Health: Quad-demic

Lord Bethell Excerpts

Tuesday 10th December 2024 Lords Chamber

[Baroness Merron (Lab)]

I listened carefully to the noble Lord. The JCVI considered that there was less certainty about how well the RSV vaccine works in people aged 80 and over when the programme was introduced in 2023, and that is because, as the noble Lord said, there were insufficient people aged 80 and older in the clinical trials. The JCVI continues to keep this under review, including looking at data from clinical trials and evidence in other countries, and there will shortly be an update to your Lordships’ House in respect of research and clinical trials.

[Lord Bethell (Con)]

The Minister says that we are determined to learn the lessons of Covid. During Covid we had vaccination rates of 90% but, as she said, only 16 million—just 25%—of our citizens have had the flu jab and vaccination rates among children are also deteriorating at a rate. I say this with some personal interest because there was an outbreak of the quad-demic in my own household at 2 am today. There are three times as many people in hospital today with flu than in this week last year. Can the Minister please explain what she is doing to increase vaccination rates, particularly among children?

Vaping Products: Usage by Children

Lord Bethell Excerpts

Monday 2nd September 2024 Lords Chamber

[Lord Bethell (Con)]

The noble Lord, Lord Winston, may be right that vaping has been around for longer than we think, but the current boom came out of a deliberate exercise by two academics at Stanford University, Adam Bowen and James Monsees, in 2005, to find a medical technology that would give people a route out of smoking which would give them the same social interaction—the smoking, the fiddling and the what have you. They deliberately sought to find a device that would help people give up smoking. In this endeavour they succeeded fantastically well. The business that span out of their work in Stanford became Juul, the big success story in the American vape industry, sold in 2017 for billions. In that respect, it is a wonderful success story of how medical technology can be used to crack one of the big, difficult knots in our medical challenges.

We should be honest with ourselves. In the UK, smoking cessation has completely stalled. There are still 50 million cigarettes smoked every day by around 15% of the country. There is no way that we will hit the 2030 smoke-free objective that we have set for ourselves on the current trajectory. In some demographics—the poorer demographics—we will not get there until 2050, if at all.

Vapes are a really promising opportunity—a way out. This is innovation at its best. However, vapes also present us with a classic but horrible public health dilemma: in seeking to forestall one deadly epidemic, we might accidentally be creating another one. Clearly, the vape companies, now largely owned by the tobacco companies, are targeting children. My noble friend Lord Storey put it really well. The statistics are plain. They have created a £1.5 billion nicotine addiction industry here in the UK, which is mostly made up of young people who have never smoked and never intended to smoke. I find that extremely uncomfortable.

As noble Lords have pointed out, current regulation is completely failing to prevent young people taking up vaping. I say this with due consideration of and respect for the efforts of those concerned, but the truth is that trading standards officers, HMRC inspectors, MHRA officials and local authorities are tripping over each other to try to find a way to control this. But the business moves more quickly than regulators can adapt, and, frankly, it is a bit of a mess. I have little hope that the various piecemeal ideas that are being proffered will be an effective answer.

This state of confusion is compounded, as the noble Lord, Lord Winston, quite rightly pointed out, by the ambiguity around the long-term health implications of vaping. I am a lay person, not a clinician, but I think I would be right to summarise by saying that although there is not conclusive evidence today that vaping is bad for you, there is enough on the books to make us worry that there is a fair chance of significant consequences sometime in the future.

What we end up with is a debate around whether we should have flavours, but we should be honest: the debate around flavours is a bit of a legislative displacement exercise. Flavours are intrinsic to the attraction of vapes, both to adults and to children, but the real dilemma facing us as legislators is how comfortable we feel about this industry growing in size. Are we comfortable with the number of vapers in the UK rising from 5% of the country to 15% or 25%? Are we comfortable with the industry being worth £3 billion or £5 billion, or maybe more? Are we comfortable with it attracting largely a poorer consumer group, for vapes to be used largely by young people and children, and for it to store up a potentially massive healthcare liability for the future? Those are the key questions. Or are we so worried that our smoking cessation tool may become a backdoor for another nicotine addiction sector that has dangerous health effects that cost our society another fortune, just like the tobacco industry did, that we should close the whole thing down, as many other countries have done or are trying to do? Is there a way of using regulation to walk the line between these two vivid and quite different choices?

This is the dilemma facing many areas of consumer medical advance. There is a wonderful revolution in the world of medicinal innovation. We must work much harder on the edge cases to make this bountiful for our taxpayers and our patients. This is true in nutrition, medtech, social media and many other fields. Let me give three quick examples.

There is mounting evidence that hallucinogenics might offer treatment for the horrible effects of PTSD. We should probably be encouraging more investment and research, but we will need a regulatory regime that prevents misuse of these potent drugs. After 10 years at the Ministry of Sound, I can testify that they can have both wonderful and devastating effects on one’s psyche.

