Eating Disorder Services: Referrals

Lord Bethell Excerpts

Monday 17th May 2021 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the change in referrals to eating disorder services since April 2020.

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

My Lords, eating disorders are serious, life-threatening conditions. We recognise eating disorder services are facing increased demand from children and young people, with 719 urgent cases starting treatment in the fourth quarter of 2020-21. That is why we made £10.2 million of additional funding available to mental health charities, including those that address anorexia, at the beginning of the pandemic, we convened a cross-government ministerial group to publish a mental health recovery plan and we are holding a ministerial round table on eating disorders.

[Baroness Bull (CB)]

My Lords, Q4 data on waiting times released last week showed, as the Minister said, 719 patients starting treatment for urgent cases of eating disorders, but this compares to 353 at this time last year. At this point in 2020, 18 people awaited urgent treatment, and 543 awaited routine treatment; those numbers are now 130 and 1,404. While much has been said about the pandemic’s role in driving this spike, most studies into young people’s mental health over the last year were not designed to detect eating disorders so, beyond anecdote, the reason for this increase, and therefore the best way to address it, is not clear. What will Government do to better understand this sharp increase? Does it represent broader and lasting behavioural changes among young people? Will the Government closely monitor the impact of their obesity strategy on referral rates, given that some of the planned measures—calorie labelling on menus, for instance—are shown to exacerbate existing eating disorders and increase the risk of their development in the general public?

[Lord Bethell (Con)]

My Lords, undoubtedly, the increase in referrals is something of concern. It is something we are monitoring closely, with the round table and the ministerial group dedicated to looking at this. That shows the seriousness with which we regard it. The reduction in the impact of community services, which is the best way of addressing these kinds of issues, has undoubtedly had an effect on urgent needs. During this period, there has also been a large increase in the number of young people who have started treatment, which is encouraging. If the noble Baroness has evidence that measures such as nutrition information on packaging has an effect on anorexia, I would welcome correspondence from her.

[Baroness Thornton (Lab)]

My Lords, as the noble Baroness has said, we know that eating disorders among children and young people have increased during the pandemic. There is a very welcome increase in the grant of £11 million from the grant in 2018-19. Despite this, total spending by CCGs on children and young people’s community eating disorder services increased by just £1.1 million, from around £54 million in 2018-19 to £55 million in 2019-20. This increase is cancelled out if you adjust for inflation, and this means that total spend flatlined in real terms. What are the Government going to do to ensure that this money is spent on what is growing into an epidemic of eating disorders and the suffering they cause?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that community eating disorder services are critical. They are the backbone of our measures to address these difficult cases. But money for the treatment of eating disorders comes from many different pots. During 2021, a total of 10,695 children and young people started treatment, which is up from 8,034 children in the year before. So, clearly, resources are getting through to cope with a large number of people, and that is an encouraging sign.

[Baroness Jolly (LD)]

Is the Minister confident that all referrals to a community eating disorder specialist can be managed without excessive travel on the part of the individual and their family and that, where necessary, local in-patient services are available right across England?

[Lord Bethell (Con)]

The noble Baroness refers to a perennial issue in any national health service, which is the inevitable concentration of expertise in some hubs where there is particular specialist knowledge. But she is entirely right that we should try to avoid excessive travel. That is why community eating disorder services are so important, because they bring the treatment as close as possible to the people who are suffering.

[Baroness Fall (Con) [V]]

My Lords, the noble Baroness, Lady Bull, is quite right to raise this important issue today. Young people have had their lives turned upside down over the last year, their plans put on hold and their prospects blighted and, with a sense that they have lost control, it is hardly surprising that we have seen a huge rise in mental health issues. Can the Minister give us an indication of the waiting rates at the moment, especially for those diagnosed as urgent cases? Is it his view that we have enough practitioners? If not, does he have any plans to discuss the need for more training and a recruitment drive?

[Lord Bethell (Con)]

My Lords, my noble friend puts it extremely well. Young people have been under huge pressure during the pandemic. It is a huge tribute to the young people of Britain that they have borne it so well. I do not have to hand the statistics on waiting lists that she asked for, but I would be glad to write to her with the details. We are recruiting right across the NHS at the moment; it has been an extremely successful recruitment round, and those kinds of recruits will go to services such as those dealing with eating disorders.

[Baroness Parminter (LD) [V]]

My Lords, to return to calorie labelling on menus in restaurants, as raised by the noble Baroness, Lady Bull, there is limited evidence for its efficacy in reducing levels of obesity, but there is clear evidence from the Royal College of Psychiatrists eating disorders faculty—and anecdotal evidence from my daughter and others—that it can be responsible for triggering those with eating disorders. Can the Minister respond to what the noble Baroness, Lady Bull, asked for and confirm that, should the Government introduce this labelling on menus, they will review its impacts not just on reducing levels of obesity but on those suffering from eating disorders?

[Lord Bethell (Con)]

My Lords, the eating habits of the nation have changed considerably in recent years. The amount of food that people eat that has been prepared by others has risen dramatically, and many people have no idea what is in the food they are eating. That is why we have moved to bring in calorie labelling on food that is delivered and in restaurants. I am acutely aware of the concerns of the noble Baronesses, Lady Parminter and Lady Bull. We are committed to engaging with eating disorder charities, Beat and other key stakeholders, and to listening very carefully to their concerns on this.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Lord Bethell Excerpts

Monday 17th May 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021.

Relevant documents: 52nd Report from the Secondary Legislation Scrutiny Committee, Session 2019–21, and 48th Report from the Joint Committee on Statutory Instruments, Session 2019–21 (special attention drawn to the instrument)

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

My Lords, we are here today to discuss the regulations allowing the move to step 2 of the coronavirus road map, a decision which not only allowed us to reclaim some normality in our lives but set the platform for today’s move to step 3. Getting to this point has taken remarkable perseverance and resolve; I am hugely grateful to everyone involved in getting us there. We are clearly not free of coronavirus yet and, while we have met the first four tests that have enabled the move to step 3, the disease still poses a clear and present threat.

The Prime Minister’s address last week clearly highlighted the threat from variants of concern and we must remain cautious and vigilant. We are putting in place measures to combat variants. The evidence so far suggests that the vaccine is effective. I am heartened to hear that teams deployed to Bolton over the weekend were well received and reported a positive atmosphere—a result of strong community engagement and an effective communications campaign conducted in the area. As the Prime Minister made clear on Friday, while we progress further along the road map today, we must continue to exercise caution and common sense because the choices we have to make in the coming days will have a profound effect on the road ahead.

It has been a year like no other but we are taking significant steps forward to regaining our freedom. It is this combination of the public’s dedication, our world-leading vaccine programme and the unrelenting hard work of our health and care workers that has allowed us cautiously to unlock the country.

The road map seeks a balance between our social and economic priorities and the need to save lives and avoid another surge in infections. The decisions to move to step 2 and 3 were both informed by the latest scientific evidence and based on the assessment that all four tests set out in the road map had been met.

The tests are as follows. First, the vaccine deployment must continue successfully. We continue to make great progress in vaccinating the most vulnerable, having offered a first dose to the nine priority cohorts, which included everyone aged over 50, front-line health and care staff, residents in care homes for the elderly and those deemed clinically vulnerable. As of 15 May, more than 36.5 million people have received their first dose of an approved vaccine and another 20.1 million have received their second dose. In total, a staggering 56.6 million Covid vaccine doses have now been administered in the UK.

On test 2, the evidence suggests that the vaccine continues to be effective in reducing hospitalisations and deaths. Public Health England reports that the UK Covid-19 vaccination programme has so far prevented more than 12,000 deaths in those aged 60 and above. Furthermore, it is reported that 33,000 hospital admissions have been prevented in those aged 65 and older.

On test 3, we need to determine that infection rates do not risk a surge in hospital admissions, which could put undue pressure on the NHS. Currently, hospital admissions continue to fall and case rates among the over 60s are also declining. The NHS emergency alert level has been dropped from level 4 to level 3, mirroring how the NHS was operating in the summer of 2020.

On test 4, our assessment is that the risks have not fundamentally been changed by the variants of concern. We will continue to monitor variants closely as we ease restrictions and the Government will not hesitate to take firm action as necessary and where needed to protect lives and livelihoods. Having met these four tests on 12 April 2021, we were able to take the next cautious step in easing restrictions. Today we are debating this move to step 2, as set out in the regulations agreed by the House on 25 March. They were as follows.

The first was the reopening of non-essential retail, personal care and indoor leisure, including hairdressers and gyms, and additional outdoor settings, including the hospitality sector and attractions. Outdoor hospitality is no longer required to provide a substantial meal alongside the serving of alcohol, although there is the requirement for table service. As well as ordering via table service, if the venue sells alcohol, payment must be taken at the table or another outdoor location wherever possible. Further to this, the early closures imposed on pubs and restaurants were removed.

Step 2 also allowed the resumption of indoor childcare and supervised activities for children, provided they are not in private homes, and includes indoor sport, and parent and child groups of up to 15 people. It also allowed wedding ceremonies for up to 15 people, with wedding receptions permitted outdoors for up to 15 people in the form of a sit-down meal. This has changed again from today, with up to 30 people being able to attend weddings and other life events, and the capacity limit at funerals is removed. Furthermore, smaller outdoor events, such as fetes, literary fairs and fairgrounds can restart, as can the use of self-contained accommodation for single households or bubbles. Finally, social restrictions remain the same as those in place from 29 March, with the rule of six or two households allowed to mix outdoors only.

