to local implementation and that these communications are sometimes extremely complex. We should not be surprised if sometimes there are differences between how different areas implement those communications.

[Lord Balfe (Con)]

My Lords, is it not time for the department to stop formulating rules that are neither enforced nor obeyed? Instead, if it wants to publish lists, could it not consider publishing a list of the growing waiting lists for treatments for cancer, heart problems and the many other things which are growing out of all proportion to the amount of effort put into constantly talking about Covid?

[Lord Bethell (Con)]

My Lords, my noble friend makes an extremely pertinent point but the two things are inextricably linked. We can get back and address the backlog of operations to which he quite rightly alludes only if we are not fighting the pandemic and if our wards are not full of Covid victims. Only through the right kind of guidance, testing, the vaccine and the behaviours of the public can we contain this virulent virus, a new strain of which has arrived on our shores, and if we do not, our hospitals will be overwhelmed and we will not be able to address the backlog.

Covid-19 Internal Review

Debate between Lord Balfe and Lord Bethell

Thursday 20th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, as I said before, there was an internal ways-of-working review into the department’s early response to the pandemic, way before the threat of variants was on the horizon. None the less, it is our commitment to focus on the pandemic and the threat presented to us by its future evolution. That is why we are focused on today’s measures. We will leave reflection on the past to the inquiry.

[Lord Balfe (Con)]

Does the Minister see that we will keep on having variants of this virus and, to an extent, will have to learn to live with it? I am sure people would be much happier if we were to downscale the amount of advice that we get from a variety of often dubious sources. The sooner we can publish an inquiry into it, the better. We must recognise that the Government faced an enormous challenge. Overall, they have come out of it pretty well, and we should not carp.

Covid-19: Update

Debate between Lord Balfe and Lord Bethell

Tuesday 20th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I hear the message from my noble friend loud and clear. Vaccination rates among care home workers in some communities are just not high enough. The Government have acknowledged that point, and that is why we have launched the consultation. We must be fair to the social care workers who work so hard, looking after those we love and care about. We have put this consultation in place to understand the most thoughtful, fair and meaningful way to go about this knotty problem. The consultation is moving as quickly as it can, and I assure my noble friend that everything is being done to expedite this matter.

[Lord Balfe (Con)]

My Lords, as the Minister will know, I have been a little doubtful about the amount of effort that has gone into this particular exercise. NHS waiting lists have gone through the roof in the last year, and the amount of care being given has dropped substantially. There is now a huge backlog. What plans do the Government have to get the NHS open again? Surgeries are still closed; hospitals are still closed; doctors are still seeing people only on videos. There is no reason now why surgeries should not start to be opened, and no reason why hospitals, apart from looking after their own convenience, should not start to cut the waiting lists back. I ask the Minister whether one of the very able people who are looking after the Covid programme could be diverted to getting the NHS back into action.

[Lord Bethell (Con)]

My Lords, I completely recognise my noble friend’s concerns, but I reassure him that surgeries simply are not closed, and if he has any examples of those he thinks are closed, I would be grateful if he would write to me. Hospitals are not closed and if he has any examples, I would be grateful if he would write to me. In fact, the NHS has for months done a huge amount not only to be wide, wide open, but to grow in its capacity quite dramatically. It is an inevitable, predictable, sad but frustrating fact that the impact of the coronavirus pandemic, like every other pandemic, is the hit or the follow-on effect on all the other procedures that are needed from a healthcare system. We have diverted a huge amount of capacity from Covid to ordinary, business-as-usual care; we are doing a huge amount to address the backlog and we will continue to move the resources accordingly, but we have to keep provision in place for those who, I am afraid to say, are still in hospital with Covid, and we are aware that the threat remains on the horizon.

Crohn’s Disease and Ulcerative Colitis

Debate between Lord Balfe and Lord Bethell

Thursday 15th April 2021 Lords Chamber

[Lord Bethell (Con)]

We are doing a huge amount in this area, as the noble Lord rightly points out. In particular, we are working with Crohn’s & Colitis UK on the scenario work I mentioned. That is on top of working on diagnostic waiting times, formal personalised care, access to specialist treatment and formal, structured education. I will look into the possibility of having a formal leader to oversee all these strands, but my impression is that, at present, the work is best done by the individual workstreams I mentioned.

