Care Homes: Guidance

Lord Bethell Excerpts

Wednesday 21st April 2021 Lords Chamber

[Baroness Jolly]

To ask Her Majesty’s Government what assessment they have made of the impact of their guidance Visits out of care homes, last updated on 7 April, and in particular the requirement that residents making a visit out of a care home should isolate for 14 days on their return.

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

My Lords, the Government do not underestimate the heavy burden of infection protocols on those who live in social care and on their loved ones. However, the public health advice is clear: once an infection enters a closed environment such as a social care home, it spreads far and fast, as we found out last year. We hope that the vaccines will change this and we keep the policy under review but, until the evidence is conclusive, the safety of residents remains our priority.

[Baroness Jolly (LD) [V]]

My Lords, care home residents have been cooped up for more than a year. Most of them have received two doses of the vaccine and many are becoming depressed at not being allowed to go for a walk with a family member, or even to vote in person at the polls. At a recent sitting of the Joint Committee on Human Rights, the pressure group Rights for Residents told the committee that

“the Government’s guidance on visiting out of care homes … is blatant human rights abuse”.

As the situation is easing somewhat, when do the Government expect to reassess that guidance?

[Lord Bethell (Con)]

My Lords, the noble Baroness puts the case extremely well. I do not deny her suggestion that this is a huge burden on those involved. However, data from the ONS makes it clear that, across care homes, when one case of coronavirus is reported, an estimated 20% of residents typically subsequently test positive for Covid—even under the current state of the vaccine rollout. We remember Holmesley care home in Sidford, Devon, where there were 11 deaths because of a major outbreak. We are still in the middle of the pandemic. The vaccine is making progress, but we have to take things one step at a time.

[Baroness Wheeler (Lab)]

Can the Minister explain why the visiting out guidance is not aligned with the road map for the national lockdown? Is there not a gaping discrepancy between the advice for care home residents, who are advised to keep the number of contacts to a minimum, and the advice for care workers, who can go to the hairdresser’s, sit outside a pub, meet up in groups of six and then go back into a care home to provide personal care?

[Lord Bethell (Con)]

My Lords, these protocols are not tied to the road map because we hold them under constant review. We hear loud and clear the case made by the noble Baroness and others who make the case for change. We are open to making that change when the evidence says that the situation is ready. We expect care home workers to behave in a way that is responsible and keeps infections to a minimum, but we cannot have protocols for every aspect of their lives.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I declare an interest: I have a close family member who is a care home resident. People living in care have endured over a year of rules keeping them separated from family and friends, with the double isolation of relatives being unable to go into the home and residents being unable to leave. Although I welcome the recent relaxation of the rules on visiting out of care homes, the guidance states that the requirement for a 14-day isolation period on return

“is likely to mean that many residents will not wish to make a visit out of the home.”

What is the point of pretending that it is being allowed? Does the Minister understand why imposing a blanket quarantine on visits out feels to many arbitrary, unfair and as though it is interfering with their liberty? Can he explain why it is not possible for a resident who has been outside for visits to be tested on return and again after a specified number of days, rather than enduring a 14-day isolation during which they are often confined to a small room?

[Lord Bethell (Con)]

I can only express complete sympathy for the noble Baroness’s points. She puts them extremely well. Undoubtedly, the pressure put on residents and their family members is profound and I regret it enormously. However, this is not an arbitrary or thoughtless measure from the Government; it is to protect residents who have shown themselves to be highly susceptible to the disease. We have instances of serious illness and death to remind us how important these measures are. The noble Baroness is entirely right that the protocols are in place in order to deter external visits. In terms of testing, the unfortunate truth is that the virus can harbour in someone’s body, undetectable, for days. We know from protocols around international travel that pre-travel testing catches only about 15% or 20% of those with the disease and it is for that reason that we cannot turn to testing as an alternative.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, grass-roots relatives’ campaigns such as Rights for Residents, John’s Campaign and Care Unlocked describe this guidance as “false imprisonment”, “barbaric”, “cruel”, “treating residents as second-class citizens” and “more scandalous than any Greensill revelations”. I want to press the Minister. Can he really explain from a virus control point of view, as the noble Baroness asked, what the risk difference is between care home workers who leave those care homes, go about their business and then return and give personal care in the same home and a vaccinated care home resident who, after a family day out to the seaside, has to endure 14 days of solitary confinement? From a risk point of view, it makes no sense.

[Lord Bethell (Con)]

My Lords, there are two points of difference. One is that we can take certain measures to guide the behaviours of care home workers but we cannot mandate for every aspect of their lives. Secondly, care home workers wear PPE and that significantly reduces their infectiousness. We do not ask care home residents to wear PPE. Were we to do so, I think it would provoke suitable concern among residents and their families. As a result, we have to have these isolation protocols in place to avoid the spread of the virus.

[Baroness Ludford (LD) [V]]

My Lords, I am a member of the Joint Committee on Human Rights, which has been concerned about the treatment of care home residents over the past year. It is continuing its inquiry with an evidence session this afternoon. As colleagues have asked, are not the Government sabotaging the chance for care home residents to have a trip outside, especially given that staff are coming and going without quarantine? The Government’s guidance says that they “recognise how important” outside trips are

“for residents’ health and well-being”.

At the same time, and as the Minister has affirmed in his answers today, they recognise that their requirement for a 14-day isolation period

“is likely to mean that many residents will not wish to make a visit out of the home.”

This is insulting and treats care home residents and their families like children, not as responsible adults.

[Lord Bethell (Con)]

I completely sympathise with the noble Baroness’s point. She is right: this puts huge pressure on residents and their families. I am heartfelt when I say that I completely agree with her that this has an impact on the mental health and well-being of residents. However, their health, their safety and their actual lives take priority, I am afraid. We are at a moment where, even with the rollout of the vaccine, there is still a high infection rate in the country. If the virus gets into a home it has a potentially devasting effect, spreading very quickly within the confined spaces of the home among people who, typically, are highly vulnerable. That is why we have to put in place these serious protocols. This is done with huge regret and we review it constantly. It is my sincere hope that we can lift these protocols as soon as we possibly can, but until the day when the evidence is conclusive, we have to have them in place in order to protect lives.

[The Lord Speaker (Lord Fowler)]

My Lords, all supplementary questions have been asked and that brings Question Time to an end.

Covid-19: Obesity

Lord Bethell Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Robathan]

To ask Her Majesty’s Government what assessment they have made of the report by the World Obesity Federation COVID-19 and Obesity: The 2021 Atlas, published on 4 March, which shows a correlation between obesity rates and COVID-19 death rates; and what steps they intend to take in response.

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

My Lords, the World Obesity Federation’s Covid-19 report makes stark reading for us all. It is clear that excess weight is one of the few modifiable factors that contribute to severe symptoms of Covid and, very sadly in some cases, to death. This is a wake-up call. Britain is clearly carrying too much weight. That is why the Government are committed to helping the country reduce obesity and get fit and healthy.

[Lord Robathan (Con)]

My Lords, I am delighted to hear my noble friend’s response because this research shows that being obese is a huge factor in deaths from Covid, second only to old age. It was described as a wake-up call to Governments by the head of the WHO, and last week the British Heart Foundation published research that showed that 31,000 deaths per year from heart conditions are caused by excess weight. The Prime Minister has said that it was obesity that nearly killed him with Covid last year. I welcome the steps that the Government are taking over junk food, but what further action can they take so that everyone, especially those in leadership roles—be it in schools, the NHS or, indeed, Parliament—understands that being obese should not be socially acceptable, because obesity is killing people?

[Lord Bethell (Con)]

My Lords, I completely agree with my noble friend that obesity has been a sad and tragic driver of death from Covid. Overweight people are 67% more likely to need intensive care from Covid than those who are not overweight. The list of the measures that we have in place is extensive—there are 17 in number before me—and we are not going to stop there. This is a really important project for the Government. It is not our business to shame those who are overweight, but it is our business to enable those who seek to lead fit and healthy lives to take the necessary steps to reach that objective.

[The Lord Bishop of London]

My Lords, the reduced use of school space during lockdown highlighted an opportunity for us to make use of school kitchens as community kitchens. This holds real potential for addressing multiple issues such as poverty, obesity, lack of food or loneliness, all at one time. Will the Government consider supporting school kitchens to become community kitchens when not in use by students in order to tackle obesity in underserved neighbourhoods where people often have limited choices in their nutritional options?

[Lord Bethell (Con)]

The right reverend Prelate puts the case extremely well. The community kitchen measures she describes are beyond my brief. I do not have the details to hand, but I should be glad to follow this up and write to her.

[Baroness Chisholm of Owlpen (Con)]

My Lords, as we know, there are no real redeeming features to Covid but, my goodness, it has managed to magnify the obesity problem in this country. As my noble friend said, it is a real wake-up call. Does the Minister feel, like me, that we have had enough initiatives that last for a period and then disappear without any real success? Is it time to put someone in charge of this serious health problem who has time and real clout to take on the food industry, tackle the root causes and work with all government departments to deliver change?

[Lord Bethell (Con)]

I do agree with my noble friend that the answer to this issue is sustained action. This is not something where snazzy initiatives are going to have the necessary impact. But the key to our efforts is creating cross-governmental co-ordination—that very difficult thing to achieve. We are working extremely hard with other departments, particularly with DCMS and DCLG, in order to address the kind of housing, cultural, advertising and nutritional issues at the heart of this problem.

[Lord Birt (CB) [V]]

My Lords, the UK has among the highest rates of obesity in the whole world— 28% compared with the benchmark, Japan, at 4%. We know, however, that payback on public health investment is high—witness our historic success with cigarettes, safety belts and AIDS. All of us are painfully aware of how difficult it is to control our weight, but does the Minister not agree that we need a massive and truly transformative programme of public health and education to reverse this deadly trend?

[Lord Bethell (Con)]

As the noble Lord rightly points out, the cost is enormous: £27 billion is the estimated cost to society, and 64% of people are classified as overweight. The challenge is enormous. We have to strike the right balance between government action and personal agency. The noble Lord is right that the return on investment is huge, but the Government cannot lose weight for people on their behalf. No amount of government initiative will shed the pounds. We have to get people to change their behaviours. We are trying to understand what the right measures are to give people the inspiration and information they need to take the right steps.