I thank the Joint Committee on Statutory Instruments for its crucial and tireless work in scrutinising all the secondary legislation that the Government bring forward, and I acknowledge the committee’s report on the wider steps regulations, which are amended by the regulations that we are debating today. I am pleased to say that we have already implemented responses to some of the issues the committee raises, through the regulations that we are debating today, and we have brought forward more amendments as part of the separate step 3 regulations.

It is unfortunate that there was a delay in debating these regulations. However, the content of each step received the prior approval of Parliament during the extensive debates on 25 March, and it was essential to bring these measures in quickly once it had been determined that the four tests had been met. As ever, no restrictions should be in place longer than is necessary, and it remains extremely important that decisions on the road map steps are informed by the latest evidence.

By way of closing, I just say this: as we journey through the road map we are making great progress but will maintain caution; we are not out of the woods yet. New variants are a risk—we remain in a global pandemic. Events in India show the heartbreaking and devastating impact this disease can cause. We must all remain vigilant; it is vital that people continue to follow the restrictions in place to minimise the risks to themselves and others—hands, face, space, fresh air and take up the offer of a vaccination as soon as it is offered.

We hope that the continued successes of the vaccination rollout, and our increased testing capabilities alongside falling infections and hospitalisations, will allow us to continue to lift restrictions. In light of the most recent data and advice from the Joint Biosecurity Centre, we have not only moved to steps 2 and 3 but the UK Chief Medical Officers and the NHS England national medical director were recently able to announce that the UK alert level should move from level 4 to level 3. This is another positive sign on the road to recovery. We must continue the cautious approach and be guided by the latest data and scientific evidence before moving to step 4. However, considering all that we have achieved to bring us to this point today, there is reason for cautious optimism. I commend these regulations to the House.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful to noble Lords for their thoughtful, at times passionate, but at all moments detailed and challenging points. Rather than dwell on the regulations themselves, I will address the three key themes that have been raised in this important debate.

The first theme I will address is that raised by the noble Lord, Lord Rooker, the noble Baroness, Lady Thornton, and others on the presentation of the regulations themselves. I completely acknowledge the specific points made by the noble Lord, Lord Rooker, and the noble Baroness, Lady Thornton. I fully acknowledge the power of scrutiny, the consideration that noble Lords give to legislation and the benefits of that scrutiny, but I do not accept the implication of the noble Lord’s comments that there has in some way been a grand injustice or that these regulations have in any way undermined the power of the policy behind them.

I gently remind noble Lords of the immense complexity of the policy we are trying to apply in these regulations. They are extremely legally delicate and subject to judicial review. It is therefore quite reasonable that legal colleagues wish to spend as long as they possibly can getting them right. The environment in which they are drafted has been fast changing, as this debate has very clearly illustrated. They often require a very large amount of cross-government consensus and collaboration, which in itself brings in delays and a certain amount of complexity.

Given all those considerations, I pay tribute to the officials, the clerks and the legal support, who have done a heroic job tabling these regulations. It is of course up to the House of Lords itself to determine the sequencing of House business. I am afraid it is above my pay grade to comment on that, but when the inquest is finally done I think that the regulations will be a huge testimony to the thoughtfulness and effectiveness of our democratic processes. I say to the noble Lord, Lord Bourne, that the regulations are tweaked at the last minute to accommodate the changes in the situation we face. That is why they are sometimes laid at the last minute. I remind noble Lords that the House of Lords Constitution Committee is looking at processes around emergency legislation. My noble friend Lord True and I have given evidence to that committee. I very much look forward to its recommendations.

The noble Baroness, Lady Wheatcroft, asked about learning on the job, as it were, and what we are putting in place today for our future pandemic preparedness and to prepare for any potential third wave. I assure her, my noble friend Lord Moynihan and the noble Baroness, Lady Tyler, that we are doing a huge amount to put in place new systems, institutions and practices. The launches of the UK Health Security Agency and the office of health promotion have been brought forward to ensure that we have the institutional resilience to meet any future pandemics, and to bring the learnings from the handling of this epidemic in real time. They are already making huge strides in the institution-building and management systems necessary to upgrade our arrangements.

The investment in diagnostics is remarkable. Last week, I visited Leamington Spa, where I stood by a machine that could do 13,000 tests in one go. It reminded me of the days last March when we were struggling to do 1,300 tests in a day. In terms of our outbreak management, we have learned a huge amount from the success of Project Eagle in containing both the South African and Manaus variants, although the escape of the Indian variant demonstrates how a highly transmissible variant is something that even the best systems cannot fight.

To the noble Lord who asked about the stay-at-home protocols, I clarify that the guidance as of today is that people should continue to work from home wherever possible, but we look forward to a moment when we can have a general return to the offices.

We are looking at ways of dealing with new variants by potentially introducing booster shots in the autumn, introducing VoC vaccines through other providers and investing in therapeutics and antivirals. A huge amount of work is going into every level of our pandemic preparedness.

Let me tackle head-on the key issue of the India variant and our travel arrangements, which several noble Lords raised. On 8 April, we had the benefit of more surveillance, more genomic sequencing and more analysis of the infection rates in the UK than any other country. It is easy to imagine that all that data, which is so impressive to look at in retrospect, somehow gave a clear projection of what was going to happen, but at that date the India 2 variant with which we have now become so familiar had not been ascribed as a variant of concern. There were in fact three variants in India, all of which were competing with each other, none of which we had here in the UK—we therefore could not analyse them hands-on—and the anecdotal evidence from India was extremely unclear, whereas we had a lot more information on the presence of the South Africa and Manaus variants in the other neighbouring countries.

At that time, it was right that we invested in our red-list capacity, and I pay huge tribute to the officials managing the managed quarantine system, the airports and transport partners running an extremely efficient travel system, and the hotel and transport partners doing so much to ensure that the system for both red and amber-list countries is as good as possible. The red-list system has been an incredibly impressive mechanism for containing variant spread. It has grown dramatically since launch to contain a very large number of travellers each day. No other similar country has quite such an effective system in place. It continues to be an effective way in which we can maintain flights in and out of the country—something we are extremely reluctant to turn our backs on.

On ongoing travel, to clarify for my noble friend Lady Wheatcroft, it was not legal to travel until step 3 was brought in. It is now lawful, but it is not advised. Whatever was heard on the radio this morning, I reassure the noble Baroness, Lady Thornton, that we are not in talks with airport operators—we have been in daily contact for many months, running a complex and detailed managed quarantine scheme, and I pay enormous tribute to both Heathrow and the Border Force for the incredibly impressive arrangements that they have in place. I say to my noble friend Lord Bourne that, yes, there are still direct flights to India and Pakistan. It is actually better to channel passengers from those countries in direct flights to avoid what has become known as the Maldives hop and to avoid mingling wherever possible.

My noble friend Lord Bourne asked about the VoC map, which is available on the department and the Sanger institute websites, and I would be glad to send a map.

In response to the noble Baroness, Lady Thornton, I pay enormous tribute to those in Bolton who have done an enormous amount to upgrade the vaccination of local people there. I remind her that the priority is still very much to get the most vulnerable vaccinated—those who are older or with pre-existing morbidities. That is more important than getting young people, who are relatively low-risk with regard to the virus. The priority is to get those who have had a first jab and convert them into having a second jab, because it has emerged that, with the Indian variant, the second jab is all the more significant.

In conclusion, the good news is that the vaccine does seem to work. The Indian variant is highly transmissible, but the vaccine is protection for all people against severe illness and death. We should give thanks for that, but we are not counting our chickens quite yet and we remain extremely diligent and determined to contain any other variants that may come along. I commend the regulations to the Committee.

Motion agreed.

Social Care: Person-centred Dementia Care

Lord Bethell Excerpts

Monday 17th May 2021 Lords Chamber

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

My Lords, we want a society where every person with dementia—and their families and carers—receives high-quality, compassionate care from diagnosis to the end of their life. The Government are committed to sustainable improvement of the adult care system and will bring forward proposals in 2021. We are working closely with local and national partners such as the Alzheimer’s Society to ensure that our approach to reform is informed by diverse perspectives, including those with lived experience of the care sector.

[Baroness Browning (Con) [V]]

My Lords, I refer to my interests in the register as an ambassador for the Alzheimer’s Society and as a carer. This is Dementia Action Week. I am grateful to my noble friend and urge him that, as people with dementia are by far the majority of users of social care, the promised reforms deliver person-centred care to enable people with dementia to live in places they call home, take part in activities they enjoy and live their lives safely with meaning, purpose and connection with others.

[Lord Bethell (Con)]

My Lords, I am extremely grateful to my noble friend for raising Dementia Action Week, a time to celebrate the contribution of those who care for people with these conditions. I know from my own experience the incredible importance of personalised care and of being able to have loved ones at home for as long as they can safely and reasonably be cared for there. My noble friend puts the experience of living with dementia for families and carers extremely well. I entirely endorse her sentiments.