[Lord Balfe (Con)]

My Lords, what assessment have HMG made of how many treatments and admissions for inflammatory bowel disease have been impacted by Covid-19?

[Lord Bethell (Con)]

My Lords, Covid-19 has hit all services in the NHS. I pay tribute to those involved in the IBD area who have moved extremely fast to anticipate these problems. Rapid guidelines for gastrointestinal and liver conditions treated with drugs have been made available over telephone, email and text messaging services. NICE issued new guidance in August 2020 to advise healthcare professionals on gastrointestinal and liver conditions.

Folic Acid

Debate between Lord Balfe and Lord Bethell

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I accept the passion with which the noble Baroness has made her case, but it is not fair to say that we have done nothing. The consultation is in place, policy-making is being undertaken and the engagement with mill owners is well progressed. I am hopeful that we can make progress in this area.

[Lord Balfe (Con)]

My Lords, since I entered this House at the end of October 2013, there have been 14 Oral Questions on this subject. I had four years as the president of the British Dietetic Association, which came and went with us pressing for government action. On 3 September last year, the Minister said that

“I am not in a position to give him”—

that is, the noble Lord, Lord Rooker—

“the date he wishes, but we will come back to the House and answer his Question in due time.”—[Official Report, 3/9/20; col. 445.]

When on earth is “due time” going to arrive?

[Lord Bethell (Con)]

My Lords, I accept the challenge from my noble friend, who articulates his point extremely well. I can see in front of me the timeline on this issue. I can only say that we are trying to approach this in a way that creates a durable, long-lasting solution that is endorsed by mill owners, paediatricians and all the relevant stakeholders. It takes time to build that sort of consensus but we totally recognise the importance of this issue—1,000 NTD deaths a year is far too many. I undertake to put pressure on the department to ensure that this issue makes progress as soon as possible.

NHS: Pay

Debate between Lord Balfe and Lord Bethell

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure that retention is necessarily the challenge that the noble Baroness suggests. There has in fact been a 26% increase in acceptances to nursing and midwifery courses when compared to last year, and 1,290 more applications were made in 2020 compared to 2019. The truth is that nursing is a challenging job but one that many people want to take up. There is a long queue of people who want these positions because they are rewarding in many different ways. We appreciate the contribution made by nurses and the whole healthcare sector, but there is no disguising the fact that these are attractive jobs, which many people wish to take up.

[Lord Balfe (Con)]

Does the Minister accept that it was not a 2.1% increase but a 2.1% addition to the bill, which included a number of emoluments that are added each year? It was not 2.1% for everybody; it was a whole package. The Government need to get their case across a bit better, particularly with what the Minister just said about recruitment. I suggest that the Government pay attention to getting their case across. As the Minister said, nursing, with its lifetime pension, is a very attractive proposition at the moment.

[Lord Bethell (Con)]

My Lords, the percentages are unbelievably complicated. It is difficult to stand by one single number to represent pay that goes to hundreds of thousands of different nurses under different circumstances. However, I agree completely with my noble friend. What is at stake here is not just one pay rise in one year but the entire package of circumstances in which nurses do their job. We are determined to ensure that that workplace package is as good as it can possibly be. We acknowledge that there are cultural challenges of working in the NHS, which we are fighting hard to improve. We recognise that training opportunities for nurses should be better and we are working hard to improve those. We recognise that nurses have little capacity for holidays, which is why we are recruiting a very large number of new nurses. It is the entire package that we are focused on, which is why we have put forward the affordability argument as we have.

Covid-19: Brazilian Variant

Debate between Lord Balfe and Lord Bethell

Tuesday 2nd March 2021 Lords Chamber

[Lord Balfe (Con)]

My Lords, we seem to be devoting a huge amount of state resources to chasing one person with a mutating virus at a time when the National Health Service is on the point of collapse. Waiting lists are going up and we are in a terrible mess. Will the Government accept that viruses mutate and that we need a strategy to deal with that? Constantly locking people up and extending the list of countries so that you can put more and more people into hotels is a self-defeating policy.