[Baroness Thornton (Lab)]

My Lords, this Government’s proposal is the 14th government obesity strategy since 1992. Despite 689 policies having been introduced in the past 29 years, obesity rates have increased. Another major indicator is deprivation. Children from deprived areas are twice as likely to be obese as children from the richest areas, as acknowledged by the Government’s strategy. However, the strategy was criticised for not going far enough on poverty. Healthy foods are three times more expensive per calorie than less healthy foods. Can the Minister address this grave and vital matter of people from lower socioeconomic backgrounds not having access to, and being unable to afford, healthy and nutritious food?

[Lord Bethell (Con)]

My Lords, I agree with the correlation pointed out by the noble Baroness. We must acknowledge and address the fact that areas of deprivation undoubtedly have higher levels of obesity. However, we have to be careful about taking away people’s sense of agency. It is possible to buy affordable healthy foods at any price point. Food has never been cheaper than it is today. We must put into people’s hands the knowledge and inspiration to take the steps necessary to shed the pounds that need to be shed.

[Baroness Walmsley (LD) [V]]

My Lords, can the Minister assure me that the Government will not renege on their promise to ban the advertising of high-fat, high-sugar and high-salt foods online? Will he ignore the objections of junk food producers and advertisers, and remind them of the similar ban on Transport for London when the amount of advertising actually went up? Reformulated and low-calorie options generate revenue too.

[Lord Bethell (Con)]

My Lords, the Government take the advertising of unhealthy foods seriously, which is why we have commissioned this consultation. It has not finished yet so it is not possible for me to pronounce on its findings, but I assure the noble Baroness that we are looking at this issue extremely carefully indeed.

[Lord Lilley (Con)]

Does my noble friend agree that the determination of the opposition parties and much of the media to pin the blame for the high level of deaths in this country from Covid on the Government has obscured the fact that the major reason why we suffer from a high mortality rate, compared with other countries, is that we are fatter than other countries? Nearly two-thirds of adults in this country are overweight, and the number of obese people in this country is six times the proportion of obese people in Japan. Can we give those facts to people? They can then make their own decision on whether to take this risk or not.

[Lord Bethell (Con)]

I thank my noble friend for his question. It is for others in the post-mortem process to pronounce on the exact cause of deaths during Covid, but it is an unavoidable fact that, of the 2.5 million Covid deaths reported by the end of February, 2.2 million were in countries where more than half of the population is classified as overweight; that includes Britain. This is a stark fact that, as my noble friend rightly points out, is sinking in among the British public. We want to use this fact as an inflection point—it is an opportunity —to give people the inspiration they need to take the necessary steps towards healthy and fit living.

[Lord Bird (CB)]

Is it not important to bear in mind the fact that people who are poor and obese are living in a permanent emergency? That emergency starts in the early years of their lives and carries on; they take food and do many short-term things. We must break this emergency and remove the poor from it through education, social opportunity and giving people jobs that raise their wages. Also, social security is often used as a way of saying, “Go over there and we’ll forget about you for a certain period of time.” It is the emergency that they live in that we have to challenge.

[Lord Bethell (Con)]

My Lords, I defer to the noble Lord’s expertise and authority in speaking on behalf of those who live in deprivation. He is a valued spokesman for people in such conditions. However, on his analysis, I do not think that poor people cannot lead healthy and fit lives. I do not believe that they cannot make the right decisions for their futures. I have the utmost respect for those who live in poverty; it is for us to give them the inspiration and knowledge that they need to make the right decisions.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. We now move to the fourth Oral Question.

Covid-19: Update

Lord Bethell Excerpts

Tuesday 20th April 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I add my tributes from these Benches to all those who continue to work well above and beyond the call of duty in all areas to do with managing the Covid pandemic. This includes the vaccination teams, the invisible workers—the scientists working in labs and all those who we do not see on a daily basis—as well as our overtired doctors, nurses and other clinical healthcare workers, and those in social care who are still taking remarkable precautions.

It is worth noting despite the reduction in cases, hospital cases and deaths that daily cases are still double the level that they were at the lifting of lockdown 1, so it is good that the Government are not speeding things up. We need to continue to move carefully and steadily, as later parts of the Statement talking about the India and South African variants give cause for some concern. It is also reassuring to see that uptake of the vaccine is excellent. However, the Statement is silent on when all adults will have been offered the second vaccine. That is important because, as scientists constantly remind us, two doses are needed. Focusing only on the first vaccine is giving the vast majority of the public overconfidence about protection. If people want to go on holiday, one dose of the vaccine will not be enough, whether that holiday is in the UK or abroad.

That leads also to those who are immune-suppressed and to those under 18, because until all are safe, none are safe. Can the Minister say if there is any news on the OCTAVE clinical trials on the ability of those who are immune-suppressed to make and retain antibodies? Those formerly shielding—including me—still need to avoid mixing with people. They are still waiting for news to see if they can relax, even after two doses of the vaccine.

What is the news for children? I understood that the trials on over-12s had been halted following the blood clot issue with the AstraZeneca vaccine. Is that still the case? What are the long-term plans to ensure that our under-12s and, indeed, our under-18s are safe? The Statement says that:

“The vaccine is our way out of this pandemic”.


Not on its own, it is not. We must continue to test, trace and isolate to keep people safe. The Government are to be applauded for the large number of lateral flow tests because they are useful, but they are not as effective as PCR tests for really tracking the virus.

Had I not been unable to do so, I would have loved to have been at Wembley on Sunday supporting my team, which, sadly, lost to Leicester. I would have been delighted to have been part of a testing arrangement to see what happens, but other fans have said that they were only asked to be tested in advance and that there is no testing afterwards. Is that correct? In other words, how detailed is this testing for moving back into normal life going to be?

I am a member of the All-Party Group on Coronavirus, and this morning we heard from scientists who are bemused that immediate contacts of those who test positive are still not routinely PCR tested, which all the countries with a truly effective test and trace system operate. That is vital with the high percentage of people with Covid still having no symptoms, so they would believe that there is no reason for them to be tested, and it is particularly important with the information about the spread of the variants from South Africa and India.

I have family who live in Wandsworth. This time last week, as the announcement about mass testing across Lambeth and Wandsworth was made, we were told that everyone in those areas would be publicly informed. Three days later, not only had my son heard nothing, but he walked past a newly set up testing site a few hundred metres from his house, went in, and discovered that he did need to be tested. So, he and my daughter-in-law had their tests. It transpires that the only notification from Wandsworth Council before the weekend was a tweet, with none of the mechanisms used elsewhere such as texts via GPs, posters up in the street, word of mouth, or even leaflets. How on earth can that be real surge testing if only a small percentage of the population see a handful of tweets?

On the India variant, scientists also told the APPG this morning that the estimated figure of 103 cases was considerably lower than the likely number of cases circulating because only 10% to 15% of positive lateral-flow swabs are sent on to laboratories where they are scanned for variants. This might mean that the actual number is 10 to 20 times the official estimate. This brings us full circle, back to test, trace and isolate. Even with vaccines, it is vital to have an effective test, trace and isolate system to keep people safe. As the noble Baroness, Lady Thornton, outlined, adding India to the red list but giving people three-and-a-half days’ notice before implementing it, means that a large number of cases are likely to slip into the country. Even if they are caught through positive testing, we are unlikely to have a real sense of the actual number of cases.

This follows on from the concern that we from these Benches have had about successful self-isolation and quarantining for a year. The APPG heard evidence this morning that demonstrated that arrangements at our borders, particularly in airports, are not Covid safe, either for travellers or staff, and they risk becoming breeding grounds. This now needs to include effectively separately passengers who arrive from red-list countries from those who arrive from others, and ensuring that all quarantine rules are observed. We heard evidence that people were leaving their quarantine hotels early, and that others, quarantining at home because they did not come from red-list countries, were being forced to use public transport to get to testing centres for their day eight tests. Worse, border staff are discovering around 100 fake Covid test certificates daily, and there are probably many more. If that does not signify a real worrying standard for the possibility of vaccine passports, I do not know what does. When will a proper test, trace and isolate system be put in place that includes immediate contacts and more lateral-flow tests being tested for variants, along with vital, proper, paid arrangements for self-isolation, including quarantining and proper separation in the transport arrangements for those coming from abroad?

Finally, I will spend just one minute on Greensill. It is not just Greensill: we need desperately to see full publication of all meetings and correspondence—informal and formal—that Ministers have had regarding all contracts, whether it is payday loans, PPE or testing arrangements. This also includes the new quarantining partners; the Health Secretary said on Monday that two have already been sacked, having been in place only for a short time. It is vital that the smell-test on all these contracts is evident and sure.

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

My Lords, I am enormously grateful to both the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful questions. I totally and utterly endorse both with regard to their massive thanks to NHS staff, to the vaccinators and, in particular, I echo the words of the noble Baroness, Lady Brinton, who thanked the invisible workers. I am acutely and particularly aware of the lab technicians, many of whom have worked unbelievably hard in difficult circumstances, often located far from their homes, supporting our laboratories up and down the country. There are many other categories of invisible workers in our healthcare system and they deserve our huge thanks.

I am as concerned as the noble Baronesses about the threat of variants of concern. It is an absolutely frustrating and anxiety-making fact, that we simply do not know a huge amount about what the impact of these variants will be on transmissibility, severity and escapology. We are throwing absolutely everything we have got at this to try to understand the features of this disease. However, it is true that while we can study them in a mathematical or computer-generated model, we get only so far with that. We can study them on the workbench and get a little bit further, we can stick them in a tube with some serum from someone who has had a vaccine, and maybe figure out a bit more, but it is only when we have the real-world data of how the vaccines have worked in real life when put up against the virus that we can accurately conclude what the impact will be. Therefore, only the passage of time will give us the critical data we need to go forward.

In the meantime, we are standing up a huge international effort to try to understand the variants that are emerging around the world. The noble Baroness, Lady Thornton, asked me about global co-ordination. Britain is absolutely playing its role; it is using its chairmanship of the G7 to full effect. As noble Lords are, I am sure, fully aware, we have a world-leading facility in genomic sequencing. We have made a massive, open-hearted offer to the world to sequence the genomes of any variants of concern, from any country in the world, through the newly launched New Variant Assessment Platform. We are working to set up hubs to develop expertise in that capacity around the world. We are working extremely closely with multi-laterals such as the WHO, with the relevant major trusts such as the Gates and Rockefeller foundations and the Wellcome Trust, and with individual countries, to provide the insight, the fast-turnaround analysis and the assessment of new variants as they turn up.