Ketamine technology is being offered as a new treatment for unlocking psychological challenges, and I know many people who swear by it. However, I read with anger, as other noble Lords might have, about the death of Matthew Perry, the “Friends” star who died when his cynical doctor overprescribed the drug in exchange for hundreds of thousands of dollars in fees.

Cannabinoid medicines are another case. They offer treatment for those with epilepsy. Campaigners have argued very persuasively for more investment and research, and that they have been held back by arcane attitudes and laws about drug control. Recreational users of cannabinoids argue that edible highs are a healthy alternative to booze. I have grave concerns about the legalisation of cannabis, but, with global attitudes changing quickly, it is surely a possibility that this could happen here in the UK. Too many countries have already legalised marijuana without enough thought; they have not done the boring but important regulatory work around taxation, packaging, sanctions and transparency that encourages responsible behaviours.

We used to live in a binary world where medicines were for doctors, narcotics were for the police and there was a duty for the taxman to collect. But now we are in a more complex world of vapes, hallucinogenic treatments and cannabinoid edibles, where there is a leisure industry, a cosmetics industry and a nutrition industry all with one foot squarely in the medical world and aggressively trying to bend the rules to their advantage. Quite rightly, these industries are making claims that their products can help promote healthiness and fight disease. They have a point: we cannot rely on hospital treatment of disease alone to make Britain healthy. But this shambles around vaping flavours demonstrates what happens if the regulators are fragmented and decision-making does not keep up with innovation. That is why I encourage the Minister to really get stuck into the detail; to bring the various regulators together; to assign responsibility; to insist on much clearer data and reporting from the industry; to set deadlines for changes; to timetable reviews; to move quickly to close gaps; and to identify ingredients—as the noble Lord, Lord Winston, rightly pointed out.

We have a huge opportunity to apply exciting innovations to help the health of the nation and to build valuable businesses, but that is not going to work if our regulators are heavy-handed and move so slowly. Thesequasi-medical industries depend on an unremittingly activist approach to regulation and I ask the Minister to commit to more agile supervision than we have shown around vapes to date; to be prepared to close down bad behaviours when they are explicit; to put in place strict descriptions of what vapes can contain; to look very seriously at the licensing regime, as the noble Lord, Lord Storey, recommended; to look closely at advertising restrictions that get round many of the restrictions that we have on tobacco; and, if necessary, to act firmly in order to protect the vulnerable.

NHS: Long-term Sustainability

Lord Bethell Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is a great privilege to speak after the noble Baroness, Lady Warwick. I thank my good friend, the noble Lord, Lord Patel, for bringing about this important debate. I declare my interests as a research fellow on public health at the Milken Institute School of Public Health and a research fellow on biodefence at King’s College London, and as chairman of Business for Health, a community interest company which advocates for greater involvement in health by businesses.

There have been so many powerful words about the importance of investing in our healthcare system. I saw at first hand the incredible power of our national health system during the pandemic. I love the system and what it does for our society. However, we cannot duck two particularly important problems when debating this key issue.

One is the unbelievably heavy cost to society of our healthcare system. The deputy chair of the NHS, Wol Kolade, whom many will know, put this very bluntly; when he joined the board it was £100 billion a year, and it is now edging towards £200 billion a year. He asks:

“Where the hell is it going to stop?”


That is a pertinent question for this debate. We cannot treat our way into good health. We have to look at the underlying health of the country and at how we prevent disease.

We also have to think about the return on investment of our healthcare system. If we want to sustain it and to have it in a secure financial position, we have to ask whether it is giving a return on investment. We have 2.8 million people who are long-term ill at the moment and half a million extra who have left active employment. The OBR predicts that there is no hope that they will return, and there may well be another half a million on the way out in the next year or so. If the economic and spiritual prosperity of the country is not being underpinned by our healthcare system, we have to wonder whether, as a number of noble Lords have pointed out, we need a bit of a rethink.

That is why, alongside the noble Lord, Lord Filkin, and other colleagues, I launched Health is Wealth: A Fast Start for a Covenant for Health. We prioritised five areas of prevention which I believe are achievable and affordable and will yield a massive economic benefit. First, we have to scale up and deliver on our ability to detect and address the risk factors of disease. I am grateful to my noble friend Lady Blackwood for her words on genomics. Secondly, we have to strive for a smoke-free Britain. We should all celebrate this week’s achievement on the smoke-free generation legislation, but there is so much more we can do in the next 10 years to reduce the 5 million people who already smoke. Thirdly, we need to build a much stronger focus on healthy eating, making it affordable for all and helping us reverse the upward trend in obesity. Fourthly, we must focus on the health of our children, ensuring that healthy habits are ingrained from an early age. I emphasise mental health here, in particular the role of the digital world in provoking a mental health challenge for our young people. Finally, we need to ensure that no area is left behind and look at helping those who live in areas with the worst health to live longer. That includes the underlying environment in which they live—the dirty air, the mouldy homes and online and toxic workplaces.