[Lord Bethell (Con)]

The vaccine is absolutely central to our strategy. It is an approach that has proved enormously popular, and I think I speak for a large number of people when I say that defending the vaccine has to be our number one priority. If there were a highly transmissible vaccine-escaping mutation, it would take us back to the beginning of this whole pandemic. That is why we have put in place red list countries and managed quarantine. That is why we are committed to Operation Eagle and the efforts to track down those bringing variants of concern into this country.

Covid-19

Debate between Lord Balfe and Lord Bethell

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

While I acknowledge the Green Party’s views on this matter, the JCVI has been clear about what prioritisation levels 1 to 4 are. As I said earlier, we will be looking at the other prioritisation lists in time. I am in no way signalling a change in government policy, because that, I am afraid to say, is not in my gift.

[Lord Balfe (Con)]

My Lords, we seem always to be talking about holidaymakers. There is a small amount of legitimate business still being carried out in Europe. A few days ago, the Parliamentary Assembly of the Council of Europe met in Strasbourg under suitable conditions, with no Covid cases reported at the end of that meeting. NATO and the European institutions are also holding a limited number of meetings. Could the Government at least accept that some legitimate business has to go on across frontiers, even at this time? Or are we going to be like the late Markus Wolf of the Stasi and try to do the impossible by closing down the country—and, in the end, discovering it will not work?

[Lord Bethell (Con)]

My noble friend of all people should know that it is an unfortunate comparison to make between the quite legitimate efforts of the Government to keep out killer viruses with those of a nasty East German regime for which I have no sympathy whatever. We have seen that a large amount of business that we previously thought required travel does not require travel. I must admit I am extremely surprised by the news that the Council of Europe thought it was a great idea to get together for a meeting. It is a decision I am querying, and when I get back to the department I will chat to my Foreign Office colleagues to see if that really was a sensible thing to happen.

Covid-19 Update

Debate between Lord Balfe and Lord Bethell

Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

If I have heard the question correctly, that is exactly how the test release scheme works. Travellers are invited to sign the appropriate forms and after some days they can be released from isolation early by taking tests. That scheme has been signed off by the Chief Medical Officer and data from the test is transmitted to Public Health England. We currently have a UK-only testing regime and we do not take tests from overseas, but we are keeping the scheme under review.

[Lord Balfe (Con)]

My Lords, it appears that it is among younger people where the spread is now concentrated. What is the severity of the infection? It has been put to me that it is not that severe and that, indeed, many younger people are saying that they have to learn to live with it. I do not think that things are helped by the harsh rhetoric of “4,000 deaths a day” and so on. It just goes over people’s heads. They are saying, “This is not believable. They are going on about it, but it doesn’t matter.” Instead of using punitive terms, could the Minister go for more of a nudge theory, as put forward by David Cameron, and try to persuade people that it is in the interests of everyone to do certain things, rather than terrify them all the time—because that is not working?

[Lord Bethell (Con) [V]]

My noble friend Lord Balfe is entirely right to say that the symptoms in young people are zero in many cases. There are issues of both saliency and believability among many young people who think that this is a disease that simply does not touch their lives. It is understandable that they may think it implausible that they could be carrying the disease. However, the statistics are crystal clear. When looking at the heat maps, you can see easily how infections grow among the young and then graduate through the demographics until they hit older people, and then hospital admissions rise. I am extremely sympathetic to young people and why they find this idea a challenge to believe in, but we have to hit home with this message—otherwise, we will not be able to contain the disease.

Personal Protective Equipment: Procurement

Debate between Lord Balfe and Lord Bethell

Thursday 19th November 2020 Lords Chamber

[Lord Balfe (Con)]

My Lords, the report does not make for happy reading, to put it mildly. There is a perception that the reality is some way away from where the Minister thinks it is. That may be fanned by the press, but the image of a tawdry chumocracy is to the fore in many newspaper reports. There were five recommendations in this report, all of which would benefit from the disinfectant of sunlight. My question to the Minister is quite simple: will the Government accept, implement and investigate the five recommendations?