Within our own country, it is concerning that variants have made landfall, but I reassure noble Lords that we have put in place remarkably diligent efforts to close down any spread of variants of concern when they have occurred, whether they are from India, Brazil or South Africa. It is a fact that the Operation Eagle process, which is supported by local authorities, DPHs, test and trace and by the JBC, has so far—touch wood—proved to be extremely effective at closing down community spread. We have numbers of the variants in the UK but a very large proportion of them are known to be related to travel and they have not yet created clusters of infection of the kind that might cause concern. The MQS—Managed Quarantine Service—has played an absolutely critical role. I pay tribute to the MQS team, who are at this very moment putting in place arrangements for managed quarantine for flights with travellers from India. They have put in place the necessary pre-testing, the hotels and the assessment.

While I hear, loud and clear, the concerns raised by the noble Baroness, Lady Brinton, about that process, I reassure her that her list of concerns is quite different from the operational notes that I am given every day. The truth is that it has kept a lid on any spread of VOCs in the UK to date. On Wandsworth, I pay tribute to the enormous civic response to our concerns around the cluster there. I recognise the concerns of the relative of the noble Baroness, Lady Brinton, in that area, but there has been an absolutely massive news and community-marketing promotion of the home testing, pharmacy testing, MTUs and ATSs in Wandsworth. Very few people indeed cannot have heard of the arrangements that are in place.

With regard to the OCTAVE clinical trials, that is of grave concern to all those who have immunosuppressed circumstances. We are working extremely hard with Birmingham University, with Professor Paul Moss, to understand more about the response of those with immunity issues. It is a frustrating fact that those with pre-existing immunity issues are likely to be the ones who have the lowest and least response to the vaccine. We are trying to understand as best we can how that can be supplemented. As noble Lords may know, we have already invested considerably in new arrangements for therapeutics and antivirals that we believe will support those with immunosuppressed conditions. I would be glad to write to the noble Baroness about our arrangement for vaccines for the under-12s.

If there are any other questions that I have not had time to answer, I would be glad to write to the noble Baronesses with full answers.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, we now come to the 30 minutes for Back-Bench questions. I ask that noble Lords keep their questions as short as they can.

[Baroness Jenkin of Kennington (Con) [V]]

What plans are being put in place for flu and Covid vaccine booster shots for the winter?

[Lord Bethell (Con)]

I am extremely grateful for that perceptive question. We are looking, at this very moment, at our arrangements for the autumn. For the flu vaccine, we hope to double down on our hugely successful efforts from last autumn. We hope to build on the experience of the Covid vaccine to ensure that a much wider range of people have the vaccine, so that we can deal with those who might head towards severe illness, and to stop transmission. When it comes to the Covid vaccine, we are beginning to try to understand whether a booster shot will or will not be necessary to address the threat of VOCs. As I said earlier, we are still at a stage where we do not have the full science at our disposal but, if necessary, we will roll out a vaccine booster programme in the autumn.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, India being placed on the red list will cause real hardship to many UK citizens with close family ties in the subcontinent. Does the Minister agree that, while this has necessitated the cancellation of the Prime Minister’s visit to India, it will also have prevented him bringing back a virulent strain of the virus Modi-us bigotus, which attacks and can seriously harm a country’s entire democratic immune system?

[Lord Bethell (Con)]

My Lords, our thoughts are with the people of India at a time when they are fighting the disease in very difficult circumstances. I acknowledge that, for families in the UK with family and business ties with India, the arrangements under the red list are extremely inconvenient, and we are doing it only because it is absolutely necessary.

[The Lord Bishop of London]

I am sure the Minister knows that those from deprived communities are more likely to catch Covid-19, be admitted to ITU and to die from the disease. They are also less likely to take up a vaccination. Could the Minister update us on action by the Government to ensure that Covid-19 does not continue to be a disease of poverty?

[Lord Bethell (Con)]

The right reverend Prelate hits the nail on the head. It is extremely sad, frustrating and hard to acknowledge the fact that those who live in deprivation are often those who are hardest hit by this awful disease. We have worked extremely hard to get the vaccine, and testing and tracing, into those communities and to support them with whatever education and community support we can. But the fact remains that this country has an unequal health outcome for too many families, and it is part of our levelling-up agenda that we try to address that. The obesity strategy is one way in which that we can do that, but there are a great many others that we need to look at.

[Lord Sikka (Lab) [V]]

My Lords, 4.7 million people in England are waiting for routine operations and procedures. Some 388,000 have been on waiting lists for more than a year. Even with the extra £7 billion a year, it is estimated that it will take five years to clear the backlog. Can I urge the Government to declare an NHS emergency, equivalent to that of Covid-19, provide additional resources to the NHS, and inform the House of the targets they will set for reducing the waiting list?

[Lord Bethell (Con)]

The noble Lord is right that the backlog is a grave issue, and we are fighting as hard as we can to address it. The big guns of the NHS are moving from Covid to addressing the backlog, but we should not overstate its threat either. Large parts of the NHS remained open all the way through Covid, and I pay tribute to those in the NHS who worked extremely hard to ensure that many elective procedures and much diagnosis continued. We do them and their reputations no favours if we imply that the NHS was in any way doing less than it should have done to work through Covid. But the noble Lord is right; this is a grave issue, and we take it extremely seriously.

[Lord Scriven (LD)]

My Lords, overwhelming evidence now exists that lower-paid people are less likely to take a test, self-isolate or isolate for the full period, due to not being able to afford to do so. What extra support will the Government now put in place to deal with this Achilles heel of the test, trace and isolate system?

[Lord Bethell (Con)]

My Lords, we put in place a considerable amount of support for those on low wages, including the furlough scheme, and a huge amount of economic support. It is true that those on low wages have wage pressure put on their lives, but we have statutory sick pay for those who are sick and out of work, and we have a huge amount of investment in local government and in charities, which also provide support for those who live in deprivation.

[Lord Sarfraz (Con) [V]]

My Lords, I join other noble Lords in thanking my noble friend the Minister for just how hard he has worked and for all that his department has achieved over the last year. Will he tell us what plans there are for the development of new vaccines in response to new variants?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, all the major vaccine companies are already looking at tweaking their existing vaccines, or developing new ones, in response to the new variants. AstraZeneca, for instance, has been working on that for some months. It is not clear, at this stage, whether we will have to start again on the vaccine programme or simply arrange new booster shots, or whether the existing vaccines will, in fact, run the full course. It is unbelievably frustrating to be in this hiatus of short knowledge—that is where we are at the moment—but please be reassured that this Government are investing absolutely everything necessary to ensure that vaccines will be available for whatever comes down the track.

[Lord Rooker (Lab) [V]]

I can confirm what the Minister said about other services in the NHS. The staff at the Macmillan Renton Unit at Hereford County Hospital were working flat out this morning when I went for one of my check-ups. I have two brief questions for the Minister, one of which follows on from what the noble Baroness, Lady Jenkin, said, in a way. First, there was a reference in the Statement to the flu issue. I understand that our flu jabs have always been made in India, which will be more than occupied producing Covid vaccines for itself and others in the next few months, so where are the UK flu jabs for the forthcoming season later this year coming from? Secondly—if I cannot have an answer now, I would like a letter—who is responsible for maintaining and monitoring the shelf life of the PPE that we have?

[Lord Bethell (Con)]

My Lords, I join the noble Lord in commending the people who work at Macmillan and all the other important diagnostic centres that have remained committed to their work throughout Covid under extremely difficult circumstances, delivering hugely important healthcare services. The noble Lord is stretching my knowledge of vaccination with this question, but it is my understanding that most of our flu jabs are grown in eggs in East Anglia and we do not rely on Indian supplies for the flu jab. This may seem like an extraordinary fact, and I doubt it, even as I stand here at the Dispatch Box, but I would be glad to write to him to confirm the point.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I welcome the Government’s consultation on whether vaccines should be required for care staff working with older adults. To make this easier, could the Minister say what plans the Government have to ensure that care staff are paid for time spent being vaccinated, particularly if they have to come in when not on shift or have to take time off because of any short-term reaction to the jab? Also, are the Government prepared to support care homes financially to enable staff who cannot have the vaccine for clinical or other specified reasons to be redeployed to non-front-line work?

[Lord Bethell (Con)]

My Lords, the vaccine is typically seen as personal medical hygiene. I am not sure if arrangements have been made for people to be paid while they get vaccinated, but I would be glad to write to the noble Baroness to confirm that. She makes an extremely sensible point about redeployment; I do not know the precise details, but would be glad to write to her.

[Lord Sharpe of Epsom (Con)]

My Lords, one of the very few positives to come out of the pandemic is that the spotlight has shone on the superb life sciences sector in this country. For example, 47% of all global genomic sequencing is conducted in the UK. Could my noble friend the Minister elaborate on any future collaboration plans between the Government and the sector and how we intend to continue to grow our world-leading position in this space?

[Lord Bethell (Con)]

My noble friend is entirely right: life sciences is a huge national strength. It was a quiet industry that people did not speak of much; now it is centre stage. Post Brexit, the role of the MHRA, as one of the world’s leading regulators, is something of which we can be enormously proud as a country. It is also making a lot of businesses think that the UK should very much be the focus of their investment, going forward. BEIS and the DHSC are working together very closely, through the Office for Life Sciences, to ensure that the message is heard loud and clear, around the world, that Britain is the right place to invest.

[Baroness Verma (Con)]

My Lords, will my noble friend the Minister tell me what plans are in place to monitor the work being done to ensure that cities such as Leicester, which was in the longest lockdown ever, do not go backwards now that people are being vaccinated? How will they monitor that? Could my noble friend also tell me what is being done to encourage people into the social care sector? There is an enormous demand for care workers, and yet we do not seem able to fill those gaps.