[Baroness Pitkeathley (Lab) [V]]

Does the Minister agree that person-centred care for dementia sufferers must include support for those who care for them? Since today’s survey by the Alzheimer’s Society says that carers are at breaking point and 95% of carers say that their caring has affected their physical or mental health, how and when is that support to be provided? Will support for carers be an essential element in the proposals for social care reform when they eventually appear?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the pressure the pandemic put on both formal and unpaid carers. That is why we put £6 billion into local authorities, to help support them in the care they gave to carers. However, I acknowledge the concerns of the noble Baroness about the pressure of the last year and reassure her that the full spectrum of social care will be considered in the forthcoming review.

[Baroness Walmsley (LD) [V]]

My Lords, Alzheimer’s disease has been described as a future epidemic. Without a known cure, research into causes of and treatments for Alzheimer’s and other dementias is vital. At the last election, the Government committed to a dementia moonshot, which would double research funding to over £160 million a year. Can the Minister say when this funding will become available?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, according to the briefing before me, the 2020 dementia challenge commitment to spend £300 million on dementia research over five years has been delivered already, with £344 million spent over four years. However, I am happy to clarify that point with the noble Baroness, just to ensure that I have got my briefing correct.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, one cruel aspect of dementia is how the condition gradually eats away at a sufferer’s individuality. In the context of this disorientation, with individuals forgetting who they are, one key to clinging on to personhood is family and friends. Can the Minister ensure that any Covid inquiry looks at the specific problems of those with dementia in care homes, who were deprived of any visits from relatives and forcibly isolated from familiar faces, robbing them of the resilience to fight the virus? Will he consider that, as a quarter of those who died of Covid had dementia, this one-size-fits-all approach to protecting the vulnerable did not work and makes person-centred dementia care all the more important?

[Lord Bethell (Con)]

My Lords, I am afraid it is beyond my reach to define the terms of the inquiry, but I entirely endorse the noble Baroness’s depiction of the very cruel dilemma we have faced over the last year: between safety—the preservation of life—and the care, love and consideration we owe to older people, particularly those with dementia. It has been a horrible and extremely uncomfortable dilemma. I pay tribute to those in social care who have sought to navigate it as thoughtfully as they could, but there is no doubt that it has been a horrible moment.

[Lord Laming (CB) [V]]

My Lords, as we have heard, dementia is a cruel illness because it strips away both individual personality and memory. Does the Minister agree that, learning the lessons of this past year, we must in future do everything possible to reinforce the message to each sufferer that they are loved for who they are, a unique person, rather than for what they are, just another patient with dementia?

[Lord Bethell (Con)]

My Lords, I entirely agree with the extremely touching way the noble Lord put that. To take a glass-half-full approach for a moment, I have been struck in the pandemic by the huge amount of public support for the protection of those who are older and vulnerable, including those with dementia. It has been a very touching feature of the national response to the pandemic that the country has come together to protect the most vulnerable, and I think there has been a national rethink about how we relate to those in that condition.

[Baroness Wheeler (Lab)]

My Lords, we know that the costs for families of caring for those with dementia can be long-lasting and catastrophic, as the Commons Health and Social Care Committee has emphasised in setting up a new inquiry, and from our excellent Economic Affairs Committee report on social care, which found that the typical cost of an individual’s dementia care is £100,000. According to the Alzheimer’s Society, two-thirds of this cost is currently being paid for by people with dementia and their families, either in unpaid care or in paid-for private social care, in contrast to other conditions, such as heart disease and cancer, for which the NHS provides care free at the point of need. People with dementia should not bear the sole responsibility for saving and paying for their care. When will this Government address this key parity of esteem issue, end this disparity and protect people with dementia from the catastrophic costs of care?

[Lord Bethell (Con)]

My Lords, the Prime Minister has made it very clear that he is committed to bringing forward proposals to address this issue before the end of the year. He stands by that commitment. I look forward to the kind of cross-party and cross-society collaboration that will be necessary to address that massive generational challenge.

[Lord Jones of Cheltenham (LD) [V]]

My Lords, as someone who knows the demands of caring for a close relative with dementia, I ask the Government to ensure that there are enough high-quality short-term placements for person-centred dementia care to give carers the chance of an occasional break. Given that person-centred care is at the very heart of the care provided by our hospices, do the Government have any plans to review the sector’s long-term financial situation and move it on to a more sustainable footing?

[Lord Bethell (Con)]

I pay tribute to those who deliver person-centred care. The noble Lord referred to hospices, and I am extraordinarily touched and impressed by the way in which they delivered on an enormously difficult task during the pandemic. We debated earlier the financial arrangements around hospices and the delicate state of their finances. We continue to be in touch with the industry and will take whatever measures necessary to ensure its financial stability.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain what plans the Government have to invest in socially rented supported housing for people with early dementia? It is very clear that this would reduce short-term admissions to acute hospital beds, which will be necessary in order for us to meet the challenges that the NHS faces with current waiting lists. If the Government have no plans for considering this kind of supported housing, which many people who can afford it purchase for themselves, can the Minister assure us that he will ask the Government to consider this issue?

[Lord Bethell (Con)]

My Lords, the noble Baroness puts the case for supported housing social care for those with low levels of dementia extremely well. It is slightly beyond the purview of the Department of Health, but the case she makes is strong. I would be glad to go back to the department and find out if any measures are taking place.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

[Inaudible.]

--- Later in debate ---

[Lord Curry of Kirkharle (CB) [V]]

My Lords, I hope I am unmuted. The impact of Covid has reinforced the evidence that early detection and intervention can help defer the worst impacts of dementia and significantly help with the quality of life of those affected, their families and carers. Can the Minister reassure the House that this will be given priority in the long-awaited social care Bill?

[Lord Bethell (Con)]

The noble Lord hits the nail on the head. Our entire response to the pandemic has taught us that early intervention and diagnostics are absolutely critical, and that is at the very centre of not only the NHS Long Term Plan but the departmental priorities for the years ahead. This can indeed make a huge difference to the treatment of and prognosis for those with dementia, Alzheimer’s and Parkinson’s, and we are very much focused on taking that forward.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked. We now move to the next Question.

Office for Health Promotion

Lord Bethell Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Moynihan (Con) [V]]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and reinforce all the plaudits rightly directed at our outstanding Lord Speaker.

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

My Lords, we are redoubling our efforts on obesity, mental health, well-being and other aspects of prevention. That is why the Office for Health Promotion will operate from within the Department of Health and Social Care. It will be directed by the professional leadership of the CMO and it will drive forward our prevention strategy. It will focus on reducing health inequalities and its approach will be proactive, predictive and personalised interventions.

[Lord Moynihan (Con) [V]]

This welcome government initiative has the potential to lead on vital cross-departmental work to improve physical and mental health, well-being and active lifestyle measures for all ages. Does my noble friend agree that this agenda deserves a well-being statement and budget from the Treasury, as in New Zealand? Given the critical importance of the nation’s health and the widespread interest shown in this Question, will my noble friend accept a request for an online meeting involving interested Peers and officials appointed to the OHP?

[Lord Bethell (Con)]

My Lords, I absolutely endorse my noble friend’s points. This is an extremely important agenda which we are getting behind in a very big way. I also completely acknowledge and recognise the enormous amount of interest from noble Lords in this agenda; we have taken a number of Questions on this and I celebrate the fact that noble Lords have as much interest as they do. I would be very glad to arrange such a session as my noble friend suggests.

[The Lord Bishop of Carlisle [V]]

My Lords, I too echo all the appreciative comments made about the Lord Speaker. Does the Minister agree that any interventions to address obesity must take account of the complex relationship between mental health and obesity? For example, people who are obese have a 55% increased risk of developing depression over time, and people living with depression have a 58% increased risk of becoming obese. Can we ensure that attempts to remedy one problem do not exacerbate the other?

[Lord Bethell (Con)]

The right reverend Prelate makes an extremely valuable point. He is spot on; these comorbidities are related and dealing with them is complex. It is possible to exacerbate one while trying to cope with another. That is one reason why we are putting so much investment into the cross-governmental effort and why this agenda will be led by a cross-departmental ministerial board, to ensure that that kind of co-ordination happens.

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

My Lords, as the country and the NHS emerge from crisis mode and we understand better that we were disproportionately hit because of the country’s general poor health, I urge the Minister to ensure that the Office for Health Promotion will focus on helping and supporting individuals attain a healthy lifestyle. Will he confirm that, despite what I know to be intensive lobbying, the Government will not water down proposals in the obesity strategy on, for example, advertising on social media and before the watershed and will stick to calorie labelling for alcoholic drinks, restaurants and other food outlets?

[Lord Bethell (Con)]

My Lords, as my noble friend knows, the publication of the consultation on advertising is due soon, and I look to it very much. She is entirely right that obesity, seriousness of illness and death from Covid are clearly related; this has been a wake-up call and we are stepping up to the challenge as of now.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Royal College of Nursing has called for a substantial increase in the number of school nurses to ensure the monitoring and promotion of healthy lifestyles for pupils, so that they are better prepared for learning after substantial absences associated with Covid-19 lockdowns. Can the Minister outline how the Office for Health Promotion will work with the Department for Education to co-ordinate and lead improvements in children’s health, including in school nursing reform?

[Lord Bethell (Con)]

My Lords, I am grateful to the Royal College of Nursing and the noble Baroness for that extremely constructive and thoughtful suggestion. That is exactly the kind of cross-government, inter- departmental suggestion that the OHP will focus on. I will be glad to take that to the OHP and make it clearly.