The moral argument for this prevention and upstream focus is very strong, but the economic argument is overwhelming. We cannot keep pouring increasing amounts of money into more hospitals, doctors, nurses and medicines in the hope that we can treat our way out of this problem. We have to address the determinants of health. Can the Minister say what more can be done in this space from a position of ambition for the NHS? We cannot keep scapegoating the NHS for the poor health of our country. We have to look upstream and focus on the determinants of health.

Anaesthesia Associates and Physician Associates Order 2024

Lord Bethell Excerpts

Monday 26th February 2024 Lords Chamber

[Baroness Harding of Winscombe (Con)]

My Lords, I support this Motion and, not for the first time in a debate on health, I find myself in almost complete agreement with the noble Lord, Lord Hunt, and the remarks he made earlier in an extremely powerful speech. We are exemplifying the right debate here, in that this is a subtle and important issue.

I do not wish to suggest that I challenge the esteemed clinicians from a number of the different clinical tribes who have spoken this evening. I speak as a non-expert, as a manager of people, and as a patient. Non-experts in healthcare would find it completely baffling that we have 3,000 people working day in, day out in clinical roles who are currently unregulated. It cannot be right, and I have not heard any argument this evening that suggests that anyone in the Chamber thinks it is right. I think we are all united in our agreement that these hard-working, brilliant people need proper professional statutory regulation.

I hope that, therefore, the order, as it stands, passes. But it is worth dwelling on why this has created so much controversy. Fundamentally, it is because change is hard—and people change is hard and scary. There is a real danger that we underestimate how important it is to look after the people who care for us, and that what we are really hearing from a number of the different clinical tribes is fear, frustration and hurt that they are not being looked after. The real tragedy is that, as the noble Lord, Lord Hunt, said, in the process we have made 3,000 more people feel hurt, unloved and uncared for in the awful debate out in the Twittersphere or X-sphere or whatever it is called.

I will not talk for very long. I just want to register that this has been far too long unfixed, that 20 years is too long for people to be practising without regulation, and that other countries around the world are far ahead of us on this. We should be discussing how we properly define the scope of practice and how we then extend that scope of practice, with the appropriate training for prescribing rights and the ability to order X-rays, just as happens in many other countries in the world. We are all in this Chamber rightly proud of the NHS, but we must not stick our heads in the sand and convince ourselves we are brilliant when others fixed this issue 20-plus years ago.

I finish by saying that regulation is clearly not enough. I completely agree with the noble Baroness, Lady Finlay: we have to recognise that our health and care workers feel unloved and uncared for. There are far too many stories of people unable to get a hot meal when they are working night shifts or having to cancel their own wedding because they are not rostered to be allowed to take the time off. None of that requires professional regulation; that requires professional management. We need both of those.

[Lord Bethell (Con)]

My Lords, I hope that my noble friend the Minister will not mind if I say that I am very grateful to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, for the regret amendments and this debate today. Secondary legislation comes through the House and too often we overlook it. Every now and again we need to put a spotlight on some of the important measures that go through.

I regret two things. I deeply regret the way in which the professions of associate physician and associate anaesthetist have been denigrated in the press, in the lobbying material that has been sent around, and, frankly, in aspects of this debate. I agree with my noble friend Lady Harding and the noble Lord, Lord Hunt, that the feelings and sentiment of these hard-working contributors to our healthcare system have been overlooked. I was sent a very robust briefing by the BMA. I replied: “Is there nothing positive you can say about these hard-working healthcare professionals?” The reply came back—the noble Baroness, Lady Finlay, was copied in on it—that there was not: there was nothing positive it could say about them. I greatly regret that tone, and wish it had not happened.

I am not a clinician and I do not have anything to rival some of the comments made by the clinicians. However, I point out that our hard-working healthcare professionals are incredibly stretched. Take GPs, for instance: 350 million appointments were conducted in primary care last year, 160 million of which were by GPs themselves. That was 50 million more than in 2019, so 44 more appointments per practice. That trend is going up. Britain is getting less healthy, and there is a large amount of immigration. The number of full-time equivalent GPs—although the number of GPs has gone up, a lot of them are working fewer hours—has decreased from 28,000 in September 2015 to 27,000 in October 2023. The complexity of many people turning up to these appointments is very high.

We have to find people from somewhere to do some of these appointments, and there are going to be people who have a lot to contribute who do not necessarily go through the 10 years of qualification to become a GP. We should be embracing them. That is what is happening in every other professional walk of life—it is happening with the astronauts who fly to the moon, the people who fly our planes, and the lawyers who run our courts. The modernisation of workforces is happening everywhere; we should embrace that. My noble friend the Minister alluded to 12,000 AAs and PAs by 2036; that would be just 8% of the number of doctors. That is not a revolution or a threat that the doctors of Britain should be worried about.