[Lord Bethell (Con)]

My noble friend is right: the people of Leicester have done a terrific job at getting the rate down. It was once 571 per 100,000, and on 15 April it was 74 per 100,000. This is a huge achievement, but I am afraid that behind that lie some concerns. Nationally, we are at 26 per 100,000, but 23 local authorities have cases above 50, and Leicester is one of them. In some areas of the country, the virus is proving extremely resilient. That is partly due to the deprivation referred to by the right reverend Prelate and the noble Lord, Lord Scriven, and partly due to the cultural and practical habits of those involved. We are working really hard to try to address those knotty problems, and I welcome the civic engagement of all who live there.

[Lord Robathan (Con)]

My Lords, last week, the Prime Minister said that the lockdown has been doing

“the bulk of the work in reducing”—

—infections, then Simon Stevens said that

“'Vaccines are successfully reducing hospitalisations and deaths”.

Around the world, lockdowns are not being as successful as one might have imagined, so could my noble friend say whether it is the Government’s opinion that the reduction of deaths and serious cases is down to the lockdown or to the amazing success of vaccinations? Secondly, is what I read true—and it may be completely untrue—that the average age of death from Covid is higher than average life expectancy?

[Lord Bethell (Con)]

My noble friend is quite wrong if he is seeking to imply that there is any doubt about lockdowns working. Lockdowns work incredibly well because they put space between people. The science behind lockdowns is very simple and incontrovertible. That is the learning of the last year, and those who seek to cast doubt on it, time and again, session after session, do us no favours at all. We are at a moment in the cycle of the disease when the weight is being lifted by the lockdown and by the vaccine—it is somewhere between the two. I cannot call it, and Sir Simon Stevens and the Prime Minister cannot call it—it is somewhere between the two. But we should be in no doubt: if there is a variant of concern that makes landfall in the UK and threatens the success of the vaccine, we will be back in lockdown. We should be extremely careful to avoid that eventuality.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, I join the Minister in thanking all those involved in the vaccination programme. I was surprised that the Secretary of State in another place did not mention in his Statement the important topic of Covid passports. It is reported that Michael Gove, who is in charge of the Whitehall study into their use, is visiting Israel and is a big fan of its use of the “green pass” scheme for entry to venues including gyms, swimming pools, restaurants, theatres, cinemas and the like. Putting to one side whether such a system would be discriminatory, can the Minister explain whether it would include, as well as evidence of vaccination, recent proof of a test or of having had Covid recently? Also, does the vaccination, or recovery from Covid, nullify the chance of reinfection and therefore of becoming a vector?

[Lord Bethell (Con)]

My Lords, the Cabinet Office is reviewing whether Covid status certification could play a role in reopening our economy, reducing restrictions on social contact and improving safety. That work is under way. The noble Lord refers to the importance of social justice and civic rights, and he is entirely right to do so; those are exactly the kinds of issues that the Cabinet Office is weighing up. We need to look at everything that the technical toolkit can provide us with to fight this virus and any others that may emerge from the back of the bat cave. We are trying to avoid the kind of social, health and economic impacts that these 21st-century pandemics have on our country. Technology such as Covid certificates can provide an important defence mechanism.

[Lord Cormack (Con)]

My Lords, my noble friend knows that I have repeatedly raised the subject of care home workers. I am grateful for his responses and for the letter that I have had from our honourable friend Nadhim Zahawi in the other place. However, in that letter, the Minister for vaccines acknowledges the vulnerability of people in care homes and that they can be a source of spreading the virus. I urge that an early decision is made to ensure that care home workers, who attend to the most intimate needs of their often extremely frail patients, are vaccinated. To compel them to be vaccinated may seem a bit draconian, but, if we are concerned about the containment of these viruses and their spread, surely being vaccinated is not too high a price to ask care home workers to pay.

[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.

[Lord McColl of Dulwich (Con) [V]]

My Lords, in addition to the great success of the vaccination campaign, at last it is now accepted that the high mortality from Covid in the UK, and in many other countries, is due to the high prevalence of obesity. The high Covid mortality is not the fault of politicians, civil servants or scientists. Does the Minister agree that what we now need is for everyone to unite to support the Prime Minister’s campaign to reduce obesity in order to promote a healthier nation and reduce the mortality from any future pandemics?

[Lord Bethell (Con)]

My Lords, the post-mortem is not fully written. When it is, the causes of our relatively high mortality rate will undoubtedly be complex and a number of factors will have played a role, but the noble Lord is right that obesity will definitely be on the list. This country is too heavy in comparison even to our European partners. We are one of the heaviest countries in the whole of Europe and if you are overweight, I am afraid to say that the brutal truth is that your heart is having to work too hard, your lungs are having to work too hard, your immune system is run down and the ability of your organs to fight disease is greatly reduced. That is one of the reasons why a very large number of people have really struggled in hospital to fight this disease. If you are carrying an obesity-related illness, such as diabetes or some other major affliction, you really are in no shape to fight off one of the major diseases.

The resilience of this country depends on it getting fitter. That is why we have focused on the obesity strategy that we have, and we will be building on it further. The noble Lord is entirely right that this challenge is well recognised by the Prime Minister from the top, from his own personal experience and his acknowledged fight with the disease last year. It is recognised by the whole of government and by the NHS and our healthcare system.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Lord Bethell Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

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

My Lords, I am enormously grateful to all those who have contributed to this lively debate today and pay particular tribute to my noble friend Lady Wyld for sponsoring the Bill, as well as to the honourable Member for Sevenoaks who navigated its passage through the other place. It would also be right to pay tribute to Professor Sir Bruce Keogh for his review of regulations on cosmetic interventions, which was mentioned by many noble Lords and has clearly paved the way for this important Bill. I reassure my noble friend Lord Lansley that his plug for his Private Member’s Bill has been well and truly heard by the Minister.

The Government are pleased to support the introduction of an age restriction for botulinum toxin and fillers. As my noble friend Lady Wyld showed so clearly, the provisions in the Bill will ensure that young people are accorded the highest protections to safeguard their physical and psychological health. There are already statutory age restrictions in place for tattooing, teeth whitening and sunbed use. It makes no sense that there are not similar protections for invasive, injectable cosmetic procedures.

Botulinum toxin, dermal fillers and laser hair removal account for nine out of 10 non-surgical treatments performed in the UK—an astonishing proportion. Analysis by my department last year estimated that as many as 41,000 botulinum toxin procedures may have been carried out on under-18s in 2020 and that more than 29,300 dermal filler procedures may have been undertaken on under-18s in 2017. I support the decision to focus on the treatments covered by the Bill, as introducing an age restriction on botulinum toxin and fillers will protect the greatest proportion of young people seeking a cosmetic procedure at this time.

To practise in the UK, doctors must be registered and hold a licence to practise with the General Medical Council, the regulator of doctors. The GMC publishes clear standards of practice and guidance for doctors, including Good Medical Practice, which covers consent, the treatment of patients aged under 18 years and safeguarding vulnerable patients. On my noble friend Lady Neville-Rolfe’s point on costs, keeping up to date with these provisions is the normal cost of doing business in this area.

The department is working with stakeholders to assess the need for strengthened safeguards around the regulation of providers who offer some of the more invasive non-surgical cosmetic procedures. I completely take on board the points made by the noble Baronesses, Lady Wheeler and Lady Brinton, on the advice given by the excellent Changing Faces charity on the need to protect the surgery that some young people with particular needs may require.

I assure the noble Lord, Lord Addington, the noble Baroness, Lady Walmsley, and others who have asked that the department is working closely with the Medicines and Healthcare products Regulatory Agency to develop our future regulatory regime for medical devices, which prioritises patient safety. As part of this, we will consider whether to bring all dermal fillers and any other relevant procedures into the scope of the device legislation.

Measures in the Bill complement other important work that we are taking forward. I assure the noble Baroness, Lady Massey, and others who asked that public health and mental health messages to our children and young people are key priorities in our long-term plan for the NHS. In addition to the existing funding as part of the long-term plan, the Government recently announced a further £79 million boost to funding for children and young people’s mental health. In addition, in July last year we launched Tackling Obesity: Empowering Adults and Children to Live Healthier Lives.

On the touching comments on body image by the noble Baroness, Lady Bull, I completely agree that we must seek better understanding of the motivations that may be driving consumer demand among young women. We have put in place the first government-led women’s health strategy for England. This will set an ambitious and positive new agenda to improve the health and well-being of women across England. I encourage the noble Baroness, Lady Bull, and all other Peers who have a valuable contribution to make to ensure they hit the end-of-May deadline for evidence.

The Government plan to make a full response to the Independent Medicines and Medical Devices Safety Review report chaired by my noble friend Lady Cumberlege later this year. To ensure that patient voices are heard as we move forward, a patient reference group has been established and is working closely with the department.

On the points made by the noble Baroness, Lady Bull, I note that the House of Commons Women and Equalities Committee recently published the findings of its inquiry into body image. The findings offer insight, and it is disturbing to note that the inquiry’s public survey found that 61% of adults and 66% of children feel negatively or very negatively about their body image most of the time. These figures are even higher for specific groups including women, people with disabilities and transgender people. It is clearly far too high.

These are very personal issues. My noble friend Lady Wyld has spoken of her three daughters and my noble friend Lady Neville-Rolfe spoke of her beautiful granddaughters. I have two daughters of my own and worry daily about the world they live in and their consumption of social media. I should be clear to noble Lords who have raised these points that the Bill before us has a tight focus, and social media is not the target of the Bill. I join my noble friend Lady Mobarik in calling for big tech to do all it can in this area. I reassure noble Lords that the online safety Bill will be ready this year. The legislation will help ensure that children can make the most of the benefits of going online while staying as safe as possible.

The noble Baroness, Lady Wheeler, asked some specific questions about the Bill’s powers. I would be glad to write to her to clarify her questions. In the meantime, I urge noble Lords to resist any temptation to try to improve the Bill through amendments and risk losing it altogether. Time is so tight before the end of the Session.

That leaves me to congratulate my noble friend Lady Wyld and, recognising the encouraging words from the noble Baronesses, Lady Brinton and Lady Wheeler, I offer the Government’s support to this important Bill.