[Lord Bethell (Con)]

My Lords, I encourage my noble friend to look beyond newspaper reports. The reality is—

[Lord Balfe (Con)]

No, it is in the report.

[Lord Bethell (Con)]

I ask my noble friend to look beyond newspapers for his analysis of the report. I take the five recommendations very seriously. They are encouraging and ally absolutely with the Government’s values. We will look at how to implement them in due course.

Face-to-Face Medical Appointments

Debate between Lord Balfe and Lord Bethell

Thursday 19th November 2020 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what progress they have made towards the return to face to face appointments on demand for medical patients.

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

My Lords, face-to-face GP appointments increased from 10 million in August to 15 million in September. I should like to take this moment to thank those who have worked hard to restart primary care and serve patients in difficult circumstances. But I should also flag that the proportion of consultations by phone and video is currently running at around 40% and, for many people, this represents a safe, convenient, low-stress, low-cost and hygienic way to get the clinical engagement they need.

[Lord Balfe (Con)]

My Lords, I thank the Minister for his response and note that public trust in the Government is not rising at the moment, and that many people feel that the absence of effort to get medical practice back to normal is a contributory factor in this. Will the department make it a priority to get face-to-face appointments back to the level that they were before? If it cannot, the Government will find that trust declines even further.

[Lord Bethell (Con)]

My Lords, I thank my noble friend for his comments and reassure him that the Government are absolutely focused on the restart programme. The chief executive of the NHS has written to GPs, emphasising the absolute and primary importance of face-to-face appointments, for exactly the reasons that my noble friend knows full well. I also emphasise the enormous response that we have had from the public, and that we are meeting exacting targets for those face-to-face meetings. I also emphasise that new technologies and techniques have been very much welcomed by the public. Telemedicine, and telephone and video consultations, have proved to be extremely popular and helped to increase the number of appointments last month compared with this time last year.

Covid-19: Vaccine

Debate between Lord Balfe and Lord Bethell

Wednesday 11th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we have extremely detailed and thorough arrangements for our borders on 31 December. No problems are envisaged with regard to the vaccine.

[Lord Balfe (Con)]

My Lords, I draw attention to the bit of the Question that says:

“distribute approved coronavirus vaccines in the UK and internationally”.

There is a great danger in the international distribution that corruption will creep into the system. Can the Minister assure me that the Government will co-ordinate with the EU and like-minded international aid agencies to ensure that corruption is avoided and the vaccine that we donate is delivered for free to vulnerable groups in countries overseas?

[Lord Bethell (Con)]

My noble friend makes a very reasonable point. The marketplace for vaccines is extremely competitive. The British Government have been emphatic in our commitment to CEPI, Gavi and the other vaccine organisations. The COVAX advance market commitment aims to produce 1 billion doses for high-risk populations in 92 developing countries in 2021. We support that initiative enormously and work with other partners to ensure the fair and equitable distribution of vaccines around the world.

Covid-19: Intensive Care Treatment

Debate between Lord Balfe and Lord Bethell

Thursday 29th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do not know whether that specific instruction has been withdrawn; I will be glad to write to the noble Lord on that. I reassure him that, during an epidemic of a highly contagious disease, a hospital might not be the safest place for someone who is ill in a care home; nor would it necessarily be the safest place for someone who has gone to their GP and is sitting in the GP’s surgery. It is therefore absolutely essential that clinical risk management and advice is sought before referral to a hospital. There is no prejudice or unfairness here: it is simply good clinical practice.

[Lord Balfe (Con)]

My Lords, the Sunday Times has form on inaccurate stories, as does the Telegraph. Indeed, I asked the Minister a Question on 21 September about a Telegraph story about age restrictions, and he assured me that there were none. I asked him

“will he agree to place a copy of all the circulars from DHSC in the Library so that we can see what is going out?”

In reply, he said

“I will inquire as to what we can possibly share, so that these decisions are as transparent as my noble friend wishes”.—[Official Report, 21/9/20; col. 1596.]

I think it would help keep the papers on the right track if more was put into the Library. Will the Minister tell me how he is getting on with his endeavours to get this information into the public domain?