If these regulations do not go through—the noble Baroness, Lady Bennett, has said that they will—then it would be difficult to enforce standards, there would be years of delay to regulate the professions, there would be a reduction in the number of healthcare professionals to support our healthcare system, and training programmes would be on hold. I support the passage of this legislation, so that we can modernise the workforce, increase primary care capacity, improve the lot of our hard-pressed GPs and make it easier for a wide range of talents to make a difference to the British healthcare system.

[Baroness Bloomfield of Hinton Waldrist (Con)]

My Lords, I will speak very briefly in favour of these regulations. I am absolutely in favour of any way in which we can leverage the ability of our doctors to concentrate on what they want to do, and what they have been highly and expensively trained to do, which is to take responsibility for seeing, diagnosing and treating patients who are ill and in need of medical help. I am also in favour of trying to reduce the exorbitant cost of locum GPs, which bleed resources from the National Health Service—resources which could be much better spent elsewhere. Some of the Government’s initiatives, such as allowing pharmacists greater and more extensive advisory and prescribing powers, are also very welcome.

I have no philosophical objection to the concept of physicians or anaesthetists being supported by assistants, whether they are senior nursing staff or others, but I share the concern that the very term “associate” implies a greater degree of qualification than is actually the case. Two years’ training post a science degree does not a doctor make. Of course they should be regulated by an organisation which enjoys public confidence, so long as that in itself does not imply a greater medical qualification.

It is easier to prevent overreach in a hospital environment, where supervision in anaesthesia should be routine, but it is much harder in general practice. The reason I rise now is because my husband was seen by a physician associate when his throat failed to heal weeks after he burned it with a hot cup of coffee. After the young man had taken a photograph and disappeared up the corridor with his phone, allegedly to see a GP, he reappeared with an ominous pamphlet entitled “Suspected throat cancer” and suggested an urgent appointment at the John Radcliffe Hospital. I am pretty sure he was not trained to be the bearer of such bad news. So undoubtedly physician associates need to be regulated, though I acknowledge it was better this way round than ignoring something and saying that there was no issue to be dealt with when there might have been.

We have 14 GPs in our local practice, in a small town in Oxfordshire: 11 work three days per week, none of them works full-time and one of them works one day per week. Perhaps we should also address the loss of 40 working days per week from any similar team, as well as putting in place things that make doctors’ working lives more rewarding and meaningful. If physician associates are part of that then I am fully supportive, so long as they are properly regulated. The Faculty of Physician Associates code of conduct, produced with the GMC, says that physician associates will always work under the supervision of a designated senior medical practitioner and that they must work within the limits of their experience. Let us make sure that these regulations will help make that happen.

Premature Deaths: Heart and Circulatory Conditions

Lord Bethell Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

Absolutely. These are all key parts of a good, healthy lifestyle for mind and body—for mental health as well. Social prescribing is important for all this as well.

[Lord Bethell (Con)]

My Lords, following the appointment last year of Professor John Deanfield as the champion for personalised care, can my noble friend the Minister please update the House on the progress of his report on radical approaches to prevent life-threatening cardio- vascular disease?

[Lord Markham (Con)]

I will need to come back in writing to my noble friend on this. I take this opportunity to thank him for his work on the Times Health Commission and for generally pushing forward the whole prevention agenda.

NHS: Doctors’ Strikes

Lord Bethell Excerpts

Wednesday 5th July 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct; that is why I was delighted, as I think all sides of the House were, by the launch of the NHS Long Term Workforce Plan. As Amanda Pritchard, the CEO of the NHS, said, it was a “truly historic” moment for the NHS; it absolutely recognises that staff are the backbone of it all and that we need to do everything to recruit and retain them. Retention is all about professional development and all those things that make up staff morale.

[Lord Bethell (Con)]

I congratulate all noble Lords who joined me this morning on the five-kilometre fun run in celebration of the 75th anniversary of the NHS. It was a tremendous event and all those involved greatly enjoyed themselves. With that in mind, will my noble friend explain what the NHS is doing today to reduce the incredible pressures on doctors and nurses from the huge amount of sickness in the country and what it is doing to make Britain healthier in order to reduce those pressures?

[Lord Markham (Con)]

As my noble friend says, wellness is about a lot more than treatment in hospitals. That is why I was so pleased by the long-term workforce plan, which recognises the importance of primary care and, especially, prevention—the use of our whole wellness through social prescribing and keeping fit through things such as fun runs, which is important for keeping people and staff well. As part of that, we are working on the technology front, because a lot of the frustration of doctors is that they spend so much time not seeing patients but filling in paperwork and forms. Earlier this week, I saw all the changes Chelsea and Westminster Hospital is making so that doctors can be where they want to be—in front of patients and caring for them.