Crohn’s Disease and Ulcerative Colitis

Lord Bethell Excerpts

Thursday 15th April 2021 Lords Chamber

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

My Lords, on the basis of the IBD audit, NHSEI is working closely with front-line clinical experts, patient representative groups and leading charities, including Crohn’s & Colitis UK, to develop evidence-based improvement tools to address possible variations in service. This work includes an important new inflammatory bowel disease right-care scenario, setting out what high-quality, joined-up care looks like at every stage of the patient journey.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I am grateful to the Minister. He will know that over 500,000 people are living with inflammatory bowel disease, often with debilitating long-term symptoms and complications. Given the current huge variation in standards of care to which the noble Lord referred, will the Government appoint a national clinical director for IBD, solely to concentrate on spearheading a drive to implement the national IBD standards, which are backed by 17 healthcare professional and patient organisations?

[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.

[Baroness Greengross (CB) [V]]

My Lords, what plans do Her Majesty’s Government have to introduce sanitary bins in public toilets for men? There is a terrible shortage of these, and many men need somewhere to put items such as pads when they have a disease.

[Lord Bethell (Con)]

I am afraid that the management of public toilets is outside the reach of the department, but I will take that idea back to the department and write to the person responsible.

[Lord Turnberg (Lab) [V]]

My Lords, when I was a gastroenterologist, I knew that patients with inflammatory bowel disease did best when managed by a team made up of a gastroenterologist, surgeon and specialist nurse. Too often now, patients are denied access to such teams. In view of what the Minister has said, will this team approach be part of how we might correct this deficiency?

[Lord Bethell (Con)]

I would like to reassure the noble Lord that the scenario I described typically includes two gastroenterology consultants, a clinical intermediate fellow, a GP partner and a patient representative. It is exactly this kind of team approach that delivers the best patient outcomes, as the noble Lord rightly outlined.

[Baroness Brinton (LD) [V]]

In 2012, NICE published a treatment pathway for Crohn’s and colitis. It was a groundbreaking change to ensure consistent and comprehensive services, including the team approach referred to by the noble Lord, Lord Turnberg, and outcomes for all patients of this autoimmune disease across England. NICE further updated this in 2019, so there has been a pathway for nine years. Why is it not being adhered to by NHS England? What will the Minister do to ensure that all Crohn’s and colitis patients get the treatment they are promised by NICE?

[Lord Bethell (Con)]

I am not sure it is correct that it is not being adhered to widely, but there is some variation in all parts of the NHS. That is why we are developing a right-care scenario for IBD with key stakeholders. This will create a very clear template for all patients and all those involved in their care. It will, I hope, help create more consistent standards across the healthcare system.

[Baroness Young of Old Scone (Lab) [V]]

My Lords, I suffer from ulcerative colitis and understand how disabling this condition can be. Support from IBD specialist nurses is a lifeline in managing periodic flare-ups of the condition, yet the postcode lottery means that one-third of IBD patients do not have access to a specialist nurse. This is just one of the many examples of uneven standards of care. I do not know why the Minister cannot simply commit to endorsing IBD UK’s 2019 IBD standards and ensure that services are commissioned to these standards across the country. We have waited an age—at least three years—for the scenario he is talking about. Half a million patients are fed up of waiting.

[Lord Bethell (Con)]

I am extremely grateful for the testimony of the noble Baroness. She speaks very movingly about the challenge faced by those with IBD—a challenge that we all sympathise with. We are working extremely hard with both Crohn’s & Colitis UK and IBD patient groups on this scenario. There has been disruption in the last year, but I reassure the noble Baroness that we are working extremely hard to get the scenario out as soon as possible.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that, even for very experienced clinicians, diagnosis and treatment of these conditions can be very difficult indeed—as my experience over the years has taught me? Patients may present in bizarre ways—for instance, with a disease of the skin, eyes or joints. Furthermore, a patient with ulcerative colitis can almost imperceptibly become dangerously ill, requiring drastic emergency surgery. Clinicians are always trying to do better, and they need encouragement and thanks, particularly over this very difficult pandemic.

[Lord Bethell (Con)]

My noble friend is entirely right that diagnosis is key to the accurate and prompt treatment of IBD and associated conditions. That is why we have put diagnosis at the heart of our research programme. Between 2015 and 2020, we funded 20 research projects, many of them on diagnosis, with over £17 million committed. That includes a study into the overlap of IBD and magnetic resonance enterology to image Crohn’s disease patients. This approach is extremely promising.

[Baroness Masham of Ilton (CB) [V]]

Does the Minister agree that some people are hesitant to go to their GP about problems with their bowels as they are embarrassed? Can there be a campaign across the country saying, “Early diagnosis can be vital”?

[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness. A lot of late diagnoses are caused by the kind of delicacy the noble Baroness refers to. My noble friend talked about the challenge of diagnosis, which is made more complex by patients finding a lot of these subjects extremely delicate. The approach taken in primary care to handling such delicate issues has improved dramatically over the years. We are working with GPs and clinicians to make their bedside manner more delicate, so that they are able to broach such delicate issues more sensitively. That, I believe, is at the heart of the problem.

[Baroness Wheeler (Lab)]

My Lords, Covid-19 has widened the huge cracks in the quality of IBD care, with patients facing even longer waits for elective care, surgery, investigations and a personalised care and support plan to support their daily lives. Surveys have shown nearly one in five IBD patients have suffered a flare-up crisis during the pandemic because they were unable to obtain specialist advice. We know that many have had to continue shielding because Crohn’s disease compromises the immune system and they have to wait for their two vaccines. What recognition and support of their particular care needs is being given at primary care and community level?

[Lord Bethell (Con)]

I completely sympathise with all those with IBD and associated conditions. The situation the noble Baroness described is exactly right and it is extremely challenging. I have particular concern for those shielding for a very long period, although I hope many of them will not be waiting long for their second vaccine. Those with all conditions have endured some waits because of Covid, but the NHS is working incredibly hard on the catch-up. Huge progress has already been made and there is a massive focus on diagnosis in particular, to ensure that we catch up with all those presenting with problems who need diagnoses.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Health Protection (Coronavirus, Restrictions) (Steps) (England) Regulations 2021

Lord Bethell Excerpts

Thursday 25th March 2021 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 22 March be approved.

Relevant document: 50th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument). Instrument not yet reported by the Joint Committee on Statutory Instruments.

Motion agreed.

Health Protection (Coronavirus) (Wearing of Face Coverings in a Relevant Place and Restrictions: All Tiers) (England) (Amendment) Regulations 2021

Lord Bethell Excerpts

Thursday 25th March 2021 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 5 March be approved.

Relevant document: 49th Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.

Motion agreed.

Covid-19: One Year Report

Lord Bethell Excerpts

Thursday 25th March 2021 Lords Chamber

Moved by

[Lord Bethell]

That, for the purposes of section 99 of the Coronavirus Act 2020, this House takes note of the One year report on the status of the non-devolved provisions of the Coronavirus Act 2020, published on 22 March 2021.

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

My Lords, it has been a year since the House passed the Coronavirus Act, and this anniversary gives us a moment to reflect. Despite the remarkable challenges of the past year, the spirit of co-operation and consensus that epitomised the passage of that Bill at that time of national crisis stands firm today. Now, a whole year later, it seems that our legislative approach has stood the test of time.

Our response required using the tools that were already available, such as the Public Health (Control of Disease) Act 1984, and at the same time rapidly developing new tools such as the Coronavirus Act. This dual approach has enabled us not only to tackle the public health threat but to underpin our public health response with a broader package of civic and financial support.

At the time we looked very closely at the Civil Contingencies Act, and I know many noble Lords feel we missed an opportunity there, not least because it might have meant that we engaged more fully with Parliament, but also because it would have taken us down an all-UK approach that would have perhaps somehow have spared the pressure on the union. However, the truth is that that choice was never possible. The Civil Contingencies Act is a provision of the last resort and its use is subject to very strict triple-lock criteria. A change to the CCA would have been necessary for it to have been usable. Instead, we used the Public Health Act 1984 to enact most of our public health legislative responses to the virus. It is an unloved Act, and many suggest we stretched it beyond its intended purpose. That is not true. We used it for what it was designed to do: to protect the population from communicable diseases of pandemic proportions. Indeed, the Act had been enhanced after the swine flu pandemic in 2008 with amendments specifically to enable a rapid response to a pandemic. Further, we chose to use the 1984 Act because it was and remains preferable to use existing powers. It was and is the right way to respond.

The 1984 Act provided us with many of the tools to respond to the public health risk, but it did not give us everything we needed. We needed to support our people: individuals, businesses and the economy; to shore up the capacity and resilience of our health and care systems; and we needed the continued delivery of essential public services. These are the three reasons we introduced the Coronavirus Act and, one year later, they are the reasons why we still need it. Yes, vaccines are happening at breakneck speed, but we are not out of the woods yet. We all need the continuation of this support and, while it is still required, it is our duty to provide it. The continued need for this dual legislative approach does not mean that we should remain static. A key feature of our response has been our ability to adapt and to respond to a changing set of circumstances, and this is precisely what the road map and today’s legislation are about: taking cautious steps towards ending public health restrictions and getting back to normal.

I will take a moment to reflect on a few of the benefits and achievements of the Act. It enabled the temporary registration of over 15,000 nurses, midwives and nursing associates, as well as over 21,000 temporary paramedics, practitioners, radiographers and other professionals. It has eased the burden on front-line staff by reducing administrative tasks, so that their time can be focused on where they are most needed. It has facilitated innovation, with comprehensive indemnity arrangements that give clinical staff the confidence to treat their patients to the best of their ability. The Act has allowed us to provide key financial support and resilience to individuals and businesses impacted by Covid-19 through schemes such as the Coronavirus Job Retention Scheme, the Bounce Back Loan Scheme and the Self-employment Income Support Scheme.

The Act has preserved access to justice by enabling 750,000 hearings to take place through remote technology. Section 78 of the Act has enabled local authority meetings to take place either remotely or in hybrid form. Death rates are now coming down, but it is worth remembering that we used the Act to guarantee the continuation of death management services, easing the administrative burden at a time when funeral services were struggling and the nation’s morgues were almost overwhelmed. Section 18 of the Act modified death and stillbirth registration; since the provisions came into force, nearly 95% of death registrations in England and Wales have been completed by telephone.

I completely acknowledge that some aspects of the Act cause noble Lords concern. We did not take the measures lightly and we do not use them freely. However, it remains vital to have the ability to take appropriate action for our response to be effective. These key functions that I have just described illustrate why we seek Parliament’s approval today to keep the powers in place.

