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.

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.

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.

Covid-19: Obesity

Lord Bethell Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Robathan]

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

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

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

[Lord Robathan (Con)]

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

[Lord Bethell (Con)]

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

[The Lord Bishop of London]

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

[Lord Bethell (Con)]

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

[Baroness Chisholm of Owlpen (Con)]

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

[Lord Bethell (Con)]

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

[Lord Birt (CB) [V]]

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

[Lord Bethell (Con)]

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

[Baroness Thornton (Lab)]

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

[Lord Bethell (Con)]

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

[Baroness Walmsley (LD) [V]]

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

[Lord Bethell (Con)]

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

[Lord Lilley (Con)]

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

[Lord Bethell (Con)]

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

[Lord Bird (CB)]

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

[Lord Bethell (Con)]

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

[The Lord Speaker (Lord Fowler)]

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

Care Homes: Guidance

Lord Bethell Excerpts

Wednesday 21st April 2021 Lords Chamber

[Baroness Jolly]

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

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

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

[Baroness Jolly (LD) [V]]

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

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

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

[Lord Bethell (Con)]

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

[Baroness Wheeler (Lab)]

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

[Lord Bethell (Con)]

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

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

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

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

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

[Lord Bethell (Con)]

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

[Baroness Fox of Buckley (Non-Afl)]

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

[Lord Bethell (Con)]

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

[Baroness Ludford (LD) [V]]

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

“for residents’ health and well-being”.

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

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

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

[Lord Bethell (Con)]

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

[The Lord Speaker (Lord Fowler)]

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

Covid-19: Update

Lord Bethell Excerpts

Tuesday 20th April 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[The Lord Bishop of London]

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

[Lord Bethell (Con)]

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

[Lord Sikka (Lab) [V]]

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

[Lord Bethell (Con)]

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

[Lord Scriven (LD)]

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

[Lord Bethell (Con)]

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

[Lord Sarfraz (Con) [V]]

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

--- Later in debate ---

[Lord Bethell (Con)]

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

[Lord Rooker (Lab) [V]]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Lord Sharpe of Epsom (Con)]

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

[Lord Bethell (Con)]

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

[Baroness Verma (Con)]

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

[Lord Bethell (Con)]

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

[Lord Robathan (Con)]

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

“the bulk of the work in reducing”—

—infections, then Simon Stevens said that

“'Vaccines are successfully reducing hospitalisations and deaths”.

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Lord Cormack (Con)]

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

[Lord Bethell (Con)]

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

[Lord Balfe (Con)]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

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

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Lord Bethell Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Crohn’s Disease and Ulcerative Colitis

Lord Bethell Excerpts

Thursday 15th April 2021 Lords Chamber

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

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

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

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

[Lord Bethell (Con)]

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

[Lord Balfe (Con)]

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

[Lord Bethell (Con)]

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

[Baroness Greengross (CB) [V]]

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

[Lord Bethell (Con)]

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

[Lord Turnberg (Lab) [V]]

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

[Lord Bethell (Con)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Lord McColl of Dulwich (Con)]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Baroness Wheeler (Lab)]

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

[Lord Bethell (Con)]

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

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

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

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

Lord Bethell Excerpts

Thursday 25th March 2021 Lords Chamber

Moved by

[Lord Bethell]

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

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

Motion agreed.