Long Covid

Lord Bethell Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I start by thanking the noble Baroness, Lady Thornton, for bringing about this important debate. She has held the Government’s feet to the fire—in fact, she held my feet to the fire—on this issue, and I absolutely commend her persistence.

Rehabilitation in general and post-viral syndromes in particular have a long history of being horribly overlooked in this country. I am afraid that this regrettable neglect has contributed darkly to the long-term poor health of many in this nation. However, before I speak about the consequences of this on long Covid, I will take a moment to recognise that Britain has done more than almost any other country to address long Covid. Professor Chris Whitty and the CMO’s office prioritised NIHR research, with £50 million going into 19 projects, giving a clear signal for other research. The NHS, and in particular the noble Lord, Lord Stevens of Birmingham, launched a welcome five-point plan, as the noble Baroness mentioned, and Amanda Pritchard has rolled out excellent long-term long Covid clinics. Treatments such as monoclonal antibodies and pulmonary rehabilitation are emerging as a result. I pay tribute to Dr Harry Brünjes, who pioneered the Breathe programme at the English National Opera, which is a fantastic example of social prescribing that has produced some very promising clinical trial results. I thank the noble Lord, Lord Darzi, who kicked off the important REACT programme at Imperial College which has generated hefty longitudinal population studies. Lastly, I pay tribute to the patient groups, who are both vocal and thoughtful in their responses, for their testimony.

Despite these considerable collective efforts, I am sad to say that the long Covid story has become a parable for how the UK health system fails to protect people’s freedom from disease and illness. It fails to properly rehabilitate our sick, and we are paying a horrible economic price as a result. The scale of long Covid is enormous, as the noble Baroness rightly pointed out, but the clinical response I referred to is sadly inadequate. The ONS says that there are 1.5 million sufferers, yet the long Covid clinics can see only 60,000 patients per year. Patient groups are frustrated that, when they do get seen, clinicians do not have the latest pathways that might lead to positive outcomes. The NIHR agrees with patients that there are a lot of unanswered questions.

We are familiar in this country with the rationing of scarce health resources and the uneven distribution of the latest research—uncomfortable though that is—but I will focus a few words on the profound economic effects of this troubling British healthcare strategy. ONS data reports that 500,000 people have left the workforce over the last 18 months, and 75,000 of those are economically inactive due to long Covid. The Institute for Fiscal Studies has a slightly different figure of 110,000, and it says that the cost is almost £1.5 billion in lost earnings a year. Another IFS study suggests that there is an average of 2.5 hours of sick leave per worker being taken due to those who have long Covid. Either way, the OBR has recognised that Covid in the round could cost around £2.7 billion in welfare benefits such as incapacity and housing. That is an absolutely staggering sum.

My point is that we cannot shrug our shoulders about the impact of conditions like long Covid on the economy. We have to take on the challenge of making this country healthier and pivot towards prevention. Andrew Haldane, chief executive of the Royal Society of Arts, put it well in his recent speech:

“We’re in a situation for the first time, probably since the Industrial Revolution, where health and wellbeing are in retreat … Having been an accelerator of wellbeing for the last 200 years, health is now serving as a brake in the rise of growth and wellbeing of our citizens.”


Yesterday, Andrew Bailey, the Governor of the Bank of England, told the House of Commons Treasury Committee that part of the reason the country was being held back was the sharp decline in the size of the workforce since Covid.

Despite this, the Treasury plan for living with Covid makes no mention of investment in rehabilitation or major initiatives for getting the workforce back to work. Finances in the UK Health Security Agency and the Office for Health Improvement and Disparities, the main legacy public health organisations—

[Lord Framlingham (Con)]

Will the noble Lord give way, please? Does he agree there is a growing concern about the serious side-effects that the booster vaccinations can have? Does he agree with me that the Government should look at this very carefully?

[Lord Bethell (Con)]

My Lords, the vaccine programme has been an astonishing success, and the uptake of those vaccines has shown the enormous public confidence in them. I will speak on another date about the profound impact this has had on the health of the nation.

My point here is that, at this moment when we are feeling the effects of Covid heavily on our workforce and economy, the finances at the UKHSA and OHID are under huge pressure. The public health infrastructure built over the pandemic has largely been dismantled. At the same time, we have an NHS straining to look after the sick and a workforce many of whom are too sick to work.

It is time that we work towards a new political settlement that prioritises the health of the nation and not just the treatment of the sick; and that we make the operational decision in health and care to move towards prevention.

--- Later in debate ---

[Baroness Neuberger (CB)]

My Lords, I declare my interests as chair of University College London Hospitals NHS Foundation Trust, chair of Whittington Health NHS Trust and a member of the North Central London Integrated Care Board, as well as other interests stated on the register. I am most grateful to the noble Baroness, Lady Thornton, a wonderful fellow non-executive director at Whittington Health, for securing this debate. I too am very grateful to the Library, which has been hugely helpful, and I am enormously grateful to all other speakers, because most have said most of what I was going to say.

I have a very specific point. At UCLH, we a run a well-known and much-admired long Covid service, which is led by the remarkable Melissa Heightman, who is also a national specialty adviser for NHS England and the co-chief investigator for the STIMULATE-ICP study, the largest long Covid trial to date. We know that the service is desperately needed; we have heard that all around the House. Those who run this particular service are working night and day; it does not have the resources to do what is needed, to the extent that those who run it are begging for bits of resource from elsewhere, mostly for people. So short is the service of staff that they recently asked UCLH Charity to fund an extra consultant for two years, which it has agreed to. I am well aware, as we all are, that today is the day of the Autumn Statement and that times are tough, but it is really serious when an NHS trust with a £1 billion turnover has to ask its charity to support an on-the-ground service led by the national lead, even for a limited period of time—particularly for a service designed to help other NHS staff across London.

Worse still, as other noble Lords have said, some 10% to 14% of reported cases are NHS staff. Although we all know that, it is not generally known among the population—but it is not really surprising, given the higher exposure to the virus that they all had. What a difference getting them well and back to work would make to the cash-strapped NHS and to the challenge over staff numbers. We have real trouble in recruiting and, as others have said, we have people leaving the service.

[Lord Bethell (Con)]

Can I personally endorse what the noble Baroness just said, in particular her testimony on Melissa Heightman and the team at UCLH? I had extensive dealings with them as a Minister, and their work is absolutely first class. I am heartbroken to hear that they are having to reach to charity for financial support.

[Baroness Neuberger (CB)]

I am extremely grateful to the noble Lord, and I shall make sure that Melissa knows about that.

Meanwhile, we have all the figures that everybody has cited, and the ONS has reported that long Covid has adversely affected the day-to-day activities of 1.6 million people—that is absolutely huge, and other noble Lords have mentioned that fact. The NHS has tried to help with that ongoing issue but, unfortunately, not enough. I want to go through that, because I think that it is relevant.

In October 2020, NHS England announced a five-point plan to support long Covid patients; it commissioned NICE to develop new guidance and established designated long Covid clinics to provide

“joined up care for physical and mental health”.

It also created the NHS long Covid task force to guide the NHS’s national approach on long Covid, and it funded NIHR research on long Covid better to understand the condition. In July 2021, NHS England published its long Covid plan for 2021-22, which included investing £70 million to expand long Covid services and £30 million in the rollout of an enhanced service for general practice, to support patients in primary care. But when NHS England published its updated plan in July this year, the previously enhanced service funding was not continued, so primary care no longer receives any ring-fenced funding for this condition—yet, as we know, it affects nearly 2 million people.

The problem is both insufficient resources to do all the work that is needed and insufficient forward planning to enable those services that do exist to build up capacity, engage in research, recruit, train, educate, and care for patients, including, importantly, the large number of NHS staff who appear to have been affected. We have a major health problem here that is likely to run for many years. Treatment is uneven across the country and research, which will need a lot of funding, is in its early days. This is an additional burden on an already very stretched NHS, both with patients with long Covid and with the large numbers of staff who have it.

What we really need is a properly NHSE-commissioned service to be put in place now, with secure funding for the next several years, even in these cash-strapped times. It feels like a hand-to-mouth, temporarily funded arrangement, so it is really hard to build a resilient service for the longer term. Can the Minister assure this House that such long-term commissioning will now be put in place, given the recent evidence of the numbers of people away from work with long Covid, the huge proportion of NHS staff affected, making other NHS backlog issues worse, the general impact on the UK economy, which others have mentioned, and of course the sheer suffering that long Covid is causing?

Primary and Community Care: Improving Patient Outcomes

Lord Bethell Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I thank the noble Lord, Lord Patel, for bringing about this important debate. As ever, he has a canny nose for the timing of these things and he is absolutely spot on. I know from my time in office that the pressures on primary and community care are intense and I agree that we need an urgent rethink. That is why I will put my name to any forthcoming proposal from the noble Lord to the Liaison Committee for a Select Committee on primary and community care.

The NHS has experienced long waits in hospital care before, which are extremely distressing, but it has never faced such a grave challenge in general practice—and as we know, general practice is the bedrock of the NHS. This is the right moment for noble Lords to distil complex recommendations for primary and community care into succinct, wise counsel for the Government to consider. I will share a few thoughts on how that might work. First, primary and community care is the first point of contact with the care system for the public. When we consider the remit of this Select Committee, we must remember that for many people this is not a GP. It is likely a website, an app, a school nurse, a community hospital or a pharmacist.