When we introduced the Coronavirus Act a year ago, we were clear that this was only a temporary measure. We made a promise to Parliament that we would not keep any provision in place for longer than was necessary, and we have made good on that promise. In line with the spirit of the Act, we are dropping every single additional provision possible. Today we are announcing the expiration of 12 provisions, which represent nearly 25% of non-devolved powers. Recommending the expiry of so many provisions is a clear demonstration of our commitment to balancing the ability on the one hand to respond effectively and on the other to ensure that only those provisions deemed necessary and proportionate are kept in place.

We note our thanks to our colleagues in all devolved Administrations for their collaboration in working to expire so many provisions. In addition, we are also suspending a further three provisions; the full one-year status report outlining the outcome of this review was laid before Parliament earlier this week. The temporary modification of mental health and mental capacity legislation is one example of a provision which we had already expired on 10 December 2020. We identified that these provisions were no longer required due to the commitment and resilience of NHS staff—and there is a long list of other provisions we have retired.

Over the course of the pandemic there have been all manner of unexpected twists and turns; just as the virus has evolved over time, our response has had to evolve. We worked hard to get the tiering system right, because we wanted a system that worked for the whole country. The differential approach we took last summer yielded significant results, for instance in Leicester, where the incidence rate decreased from 135 per 100,000 to below 40 by the end of August 2020. However, it also had its downsides: it led to more legislation and some confusion. The tier system was intended to bring consistency, but we have since realised that simplicity and clarity are absolutely paramount. The emergence of the Kent variant showed us the value of a national approach. Our learning from the tiers has also enhanced what we have been able to do in the road map.

I know that lots of noble Lords feel frustrated and like they have not been heard, but I want to reiterate that they have been heard, and we have been listening. We are sensitive to feedback, as demonstrated by some of the adjustments we have made. We have introduced support bubbles to enable people at risk of isolation to access their informal support networks. We have changed the rules on places of worship, keeping churches, mosques, synagogues and other holy places open for communal worship throughout the last lockdown. Today we are making an amendment to the self-isolation regulations to include additional exemptions to allow people to self-isolate to support a pregnant person as a birthing partner. We introduced shielding to protect those most at risk of the virus. We know, however, that shielding has been hard, and we listen to feedback and modify guidance wherever possible.

Noble Lords also asked for local authorities to be brought in, and they have, through the contain framework. Contain works closely with local authorities to understand the challenges they are facing and to help ensure that national responses provide the support local areas need. The challenge provided by parliamentary scrutiny over the past year has enabled us to make our approach more sophisticated, and the road map, with its emphasis on simplicity and clarity, has benefited greatly from these challenges and improvements.

We cannot stop now. There is more to do. That is why I am setting out the eagerly awaited sequence of steps to ease restrictions and lead us towards lifting limits on social contact by 21 June. We could not have reached this point in this journey were it not for the provisions and achievements of the Coronavirus Act, our world-leading vaccination programme and the perseverance and commitment of the British public. There are four clear steps which rely on four clear tests, each of which is underpinned by the scientific evidence. Opening too early or too quickly risks a further lockdown. Therefore, our approach focuses on data, not dates, which I know will be well supported here.

As long as we see no significant regional disparity, the steps for easing restrictions will be taken at the same time across England in a national approach. The first measures of step 1 took place on 8 March, with an amendment to the all-tiers regulation. As promised, we prioritised education, and all school and college pupils have now returned to face-to-face education. Alongside the pre-existing exercise provision, the regulations allow outdoor recreation with your household or one other person and make provision for the gradual reopening of care homes for visits. On 22 March, we laid the steps regulation, which enables us to move forward to the next stage of the road map and puts the remaining steps of the road map into law.

Today marks the start of a new chapter, one of progress and happier times to come, but it is only the start of the journey. We need to be cautious and not put the significant progress we have achieved so far at risk. I thank noble Lords for their continued, constructive challenge and all those who worked so hard on this cross- government, cross-public service movement to fight this horrible disease. I pay particular tribute to the noble Baronesses, Lady Brinton and Lady Thornton, who have made sure that their challenges have been heard and reflected on. Our approach has been better for it. It is not possible to namecheck everyone, but I single out thanks for all those NHS and social care staff, volunteers, returned healthcare staff, and the Army, who were involved in the deployment of the vaccine. Lastly, I extend an enormous thank you to the general public for continuing to follow the lockdown rules. The attitude of the public remains resolute. These measures are doing the lion’s share of the work in protecting everybody’s families and loved ones. I commend these regulations to the House.

--- Later in debate ---

[Lord Bethell (Con)]

I very much thank noble Lords for an incredibly broad and wide-ranging debate. It has been a really honourable birthday party for the Coronavirus Act, and I hope that the Act is grateful for the tributes it has had. I confess that I am proud of the Act, and proud of the collaborative spirit in which it was drafted and passed. I am proud of the measures it supported to make the lives of the people of Britain a lot better during this awful pandemic and I am enormously grateful for the wide-ranging support here in this House during the last year. There has been scrutiny and challenge, but I am grateful to noble Lords for the general tone of support offered to the Government, and to myself in particular.

In terms of the regulations, I think the noble Baroness put it very well: the regulations we are debating today are tough but they are necessary, and I cannot think of a better way of putting it than that. On the specific question asked by the noble Baroness, Lady Thornton, on gatherings, I would be glad to write to her with an answer. On the questions that many noble Lords had on the road map, I am not in a position to do a road map pub quiz from the Dispatch Box right now. The Prime Minister has laid out a really clear schedule and there are update sessions already built into that schedule. Noble Lords will need to wait, I fear, for updates from Downing Street on that.

Instead, I should like to pick out two or three of the major themes that noble Lords raised in this broad debate. One of the most powerful came at the beginning with the comments from the noble Lord, Lord Hunt, reinforced by many other noble Lords, on the issue of health and the question of levelling up. I recognise the deep concerns, which I share, about the spotlight that the pandemic has put on the health of the nation. Without doubt, one of the reasons why we have been hit hard by the pandemic is that large parts of our population are simply not in great shape at the moment. They have either poor health, poor living conditions or poor circumstances. The noble Lord’s comments were absolutely spot on.

My noble friend Lord Moynihan put an emphasis particularly on BMI, weight and fitness in the country. They are clearly not good enough and there is widespread acknowledgement of that. That is in no way to shame any individual or section of society. It is a simple fact of life that we do not compare well to other countries. The Prime Minister has spoken movingly about his personal experience and the issue is something that the nation has to have a conversation about. The obesity strategy is a framework for that, but it is not the only thing that we will be doing in this area.

Our reach-in as government—not just as national government but in local government, agencies of government and the NHS—to some parts of society is just not good enough. This is not a BAME issue, although that is part of it; I am talking about everywhere from the sweatshops of Leicester to the apple orchards of Herefordshire. There are too many communities where we simply do not get our message across or have a dialogue, and where our services are not provided in a way that people find accessible. We have to ask ourselves tough questions about how we can do better. That is because we are only as good as a nation as the health of the most vulnerable people in our society. That includes everyone from working-class white communities in South Wales all the way through to those in the mill towns of northern England. We have to work with faith groups, on our languages and on the services that we offer in a great many ways.

We have to join up our healthcare services. That is something for which the healthcare system has been calling for a long time, which was apparent during our engagement exercise two years ago. It is well built into the NHS Bill that will be coming our way very shortly. We have to join up primary, secondary and public health across the piece. Only in that way can we address the population health issues that have bedevilled the country in the past year.

Lastly, we have to embrace technology. We have done a huge amount of good work in the past year with data, med tech and a more 21st-century approach to healthcare. There is still a huge amount that we need to do. We need to encourage people to engage with their own patient records and data and help them to understand that they can take greater responsibility for personalised medicine if they engage with their patient records and systems. I am optimistic that we can make progress in that area.

My noble friend Lady Noakes and a great number of others remarked on the impact of the pandemic, not just on those who have been ill from Covid but on all the others who have not had either elective surgery or treatment, or missed out on diagnostics and testing—those secondary impacts on the healthcare system. That does not come as a surprise. It is neither a secret nor a conspiracy. It is exactly how epidemics hit healthcare systems. It happens time and again.

[Baroness Penn (Con)]

My Lords, I am sorry to interrupt the Minister’s speech but those participating remotely cannot hear it. Therefore, the House will adjourn while we try to resolve the technical issues.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, to pick up from where I left off: as my noble friend Lady Noakes quite rightly pointed out, the effect of the virus is not limited to those who catch the disease; it has a profound effect on the entire healthcare system. We are going to work extremely hard to catch up; £1 billion of funding has already been committed, with £325 million on diagnostics. These are massive commitments, and we want to use the catch-up as a forcing agent for important improvements to our healthcare system. It will make it more efficient and deliver a better patient outcome.

I know many noble Lords have been focused on social care. The pandemic has certainly hit the social care of both adults and children extremely hard. Any pandemic is going to hit the most vulnerable. But we have moved emphatically to meet the challenge of the pandemic. We have done everything we could to keep the infection rate down, with a huge cost to the Treasury. We have put special measures in for PPE, for care workers and for diagnostics, and we have put in a strict vaccine prioritisation scheme which saw those living in social care at the front of the queue.

On illegal immigrants, I reassure all noble Lords that anyone who is in the UK, whether they have a passport, NHS registration number or any other administrative practicalities, can have the vaccine under any circumstance. They do not need to be plugged into the formal structures of the NHS. It is, however, a terrific opportunity for the NHS to upgrade its patient records and its systems, and the NHS is grabbing that opportunity with both hands. It is also an opportunity for patients to engage with their own patient records, as I discussed earlier.

There are many reasons the pandemic has hit the healthcare system so hard. But there are also many reasons for us to use this immense disruption as an inflection point for improving the healthcare system we have got. The launch of the UKHSA, which was announced yesterday, will combine test and trace, PHE and the JBC in a new pandemic protection agency, with a huge impact in resources. The NHS Bill will, as I said earlier, bring together a new collaborative approach between the different arms of the healthcare system. There will be an overall pivot from late-stage acute medicine to early-stage preventive medicine, which was already outlined in the NHS long-term plan. The vaccine itself is the ultimate icon and metaphor for the preventive approach. We are going to be working extremely hard on that agenda.