[Lord Brooke of Alverthorpe (Lab) [V]]

Does the Minister agree that, whichever office is in charge of it, any successful obesity strategy must engage with the so-called hard-to-reach groups in society? As many play the National Lottery, scratch cards and so on, will the Government consider how this link might be used to incentivise and reward players for moves to better and healthier eating, drinking and exercising? As the National Lottery franchise will soon come up for renewal, will the Government consider changing its remit so that it is more focused on health than at the moment, or even consider taking a stake and creating a public/private partnership with a focus on not just cash prizes but better health rewards for the nation?

[Lord Bethell (Con)]

My Lords, Covid has been an extremely important educational experience; we have backed off from using the idea of “hard to reach”. Instead, we try to be much more effective at making ourselves approachable for the kinds of people the noble Lord talks about. He is entirely right that the levelling-up agenda means nothing if it does not mean levelling up health outcomes; we are very focused on addressing the kind of health inequalities he refers to. That will be a central mission of the whole project.

[Lord Scriven (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association. The public health grant to local authorities is 20% lower per head in real terms than it was in 2015-16. Restoring spending per head to this level would require an extra investment of £1 billion. How can poor health prevention and promotion of well-being be achievable and sustainable with such reductions in local public health funds?

[Lord Bethell (Con)]

My Lords, local public health resources have made a huge contribution in the last year through Covid. I pay tribute to those in local public health who have contributed so much during the pandemic. The grant to local authorities is slightly beyond the scope of the Office for Health Promotion, but the noble Lord’s point is very well made.

[Baroness Sater (Con) [V]]

My Lords, I declare my interests as set out in the register. I warmly welcome this new and important government initiative to establish an Office for Health Promotion, leading national efforts to improve the public’s health, particularly through promoting physical activity. Given that we know that physical activity can lead to better health and well-being, has my noble friend had any discussions yet on how the promotion of physical activity will be measured, to help ensure that these improved health outcomes can be achieved?

[Lord Bethell (Con)]

My Lords, there is already considerable co-ordination between the department, DCMS and DfE on exactly that. I highlight the money that has gone from the tax on soft drinks to contribute to funding outdoor activity in schools, which has had an enormous impact. My noble friend is entirely right that physical activity is linked to better health outcomes; that is why it will form part of the agenda for the Office for Health Promotion.

[Baroness Thornton (Lab)]

My Lords, the policy paper does not reference the measures proposed in the childhood obesity plan and the recent Tackling Obesity strategy released last July. I hope that omission is not significant. Can the Minister confirm—I was slightly concerned by his response to the noble Baroness, Lady Jenkin—that the ban on online adverts for foods high in fat, sugar and salt has been watered down? In awaiting the consultation from the advertising industry, is that a “whether” or a “how”?

[Lord Bethell (Con)]

My Lords, consultations are there to have an honest conversation. It would be wrong for me to try to pre-empt the outcome of that consultation from the Dispatch Box.

[Baroness Bull (CB)]

My Lords, the Government have pointed to Singapore’s health promotion board as a model, citing its digital public health schemes such as the national steps challenge or the “Eat, Drink, Shop Healthy” challenge. Is the Minister aware of the risks that gamification and incentivisation of what for many of us are healthy behaviours present to people living with eating disorders? With its responsibility for both obesity and mental health, will the office ensure that eating disorder experts are always involved in planning obesity interventions so that the complex relationship between the two is taken into account?

[Lord Bethell (Con)]

I completely take the point of the noble Baroness. We are extremely conscious of the challenge presented by social media in particular to identity and sense of body image. I know that there is much liaison between Public Health England and obesity and anorexia charities about its marketing to ensure that it hits the right note. We are investing in digital technology to try to get people moving and change their lifestyles; I pay tribute to the team behind Couch to 5K, who have used apps and digital engagement to encourage millions of people to take important steps towards a more active lifestyle.

[The Lord Speaker (Lord Fowler)]

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

Northern Ireland: Flight Passengers and Covid-19

Lord Bethell Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Dodds of Duncairn]

To ask Her Majesty’s Government what steps they will take to ensure that the necessary information about flight passengers who are crossing the border into Northern Ireland from outside the United Kingdom is shared with the Northern Ireland health authorities in order to prevent the spread of COVID-19.

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

My Lords, coronavirus restrictions, including the arrival of international travellers, are led by the Northern Ireland Executive. I am extremely grateful to the Northern Ireland Minister of Health who is working closely with his counterpart in the Irish Government to facilitate the sharing of data for international travellers travelling across the border. The Government continue to support ongoing co-ordination between the UK Government, the Northern Ireland Executive and the Irish Government as part of our collective ambition to drive the virus down.

[Lord Dodds of Duncairn (DUP)]

My Lords, I am grateful to the Minister for his reply. The common travel area is a very positive feature of life between the United Kingdom and the Irish Republic and has been so for many decades, predating our EU membership. Yet there remain serious problems with the Irish Republic carrying out the necessary urgent work needed to allow the sharing of information from Irish passenger locator forms for those transiting to Northern Ireland and to the rest of the United Kingdom. This delay is increasing the risk of the spread of Covid, especially variants coming into Northern Ireland and the UK. The Northern Ireland Health Minister that the noble Lord referred to expressed serious concerns as late as last week, in evidence to the Northern Ireland Assembly, about the dragging of feet. It has been flagged for many months. Will the Minister please raise this at the highest levels of the UK Government and ensure that action is taken to close this problem off?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I recognise the challenge to which the noble Lord refers. It is, of course, a fact that coronavirus restrictions in Northern Ireland are determined by the Northern Ireland Executive as part of the devolution settlement, as I am sure he would recognise. The Secretary of State for Northern Ireland has raised the issue with the Irish Foreign Minister on a number of occasions to press for a resolution, and while the UK Government continue to work closely with the Executive to drive this virus down, we respect that healthcare is a devolved matter. This is a complex issue to resolve, but we are extremely grateful to all parties who are working hard to resolve it.

[Baroness Thornton (Lab)]

My Lords, the truth is that the Northern Ireland Health Minister, Robin Swann, found out that there were cases of the Indian variant of the virus in the Republic of Ireland only from media reports. This is deeply concerning, as was raised by the noble Lord, Lord Dodds. Northern Ireland is part of the UK, so we have the same responsibilities to our fellow citizens in Northern Ireland and therefore it is very concerning. Is the Minister confident that, going forward, mutually beneficial data-sharing processes are in place to ensure that new variants are controlled and do not become seeded and spread in any of our communities?

[Lord Bethell (Con)]

My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.

[Baroness Brinton (LD) [V]]

My Lords, I think noble Lords understand that there have to be special arrangements, and the common travel area seems to work well for most things. The Minister knows that I have asked him repeatedly about the joining up of data of international travellers between whichever border they arrive at, the NHS and the testing system, especially the private testing system, otherwise any self-isolation system will fail. Can the Minister say whether this gap that there was before has now been remedied, so that every part of the NHS can pick up data information from borders, and how it works across all four UK countries? Will he explain a bit more about the CTA arrangements between Westminster, Stormont and the Republic?

[Lord Bethell (Con)]

I reassure the noble Baroness that the data flows between borders, Test and Trace, NHS and JBC work extremely well. I was in the Covid Gold meeting earlier today and we had presentations that captured all the data flows from all those places, and we have extremely good see-through on VOCs, infection rates and bed occupancy. The progress we have made on that area is astounding. Where we have a lacuna is on the transfer of data from Irish travellers to Northern Ireland, and that is something we are working to close.

[Baroness Hoey (Non-Afl)]

My Lords, I share the concerns expressed by the noble Lord, Lord Dodds, and others about data sharing between Northern Ireland and the Republic of Ireland. Will the Health Minister use this opportunity to praise the vaccination programme in Northern Ireland and all those who have made it so successful, from the Health Minister, through the GP surgeries to the many volunteers who have made it so successful? Does this success in Northern Ireland not show how important the union is, and also how important it was that we left the European Union and did not have its regulations on vaccination, as the Republic of Ireland has had?

[Lord Bethell (Con)]

I am pleased to tell the noble Baroness that, as of 27 April, 1.2 million vaccinations have been administered in Northern Ireland, of which 919,000 were first doses and 356,000 were second doses. That is an astonishing figure. I am extremely proud of the figure and very grateful to all those concerned.

[Lord McNally (LD)]

My Lords, I am pleased that the final Question in Question Time today gives us the opportunity to say something about the importance of co-operation between the Irish Republic and the United Kingdom. It is worrying that there is this lacuna; I wonder whether the expertise of the CAA is being brought to bear on it. Are there any problems because we have not yet got digital adequacy with the EU? Is that part of the lacuna? On the broader side, this Question and the earlier Question show that there is a need for a rapid response unit to deal with the genuine problems in the relationship between the Republic and Northern Ireland, and the inevitable consequences of the Brexit decision, which was facilitated by the DUP.

[Lord Bethell (Con)]

My Lords, I reassure the noble Lord that the issue is caused by no lack of friendship or spirit of collaboration between the two Administrations. The CAA and all the relevant authorities have a huge amount of commitment to resolving this. There are legal issues that require Acts of Parliament in Ireland and in Britain in order to resolve this; these are quite substantial legal commitments that need to be timetabled and conducted through Parliament, and that is what is holding things up. I am very grateful to all those who are trying to resolve the issue.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, all supplementary questions have now been asked, and that concludes today’s Oral Questions.