Secondly, there is definitely a workforce crisis—briefings from the Royal College of GPs, the Royal College of Nurses, the King’s Fund and others make that very clear, and I am grateful for their persuasive statistics—but the crisis in primary and community care is not just a workforce crisis that can be answered through solving recruitment, retention, workload and the GP contract, although those are extremely important challenges. Anyone who listened to the Minister’s answer yesterday to the OPQ about GP training will be clear that there is no massive new wave of GPs set to save the day. As the noble Lord rightly pointed out, only one in four GPs are currently working full-time, and training numbers are going sideways, so we should assume that there will be fewer GPs rather than relying on imaginary regiments of doctors riding to the rescue. Rather than deluding ourselves, we should make our plans accordingly.

Thirdly, we should not over-romanticise relational-based care when the role of the GP is evolving as quickly as that of the bank manager or the priest, and when many patients never ever visit the practice. We got through much of the pandemic with most practices shut, after all. People have extraordinarily diverse needs, from the long-term sick who certainly need regular clinical, face-to-face care to those at the other end of the scale, the occasionally sick or injured who might need a more transactional relationship. We must avoid lazy generalities, and we need a modern service that is flexible enough to meet different needs. That is why I would like any Select Committee studying primary and social care to look at four issues in particular.

The first is the importance of prevention. Too much traditional thinking around primary and community care assumes that patients turn up with symptoms and are guided by the GP on to some care pathway. These days, though, by the time patients have symptoms, it is often too late for the best treatment. This system-wide focus on late-stage acute medicine is costing the country a fortune in hard expenses and opportunity costs: expensive procedures, long recovery times, falling longevity, falling workforce productivity, and hefty social care and welfare bills. It is a huge price to pay. Primary and social care should play a much more proactive role in achieving “domain one” of the NHS outcomes frame- work, which is preventing people dying prematurely.

Secondly, technologies to “transform” healthcare are at our fingertips. I saw the power of digital transformation in primary care from my experience during the pandemic, with virtual wards, testing, the vaccine rollout, surveillance through the REACT survey, the prompt delivery of antivirals, and so on. We should study how primary and community care put digital first and become the foundational layer for scaling digital healthcare through the NHS. This approach is outlined in the persuasive policy paper from Policy Exchange that the noble Lord, Lord Patel, mentioned, At Your Service, by Dr Sean Phillips, Robert Ede, and Dr David Landau. They rightly argue that there is much to do to enhance the existing infrastructure and clarify the legal regulation of data. That is why I am interested in their recommendation for a digital health and care Bill, and in a “smart” first contact navigation programme—an “NHS Gateway”—that can deliver a more personalised “front door” to the NHS. We also need to address the use and sharing of data in primary care for management, clinical and research uses, with suitable resources allocated for this absolutely invaluable work.

Thirdly, I support the recommendation by Dr Rebecca Rosen at the Nuffield Trust for embedding more non-medical clinicians—such as pharmacists and dieticians—into primary care, an approach that worked well for us in the pandemic. There are lots of great examples already in primary care of working differently, from community health worker models in Westminster to the Healthier Fleetwood approach. The question that arises from these experiments is: how do we make innovation in primary care the norm rather than the exception?

Lastly, I will say a word about diagnostics. The pandemic demonstrated the value of consumer diagnostics, attached to digital reporting and used at home or on the high street. These tools engage people with their own healthcare, improve personal responsibility and relieve the pressure on overburdened healthcare systems. It makes no financial or clinical sense that people book a hospital or GP appointment for often extremely simple procedures such as swabs, serology, and faecal and blood pressure tests. During the pandemic, the Lighthouse Lab processed 150 million PCR non-NHS test samples, lateral flow tests were shipped at up to 4 million a day at their peak, and over 2 million blood samples were taken at home by finger prick and posted to labs to maintain the ONS infection study. I give a loud cheer to our new diagnostic hubs, but I fear that on diagnostics we are going back to the old-fashioned, cottage-industry-based pathology mindset rather than embracing the opportunity presented by the consumer diagnostic revolution.

Let us not fight the last war or try to recreate Dr Finlay. This Select Committee must examine the opportunities presented by this crisis for moving away from cumbersome paternalistic models towards a data and diagnostic-empowered citizen patient. That is what a Beveridge 2.0 could look like. That is the way to grow the economy and protect our people.

NHS: Pre-pandemic Facility Levels

Lord Bethell Excerpts

Tuesday 29th March 2022 Lords Chamber

[Lord Bethell (Con)]

My noble friend is entirely right that the technology offers benefits, but the health infrastructure plan, promised some time ago, has not yet been published. That will outline the framework for investment in the technology he mentions. When will the update be published?

[Lord Kamall (Con)]

My noble friend will be aware from when he was a Minister that there were other priorities in tackling Covid, trying to get a vaccine and procuring much-needed equipment. This was therefore all delayed, but we are now working with stakeholders to ensure that the updated capital strategy sets a clear direction for the system, taking into account significant events since the first publication. The multiyear settlement confirmed for 2021 allows us to take the next step forward. We expect the paper to be published at some time in 2022.

Health and Care Bill

Lord Bethell Excerpts

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

The evidence suggests that official statistics appear to significantly underestimate the complications and risks. The Minister will have seen that 600 medical practitioners have signed a letter highlighting concerns and calling for the cessation of the temporary measure. This is worthy of proper scrutiny and consideration. It involves the safety of women, but it also involves the taking of a new life. Science teaches us that life begins at conception. Surely, we should give this proper and due consideration before passing this into law.

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Lord, Lord Alton. I join him and the right reverend Prelate the Bishop of Durham in paying tribute to my noble friend Lady Sugg for her work on women’s issues—work that I support in every way I possibly can. I think that this amendment is a useful amendment to this Bill. My noble friend Lady Sugg is right that the world is changing: science raced ahead during the pandemic, and many things that had not been tried before were tried. Clinical tools have become more sophisticated, practices are undoubtedly evolving and there are definitely lessons from the pandemic that are worth our consideration.

That is why I very much welcome an opportunity to stand back and reflect on what has changed since 1967, which the noble Lord, Lord Alton, referred to, when the current settlement on abortion was agreed. That was an incredibly important moment, when those with different views engaged with public opinion, clinical judgment, ethical analysis and spiritual leaders. I accept that that settlement made in 1967 will not last for ever. In fact, I agree with my noble friend Lady Sugg that the arrangements that have been in place for many years definitely need a second look. If we agree that the moment is right, I emphasise that any reconsideration of these issues should be done in a thoughtful, considered fashion and that we should engage the large number of people who have strong feelings, as well as expert opinion.

We need to do this because these issues are extremely complex and the evidence is conflicted, and they engage so many different strands of our emotional, spiritual and intellectual life. If this this debate this evening is a starting gun for that process, I would recognise its significance and ask the Minister to reflect on the moment in his comments.

However, if this amendment is a realistic attempt to bring about a significant long-term change to the clinical pathways of our health system, I would be extremely alarmed. Regarding the point made by the noble Lord, Lord Alton, on procedure, I have serious concerns. There is no value in blowing up the long-term arrangements that were agreed in 1967 in a late-night Report debate on an amendment introduced at the last minute to a Bill that is about the integration of our healthcare system. It would be a travesty if the easements that were brought in to cope with a global pandemic were used as a pretext for a long-term rewriting of our abortion laws. We were promised that that would not be the case, and it would be regrettable if this Government went back on those reassurances.

I draw to the attention of noble Lords the report by Gynuity Health Projects, published in March 2021, on its study of the efficacy of telemedicine abortion. It found that 5% of participants using the medical abortion treatment at home needed surgical intervention to complete the procedure. These are worrying numbers and are worthy of further investigation before the current situation passes into legislation.

My hope is that this amendment is regarded for what it should be: a testing amendment to stimulate debate and not a serious effort to overturn arrangements that need to be reformed, not overturned. That is why I call on the Minister to explain why this amendment should not stand, and on my noble friend Lady Sugg to confirm that she will not be moving her amendment.

[Baroness Finlay of Llandaff (CB)]

My Lords, I find myself conflicted over this amendment. I am probably the only person in this Chamber who has consulted women over abortions, signed forms for abortions and performed abortions and I have been with women during late abortions for foetal abnormality. It is a complex area. I have also had women say to me, in the privacy of the consulting room, just before they go, “I have never told anybody else this before”—they have then told me about the serious abuse that they have suffered.

My worry with the first part of the amendment, on remote consultation, is that you do not know who is on the other side of camera or who is standing in the room with the woman. You do not know whether the man is using fertility and sex as a form of abuse and is standing there threatening the woman to proceed in one way or another. We know that men refusing to use condoms is a common form of coercive control of women.

The abortifacient tablets, to which my noble friend Baroness Watkins referred, are a separate step. It is inhumane to expect women to take those and then travel on a bus or even go in a taxi. Knowing what has happened before, I cannot help feeling that there is another step. Yes, let the women have their tablets and take them in the privacy of their own home. It is not pleasant to undergo an abortion—nobody should think that it is—but those women also need support and contraceptive advice as part of the package. I am concerned that I do not see that in this amendment and I have been concerned that during the pandemic the ability of women to access contraception may have become more difficult.

This is a complex issue. It is about a pathway with many steps in it. I wonder whether we should return to it at Third Reading, rather than trying to take a yes or no decision tonight on something that has some merits but also some problems. We are not adequately going into them by having a short debate now.