There are also terrific behavioural changes in the public, who are embracing new technologies such as telemedicine, have appreciated the value of tests such as the Covid test and will, we hope, take a more positive approach to vaccines such as the flu vaccine. We are preparing for a very large flu vaccine season in the autumn and winter.

A number of noble Lords raised the question of private enterprise and the accusation of corruption. I completely and utterly, once again, reject the baseless accusations the noble Lord, Lord Scriven, and others have made of corruption and cronyism. Yes, we made a national call to action for everyone to step forward to help us out. Yes, thousands replied, including hundreds from this House. Yes, the quality was variable, to put it politely. Yes, we triaged that list. But that was not fishy; that was efficient. His accusations are without evidence; they are corrosive, and they are demeaning to those who have served this country so well.

To the noble Baronesses, Lady Bennett and Lady Bowles, the noble Lord, Lord Desai, and others who have alluded to the role of private enterprise in this pandemic, let me say this: it is completely dreamy to think that we could have dealt with this pandemic without the enormous support of private enterprise. The vaccine was provided by AstraZeneca. It was only because of its innovation, manufacturing skills, reach and expertise that we are where we are today. Manufacturing is done by a large number of private firms, including for diagnostics and PPE. The surge capacity of major outsourcing companies is absolutely essential when stepping up to a pandemic of this kind. I do not need to remind noble Lords in this Chamber that the services of GPs, dentists, radiographers and a large amount of the NHS’s capacity are provided by those who own their own companies. Many of the contractors who build and clean our hospitals and care for the people we love are from private enterprise. Those who denigrate the contribution of private enterprise do those who care for us no service at all. Rather than demonising the private sector and those who work in it—

[A noble Lord]

Nobody has done that.

[Lord Bethell (Con)]

Yes, they have. Order!

Rather than demonising the private sector and those who work in it, we should be celebrating the invaluable contributions of those who have given so much. I single out the noble Baroness, Lady Bennett, who did exactly that.

Some noble Lords, including the noble Baronesses, Lady Thornton and Lady Brinton, have expressed concern about the transparency of the Government’s approach. I assure both of them that transparency absolutely has been our watchword. We have published SAGE minutes, SPI-M minutes and SPI-B minutes. We have published an enormous amount of epidemiological information from the ONS, from REACT and from public and local authorities. No. 10 has given regular briefings on an almost daily basis. We have published the major contracts of those suppliers who have supplied us. We really could not have done more to share the intellectual property, analysis and commercial details of our response to this pandemic.

To those noble Lords with concerns about the workings of the virtual House under the circumstances of the pandemic, let me say this: I completely understand and share the frustrations of those who feel that the current circumstances are not a full-blooded version of Parliament in normal times. I agree that it is not the same. I think that Ministers get the scrutiny they deserve —they are under an enormous amount of pressure—but I acknowledge the points made by my noble friend Lord Cormack and others who yearn for a return to normal service.

The House has been heard in the debates that I have been in. The House has been heard when it has called for a great number of reforms. In different debates, I have run through lists of where we have moved on issues that the House has raised in particular. I have been here. I have appeared at the Dispatch Box 248 times. There have been 1,959 individual speaking events. There have been 25 Oral Statements, eight general debates, 28 OPQs, 17 TPQs and 1,229 FoIs. The idea that we have not been accountable is not quite right. I want to take a moment to thank the Lord Speaker, the usual channels and the staff of the Houses of Parliament for the amazing job they have done to keep the House open. I know that I speak on behalf of all those in the Chamber when I say that.

The noble Baroness, Lady Noakes, said that she is concerned about the impact assessments and economic analysis. This has been a recurring theme in many of our debates. As Health Minister, I have some sympathy for her points, but I would point her to Analysis of the Health, Economic and Social Effects of COVID-19. It is an utterly emphatic document that answers many of the points she alluded to. While she may not like the findings, the report does make it clear that the colossal and massive effects of the pandemic are so huge that there is no way of avoiding them other than getting rid of the pandemic itself.

I was greatly moved by the words of my noble friend Lady Stroud and her concerns about a torrent of fear, but I will be honest: I do not recognise the situation that she described. The idea that the press has somehow been cowed into submission and some kind of blind compliance by politicians or regulators is simply not my experience. The idea that scientists have been pressurised by the Government is not the view of the scientists themselves, nor does the evidence suggest that the great British public have been intimidated by government excess. In fact, it is the opposite: as noble Lords have heard from me before, the evidence suggests that the British public support enormously the NPIs, lockdowns and infection controls that we have put in place. That support for lockdown measures remains extremely high.

We are here to make laws. My experience of making laws over the past year is that they are being put in place not to lead to prosecutions or in any way intimidate the public but to be clear. The public deserve and expect Governments to be crystal clear about the behaviours that they hope for from the public. We respect the good sense of the British public, who, for their part, have a need, interest and requirement to know what is expected of them. That is why we reach for the law book when we are applying lockdown and NPI measures. I was hugely moved by the words of my noble friend Lady Stroud on the mental health of young people, but suggest that the connection between this and government lawmaking is not as strong as she suggests.

A number of noble Lords spoke of a dystopian legacy from the pandemic. My noble friends Lord Farmer and Lady Noakes, and the noble Baroness, Lady Fox, spoke in moving terms about the loss of liberty, coercion, mandation and a perpetual cycle of locking down, and remarked, quite rightly, that these are un-British values. As I have said before, I never expected to be standing at the Dispatch Box bringing in these kinds of regulations. But I think that my noble friend Lord Farmer overreaches when he says that we are creating a world that is hardly worth living in. We are protecting those who are vulnerable and those who are elderly.

While the challenge of the pandemic is enormous—the effects on health, education and the economy are profound—my outlook is much more optimistic than that of my noble friends. There is an opportunity for a positive legacy from this pandemic. It takes the form, for instance, of the reboot to our health system that I described earlier. There is an opportunity for a degree of civic renewal, evidenced, for instance, by the massive volunteering that we saw in both the return of healthcare professionals and those who sought to help their neighbours and those in need. There is great evidence that the British people want to be involved in supporting their neighbours and loved ones, and that is an opportunity that we should grab.

There has been a massive reboot in our attitudes to the old and the vulnerable. For those who saw them, the Shipman documentaries on the BBC raised the question of whether we have respected, cared for and loved the old. In this pandemic, we have seen how the lives and final years of the vulnerable are valued. The whole of British society has made an enormous sacrifice to demonstrate its love for the elderly and the vulnerable. We should hold on to that.

There is a new confidence around science, particularly around the vaccine, the ability of science to solve problems and Britain’s commitment to scientific discipline. And there is a new confidence about Britain’s role in the world. Those are British values that we should be proud of and can hold on to. If we make the right decisions, we have a chance to make sure that there is a benign legacy from this awful pandemic. We need to take the right steps to do that, and that it what lies before us in the year ahead.

In the spirit of that optimism, I ask the noble Baroness, Lady Brinton, to stand down from her Motion to Regret. Nothing is perfect. Much of what happened during the pandemic is admirable, but we are in a much better place today than we were, and I very much hope that she sees fit to withdraw her Motion.

Motion agreed.

Covid-19: Resuscitation Orders

Lord Bethell Excerpts

Wednesday 24th March 2021 Lords Chamber

[The Lord Bishop of Newcastle]

To ask Her Majesty’s Government what assessment they have made of the report by the Care Quality Commission Protect, respect, connect—decisions about living and dying well during COVID-19, published on 18 March, on decisions about the use of ‘do not attempt cardiopulmonary resuscitation’ orders for (1) care home residents, and (2) people with learning disabilities, during the pandemic.

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

My Lords, the department warmly welcomes the publication of the CQC report on the use of DNACPR decisions taken during the Covid-19 pandemic. We are pleased to see examples of good practice detailed in the report across both health and social care, but this was not true everywhere, particularly for our most vulnerable people. That is why the department is committed to driving forward the delivery of the report’s recommendations and ultimately ensuring that everyone experiences the compassionate care that they deserve.

[The Lord Bishop of Newcastle]

My Lords, this report from the Care Quality Commission highlights that

“unprecedented pressure on care providers”

and the rapidly developing guidance has led to blanket “do not attempt cardiopulmonary resuscitation” orders being imposed at a local level, particularly affecting care home residents and people with learning disabilities. Failure to consult people about their care betrays a lack of decency and compassion, but it is also a human rights violation. I am very grateful to the Minister for his reassurance about the recommendations, but may I press him, in particular, to assure the House that the recommendation of a ministerial oversight group will be implemented?

[Lord Bethell (Con)]

My Lords, I can absolutely reassure the right reverend Prelate that the Minister with responsibility for patient safety and mental health care will be heading the ministerial oversight group to drive forward progress. The group will bring together a range of stakeholders across both health and care to ensure that the recommendations are implemented.

--- Later in debate ---

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, I am afraid that we are having questions that are far too long. Can people please keep their questions brief?

[Lord Bethell (Con)]

My Lords, we will address the audit points made by the noble Baroness. I completely endorse the importance of training; that is at the heart of the report and we acknowledge its importance. We are concerned about the number of people with learning disabilities who have died during the pandemic, and there will be a report on what the connections are.

[Baroness Thornton (Lab) [V]]

My Lords, we know that it is unlawful for DNACPRs to be imposed, and I wonder why the research has not sought to identify why physicians and care workers continue to impose them in the way that they have. Does the Minister agree that the solution must lie in completely clear, unambiguous policy to advance care planning and DNACPR decisions, and a consistent use of accessible language, communication and guidance to enable clear understanding by commissioners, providers and the public?

[Lord Bethell (Con)]

I will gently push back against the noble Baroness: the policy is absolutely crystal clear. Blanket DNACPR is not the policy of this Government, as was repeated time and time again in our communications, which I would list if I had more time. Training is the issue: we need to give the front-line workforce the skills it needs to apply these very delicate but critical interactions. That is the recommendation of the report, and that is where we are focused on applying the lessons.

[Lord Scriven (LD)]

My Lords, does the Minister agree with Age UK that the report is the tip of the iceberg and requires the Government to bring forward proposals as part of a complete overhaul of the advance care planning system?

[Lord Bethell (Con)]

No, my Lords, I do not accept that the report is simply the tip of the iceberg; it is very thorough and goes into the matter extremely carefully. However, there are important lessons on training to be learned and they will be driven by the ministerial oversight group.