Care Home Occupancy Rate

Lord Bethell Excerpts

Wednesday 28th April 2021 Lords Chamber

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

My Lords, occupancy levels are hard to measure precisely. However, data from providers indicate that occupancy rates in care homes for older people have been adversely affected by the pandemic. We have made over £6 billion available, through grants that are not ring-fenced, to help councils tackle the impact of Covid-19 on services, including adult social care. We have made it clear to councils that this funding can be used to help offset the impact of temporary reductions in occupancy.

[Baroness Greengross (CB) [V]]

My Lords, I thank the Minister for that Answer. The Alzheimer’s Society is reporting that because of care home deaths and restrictions on visits during the pandemic, some families have had to defer placing their loved ones into care homes. Given this, how will the Government support the sector to ensure that occupancy rates rise again, other than by what he just said? How will this be monitored, given that I recently received an Answer to a Written Question that said the occupancy rates in care homes were not held by central government?

[Lord Bethell (Con)]

My Lords, I note the intelligence from the Alzheimer’s Society, but I emphasise it is not the responsibility of central government to raise the occupancy rates of care homes. This area is supplied mainly by the private market. Players may choose to leave the market if occupancy rates fall, and local councils have been provided with more than £6 billion that should be drawn on to support the sector.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, a number of unpaid at-home carers have told me that even though their relatives in dire need of care home residency have been offered places, they have turned them down because of heavily restricted family visits, the invidious 14-day quarantine rule and restrictions even on taking doubly vaccinated relatives for a walk in the spring sunshine. Will the Minister acknowledge that moving to a care home can be distressing, and depriving new residents of family support when settling in will inevitably impact on occupancy? When families liken taking up occupancy to sending relatives to prison, surely it is time to review guidance using today’s data, rather than as though Covid were still rampant and vaccines ineffective.

[Lord Bethell (Con)]

The noble Baroness makes a perfectly fair point. Moving into a care home is a difficult and potentially stressful experience. Moving in at a time of Covid, when, as the noble Baroness rightly points out, there are heavy restrictions, is very difficult. Those restrictions are in place to save lives. They are under constant review, and when the infection rates warrant leaving them behind, we will make that decision.

[Baroness Altmann (Con)]

Will my noble friend join me in commending the excellent work of care staff during the appalling problems that have arisen over the past year during the pandemic? Will the Government urgently investigate the financial stability and debt levels of care home operators, which, too frequently, seem to have no controls on the amount of leverage, excessive debts or lack of equity in the sector?

[Lord Bethell (Con)]

My Lords, I absolutely join my noble friend in commending the incredible contribution of care home staff, domiciliary staff, unpaid care workers and all those who support loved ones, neighbours and residents. The Covid pandemic has shone a light on the selfless contribution of those people. The service continuity and care market review keeps a careful eye on the financial stability of the market. We are in constant contact with some of the biggest providers. The scene we see at the moment is not one that causes a huge amount of concern, but we keep close to the market.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register in relation to the Outcomes First Group quality committee. Can the Minister explain how he will ensure that the Government work with the Care Quality Commission to see how we can deliver a strategy that promotes care home financial stability so that there are sufficient beds available this winter to enable the NHS to deliver suitable care for those on waiting lists, without older people having to go into hospital unnecessarily?

[Lord Bethell (Con)]

The noble Baroness makes a good point. There is always a tension in having enough beds in care so that those who need somewhere to be supported are not sent to hospital, thereby occupying valuable beds that should be used for elective surgery or other more complex and important procedures. We are working closely with the CQC to ensure that the right strategies are in place to deal with that.

[Baroness Wheeler (Lab)]

The Minister knows we have continually raised our strong concerns about the financial stability of care homes. Now, the possibility of increased closures due to falling occupancy rates and the extra costs stemming from the pandemic have exacerbated the precarious situation the sector is in. With the downward trend in the registration of new care homes and the upward trend in closures, is not the resulting net reduction in the number of beds available deeply worrying at a time of known growth in the need for social care provision for older people? Can the Minister reassure the House that in the Queen’s Speech we will, at last, find out about the Prime Minister’s plans for how he is going to fix all this and what is going to be done to deliver long-term funding and sustainability for the social care sector?

[Lord Bethell (Con)]

My Lords, I have heard the noble Baroness and others express their concerns about the sector, but I reassure noble Lords that it is not in overall long-term decline. In fact, the number of care home beds has remained broadly constant over the last 10 years, with 460,000 in 2010 and 458,000 in April 2021. But I recognise the noble Baroness’s question, and it is right that we are going to bring forward recommendations for social care reform by the end of the year.

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

My Lords, a recent National Audit Office report highlighted how the Covid pandemic has adversely impacted the financial viability of care home providers, with occupancy rates falling significantly, as we have heard. Given this, could the Minister say what steps the Government are taking to ensure that the much-needed financial support he has referred to, to stabilise this highly fragmented and fragile sector, gets to the front line and that there is equal treatment for all care home services, irrespective of whether they are local authority-funded or NHS-funded or whether residents are older people, younger adults of privately paying residents?

[Lord Bethell (Con)]

My Lords, we have written to local authorities to make it clear what the funding is there for and to make recommendations on the sort of financial support that may be needed to bridge this moment when occupancy levels have been reduced because of concerned families taking their loved ones out of care homes. That funding is in place, and it is up to local authorities to make their decisions on the matter.

[Baroness McIntosh of Pickering (Con)]

My Lords, what has the impact of the pandemic been on those who choose to receive care in their own homes? With the rise of closures of private care homes and fewer public sector beds being available, have we got the balance in provision right?

[Lord Bethell (Con)]

My Lords, there is an important area of support for those who decide to have care at home. During the pandemic, we did an enormous amount to ensure that there were infection-safe procedures and to reduce the use of itinerant care workers in order to provide safety for those who were at home. Support for those who choose to be cared for at home should be increased. I do not recognise the idea that the number of beds in local authority care has reduced so far, but I am happy to look into the matter.

[Lord Mann (Non-Afl)]

NHS England and Public Health England’s contingency planning for pandemics was strengthened after the SARS epidemic. Will the Minister put in the Library the minutes and documents that show what the NHS policy was in January 2020 on the transfer of people between care homes and hospitals and between hospitals and care homes during a pandemic?

[Lord Bethell (Con)]

My Lords, NHS minutes are published as a routine matter, of course. I would be happy to write to the noble Lord with a link to the right minutes.

[Baroness Jolly (LD) [V]]

Given the reluctance, post pandemic, to going into care homes, one would expect more vulnerable people to require support at home, and this is delivered in part using local authority funding. What advice is being given to the sector by Her Majesty’s Government, and what measures are being taken to ensure that this need can be met?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, as I mentioned earlier, DHSE has written to local authorities explaining how we recommend some of the unring-fenced £6 billion could be spent to support both those in social care residential situations and those at home. That is the correct mechanic for guiding the spending of the money, but it is the responsibility of local authorities, not of central government, to provide the support that the noble Baroness describes.

[The Deputy Speaker (Lord Lexden) (Con)]

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

Folic Acid

Lord Bethell Excerpts

Monday 26th April 2021 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government, further to the reply from Lord Bethell on 23 March (HL Deb, cols 717-20), 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 thank the noble Lord, Lord Rooker, for keeping this issue live. Noble Lords will appreciate that we are in the pre-election period for the Welsh and Scottish parliamentary elections and, as this is a UK-wide consultation, we cannot make any policy announcements at this time. But I can advise that, since my last reply, Ministers have looked at this extremely closely and hope to discuss it promptly with the devolved Administrations after 6 May.

[Lord Rooker (Lab)]

For my 16th Oral Question, may I ask about value for money? Why can the UK Government not use their own estimate in the impact statement for the consultation, which said:

“Preventing an NTD carries a lifetime benefit of up to £3m”


per person with spina bifida? It said that fortification presents

“a significant reduction in NTDs, possibly … equivalent to 150-200 NTDs per year”.

This is every year, not a one-off, so the savings from fortification amount to hundreds of millions of pounds. The work in the United States on the CDC website confirms massive financial savings. Why are the Government so reluctant to save this money?

[Lord Bethell (Con)]

My Lords, I would be glad to take the noble Lord’s recommendation back to the department; he puts it extremely persuasively. As I said, we have looked at the substantial point closely and it is extremely persuasive, as the noble Lord rightly put it. We hope to come forward with recommendations as soon as the elections are over.

[Baroness Thornton (Lab)]

I reinforce what my noble friend Lord Rooker said. I may be addressing this with my third or fourth Minister. I am not certain whether the noble Earl, Lord Howe, dealt with it when I was opposite, but he may have done, which would make the noble Lord my fourth Minister on this issue. It is even more irritating that it was research in the UK that led the United States and other parts of the world to adopt this policy. I think The Minister has run out of road on this one, and I would like to hear what the timetable to implement this policy is.

[Lord Bethell (Con)]

I completely endorse the tribute of the noble Baroness to those who have worked on this policy. She is right: the science that has gone into this has been persuasive around the world. I thank those in industry who worked with us on our pilot, which proved extremely successful. We are in good shape when it comes to thinking through the implementation of such a policy. My hands are tied at the moment, because of purdah, but I hope to return and fulfil the noble Baroness’s wishes.

[Lord Dodds of Duncairn (DUP) [V]]

I congratulate the noble Lord, Lord Rooker, and other noble Lords on their tireless work on this issue. As former co-chair of the all-party group on folic acid fortification of flour in the other place, I remember the campaign to bring about the consultation well. As the parent of a son born with a neural tube defect, I am keen to see the Government act as quickly as possible to prevent avoidable births of children with such a condition. For the sake of the unborn and their families, can the Minister give a categoric guarantee that, after 6 May, when the elections are out the way, we will finally get definitive action and definite proposals?

[Lord Bethell (Con)]

My Lords, I join the noble Lord in paying tribute to all those who have worked so hard, particularly the noble Lord, Lord Rooker, who has delivered a playbook campaign on this. Being on the receiving end, I pay tribute to the grace, persuasiveness and energy with which he has conducted that campaign. He is not the only one, and I pay tribute to the personal testimony of the noble Lord, Lord Dodds— what a moving story he has just told. All who have been involved in these sorts of conditions would have been touched by that. I cannot deliver the categoric guarantee that he asks for but, as I said, we are looking at it extremely carefully and I hope to return soon.

[Baroness Wyld (Con)]

I join my noble friend in paying tribute to the noble Lord, Lord Rooker, for his campaign. I urge him to keep up the pace. While the Government are looking at that, we surely need more creative public information campaigns to raise awareness of the importance of folic acid, particularly when communications around health have, under- standably, focused on the pandemic. What work have the Government done with HCPs, in practice, to make sure that women are fully informed?

[Lord Bethell (Con)]

My noble friend is right: with half of pregnancies unplanned or unexpected, it is entirely right that we should seek to raise issues such as folic acid. The Government are committed to the preventive agenda, and folic acid is just one among many examples where we hope to mobilise public interest in looking after their own health to avoid these kinds of conditions. Her point is extremely well made.

[Baroness Jolly (LD) [V]]

My Lords, the department’s website states:

“More than 60 countries worldwide now add folic acid to their flour, including Australia, Canada and the US.”


It goes on to say:

“In Australia, neural tube defects fell 14%”.


This would save 400 babies a year in the UK. The department has spent the last year making Covid-related decisions in our best interests. Given the Minister’s comments, can we expect an announcement by the end of June?

[Lord Bethell (Con)]

The noble Baroness puts the statistics persuasively. The numbers I have are slightly different, but her gist is right. I hope to return after purdah to revisit this important subject.

[Lord Moynihan (Con) [V]]

As the noble Baroness, Lady Jolly, just said, does the Minister agree that it is high time that we followed Australia, which mandated the addition of folic acid to wheat flour for making bread? As long ago as 1988, folic acid fortification of all enriched grain product flour was fully implemented in the United States and Canada. It is time to say yes to the long-running campaign of the noble Lord, Lord Rooker; it should be a departmental priority on 7 May.

[Lord Bethell (Con)]

I reassure the noble Lord and others who have pressed this point that it is a departmental priority. There has of course been a pandemic and that has slowed things down. I cannot avoid that fact, but we are very much returning to the prevention agenda in the round and the issue of folic acid in particular.

[Baroness Hayman (CB) [V]]

My Lords, the Minister will understand the frustration in the House at the repeated delays in implementing a policy that has the opportunity substantially to reduce the scale of suffering that goes on, because of our failure to implement the implications of research that, I remember and as has been said, showed the benefits of fortification in the 1980s. It is desperately dispiriting to know that that research has been taken up by other countries, but not the UK. I press the Minister and suggest that it would be extremely helpful if the meetings that he has said need to take place with the devolved Administrations could be arranged now. Perhaps he could write to the noble Lord, Lord Rooker, copying the letter to other noble Lords, to tell us exactly when the meetings that he has described are scheduled.

[Lord Bethell (Con)]

I hear the frustration loud and clear and reassure the noble Baroness that we are working on this at pace.

[Lord Rennard (LD)]

My Lords, in response to numerous questions and debates on this subject over the years, no Minister has ever produced a satisfactory explanation of why we do not add folic acid to flour. Would it have made any difference if the folic acid suppliers had had the Prime Minister’s mobile phone number?

[Lord Bethell (Con)]

No.

[Baroness Altmann (Con)]

My Lords, I too congratulate the noble Lord, Lord Rooker, on his relentless campaigning on this issue and join others in encouraging my noble friend to, as soon as possible, ensure that manufacturers are mandated to add folic acid, so that we can prevent the misery and heartache of dealing with neural tube defects. I also ask my noble friend whether we can make sure that this applies to all kinds of flour, including gluten-free flour, for those mothers-to-be who are not able to have normal bread.

[Lord Bethell (Con)]

My Lords, I understand that considerable efforts have gone into ensuring that folic acid is put into flours of all kinds, and I pay tribute to the industry for trying to deliver a comprehensive service. I am happy to write to the noble Baroness to confirm that.

[Lord McColl of Dulwich (Con)]

My Lords, as fluoride has been added to drinking water to reduce dental caries, surely the Minister agrees that preventing spina bifida is more important, as a former colleague of mine, Professor Richard Smithells, pointed out nearly 60 years ago. Is it not time to act?

[Lord Bethell (Con)]

My Lords, I take on board the point that it is time to act. That is why we are working hard on the matter. As I said, I hope to return to the House on this soon.

[The Lord Speaker (Lord Fowler)]

My Lords, all supplementary questions have been asked; congratulations to the Minister. We now move to the third Oral Question.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Lord Bethell Excerpts

Monday 26th April 2021 Lords Chamber

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

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for tabling the Motion on this topic. I also take this opportunity to express our profound thanks to community pharmacies. The noble Lord, Lord Hunt, put it extremely well. They are an absolutely key part of our NHS family, and they have risen monumentally to the many challenges brought by this pandemic. Community pharmacies adapted early to working in a Covid-secure way. As has been noted earlier, they stayed open and continued to serve their communities by providing vital pharmaceutical services, typically one billion prescriptions per year. My noble friend Lady McIntosh put it very well; they absolutely stepped up when needed, including by opening on bank holidays, implementing a medicines delivery service and, more recently, as part of the Covid-19 vaccination programme and the lateral flow distribution service Pharmacy Collect.

Pharmacies are a trusted resource at the heart of our communities, an easily accessible part of the NHS, and are highly rated by the public. I am saddened by the Motion which expresses regret that the National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services)(Coronavirus)(Amendment) Regulations 2021 do not address the funding problems faced by community pharmacies. This statutory instrument amends existing legislation to ensure that if a treatment for Covid-19 or another pandemic disease is identified as suitable for use outside hospitals, it can be accessed easily and by as many people as possible without needing to pay a prescription charge or to go to a pharmacy. I assure the noble Baroness, Lady Brinton, that pharmacy contractors will be remunerated for the services in question. Fees for these services, as always, are subject to negotiations with the Pharmaceutical Services Negotiating Committee.

Noble Lord will recall, I hope, that in July 2019 a landmark five-year deal was agreed with the sector—the community pharmacy contractual framework. This deal commits almost £2.6 billion each year to community pharmacy. It is a joint vision of the Government, NHS England and the PSNC for how community pharmacy will support delivery of the NHS long-term plan. Over the period of the five-year deal, community pharmacy will be more integrated into the NHS, deliver more clinical services and become the first port of call for many minor illnesses. This will take pressure off other parts of the NHS, as has been noted by noble Lords. Good progress is already being made on this journey. For example, since 2019 NHS 111 has been able to refer patients to a community pharmacist for minor illness or for the urgent supply of a prescribed medicine. At the end of last year, we extended the service to GP surgeries, which can now also formally refer patients to community pharmacy for consultation. We are exploring extending this service to other parts of the NHS. We also recently introduced the discharge medicine service, enabling hospitals to refer discharged patients to a community pharmacist for support with their medicines. I expect more services to be introduced in the new financial year.

I am very well aware of the pressure that community pharmacists are under, like much of the NHS, particularly during the pandemic. Throughout the pandemic, the Government have worked with community pharmacy, putting in place a comprehensive package of support for the sector. Most community pharmacies have been able to access general Covid-19 business support, including business rate relief, and retail, leisure, and hospitality grants. We estimate that community pharmacies have had access to some £82 million in grants.

We have provided extra funding for bank holiday openings and the medicines delivery service for shielded patients and a contribution towards pharmacies adopting social distancing measures. We have provided personal protective equipment free of charge; this provision has just been extended to March 2022. We have also reimbursed community pharmacies for PPE purchased previously. We have provided non-monetary support, such as the removal of some administrative tasks, flexibility in opening hours, support through the pharmacy quality scheme for the sector’s response to Covid-19 and the delayed start of new services.

Between April and July 2020, a total of £370 million in extra advance payments was made to support community pharmacies with cash-flow pressures due to Covid-19. These cash-flow pressures were caused by several issues, including a sharp increase in prescription items in March and April 2020, higher drug prices, delayed payments from the pharmacy quality scheme and extra Covid-19-related costs incurred by the sector.

Acting quickly and providing the sector with £370 million in extra advance payments helped alleviate immediate cash-flow concerns. It also gave the Government time to address the causes of the cash-flow pressures. I hear the calls from the noble Lord, Lord Hunt, for the Government to write off this money and for further financial support for this valued sector, but our healthcare system is under huge financial pressure. We do not have a limitless supply of funds, so I cannot make the commitments he asks for.

I reassure my noble friend Lady Wheatcroft that community pharmacies have been paid for the increased items they dispensed. Reimbursement prices have been increased to reflect higher drug prices, and payments have been made under the pharmacy quality scheme. However, the department is still in ongoing discussions with the PSNC. To reassure the noble Baroness, Lady Thornton, these will cover the reimbursement of Covid-19 costs incurred by community pharmacies. I reassure noble Lords that the Government will take a pragmatic approach. I expect any agreed Covid-19 funding to be deducted from the £370 million of advance payments to be recovered from community pharmacists.

As my noble friend Lady Wheatcroft put so well, in England the 11,192 community pharmacies have played and continue to play a vital role in the response to the pandemic. We need community pharmacies to be financially sustainable to continue to do so, whether for everyday care or in emergencies. I am aware of concerns that the current funding is not enough. The department wants to work with the sector to look at this in more detail.

I have absolutely heard the concerns of the noble Lord, Lord Hunt, about pharmacy closures. I reassure noble Lords that we are monitoring the market very closely. Our data shows that, despite the number of pharmacies reducing since 2016, it must be recognised that there are still more pharmacies active today than there were 10 years ago. Proportionally, the closures reflect the spread of pharmacies across England, with closures tending to be where pharmacies have clustered. We monitor these closures closely. In the most recent 12 months we have data for, we saw that three-quarters of the closures were of pharmacies that were part of large chains. This data aligns with the consolidation announcements by those large chains before the Covid-19 pandemic.

Government data also shows that the increase in homeworking during the pandemic has led to a change in the pattern of pharmacy use, with more people making use of community pharmacies local to where they live. It is important that we protect this access to pharmaceutical services. Therefore, our pharmacy access scheme protects access in areas where there are fewer pharmacies and higher health needs so that no area is left without access to local, physical NHS pharmacy services.

We are about to begin negotiations with the PSNC over service developments for this financial year, having recently shared our proposals. They are confidential negotiations; I will update Parliament once they conclude.

The past year has been extraordinarily challenging for the NHS, including for community pharmacies. They have risen splendidly to the many challenges brought by the pandemic and have shown great resilience. We expect 2021-22 to be the year in which we recover from the pandemic and build on the work already achieved in the previous two years of the five-year deal. Our plans and proposals take the impact of Covid-19 on the sector into account, in terms of both the challenges and the opportunities the pandemic has presented.

In response to the questions from the noble Baroness, Lady Brinton, on the current negotiations, I reassure her that the upcoming negotiations between the department, supported by the NHS, and the PSNC are the opportunity for the sector to raise concerns and discuss what can realistically be achieved. When we talk about the funding of community pharmacy, it is important to recognise that Covid-19 is also an opportunity for it. I completely agree with the noble Baroness, Lady Barker, on the new ways of working. The pandemic has shown us the value of our incredibly highly skilled community pharmacy teams, and how they can contribute more and receive more funding as a result.

For instance, we commissioned community pharmacies to operate the medicine delivery service for shielded patients. This has been vital to help ensure that the vulnerable in our communities continue to receive their medicines safely. This has since been extended to people who are self-isolating. Another example is that we have delivered our biggest vaccination programme ever because of Covid-19; community pharmacies have vaccinated more people than ever before. Some 300 pharmacy-led Covid-19 vaccination sites are currently live and we are, of course, considering the important role that community pharmacy can play in future phases of the programme. In addition, community pharmacies are now offering a lateral flow distribution service, Pharmacy Collect, making those tests readily available at pharmacists across the country. It is proving extremely popular. These are examples of how community pharmacy is supporting the fight against Covid and how the Government are making better use of the clinical skills of pharmacists, while giving community pharmacies an opportunity to generate more income above the £2.6 billion per year in the five-year deal.

In conclusion, this Government completely understand the value of community pharmacies and this Minister most definitely does. With four children, I am utterly dependent on the Nashi Pharmacy on Westbourne Grove by day and the Bliss Pharmacy at Marble Arch by night. I pay personal tribute to the thoughtfulness and clinical insight of those important resources.

I understand the noble Lord wanting to use every opportunity to raise this important issue and to ensure that community pharmacies are adequately funded. This issue was debated in the House of Commons only last month. I can reassure noble Lords that the Government have heard the concerns expressed today. We are committed to working with the sector on a sustainable funding model for all community pharmacies. We are about to enter negotiations with the sector about what it can deliver this year. I hope that this reassurance is sufficient for the noble Lord to withdraw his Motion.

Body Mass Index

Lord Bethell Excerpts

Thursday 22nd April 2021 Grand Committee

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

My Lords, I too am enormously grateful for the successful efforts of the noble Lord, Lord Addington, in securing this important and insightful debate. Any debate on our weight, health and fitness is extremely personal and bound to arouse emotions. It certainly does in my household, and so it does in this Room. I very much welcome, though, a national conversation about these issues. It is the right time to be having it.

As noble Lords have pointed out, we face two major challenges. The first is that too many people are overweight or living with obesity. I have already spoken this week about this grave challenge faced by this country, which was clearly outlined by the World Obesity Federation report on Covid death. That is a real wake-up call. The Government have already swung into action to a degree. More is planned. We are trying our hardest to address the knotty problem that few countries have ever completed successfully.

The second issue that the country faces is that too many people have eating disorders that make their lives a misery and threaten their health. I am grateful to noble Lords who have spoken movingly on this subject. Although she did not speak this afternoon, I reference the noble Baroness, Lady Bull, who recently arranged a stakeholder session with me that gave me first-hand testimony from those seeking to address these important issues.

I fear that poor old BMI, the much-maligned metric and subject of this debate, has in some ways become a surrogate and a scapegoat in a battle between two groups that see these two big issues—obesity and eating disorders—as somehow in conflict with each other. I do not want to take sides in any such battle. While I always welcome policy dialectic and the battle of ideas to hammer out the most sensible policy on complex issues, I do not think this should be a zero-sum game with winners and losers on opposing sides. Instead, I would like to work towards finding a way through, because it is imperative that, as policymakers, government Ministers understand the impact of our policies in one area on our policies in another area and somehow find a way of tackling them both in a complementary fashion.

Before I try to do that, let me say a few words in defence of the poor old maligned metric, BMI. It is, as noble Lords have pointed out, a very simple calculation—body weight divided by the square of height. It has been used by the National Institute for Health and Care Excellence, the World Health Organization and countless health organisations around the world for decades as just this: a simple first step to establish if individuals might be carrying too much or too little body fat for their long-term good health. To answer the noble Lord, Lord McNally: as risk assessments go, BMI has proven value year after year, study after study, in countries around the world, for predicting premature death and many chronic diseases, including type 2 diabetes, some cancers and some heart disease. As my noble friend Lady Jenkin rightly pointed out, it is simple to measure and highly reproduceable. It does not require specialist equipment or clinical training, unlike many methods of assessment noble Lords mentioned.

None the less I recognise, as the noble Lord, Lord Addington, pointed out, that it is not perfect for all people. Muscly athletes are considered too fat, and it is problematic for the very old. It is not unique, and, as the noble Lord, Lord Thomas, pointed out, a measuring tape around the waist is also very insightful. But it works for most people very well. The reality is that most people who have a high BMI are also at risk of ill health and premature death. When establishing an individual’s health risk, the noble Lord, Lord Brooke, is right: health professionals must use follow-up measures and assessments as well, such as waist circumference. NICE is crystal clear about this and, as my noble friend Lady Wheatcroft pointed out, BMI is just the recommended first step in the assessment pathway.

I hear the noble Baroness, Lady Parminter, loud and clear. I have read the stories to which she referred. I am extremely disappointed by them. It is not right and it is not recommended in the eating disorder commissioning guide. I agree that we need to listen to patients much better. I agree completely with my noble friend Lady Altmann that, in such cases, mental health assessments are absolutely essential. Similar safeguards apply to assessing whether someone is underweight, and of course it is absolutely true that conditions such as anorexia and other eating disorders require specialist assessment. NICE is looking at ways to improve the metric for ethnicity and other factors. None the less, given the large international evidence base underpinning BMI, its simplicity and its wide international use, I do not see it as likely that there will be wholesale change.

BMI is an essential tool in our battle against obesity. We have a huge problem in this area: six out of 10 adults and more than one in three children aged between 10 and 11 are overweight or living with obesity. In my briefing, I have page after page on the impact of obesity on the lives and futures of British families. It has a huge impact on the NHS, the causes of cancer and the causes of diabetes. It has an impact on women: obese women are 12.7 times more likely to develop type 2 diabetes and three and a half times more likely to have a heart attack than women who are a healthy weight. I could go on and on.

As the noble Baroness, Lady Redfern, rightly explained, it is children who are overweight or living with obesity who are sometimes affected the most. In particular, many experience bullying, low self-esteem and a lower quality of life. They are more likely to continue to be overweight or living with obesity into adulthood, which in turn increases their risk of type 2 diabetes, cardio- vascular disease and other chronic illnesses. We must do something to address this issue.

As the noble Lord, Lord Brooke, and my noble friend Lady Jenkin rightly said, during the pandemic we have seen a stark illustration of the impact of living with obesity. That is why we are acting. To answer my noble friend Lord Bourne, we are tackling the nation’s obesity with a new strategy. Published in July last year, it set out measures to get the nation fit and healthy, protect against Covid-19 and protect the NHS.

As my noble friend Lady Jenkin pointed out, there are many nudges in shops, on TV, on computers and on phones that encourage us to buy less healthy food. The Government are committed to restricting further the advertising of less healthy food on TV, and we are considering online restrictions on the promotion of less healthy food in shops. We are also committed to calorie labelling in restaurants and improving front-of-pack labelling on pre-packed foods. These actions are about helping people to make healthy choices.

At the same time, there is another issues that we must face: the national crisis around body identity and self-confidence, which, in some, manifests itself as extreme eating disorders or as mental health challenges. The Women and Equalities Committee report put it extremely well. Acute anorexia is a particularly distressing mental health condition that can ruin lives and cause horrible worries for the families of those concerned. That is why our mental health recovery plan is putting £500 million into work to ensure that we have the right support for people with mental illness, and I am encouraging further policy on positive body imagery.

I want to make my point clearly: I am concerned that there is a perception that these two agendas are somehow at odds with each other—that if we put calorie counts on menus, we will somehow trigger mental health episodes for those with eating disorders or reinforce a damaging body image culture, or that if we push our message on healthy lifestyles too much, we will stigmatise those with sensitivities about their body image. I simply do not accept that this needs to be the case. While I do not discount people’s lived experiences, it is important that we know what we are buying. The calorie count of everyday food available in fast-food chains is often absolutely shocking. The food we grab on the go or have delivered to our homes is now a big part of our diet, yet there is huge ignorance about what that food contains.

Collectively, we need to somehow work a way through this. The maths of it are really simple: there are 725,000 people with eating disorders in the UK. That number may be higher, as I recognise that some struggle to seek support and are not included in the figures. We must do everything we can to bring them the clinical support they need to address their significant mental health issues, so that they can live resilient lives and deal with the stresses of everyday living. At the same time, there are millions of schoolchildren and young people living with poor mental health. My DCMS colleagues are doing everything they can to address the challenges of social media in their lives.

In addition, there are 28.9 million adults in England who are either overweight or living with obesity. Somehow, we need to inspire those people to take on board a healthy lifestyle, which means changing their diets and taking more exercise. These are tough decisions that people can only make for themselves. It is not our business to deal in shame; we are dealing in honesty. That is where the BMI comes in, because it is a simple, unequivocal and, for most people, accurate predictor of risky lifestyles.

It is not beyond our intellectual capabilities to find a way through this conundrum. I am hugely grateful to the noble Lord, Lord Addington, for bringing us the opportunity to debate these sensitive subjects, and I hope very much that we can work together to find an answer to this challenge.

[The Deputy Chairman of Committees (Baroness Healy of Primrose Hill) (Lab)]

The Grand Committee stands adjourned until 3.30 pm. I remind Members to sanitise their desks and chairs before leaving the Room.

Alcohol Harm Commission: Report 2020

Lord Bethell Excerpts

Thursday 22nd April 2021 Grand Committee

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

That is a tremendous challenge by the noble Baroness. I will do my best, but before I do, I congratulate the noble Baroness, Lady Finlay, on securing this important debate. I commend her on her commitment to reducing alcohol-related harm and I pay tribute to her and her team for spearheading the excellent report of the Commission on Alcohol Harm. I welcome the report’s recommendations and the opportunity to debate them. Before I make progress, I shall make a disclosure that my wife is a director of the company Diageo.

I acknowledge the report’s emphasis on wanting to change the conversation within society about alcohol and challenge alcohol’s position in our culture. Alcohol is not something which affects only the “weak” or “irresponsible”. It affects many people. We know that most people drink responsibly. I take on board the warnings of the noble Lord, Lord Smith, and the noble Baroness, Lady Fox, that we must be careful about overstating the specific dangers of alcohol or demonising those who drink responsibly. There is some good news in this area: we are seeing an overall decrease in the amount of people drinking, especially young people, which is highly encouraging. But we cannot avoid the fact that there are still those who drink at very harmful levels and where alcohol misuse leads to significant harms for the people involved and their families. I speak as one whose mother died of her alcoholism when I was of a young age, and I know from personal experience the huge impact that alcoholism has on those concerned and their families.

We recognise that there is still much work to be done. I completely agree with the rapporteurs that alcohol has large impacts on society that include costs to health, lost productivity and poor quality of life. Excessive alcohol consumption is the biggest risk factor attributable to early mortality, ill health and disability among 15 to 49-year olds in the UK—full stop. It is considered to be the third-largest lifestyle risk factor for preventable diseases in the UK, after smoking and obesity.

The Government are committed to supporting the most vulnerable at risk from alcohol misuse. We have an existing agenda on tackling health harms from alcohol, and I would like to touch on some of that today.

I completely hear the call of the noble Baroness, Lady Finlay, for a new government alcohol strategy. The Government have committed to publishing a new UK-wide, cross-government addiction strategy. This will consider a range of issues, including drugs, alcohol and problem gambling and will involve many departments at the same time. While each comes with its own set of issues, there are large amounts of common ground and significant benefits in tackling addiction in a comprehensive and joined-up way. The scope of this addiction strategy is still being developed, so this debate is most timely as we consider what more can be done to protect people from alcohol-related harms.

On alcohol labelling, the Government completely agree with the noble Baroness, Lady Randerson, that people have a right to accurate information and clear advice about alcohol and its health risks to help them to make informed choices. We have worked with the alcohol industry to ensure that alcohol labels reflect the UK Chief Medical Officer’s low-risk drinking guidelines. The industry has committed to complying with this requirement, and we are closely monitoring progress. As part of the Government’s latest obesity strategy, we committed to consulting on the introduction of mandatory calorie labelling on pre-packed alcohol and alcohol sold in the on-trade sector. This consultation will be launched this summer.

My noble friend Lady Jenkin raised the shocking statistic on alcohol-related violence, and I completely agree with her analysis. It is shocking to me that between 2016 and 2018 alcohol was a factor in 66% of violent incidents that took place in the street, pub or club and on public transport; this compares with 30% of violent incidents in the home. Between 2017 and 2019, one in five homicide suspects is recorded as being under the influence of alcohol at the time of the homicide, as is a similar proportion of victims. I have a deep wad of statistics that make extremely grim reading on this matter.

On the specific issue of domestic abuse, we are making progress. We know there is frequent co-existence of domestic abuse, mental health problems and the misuse of drugs and alcohol. Research indicates that in 34% of incidents of domestic violence, the victim perceived the offender to be under the influence of alcohol. The Domestic Abuse Bill will see better protections for victims and more effective measures to go after the perpetrators. We will reflect the importance of joining up domestic abuse, mental health and substance misuse services in the supporting statutory guidance. One action of this important Bill is to establish in law the office of the domestic abuse commissioner, with strong powers to tackle domestic abuse. The description of the commissioner’s role states that they must adopt a specific focus on the needs of victims from groups with particular needs, which could include mental health or substance misuse.

My noble friend Lord Ribeiro asked about restrictions on alcohol advertising. I remind him that there are already substantial restrictions on the advertising of alcohol, but we are working to review and improve them. The Government are working with industry to address concerns over irresponsible promotions, advertising and marketing relating to alcohol. Material in the Committee of Advertising Practice and Broadcast Committee of Advertising Practice codes relating to the advertising and marketing of alcohol products is extremely robust already, recognising the social imperative of ensuring that alcohol advertising is responsible and, in particular, that children and young people are protected. None the less, the Government are reviewing how online advertising is regulated in the UK, taking into account the many serious points made by my noble friend Lord Ribeiro and looking at how well the current regime is equipped to tackle the challenges posed by the development of online advertising.

The noble Baroness, Lady Masham, spoke so movingly about children and family life. The evidence is absolutely clear that growing up in a family affected by parental alcohol dependency can cause significant harm to children’s well-being and their long-term outcomes. Thanks to the personal testimony and campaigning of many noble Lords in the Grand Committee today, the Department of Health and Social Care and the Department for Work and Pensions have together invested £6.5 million on a package of measures, over three years, to improve outcomes and support for children whose parents are alcohol-dependent.

The noble Lord, Lord Rennard, asked pressingly on minimum unit pricing. There are no current plans to implement MUP in England. MUP has been in place in Scotland for less than three years and the Scottish Parliament will not consider its extension until April 2024, when much more will be known about the overall impact on consumption. We will continue to monitor the evidence as it emerges from Scotland and Wales. In the meantime, we are committed to reducing alcohol-related harm and so have already banned alcohol sales below the level of duty plus VAT. This means it will no longer be legal to sell a can of ordinary lager for less than 40p.

I close by reiterating the Government’s commitment to supporting the most vulnerable at risk from alcohol misuse. We already have a strong programme of work under way to address alcohol-related harms, and the new UK addiction strategy will provide an important opportunity to consider what more can be done. This activity will be informed by the best available evidence, including the report from the noble Baroness, Lady Finlay. I thank her very much for pushing so hard on this important issue and securing such a thoughtful, interesting and passionate debate today, and I thank all noble Lords who have taken part.

[The Deputy Chairman of Committees (Baroness Henig) (Lab)]

My Lords, the Grand Committee now stands adjourned until 4.30 pm. I remind Members to sanitise their desks and chairs before leaving the Room.