[Lord Bethell (Con)]

My noble friend is entirely right to chase me in this matter. I remember the commitment very well and I will endeavour to find out from my colleagues at the department how they are doing in getting those important papers into the Library.

Cancer Task Force

Debate between Lord Balfe and Lord Bethell

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

The concern is serious. However, I reassure the noble Lord that although those waiting longer than 62 days for an urgent GP referral increased to about 21,000 between the end of March and the end of May this year, it now stands at about 8,000, which represents a dramatic decrease in the backlog. We have invested in the “Help Us Help You” campaign, which is directed specifically at those who are most at risk from cancer. It is a massive campaign that we are rolling out shortly, and we will continue to invest in it if that is needed.

[Lord Balfe (Con)]

My Lords, calculations by the charity Action Radiotherapy suggest that the cancer treatment backlog may cost more lives than the coronavirus itself—indeed, it estimates that it could be as high as 100,000. Can the Minister give us details—and if not, can he place them in the Library—of the investment in and expansion of radiotherapy services that is being considered and of the aim to reduce the number of machines that are beyond their 10-year lifespan?

Covid-19 Update

Debate between Lord Balfe and Lord Bethell

Tuesday 6th October 2020 Lords Chamber

[Lord Bethell (Con)]

I am grateful for the noble Lord’s question. My right honourable friend was very clear. The Chief Medical Officer analysed our assessment of the disease and its impact, and assessed that it had not substantially changed as a result of these data. The Statement from my right honourable friend is crystal clear. I will be glad to send the noble Lord a copy of that Statement if he does not have it.

[Lord Balfe (Con)]

My Lords, this afternoon’s release from the Office for National Statistics tells us that:

“There were 215 deaths involving … COVID-19 … in England and Wales in the week ending 25 September”.


This remains far below the numbers seen earlier in the pandemic and accounts for just 2.2% of all deaths in the latest week. Our liberties are being trashed and our freedoms removed. When will the Government get down to putting some hope into things? Most people do not know what the rules are, and if they do they are getting round them. I should like a commitment as to when we can open up surgeries and hospitals, and a promise that by Christmas people will be able to visit their elderly relatives in care homes and those who are unfortunate enough to be in hospital. Can we not have a bit of hope, as opposed to this constant gloom?

[Lord Bethell (Con)]

I hear my noble friend’s frustration, and he is right to call for hope. We all want some hope—we are all feeling exhausted by Covid. But it is ironic that my noble friend mentions the low level of deaths as though that were a bad thing. To me, that number is a source of huge pride, because it shows that we have kept a lid on Covid—our NHS is improving the treatment of people who have Covid and we are winning the battle against Covid. I celebrate that.

Health Care: Guidance

Debate between Lord Balfe and Lord Bethell

Monday 21st September 2020 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what guidance they have issued since the end of May 2020 to hospitals, General Practitioners and other health care providers about giving appropriate treatment to different patient age groups.

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

My Lords, I make this point very clearly. The NHS provides a comprehensive service available to all, irrespective of gender, race, disability or age. No guidance has been issued on the provision of appropriate treatment based solely on age. The NHS has issued guidance for the restoration of non-Covid-19 health services, working on the principle that the most clinically urgent patients should be seen first, followed by those who have been waiting the longest.

[Lord Balfe (Con) [V]]

I thank the Minister for his reply. He will be aware that there have been letters in the Telegraph and elsewhere, saying an advisory age of 75 is being brought in. First, is any age guidance given in any of the information sent out by his department? Secondly, will he agree to place a copy of all the circulars from the DHSC in the Library so that we can see what is going out?

[Lord Bethell (Con)]

My Lords, I can confirm clearly that reports of any sort of age limit of the kind referred to by my noble friend are completely wrong. On the matter of sharing circulars, there will be certain practical challenges to that, but I will inquire as to what we can possibly share, so that these decisions are as transparent as my noble friend wishes.

Coronavirus

Debate between Lord Balfe and Lord Bethell

Wednesday 16th September 2020 Lords Chamber

[Lord Balfe (Con)]

I want to talk about care homes and hospital in-patients, many of whom have been marooned for literally months. One of the problems is the testing regime. Could I ask the Minister, first, to give priority to relatives of people in care, so that they can be tested and go in and see their loved ones? Secondly, there is clearly a problem with a lot of the staff, because they are moved around a lot. Can the Minister undertake that his department will consult UNISON, the main trade union for those staff, and see what it can do to open things up so that people in care homes and hospitals are able to be visited again?

[Lord Bethell (Con)]

My Lords, I note my noble friend’s comments. However, I flatly deny that the social care system and social care homes have been in any way marooned. We have made a profound commitment, particularly in the testing environment, to supporting social care. One hundred thousand tests a day out of our capacity of between 200,000 and 250,000 are ring-fenced for social care and delivered to social care every day. Many of the challenges that we have for walk-in and drive-through testing centres are exactly because we are so committed to the ring-fenced testing for social care. That is a commitment that we are proud of and remain committed to.

I want to clarify with my noble friend that it is not an appropriate use of government test and trace capacity for relatives to use test and trace as a convenient method to find out whether they have the disease before they go to see relatives. That is not an appropriate use and not in the guidance.

As for UNISON, we are very much engaged with the union and are supporting staff in every way we can. However, I very much take on board my noble friend’s notes, and we will maintain that correspondence.

Folic Acid

Debate between Lord Balfe and Lord Bethell

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay testimony to the good work of my noble friend Lord Rooker on the campaign for mandatory fortification of flour with folic acid. He introduced a Private Member’s Bill and his work has been earnest. My personal experience is that my cousin James was born with an NTD; he survived two weeks and, sadly, passed away. Therefore, this is a matter that has my personal commitment. However, I am not in a position to give him the date he wishes, but we will come back to the House and answer his Question in due time.

[Lord Balfe (Con)]

I welcome the Minister to his three and a half hours at the Dispatch Box. I first raised this matter as president of the British Dietetic Association, the trade union that represents dieticians. There is overwhelming evidence in support of adding folic acid. As long ago as 1 March 2018, I was promised that the Government would be looking at a date for this to be done. I join the noble Lord, Lord Rooker, in being very disappointed about this. I ask the Minister to get on with this, please. As long ago as March 2018, we were being promised a date and we still have not got one. Please take some action.

[Lord Bethell (Con)]

My Lords, I completely accept the urging of my noble friend Lord Balfe on this matter. He is entirely right. There is very strong scientific evidence in this area; the Government accept that, and this is why they have launched a consultation, which was due to be published earlier this year. However, Covid has blown us away and that is why the announcement has been delayed. The Government have listened to the scientific evidence, which is very persuasive, and the decision will be made when the time is right.

Covid-19

Debate between Lord Balfe and Lord Bethell

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is completely talking my game here. I wish I could be 100% specific about the timeframes, but we are still going through the validation process. Personally, I am hugely optimistic. The noble Baroness, Lady Thornton, mentioned the work in this area of Yale University, which really changed our perceptions of the role that saliva testing could play. It can be used in the big PCR machines, it may be used in point-of-care machines and there is even a possibility that it could be used in the small plastic lateral-flow machines much loved by the husband of the noble Baroness, Lady Neville-Rolfe. I hope very much indeed to be able to update the House soon and to lay out a framework, but I afraid that at present the validation results have not come through and it would be premature of me to try.

[Lord Balfe (Con)]

Although the Minister mentioned the need to get back to face-to-face visits, it is not mentioned in the Statement. In our local hospital, Addenbrooke’s, the instruction has been that no people are to be seen unless it is absolutely necessary. Indeed, one consultant told me they had been forbidden to see a patient unless they needed to. Our local GP service provides no face-to-face meetings other than after you have been triaged and jumped through some hoops. It even had a tent outside for a time. Can the Minister assure us that some pressure will be put on local hospitals and GPs to get back to normal and start seeing people? As letters in the Times have proved, the fact that you do not see people means you miss serious diagnoses.

[Lord Bethell (Con)]

My Lords, massive pressure is on the NHS from every level to get back to normal. Attendance rates are increasing dramatically in every area of the NHS. I pay tribute to those who have gone through enormous hoops to create safe and protected protocols to have people back in the system, but I cannot hide from my noble friend the fact that the health system will not be the same, going forward. We will have to change our approach to infection control and hygiene and have face-to-face contact in a completely different way. It makes no sense for lots of ill people to congregate in a GP surgery and to spread their disease among one another. We have to rethink the way we did our healthcare in the past in order to protect healthcare workers and patients from each other’s infections and to afford a sustainable healthcare system that can afford to look after everyone.

Covid-19: Response

Debate between Lord Balfe and Lord Bethell

Monday 27th July 2020 Lords Chamber

[Lord Balfe (Con) [V]]

My Lords, on three occasions today the Minister has said that, if you have a Covid test today, you are not guaranteed to not have the disease tomorrow. In that case, what on earth is the purpose of having the test system at all? Secondly, the NHS is not functioning properly. Bearing in mind the precedents of my noble friends Lord Deighton and Lady Harding, would it be a good idea for the Minister’s department to appoint a specific person to get the NHS up and running again, as foreseen by my noble friend Lord Ribeiro in his perceptive question?

[Lord Bethell [V]]

My Lords, we use the tests we have got because they are the tests we have got. The way in which the disease manifests itself is not, I am afraid, something that I can negotiate with. We do what we can, but I emphasise that an unfortunate feature of this disease—and many others—is that it harbours itself silently in our bodies and manifests itself both to infect and be diagnosed only when it is ready. That is a simple fact of life. However, the testing regime has a profound impact on the spread of the disease by identifying those who have some form of symptom, even if it is a quiet one. I pay tribute to Sir Simon Stevens, who is working hard to get the NHS back to business as usual and is having a profound impact on the issue.

Social Care

Debate between Lord Balfe and Lord Bethell

Wednesday 8th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is quite right to shine the spotlight on those who are in social care but not necessarily aged over 65. Half of all social care costs are now dedicated to those under 65. Housing standards is an important question. The stock of housing for social care will be considered in any forthcoming review. It is imperative that we have a modern and up-to-date industry.

[Lord Balfe (Con) [V]]

This policy could lead to literally unlimited costs and a bottomless pit that would make the National Health Service look like a modest outfit. When we devise this policy, we must make sure that adequate contributions are made by those affected and we do not fall into the trap of saying that inherited potential wealth is somehow to be exempted. People must pay a fair share.

[Lord Bethell]

My noble friend is entirely right: there is a massive potential liability. We are acutely aware of the intergenerational implications of social care reform. It is only right that we treat both those in social care and future generations fairly. Those considerations will be uppermost in our minds.

Covid-19: Response

Debate between Lord Balfe and Lord Bethell

Wednesday 3rd June 2020 Lords Chamber

[Lord Balfe (Con)]

My Lords, I want to go back to the testing centres question. I also had a test, but I had to drive to Stansted from Cambridge. Many people in our community do not have cars and do not drive. What is the Minister doing to make it possible for all major towns to have testing facilities that can be reached either by public transport or on foot?

My second point is more doubtful. Many people do not seem to realise when they should be tested, or, for that matter, how often. If you are tested at the beginning of June, when do you need to be tested again, if at all? What does the test prove, apart from the fact that you do not have the virus? It does not prove that you have had it or will not get it. Will the Minister step up the publicity campaign he just mentioned, so that people can be better informed?

[Lord Bethell]

I deeply regret that my noble friend had to drive from Cambridge to Stansted. We are working hard to address that and are looking at alternatives. We have now put up more than 100 sites, and I hope very much indeed that there would now be a site nearer him. We have also pioneered at-home testing, which we believe will address his key point, and we are trialling walk-in centres for city centres such as Cambridge.

My noble friend’s last point is entirely right. You should have a test when you show symptoms, but defining the symptoms of any disease, and in particular this disease, is very difficult. We do miss some people who do not show any symptoms, and some people who think that they have the symptoms actually have the symptoms of something else. It is a real dilemma and part of the battle we face against Covid.

Covid-19: Response

Debate between Lord Balfe and Lord Bethell

Tuesday 19th May 2020 Lords Chamber

[Lord Bethell]

My Lords, as I stated this morning, I would be glad to meet with community leaders. However, I emphasise, as I said this morning, that it is the disease that is racist, and the Government and the NHS are doing an enormous amount to try to protect BAME workers, to whom we owe a huge debt of gratitude. I will do everything I can to help protect them.

[Lord Balfe (Con)]

My Lords, this morning, the ONS revealed that some 50,000 UK citizens are cross-border workers—in other words, English people who work part of the time outside the UK. Roughly 25,000 appear to be businessmen. There is no evidence that they are carriers; there is every evidence that when they fly back or come back on the Eurostar, they would be happy to be tested. The government proposals to suddenly clamp down on this and basically stop international business happening are not welcome and will do enormous damage to the British economy. Can the Minister try to influence his colleagues in transport to the effect that this development is not needed?

[Lord Bethell]

My Lords, I pay tribute to my noble friend’s commitment to freedom of travel—and he will remember my father’s own commitment to it. The sad truth, however, is that it is very difficult to prove a negative: to prove that someone does not have the disease or that they have not recently become infected and have the disease in a latent way or that they are young, fit and well. The restrictions are in place for those reasons. I advise my noble friend that we are working on finding a solution, but none is immediately available.

Covid-19: NHS Contact Tracing App

Debate between Lord Balfe and Lord Bethell

Monday 18th May 2020 Lords Chamber

[Lord Bethell]

My Lords, we have no current plans for using geolocation information. However, we have an open mind on options for users being able to share data of several different kinds, and we are open to the idea of consumers making those choices.

[Lord Balfe (Con)]

I want to ask the Minister about the immunity certificates. At the moment, as I understand it, medical science does not tell you whether you are immune. It can tell you whether you have had it, but surely we do not yet know whether Covid mutates. So how can you issue an immunity certificate, and, importantly, how can you make sure that it is not forged?

[Lord Bethell]

My noble friend is entirely right. The science on immunity is confounding and we do not fully understand it, although we are investing a huge amount of time, money and effort into understanding it better. We believe that there may be an opportunity to understand immunity better, and that will inform and make safe people’s commitment to going back to work. No decisions have been made yet, though, and we have in our minds all the reservations that my noble friend described.

Covid-19

Debate between Lord Balfe and Lord Bethell

Thursday 23rd April 2020 Lords Chamber

[Lord Balfe (Con)]

In the Statement, the Minister referred to the need for people who have other medical needs to still contact their GP. In Cambridge, where I live, the opticians, chiropodists, dentists and surgeries are all closed, with different fierce notices on their doors. When the isolation requirements are lifted, could the Government make it a priority to get these vital medical services open again and get doctors back into surgeries, not at the end of the telephone? Perhaps we could at least teach them that Zoom exists.

[Lord Bethell]

I reassure my noble friend Lord Balfe that the amount of video treatment being given by doctors has gone through the roof. During this epidemic, we have seen the medical trade and patients embrace a huge amount of digital technology. We are working with the colleges to try to get all the services of the medical profession open at this time and the response has been largely positive.

Covid-19: Personal Protective Equipment

Debate between Lord Balfe and Lord Bethell

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is right to question the resilience arrangements in this country. I reassure her that we have extremely well thought-through resilience arrangements. This disease, though, is more infectious than we could possibly have imagined. The need for PPE is higher than we had originally planned for. In the NHS we have an organisation in which efficiency and supply management has been put at a very high level. However, we have moved incredibly quickly to put in place central supply organisations. The entire weight of government is working hard to ensure that PPE is distributed widely and fairly throughout the system.

[Lord Balfe (Con)]

In the last couple of days, there have been news reports that a PPE package of some 400,000 pieces ordered from a Turkish company was delayed by the Turkish Government. It has been put to me that the Turkish Government are not responsible for any delay in this shipment, which was a straightforward business deal between the NHS and a Turkish supplier. Will HMG confirm that the Turkish Government have played a constructive role and have not sought to delay the shipment? Will they publicly thank the Turkish Government for not seeking to stop or delay it, even though they have their own crisis to deal with?

[Lord Bethell]

I reassure my noble friend that we have been in daily and constant contact with the Turkish Government, who have behaved with good faith and in a supportive fashion throughout all our dealings. We are thankful to them for their involvement.