[Lord Flight (Con)]

My Lords, the Care Quality Commission wrote up its findings at the time of the outbreak of Covid-19, which may have made them less reliable. A number of factors have served to raise exposure to decisions on whether or not to accept DNACPRs, and these were taken for groups rather than individually. Such groups included individuals suffering with dementia and learning disabilities who needed briefings that they could understand. The Care Quality Commission report is about how hospitals, care homes and doctors should support people to make decisions properly about how to restart. Are the Government satisfied that the decisions in this territory are now being taken properly?

[Lord Bethell (Con)]

My Lords, the report is crystal clear that we accept that more training is needed. Front-line care support workers need to be given more support in their interactions, and we will be putting that in place.

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests in the register, in particular the fact that I am a nurse involved with the Outcomes First Group, which supports people with learning disabilities. In order to increase the population’s awareness of care planning in relation to living and dying well, will the Government, in addition to training, consider incentivising healthcare workers to ensure that they have sufficient time to undertake proper assessment of individuals with cognitive impairment and learning difficulties as part of their routine care planning, which should be recorded and reviewed at least biannually?

[Lord Bethell (Con)]

The noble Baroness makes a very fair point; such care needs to be in the work plan particularly of those with learning difficulties, but of all those in care. We absolutely endorse the approach taken by the Resuscitation Council, which has extremely good guidance in this area.

[Baroness Jolly (LD) [V]]

My Lords, no one doubts the events described by the right reverend Prelate and noble Lords. By when can we be confident that the same could not happen again?

[Lord Bethell (Con)]

My Lords, we could not be moving more quickly. We got the report out before the end of the pandemic; we have acknowledged the issue and written numerous letters into the system, as I have mentioned; and we are putting in place the resources needed to support the necessary training and interactions. We are taking this extremely seriously and we are moving as quickly as we possibly can.

[Baroness Wheatcroft (CB) [V]]

As the Minister has suggested, decisions on end-of-life care are best taken long before they are necessary, so could he encourage GPs to offer all patients the opportunity to make an advanced decision to refuse treatment, properly witnessed by two individuals, if it is to become effective?

[Lord Bethell (Con)]

The noble Baroness is entirely right, and a growing number of people do take that kind of pragmatic approach. But we have to be realistic: many people are not prepared to put those sorts of arrangements in place until much later on in their lives, and it is often the family and relatives of those in care who have to be part of those important conversations.

--- Later in debate ---

[Baroness Evans of Bowes Park (Con)]

We will now hear from the Minister.

[Lord Bethell (Con)]

I reassure the noble Baroness that there has been a huge amount of stakeholder engagement, with Mencap, Turning Point and others. It is not the role of the CQC to do individual family reviews, but I can reassure her that we have learned important lessons from this process.

[Lord Patel (CB) [V]]

Does the Minister agree that the ministerial oversight committee should also consider looking at end-of-life care?

[Lord Bethell (Con)]

My Lords, yes, I do.

[Baroness Meacher (CB) [V]]

My Lords, I should declare my interest as chair of Dignity in Dying. What plans do the Government have to increase dramatically the numbers of people who have advanced decisions expressing their views on medical treatment? Does the Minister agree that patients’ wishes should be central to DNACPR decisions, and indeed to all significant medical decisions, particularly at the end of life?

[Lord Bethell (Con)]

My Lords, we absolutely agree. That is exactly how the guidelines are written and exactly the guidance sent into the system. The issue we face is much more pastoral in nature: it is one of training and creating the space and resources necessary to have extremely difficult conversations. That is the kind of front-line support we need to put in place. It is a question of patient engagement rather than a change of guidelines, but I completely take on board the noble Baroness’s recommendations.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, with the help of the Leader of the House, all supplementary questions have been asked.

Folic Acid

Lord Bethell Excerpts

Tuesday 23rd March 2021 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government, further to the reply from Lord Bethell on 3 September 2020 (HL Deb, cols 444–5), whether they have reached a conclusion on the findings of their consultation on the proposal to add folic acid to flour which closed on 9 September 2019.

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

My Lords, I pay tribute to the noble Lord, Lord Rooker, for his stamina on this important issue. Since the consultation on folic acid in flour closed, there has been considerable progress on this policy work, although this has been hampered by Covid. I commit to bringing an update to the House as soon as I reasonably can.

[Lord Rooker (Lab) [V]]

I thank the Minister for his Answer but, as he will expect, it is not good enough. Notwithstanding the Covid pressure on the health department, it found time and resources to produce an NHS reform White Paper, so the priority was organisation, not preventive health. Since the Minister answered the previous Question on this in September, on average there will have been 500 pregnancies affected by neural tube defects, resulting in more than 400 terminations, and around 80 live births of babies with a lifelong disability. Fortification can cut these figures by up to 50%. My last question is: how will Ministers face the Daily Mail, which for 15 years has supported the scientists advising that this policy be adopted? I shall be back next month, I give notice.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I pay tribute to both the stamina and the passion with which the noble Lord puts his case. He puts it extremely persuasively. We have worked hard to engage with policymakers on this, meeting mill owners, including artisanal mill owners, and those who are engaged in the supply of food. The supply of food has been a difficult area in the last year. It is difficult to lay this extra burden on the trade. It is extremely open to the option and we remain optimistic that this is a route we can walk down. There has simply not been an opportunity to make that commitment as yet, but I will update the House as soon as I possibly can.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, yesterday, the Minister said that the health of the nation had to change emphatically. The recent NHS White Paper, to which my noble friend Lord Rooker referred, actually promised a more direct government role in improving people’s health. For instance, as president of the British Fluoridation Society, I was delighted that the Government are now committed to fluoridating water supplies. Given that, would it not be a very important indicator if the Government were to announce very shortly that they are going to go ahead with this?

[Lord Bethell (Con)]

My Lords, the noble Lord blows my own words in my face very effectively indeed. He is entirely right—we are committed to preventive medicine in the round. Fluoridation is one graphic example of that and the use of folic acid to address neural tube defects is another good example. That is why we did the consultation in 2019 and are considering the responses, and it is why I have made the commitment to return to the House once we are able to give an update.

[Lord Northbrook (Con) [V]]

My Lords, while I wholly support measures for larger commercial millers to minimise the risks associated with folic acid deficiency in vulnerable groups in society, I ask that the Government exempt smaller, traditional artisan mills from having to have to mix folate into flour. These mills represent only 0.1% of flour production and it would be prohibitively expensive for them to purchase the necessary machinery and to adapt what are often listed buildings for this change. Also, some customers deliberately seek out traditional flour, free from additives.

[Lord Bethell (Con)]

My noble friend makes the case extremely well. I reassure him that, in February 2020, officials from the DHSC and Defra met representatives from the Society for the Protection of Ancient Buildings’ Mills Section and the Traditional Cornmillers Guild and visited windmills and watermills to understand at first hand the practicalities around fortification for those premises. The commitments made on those visits will, I think, build a policy that takes into account the very special needs of those important artisanal trades.

[Baroness Jolly (LD) [V]]

My Lords, I commend the noble Lord, Lord Rooker, for his tenacity on this issue, and fail to understand why successive Governments have not recommended the addition of folic acid to flour, as well as fluoride to water, following many western Governments. For those who live on junk food, folate deficiency can turn into a serious disorder and, if left unchecked, can be fatal. In addition, the possible damaging effects to the foetus during pregnancy make this a no-brainer. The consultation closed 18 months ago, so when will the Minister bring the update to the House?

[Lord Bethell (Con)]

The noble Baroness puts the case well. It is an issue that I feel personally committed to; a cousin of mine was born with a neural tube defect many years ago, and the effects of that hit my family extremely hard. I recognise the problem of unplanned pregnancies and the need to find a way to get folic acid to people who were perhaps not intending to have a pregnancy. We take this matter extremely seriously, and I commit to returning to the House when we have an update on it.

[Baroness Altmann (Con)]

I encourage my noble friend to accelerate this initiative of folic acid supplementation, which the House can see clearly he would very much welcome. But can he also comment on other preventive measures to improve the nation’s wider health?

[Lord Bethell (Con)]

My Lords, I think my noble friend alludes to the rollout of the vaccine, which has been the consummate preventive medicine programme that the country has ever seen. It is, I hope, an inflection point in the whole country’s approach to its healthcare. We have for too long emphasised late-stage, heavy- duty interventions, and we have not focused enough on preventive early-stage interventions. Folic acid is a really good example, as are the vaccine and fluoridation, and the kinds of population health measures we hope to bring in will address all of those.

[Baroness Finlay of Llandaff (CB) [V]]

I too commend the noble Lord, Lord Rooker, for his tenacity on this important aspect. Do the Government recognise that 90% of women of childbearing age have low folate levels? If these were corrected by the dietary addition of folate to flour, we could see up to a 58% decrease in neural tube defects. These are massive numbers and cannot be ignored. The clock is still ticking and there are women getting pregnant today who have low folate levels.

[Lord Bethell (Con)]

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

[Baroness Wheeler (Lab)]

My Lords, last year, a year after the consultation deadline closed, the Minister repeated his promise that, despite seriously delayed government decision-making, major efforts were being made to step up the raising of awareness of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20. Can the Minister tell the House what actions have been taken? What measurable impact has awareness raising had among these at-risk groups and on ensuring that women whose pregnancies are unplanned—as we have heard—are not missing out on these vital nutrients in the early stages of their pregnancy?

[Lord Bethell (Con)]

I am grateful to the noble Baroness for reminding me of my words on that matter. I will endeavour to find an answer to her very particular question. I worry that the very large amount of engagement we have had to do on Covid, particularly around marketing, has drowned out some of the messages that we have put through to people on these very specialist issues. I will find out from the department what progress has been made and will be glad to update her.

[Baroness Bakewell of Hardington Mandeville (LD) [V]]

My Lords, Britain has a relatively high rate of preventable birth defects linked to low folic acid—around 1,000 pregnancies are affected every year. The Government are aware of this but do nothing, and it is scandalous that this tragedy could be prevented by the mandatory fortification of flour with folates. The burden on mill owners appears to be more important to the Government. When are the Government going to stop letting women down in this way at one of the most vulnerable times of their life?

[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.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed.