Medicines and Medical Devices Bill

Lord Bethell Excerpts

Consideration of Commons amendments & Ping Pong (Hansard) & Ping Pong (Hansard): House of Lords
Tuesday 2nd February 2021 Lords Chamber

Moved by

[Lord Bethell]

That this House do not insist on its Amendments 2, 3, 12, 13, 14, 23, 24, 25, 30, 40, 48, 49 and 50 and do agree with the Commons in their Amendments 50A, 50B and 50C in lieu.

50A: Clause 42 page 24, line 36, leave out subsections (3) to (9) and insert—
“(3) The procedure for making regulations under Part A1, 1, 2 or 3 is to be determined in accordance with this table and subsection (4)—

If the regulations contain provision madein reliance on	the regulations are subject to
section 5(1)(a)	the negative procedure
section 10(1)(a)	the negative procedure
section 14(1)(a)	the negative procedure
paragraph 9 of Schedule 1	the negative procedure
section 6	(a) the made affirmative procedure, where the regulations contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health
	(b) the draft affirmative procedure in any other case
section 15	(a) the made affirmative procedure, where the regulations contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health
	(b) the draft affirmative procedure in any other case
any other provision of Part A1, 1, 2 or 3	the draft affirmative procedure

(4) Provision that may be made by regulations subject to the negative procedure may be made by regulations subject to the draft affirmative procedure.
(5) Where regulations are subject to “the negative procedure”—
(a) in the case of regulations made by the Secretary of State acting alone, the statutory instrument containing the regulations is subject to annulment in pursuance of a resolution of either House of Parliament,
(b) in the case of regulations made by a Northern Ireland department acting alone, they are subject to negative resolution within the meaning given by section 41(6) of the Interpretation Act (Northern Ireland) 1954, and
(c) in the case of regulations made by the Secretary of State and a Northern Ireland department acting jointly, the statutory instrument containing the regulations is subject to—
(i) annulment in pursuance of a resolution of either House of Parliament, and
(ii) negative resolution within the meaning given by section 41(6) of the Interpretation Act (Northern Ireland) 1954.
(6) Where regulations are subject to the “draft affirmative procedure”—
(a) in the case of regulations made by the Secretary of State acting alone, the statutory instrument containing the regulations may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament,
(b) in the case of regulations made by a Northern Ireland department acting alone, they may not be made unless a draft of the regulations has been laid before and approved by a resolution of the Northern Ireland Assembly, and
(c) in the case of regulations made by the Secretary of State and a Northern Ireland department acting jointly, the statutory instrument containing the regulations may not be made unless a draft of the instrument has been laid before and approved by a resolution of—
(i) each House of Parliament, and
(ii) the Northern Ireland Assembly.
(7) Where regulations are subject to the “made affirmative procedure”—
(a) in the case of regulations made by the Secretary of State acting alone, the statutory instrument containing the regulations—
(i) must be laid before Parliament after being made, and
(ii) ceases to have effect at the end of the period of 40 days beginning with the day on which the instrument is made unless, during that period, the instrument is approved by a resolution of each House of Parliament,
(b) in the case of regulations made by a Northern Ireland department acting alone, they—
(i) must be laid before the Northern Ireland Assembly after being made, and
(ii) cease to have effect at the end of the period of 40 days beginning with the day on which they are made unless, during that period, the regulations are approved by a resolution of the Assembly, and
(c) in the case of regulations made by the Secretary of State and a Northern Ireland department acting jointly, the statutory instrument containing the regulations—
(i) must be laid before Parliament and the Northern Ireland Assembly after being made, and
(ii) ceases to have effect at the end of the period of 40 days beginning with the day on which the instrument is made unless, during that period, the instrument is approved by a resolution of each House of Parliament and by a resolution of the Assembly.
(8) In calculating the period of 40 days for the purposes of subsection (7)(a)(ii) or (c)(ii) in relation to Parliament, no account is to be taken of any time during which—
(a) Parliament is dissolved or prorogued, or
(b) either House of Parliament is adjourned for more than 4 days.
(9) In calculating the period of 40 days for the purposes of subsection (7)(b)(ii) or (c)(ii) in relation to the Northern Ireland Assembly, no account is to be taken of any time during which the Assembly is—
(a) dissolved,
(b) in recess for more than 4 days, or (c) adjourned for more than 6 days.
(10) If regulations cease to have effect as a result of subsection (7) that—
(a) does not affect the validity of anything previously done under the regulations, and
(b) does not prevent the making of new regulations.”

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Moved by

[Lord Bethell]

That this House do agree with the Commons in their Amendments 11A, 11B, 11C and 11D.

11A: After Clause 6, line 6, after “where” insert “—
(a) the disclosure is”

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Moved by

[Lord Bethell]

That this House do agree with the Commons in their Amendments 22A, 22B and 22C.

22A: After Clause 10, line 6, after “where” insert “—
(a) the disclosure is”

--- Later in debate ---

Moved by

[Lord Bethell]

That this House do agree with the Commons in their Amendments 32A, 32B and 32C.

32A: Clause 35, line 3, after “where” insert “—
(a) the disclosure is”

32C: Clause 35, line 8, leave out subsection (4C)

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

My Lords, with the leave of the House, I beg to move that the House do agree with the Commons in their Amendments 11A to 11D, 22A to 22C, 32A to 32C, and 50A to 50C en bloc. I pay tribute to noble Lords on all sides of the House in reaching consensus on the issues dealt with in these amendments. They were put down in the other place after cross-party discussions and I believe they reflect the aims and agreement of the House.

Amendments 11A to 11D, 22A to 22C and 32A to 32C all make minor amendments to Lords Amendments 11, 22 and 32. These amendments, in the name of the noble Baroness, Lady Thornton, made further changes to the clauses allowing the MHRA and the VMD to share information with relevant persons, such as regulators, outside the UK. Lords Amendments 11, 22 and 32 create a new safeguard that information could be shared only when in the public interest or for pharmacovigilance. I thank the noble Baroness very much for her remarks on Report. She made it very clear that the reference to pharmacovigilance was illustrative. Pharmacovigilance is very important, but it is also very much in the public interest and so does not need to be included outside the reference to the public interest. It is already captured. The Commons amendments therefore remove the reference to pharmacovigilance and the purpose of the amendments remains.

The majority of the Commons amendments deal with the variety of ways that noble Lords sought to create means to bring the Bill, and the principles of the Bill, back before Parliament in the future. Three methods were put forward and, in fact, noble Lords eloquently pressed the point on all of them. Lords Amendments 2, 13 and 24, which were tabled by the noble Baroness, Lady Thornton, put forward a sunset on delegated powers. Lords Amendments 3, 14, 25, 30, 48 and 49, which were tabled by the noble Lord, Lord Sharkey, put in the super-affirmative procedure. Lords Amendments 12, 23 and 40, in the name of the noble Lord, Lord Patel, put forward the idea of bringing forward consolidated draft legislation within three years. I do not intend to repeat my arguments against all three; I have said throughout this Bill that we have been listening carefully to all noble Lords who have put forward very clearly their continued concerns.

Commons Amendments 50A, 50B and 50C are an alternative, which I believe we can agree avoids the issue of introducing a “cliff edge” for legislation—and potentially patient safety—but importantly provides the reassurances that noble Lords quite reasonably sought. They collectively create an obligation for the Secretary of State to prepare a report on the operation of the legislation within five years of Royal Assent, and the amendments specify the considerations that must be addressed in that report: first, whether the legislation should be consolidated or restructured; secondly, whether legislation ought to be in regulations or in Acts of Parliament; and, thirdly, whether any of the powers to make regulations should be modified or repealed.

This would mean actively considering all the questions raised by noble Lords. It would give the time needed for making changes to the current legislation governing medicines and medical devices using the Bill’s powers, and allow for those changes to bed down and for those complex areas of law to reach a steady state, before considering these important issues.

The Secretary of State must also take into account any report of a parliamentary committee in preparing that report. This would mean that if any committee—whether your Lordships’ Delegated Powers and Regulatory Reform Committee or the Health Select Committee in the other place—decided to take a view on the operation of the legislation in the intervening time, its conclusions and considerations would have to be taken into account. If any committee should choose to do so, perhaps on the basis of the post-legislative memorandum that must be prepared within three to five years of the Bill being enacted, Parliament will have expressed a view before being presented with the Secretary of State’s report.

I think this is a satisfactory compromise. It meets the principle of parliamentary review without the practical impact on patient safety of powers lapsing. It ensures that Parliament has the ability to express a view and for that view to be heard, without asking for review before it is practicable. Amendment 50A makes the necessary changes to reinstitute the parliamentary procedure changes made at Lords Committee stage, in place of the super-affirmative.

I hope that noble Lords will be content to accept the amendments from the House of Commons. I beg to move.

[Lord Patel (CB) [V]]

My Lords, I am extremely grateful for the amendments that the Government have brought from the Commons. I am grateful to the Minister and his team for working so diligently with the rest of us, and to all noble Lords who supported my amendments. It is not unusual—but it is infrequent—for the votes that the Government did not get through in the Lords to be reconsidered in the Commons and brought back as government amendments. I am very content that the amendments that the Government have brought are very satisfactory and I congratulate them. I thank the noble Lord, Lord Bethell, the noble Baroness, Lady Penn, the noble Earl, Lord Howe, and the legal team for working with us throughout the Bill. That is all I am going to say.

[Baroness Thornton (Lab)]

My Lords, I am very grateful to the Minister and his team for the manner in which they have engaged and worked with us throughout the passage of this Bill, particularly at this final stage. The amendment in lieu is a good compromise that reflects the need for scrutiny to be at the heart of the Bill. It provides a mechanism to examine the powers of the Act in five years’ time and will open the door for the restructuring and consolidation of the post-Brexit medicines and medical devices regulatory regime. We believe that this will prove both desirable and necessary, and look forward to working with the Minister on such issues when the time comes.

We welcome the requirement that the Secretary of State must specifically consider whether this should be in the form of primary or secondary legislation and hope that this will lead to policy being put into a future Bill rather than scrolled away in regulations. The Secretary of State will also have to take account of all parliamentary committee reports. This would include post-legislative scrutiny undertaken by a Select Committee, as well as the DPRRC and Constitution Committee, whose oversight played a crucial role in reshaping a skeleton Bill into a framework Bill; I thank the noble Lord, Lord Lansley, for explaining that to us all. I hope the Minister can assure me that stakeholders will also be consulted. I am sure that that will be the case. It is very important, given that they are the end users of the legislation, and for the report to have value and credibility it must reflect the experience of regulators, industry, patients and medical professionals.

Finally, the tidying-up amendment that retains the requirement to share information in the public interest is an important provision because it will allow for substantive and ethical issues relating to the sharing of public data to be considered. This is of the utmost importance, given the role that the NHS and patient data may have in future trade deals.

[Lord Bethell (Con)]

My Lords, I do not intend to repeat much of what I said at Third Reading. Many thanks to the noble Lords who have contributed to the changing shape of the Bill. From Committee to ping-pong, we have listened, heard proposals for change and brought workable, practicable compromises forward.

I wish to repeat the remarks made by the noble Baroness, Lady Thornton. She congratulated all of us on the effective communication that has made it possible to make considered progress on this Bill, despite all the challenges that Covid-19 has presented us with. This a very fair assessment; I agree with it completely. From the report of my noble friend Lady Cumberlege to the demonstrated expertise of our medicines regulator, the MHRA, we have seen the importance of patient safety, clinical trials, our life sciences sector and effective regulation bear out in our hospitals, clinical trials and patient community.

I look forward to the debates ahead of us on the regulations that will be made under the Bill. They will be important, as we set forward on our course for the best possible regulatory regime for the UK, with the patient at its heart.

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

Noble Lords will be pleased to know that no one has requested to speak after the Minister.

International Year of Health and Care Workers

Lord Bethell Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate the World Health Organization’s International Year of Health and Care Workers in 2021.

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

My Lords, to celebrate the work of health and care workers, there are symbolic interventions, such as the social care workforce CARE brand for shared identity and our powerful recruitment advertising, which highlights the remarkable contribution of health and care workers. However, the most important celebrations are tangible: the investment in new recruitment, the £30 million fund for those seeking mental and occupational health support, and the people plan, which is addressing the practical and cultural challenges that workers face in the workplace.

[Lord Crisp (CB) [V]]

I thank the Minister for that very positive response and I agree with him about concrete measures. The World Health Organization has adopted the slogan “protect, invest, together”, which is very powerful and sets out the priorities very well for this year. The Minister will no doubt be aware that there is discussion at the World Health Organization and elsewhere about the need for a new societal compact with health and care workers to whom we owe so much, perhaps similar to the military covenant. Would Her Majesty’s Government support the creation of a compact or covenant setting out our responsibilities to health and care workers, which mirror and match their professional responsibilities and duties towards us? If they have not considered this, will they do so?

[Lord Bethell (Con)]

My Lords, I applaud the WHO’s values of “protect, invest, together”. One of the commendable things during this awful pandemic has been the way in which British society has reconnected with the values of the healthcare community. It has rediscovered the contribution of nurses, doctors, healthcare workers and those in social care. A new relationship has been forged between civic society and healthcare; this is commendable and we should build on it. On the idea for a compact, it is not something that we are working on at the moment as far as I am aware, but I would be glad to take his idea away and find out whether we can develop it any further.

[Baroness Rawlings (Con) [V]]

My Lords, HMG have supposedly funded 85 schemes with EYN UK to develop a vaccine passport, yet they say they have no plans for one. Will they rethink their no plan-policy and collaborate with the World Health Organization in its International Year of Health and Care Workers by producing a worldwide WHO vaccine passport, perhaps even as an app?

[Lord Bethell (Con)]

My Lords, the Minister for Vaccines has been clear on this: the Government are not currently undertaking work on vaccine certification. However, the noble Baroness makes the case well. Certainly, those who have had the vaccine are very anxious to ensure that they have the correct documentation, and we will ensure that that is in place.

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

My Lords, I declare my roles at Cardiff University. Will the Government create a range of funding streams as overseas aid to ensure that UK universities’ successful distance learning programmes in practical health and care specialities and generalist care are affordable and supported in those countries? Will they work with me and others to invest in better provision of public health, infectious disease control, maternity services, dermatology, palliative care and other services around the globe?

[Lord Bethell (Con)]

My Lords, I pay tribute to the work of the noble Baroness in this important area. Her implied insight is exactly correct. We cannot be healthy and safe here in Britain if there are diseases raging around the world. It is both in our pragmatic self-interest and aligned with our values of partnership with other countries that we should indeed invest in the kind of training and support to which the noble Baroness alluded. I will definitely look into how we could do this better.

[Baroness Pitkeathley (Lab) [V]]

My Lords, the WHO puts health and care workers in the same category. Does the Minister agree that we in the UK do not see them as the same, since workers in the care sector are habitually worse paid, less recognised and more poorly trained and supported than those who work in the NHS? Would not the best way to celebrate care workers be to remedy these discrepancies in the proposals for the reform of social care, which the Minister has assured the House will be brought forward this year?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes a completely fair point. Her observation is entirely right and her recommendation is one that the Prime Minister has made clear is part of his thinking. Social care workers have done a phenomenal job during this pandemic. Their role in supporting the elderly and infirm is extremely valuable to the whole country. It is only right that they should be treated fairly; a review of their pay and circumstances will be part of the social care package when that is announced.

[Baroness Brinton (LD) [V]]

My Lords, the WHO notes with concern the increase in international health worker migration; there are also concerns about their workplace treatment in their host countries. The 14% of brilliant non-British NHS staff are essential in holding up our healthcare systems, as has been especially evident during this pandemic. Last week, there were worrying press reports that hospital trusts were telling non-UK NHS staff without NHS numbers that they were not eligible for the Covid vaccine. Please, can the Minister say whether all NHS staff are eligible for the vaccine—and if he cannot, will he explain why not?

[Lord Bethell (Con)]

I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

[Baroness Wheeler (Lab)]

My Lords, I express our strong support for the WHO statement in recognition of the selfless dedication of health and social care staff to providing care during and despite Covid-19. Following on from the comments of my noble friend Lady Pitkeathley, the WHO statement draws attention to the importance of workforce readiness, education and learning to manage the pandemic and its consequences. Will the Minister explain how the Government are ensuring that both health and social care staff on the front line of social care—particularly care staff, providing vital domiciliary care in the home and in the community—are being given this key support?

[Lord Bethell (Con)]

The noble Baroness is right. Those involved in domiciliary care, particularly part-time, make an extremely important contribution. We are naturally concerned about how they are contracted and their educational needs supported. We would like to think more about how part-time domiciliary care staff in particular, who make such a valuable contribution, can be further supported.

[Lord Moynihan (Con)]

My Lords, does my noble friend the Minister recognise that nurses remain at the heart of the world’s response to the Covid-19 pandemic? As key to the restoration of health systems that have been neglected during the crisis, will the Government support calls by the International Council of Nurses fundamentally to reset preparedness and response systems and work towards the global requirement for an additional 10 million nurses by 2030?

[Lord Bethell (Con)]

My Lords, we massively value the contribution of nurses from all areas. In fact, that recognition has manifested itself in practical terms; we are growing the nursing workforce and are committed to delivering 50,000 more nurses, putting the NHS on a trajectory for sustainable long-term supply in the future. That journey includes giving eligible nursing students an additional £5,000 of funding per academic year. I cannot say more clearly or loudly how much the contribution of nurses to our healthcare system is appreciated. We will do everything we can to ensure that it is recognised.

[The Lord Bishop of Salisbury [V]]

My Lords, in Salisbury we have had good reason to recognise the dedication and sacrifice of health and care workers, both at the time of the Novichok poisonings and in this present pandemic. The use of Salisbury and other cathedrals and churches as vaccination centres indicates a partnership between spirituality and health care, so will the Minister join me in thanking chaplains, among all the dedicated healthcare workers at this time? What we see in this country is in marked contrast with the poorest parts of the world, as in Sudan and South Sudan, with which this diocese is linked. Given that this is a global pandemic, when might the Government recognise the self-interest involved in overseas aid and move to restore the 0.7% of GDP commitment? No one will be safe until everyone is safe.

[Lord Bethell (Con)]

My Lords, the image of the vaccination work in Salisbury cathedral must surely be one of the most powerful images of our times. I found it an extremely touching picture to see those seeking solace in the cathedral and also their vaccination at the same time. I give praise to all those involved. Britain has been utterly emphatic in its contribution to global vaccination. We have given £574 million to developing countries to support those vaccinations. We do that for two reasons. One is self-interest, and the other is to ensure a fair distribution of the vaccines.

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

My Lords, the time allowed for this Question has now elapsed. Apologies to the three speakers I was unable to call.

Covid-19: Vaccines

Lord Bethell Excerpts

Monday 1st February 2021 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to ensure that the second dose of the Pfizer/BioNTech COVID-19 vaccine is delivered to patients within 12 weeks of receiving the first dose.

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

My Lords, the second dose completes the course and is vital for long-term protection. That is why all patients will be offered a second dose between 77 and 84 days after receiving their first. We have already vaccinated almost 9 million people, with the ambition to reach the 15 million people in the most vulnerable groups 1 to 4 by the middle of February.

[Baroness Thornton (Lab)]

I thank the noble Lord for his partial reassurance; however, the question is actually whether there will be a supply available in the timeframe. Given that any unvaccinated area provides a potential pool for new strains of Covid to develop and re-infect the world, extending immunisation to the whole world is not

“only a matter of altruistic engagement,”

but “of enlightened self-interest,” to quote Tony Blair. Does the noble Lord agree that countries must come together to reject vaccine nationalism in favour of co-operation? At what point in terms of vaccination of priority groups will the UK be able to make vaccinations available to other countries that are in need?

[Lord Bethell (Con)]

I completely agree with both the noble Baroness and the former Prime Minister Tony Blair on this matter. Not only must we vaccinate our own country, but we are not safe until the whole world is vaccinated. That is a basic public health and epidemiological observation. It is why we are very committed to international efforts—to CEPI, Gavi, COVAX and ACT. They are all working hard to get fair distribution of vaccines. We have also put £571 million into the funds at COVAX to support vaccines for the developing world. However, we have to start at home and it is not possible to make a commitment on the schedule for when we will be in a position to think about exporting vaccines until that is completed. When it is completed, I will update the House accordingly.

[Lord Winston (Lab) [V]]

My Lords, we welcome the efficiency with which the UK is providing vaccines, but vaccines affect only part of the problem. As my noble friend Lady Thornton and the Minister said, this is indeed a global issue. Prompt diagnosis and early treatment with antivirals will become vital. Time is limited. Can the Minister inform the House what measures the Government are taking to stimulate investment and make urgent research into effective antiviral drugs specifically designed against SARS-CoV-2, which are likely to be easier to distribute in many countries?

[Lord Bethell (Con)]

The noble Lord is entirely right: the vaccines are a hugely important development, but so is investment in all therapeutic drugs. We are extremely blessed to have had a contribution towards dexamethasone, tocilizumab and other therapeutic drugs which have greatly improved outcomes for patients in hospitals. He is right that antivirals also present an opportunity. The reason we have supported research into antivirals through the urgent regime in our clinical trials is to ensure that there is sufficient commitment in hospitals and primary care on antivirals. We are tasking the Therapeutics Taskforce with a specific mandate to look at antivirals and whether we should give greater resources to this avenue of therapeutic development.

[Lord Scriven (LD) [V]]

My Lords, having the second dose of the Pfizer/BioNTech vaccines in the right quantities in the right place at the right time is vital. Will the Minister guarantee that people will be able to get their second dose of it at the local GP hub where they had their first dose administered without being directed to a mass vaccination centre to receive it?

[Lord Bethell (Con)]

In response to the noble Baroness, I said that we were confident that we had the supplies of the vaccines to do the second dose. It is not our policy that anyone has the second dose of anything other than the vaccine they had the first dose of. We will work with people to give them the most convenient place to have the vaccine, but I cannot offer the guarantee that the noble Lord seeks.

[Lord Patel (CB) [V]]

My Lords, while it is important to extend vaccination programmes at home and abroad, the recent reports of emerging mutations of the virus—the South African, Brazilian and the recent Californian mutations—risk significantly increasing transmissibility and serious illness, particularly in younger people. It is extremely worrying, and it may lead to the virus getting around the vaccine-related immunity. We need to be ahead of the curve if we are to avoid serious illness and deaths in the young. What plans do the Government have to mitigate against this?

[Lord Bethell (Con)]

The noble Lord is entirely right; the threat of a vaccine-escaping mutation is very present on our minds. I pay tribute to the word of Sir Patrick Vallance, Clive Dix and all those who are working on this issue in the expert advisory group on vaccines. The noble Lord mentioned the threat of transmissibility among the young. We have already made the commitment of offering a vaccine to all ages. He is entirely right that we may reach a point where it is particularly important to ensure that young people have the vaccine so that they are not responsible for transmitting the disease to those who are more vulnerable.

[Baroness Sugg (Con) [V]]

My Lords, I congratulate the Government on their very impressive vaccine rollout. Bringing in retired doctors, nurses and non-healthcare professionals to be part of the national vaccination effort will be vital to being able to continue to deliver all doses of the vaccine at scale—and, of course, it will help to relieve the pressure on our hard-working NHS workers. Can my noble friend the Minister update the House on the progress of these applications?

[Lord Bethell (Con)]

My Lords, we have tens of thousands—38,000, I think—currently employed by the NHS delivering the vaccine: a remarkable army of people. We have had further offers from hundreds of thousands of people—300,000, I believe—to support the vaccination effort. Those offers are being processed by voluntary groups; I pay particular tribute to the St John Ambulance, which runs an extremely good training programme and has enabled tens of thousands of people to join the vaccination effort. We continue to engage with those offering to help to ensure that they get the training and opportunities to help wherever they can.

[Baroness Donaghy (Lab) [V]]

How can the Government ensure that the second dose of the Pfizer BioNTech vaccine is delivered to patients within 12 weeks? I do not think the Minister answered that part of my noble friend Lady Thornton’s Question. What steps are the Government taking to ensure that this is done, and are there any circumstances in which vaccines would be mixed at the second dose?

[Lord Bethell (Con)]

When you go to have your vaccine, as several noble Lords have done, you are given a card like the one I am holding, on the back of which the date of your second dose is printed. That is how we ensure that people know where and when to go for their second dose. We are working extremely hard to ensure that there are supplies of the second dose, and I am confident that we have the arrangements in place. It is not our policy to give anyone a second dose of an alternative vaccine to their first dose.

[The Deputy Speaker (Lord Haskel) (Lab)]

I call the noble Lord, Lord Willis of Knaresborough. No? I call the noble Baroness, Lady Deech.

[Baroness Deech (CB) [V]]

My Lords, how can the Minister overcome the reported suspicion of the Covid vaccines among ethnic minorities and, of course, the anti-vaxxers, no doubt fuelled by President Macron’s unfounded attack on the effectiveness of the AstraZeneca vaccine?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to be concerned, but I can report from the front line that concerns about the impact of anti-vaxxers have not materialised in a huge impact on confidence. I pay enormous tribute to all those in civic society and religious groups in all parts of Britain who have done a tremendous job of ensuring that groups and communities who might once have been suspicious of a vaccine supplied by the British Government have instead turned up in droves. I am extremely confident that the message has got across: this is a safe vaccine, everyone who qualifies should take it, and you should trust the Government and the NHS to supply it.

[Lord Mancroft (Con) [V]]

My Lords, I join my noble friend Lady Sugg in congratulating the Government on their outstanding work in rolling out this vaccine programme. As I am a bear of very little brain, can I ask my noble friend to explain: if we are to maintain the current level of first vaccinations and at the same time start giving second doses to those who have had their first, will we not have to double our capacity to give vaccinations over the next month or six weeks? Are the Government confident that they can achieve that?

[Lord Bethell (Con)]

My noble friend is entirely right: from March, we will have considerably more work both to deploy the second dosage and to supply it. We have those plans absolutely in place: the supply of the vaccine has been put in place to ensure that we have a sufficient number of doses, and the workforce and locations are in place to ensure that we can deliver them.

[Lord Rogan (UUP) [V]]

My Lords, among Northern Ireland Health Minister Robin Swann’s many achievements since the start of the pandemic, he has overseen the establishment of seven regional centres across the Province where the Pfizer Covid-19 vaccine is now administered. I understand that a further significant consignment of the AstraZeneca vaccine is due in Northern Ireland this week for distribution to general practitioners. Can the Minister assure me that the Province’s stocks of the Pfizer vaccine are also being replenished to allow the regional centres to continue their excellent work at the fastest possible pace, including the delivery of a second dose?

[Lord Bethell (Con)]

I join the noble Lord in paying tribute to the good work of the Northern Ireland Health Minister, Robin Swann, whom I commend for his collaborative approach during this entire pandemic. I reassure the noble Lord that we are allocating doses on the business-as-usual, Barnett formula split, with 2.85% going to Northern Ireland. I pay tribute to the NHS there, where 214,601 people have had their first dose. A further 24,323 have had their second dose, and I reassure the noble Lord that we will maintain that velocity of delivery in the weeks to come.

[Lord Clark of Windermere (Lab) [V]]

My Lords, when I received the Pfizer vaccine, I was given a leaflet that stated

“you should receive a second dose of the same vaccine … 21 days later to complete the vaccination series. Protection against COVID-19 disease may not be … effective until at least 7 days after the second dose.”

Now that 21 days has been extended to 77 to 84 days, what is the efficacy of the vaccine after a gap of six weeks and three months?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I congratulate the noble Lord on having his vaccine so early, and I share his concern on this matter because those who had their first dose early received a leaflet of exactly the kind he described, and, since then, the CMO’s advice has changed. I reassure him that, using data for those cases observed between days 15 and 21, efficacy against symptomatic Covid-19 for the Pfizer vaccine was estimated at 89%. Those kinds of statistics reassured the CMO to change the date to three months, and I reassure the noble Lord that he is in safe hands.

[Baroness Fookes (Con) [V]]

My Lords, I am perfectly happy with waiting for the three months, but I am concerned about people over the age of 80 who are living in their own homes, rather than retirement homes, who I understand are not yet receiving the vaccine. I can understand that it would be difficult to go to individual homes, but can my noble friend tell me what the position is?

[Lord Bethell (Con)]

I reassure my noble friend that we have put in place a systematic arrangement to visit care homes and those living at home with domiciliary care in order to bring the vaccine to their homes. That system includes GPs, community pharmacists and, where necessary, mobile vaccination units. It is proving to be extremely effective. The big numbers will be delivered by the mass vaccination centres, but we will not overlook those who cannot move from their home.

[Lord Craig of Radley (CB) [V]]

My Lords, what information does the Minister have about individuals who may have tested positive for Covid-19 after their first vaccination, either because they are a carrier but healthy or because the first vaccination—which statistically is not 100% successful—did not work?

[Lord Bethell (Con)]

My Lords, the noble and gallant Lord touches on a number of connected issues. The first vaccination does take a little bit of time; depending on which vaccination is administered, it takes between one and three weeks before it is truly in the system and protects the patient most effectively. It is, of course, possible to subsequently catch the disease without showing symptoms. One of the most emphatic results of having a vaccination is not necessarily that you do not catch the disease but that it saves you from serious disease and hospitalisation. That is where the vaccines are making a massive difference. We are expecting a dramatic fall in the number of hospitalisations and deaths as a result, but it is possible that people will still carry the disease. That is why the advice to all people, including noble Lords, is that just because you have had the vaccine, it does not mean that you can travel around the community as you did previously.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, all supplementary questions have been asked.

Social Care Funding (EAC Report)

Lord Bethell Excerpts

Thursday 28th January 2021 Grand Committee

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

My Lords, I join those who have congratulated my noble friend Lord Forsyth on securing this debate on this most important subject. The Economic Affairs Committee has done a huge service with this remarkable report. I reassure him and the committee that reform of adult social care is one of the most important priorities for this Government. It was a manifesto commitment and remains a major priority for us.

One of the silver linings of this awful pandemic has been the widespread appreciation for our carers, paid and unpaid, and I start by acknowledging the many fine words from noble Lords about the hard work of carers. I pay tribute to them and the incredible work they do every day. We owe it to them to get these reforms right.

The House of Lords Economic Affairs Committee, in its excellent and often-praised report, and many noble Lords today have made important points on social care which I want to address systematically. The committee’s report sets out the need for reform of adult social care, and on that the Government completely agree. I reassure noble Lords that, as detailed at the spending review, the Government are committed to sustainable improvement of the adult social care system and will bring forward proposals this year.

My noble friend Lord Lansley spoke with candour about the challenge facing Ministers, and I completely agree with him. Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges that our society faces. This is a complex area, a range of options are being considered, and we very much look forward to working with other parties on building a consensus around these reforms.

As many noble Lords noted, a stable social care provider market and a qualified, committed and well-paid workforce will be central to our ambitions to raise the quality of and access to social care. We want to empower recipients of care by supporting people to live independently in their own homes and communities for as long as possible. A number of noble Lords noted the Cinderella status of the sector. We want to improve the information provided to the public on the social care system, enabling them to plan for their care and make better choices when the time is right for them, and to raise the status of the sector in the public consciousness.

As regards our direction, we have made absolutely clear our commitment that nobody needing care should be forced to sell their home to pay for it. Our ambitions will necessarily take place on a longer timescale because of the pandemic, but, as the PM reaffirmed at the Liaison Committee in the House of Commons, we will bring forward proposals this year.

On social care funding, we recognise that the Covid-19 pandemic has imposed significant pressures on the social care sector, but I agree with my noble friend Lord Forsyth that the pandemic is not an excuse for inaction. In fact, it is a reason for supporting the social care sector, and that is exactly what we have done. We have now made £4.6 billion available to local authorities so that they can address the pressures on local services, including social care, that have been caused by the pandemic.

I remind noble Lords, including the noble Lord, Lord Hunt, of some of the measures we have undertaken during this period. Through the infection control fund, set up in May, we have provided over 1.1 billion of ring-fenced funding for the care sector. This has funded important measures for infection prevention and control, such as financial security for staff who are isolating, as well as PPE. On 23 December, we announced an extra 149 million to fund costs associated with increased testing in care homes, to help ensure the safety of staff and residents. Today’s announcement of the test and trace results shows the impact of that money. On 16 January, we announced another £120 million of funding to help local authorities to boost staffing levels in the care sector, which could include setting up their own staff bank to assist care homes when their staff need to isolate.

As well as this specific funding for Covid-19, we have also provided councils with access to an additional £1.5 billion for adult and children’s social care in 2020-21, on top of maintaining £2.5 billion of existing social care grants. As announced in the recent spending review, we are providing councils with access to over £1 billion of additional funding for social care in 2021-22. This includes £300 million of new grant funding for social care, on top of the £1 billion social care grant announced last year, which is being maintained in line with our manifesto commitment.

The Government are also enabling local authorities to access up to £790 million of new funding for adult social care through a 3% adult social care precept or top-up to council tax bills. The Government recognise, as is cited in the Economic Affairs Committee report, that the amount that each local authority can raise from this precept is dependent on a number of factors: for example, council tax bill levels. We are looking to address this through using some of the social care grant funding for equalisation. We also expect to provide councils with estimated funding of around £3 billion to help manage the impact of Covid-19 across their services, including in adult social care, and to compensate for income losses. This is a substantial track record of investment during a time of national emergency, and a significant response to the Covid pandemic.

I will say a word about market fragility. The report raises concerns about the strength of the social care provider market. As many noble Lords have noted, this market is varied and includes public, private and voluntary organisations. This is both a strength and a weakness. As noble Lords have noted, not all providers last for ever, but I reassure the noble Lord, Lord Liddle, and my noble friend Lady Browning that entering and exiting is a normal part of a functioning market, and local authorities should have appropriate plans in place to minimise any disruption of services.

I agree with my noble friend Lord Young of Cookham. I say to the noble Lord, Lord Shipley, that local authorities are best placed to understand and plan for the care needs of their populations, and to develop and build local market capacity. That is why, under the Care Act 2014, local authorities are required to shape their local markets.

To push back gently against the noble Baroness, Lady Brinton, on capacity, the number of overall care home beds has remained broadly constant over the last 10 years, from around 460,000 beds in 2010 to around 458,000 beds this month. At the same time, the number of care home agencies in England has increased. There are over 4,000 more care home agencies now than there were in 2010. This reflects the growing trend, noted by the noble Baroness, Lady Wheeler, towards caring for people in their own homes wherever possible. This is largely to be welcomed.

A number of noble Lords commented on the quality of care. I am grateful to the noble Baroness, Lady Young, for her testimony on her time at the Care Quality Commission, which is the independent regulator of all health and social care services in England. It notes that 84.6% of all social care organisations are currently rated as good or outstanding. As my noble friend Lord Lancaster put so well, this is testament to the hard work of so many people in adult social care, who speak of positive experiences in adult social care. We should not forget this.

I also want to cover unmet demand. We have enshrined in law, through the Care Act, the responsibility of local authorities to meet eligible needs. This eliminated the postcode lottery for eligibility across England. Under the Care Act, everybody who appears to have needs is entitled to an assessment. If, following the assessment, they are found to have eligible needs, the local authority has a duty to meet those needs, subject to a financial assessment.

That brings me to the difference highlighted in the committee report and raised by my noble friend Lord Forsyth between, say, cancer care, which is funded by the NHS, and other conditions that people may be living with, such as dementia, and those who have to pay for that care. The reason for this is the type of care required. There are limited treatment options for people living with dementia, so care is predominantly social care and support, rather than the medical treatment afforded by the NHS for those who have cancer. Social care, as we know, is subject to means testing. As I mentioned earlier, the Government are committed to social care reform, so that no one has to face excessive social care costs in their lifetime, whatever their underlying need. In answer to noble Lords, such as the noble Baroness, Lady Hollins, who asked about a timetable, we will bring forward proposals later this year.

The noble Baroness, Lady Finlay, and the right reverend Prelate the Bishop of Carlisle, asked about personalisation and choice. The report raised concerns about disabled people not having choice and control over basic decisions in their lives, such as when they get up in the morning and whether they can leave the house, due to lack of care and support.

My noble friend Lord Taylor of Holbeach was quite right when he called for dignity and respect in social care. On that, the Care Act introduced new functions for councils to focus on promoting well-being and prevention, including offering personal budgets, which are designed to give people control and choice over how their care is planned and delivered. It is based on what matters to the individual and their needs. It enables a new relationship between people, the care system, and health and care professionals, and is a step towards offering people the chance to have a say about their own care. The evidence suggests that, by doing so, people are more satisfied with their care, have better outcomes and can explore more innovative approaches to meet their needs.

I agree with the noble Lord, Lord Razzall, and other noble Lords that our NHS and social care system is facing increased pressure and that it needs to be fundamentally transformed and adapted to meet this demand. Our mission is to deliver integrated health and care services by placing people at the centre of the health and care system, working with them holistically to deliver the outcomes that matter to them most.

I want to say a word about the workforce, but, before I do, let me recognise the very large number of tributes paid to it by noble Lords. I completely acknowledge the comments on the status, training and workload of those working on the front line of social care. As the report recognises, the 1.5 million people who make up the paid social care workforce provide an invaluable service to the nation. We are indebted to their selfless dedication, and we have a duty to give them the support they need.

I have already mentioned the infection control fund to the noble Lord, Lord Liddle, and I reassure him that the £1 billion of funding to which we have given councils access in 2021-22 is designed to ensure that key pressures in the system are met, including the national living wage and national minimum wage. I reassure my noble friend Lady Fookes that the increase in the national living wage means that many of the lowest-paid workers will benefit from at least a 2.2% pay rise next year. The vast majority of care workers are employed by private sector providers, which ultimately set their pay. They must abide by national wage legislation, but they are independent of central government. Local authorities work with care providers to determine a fair rate of pay based on local market conditions.

On recruitment and vacancy rates, which were raised by a number of noble Lords, including the noble Baroness, Lady Hollins, we completely recognise that adult social care employers can struggle to recruit and retain the right number of staff. We are pleased that the vacancy rate reduced to around 7% for the period March to November 2020 from 8.4% in February 2020. We want this to reduce further and are working alongside stakeholders in adult social care to support a growing workforce with the values and skills to deliver high-quality, compassionate care.

It is vital that the spotlight we have seen placed on the social care workforce during Covid-19 is transformed into a long-lasting legacy of recognition for the workforce, as was noted by a number of noble Lords. We will celebrate their work and give them the acknowledgement and appreciation they deserve. To answer my noble friend Lady Fookes and the noble Baroness, Lady Brinton, we have responded to calls to provide the social care workforce with a shared identity to unite the sector. CARE badges are currently available free of charge, to be worn as a symbol of pride across the social care sector, and 1.1 million of them have been provided.

To noble Lords who asked about unpaid carers, I say that, like the report, the Government recognise the vital role unpaid carers play, especially given the difficulties the coronavirus pandemic has placed on those caring for family members, relatives and loved ones. We were all moved by the testimony of the noble Baronesses, Lady Kingsmill and Lady Wheeler. I want to pause for a moment to reflect the country’s gratitude to the people who have stepped up to help one another in their communities during the pandemic, alongside those who care day in and day out for their older or disabled loved ones. As the noble Baroness, Lady Jolly, said, this pandemic has highlighted the invaluable contribution of unpaid carers just as much as that of NHS and social care workers.

I reassure the noble Baroness, Lady Pitkeathley, that we have supported unpaid carers throughout the pandemic by funding the work of a number of charities that support carers, by publishing guidance tailored to carers, and by working with the social care sector to strike a balance between maintaining day care and respite services that we know are critical to many families and controlling infection risks.

In 2018, we set out a two-year programme of cross-government action on unpaid carers in our carers action plan. We will continue to work with carer organisations to support unpaid carers’ access to the support they need to maintain their own health and well-being while continuing to support their loved ones.

This is a comprehensive report. This debate has raised some really good points, and I acknowledge the frustration felt by many that there has not been more progress on this agenda. However, as my colleague, the Minister of State for Care, wrote in her response to the committee chair, this is an important priority, and we are working hard to make progress on it. We are considering the report’s recommendations carefully, and, as the noble Lord, Lord Lipsey, rightly acknowledged, we remain committed to cross-party talks to build a consensus. We remain committed to this vital work and will bring forward proposals later this year.

Vaccine Rollout

Lord Bethell Excerpts

Monday 25th January 2021 Lords Chamber

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

My Lords, I am extremely grateful for that question, because it will help me to clear up a misconception in this area. Having an NHS number is very important. We cannot know who has had the vaccine and who has not if we do not know what their NHS number is. That is extremely important for their own treatment; it is also best practice. As any clinical practitioner will tell us, it is imperative to know the identity of the person being treated. It is also very important for pharmacovigilance and for the research that will come on the back of the vaccine. If we were to vaccinate a large proportion of the population without knowing who they were, we could not do the research necessary. There will be some people who do not have an NHS number, and we have put in place protocols to ensure either that they can get an NHS number or that a workaround can be found. Those we are pursuing with haste. I emphasise to noble Lords that this is an opportunity to ensure that everyone in this country, whether a visitor or a resident, has an NHS number by the end of this programme.

[Lord Scriven (LD) [V]]

My Lords, here in Sheffield, approximately 45,000 people have been vaccinated, owing to the excellent work of our local GP hubs, but because of lack of vaccine supply, 10 out of 15 of those will be closed and will not be able to get the jab into vulnerable people’s arms again until the middle of next week. Yet the new Sheffield mass vaccination centre has opened today and has vaccine. Local GPs have asked me to ask the Minister why the distant megacentre has been given priority for vaccine supply over the local and effective GP hubs.

[Lord Bethell (Con)]

It is not a question of one place taking precedence over another. I take a moment to applaud and pay tribute to GPs in Sheffield, and to all those who have proceeded at pace and got through their allocation as quickly as they could. That is absolutely the right priority and the right approach, and it is how we are going to get through the population very quickly. However, some people will get through their list more quickly than others, and it would be a mistake then to start asking them to move down the list when there are still those with very high priority who need to be vaccinated. Although I understand that it may be frustrating for a GP to stand idle, those are the practicalities of what we are doing. The mass vaccination centres are essential to deal with the very large numbers of people that we plan to vaccinate over the next few months. That is why the Sheffield vaccination centre is such good news.

[Baroness Hayman (CB) [V]]

My Lords, I support the Government’s utilitarian public health approach to the spacing of vaccine doses, but does the Minister accept that the argument is dependent on an understanding of the full implications of different dosage regimes, and that a lack of specific data on this particular point in relation to the Pfizer vaccine is fuelling concerns? Will the Government now undertake research on this specific point as part of a vaccine rollout programme, to underpin robust and well-supported policy implementation, both here and in many other countries that could benefit from this data?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the amount of research that we have on the Pfizer vaccine and all other vaccines is huge. Most, though not all of it, is published. I assure the noble Baroness that we have all the data needed to make the decision that we have. She is right that we are doing the pharmacovigilance that is necessary to understanding the efficacy of the vaccine and any possible side effects. That research will be shared with international partners in the way that she suggests.

[Baroness Stroud (Con) [V]]

My Lords, the Prime Minister revealed on Friday the great news that 10% of all adults have now received their first dose of the Covid vaccine, with two-thirds of elderly residents of care homes now meeting that first milestone. This wonderful effort now needs to be matched by a strategy to ensure that it is not only the elderly who are protected but the young, with a commitment to reopening our schools as soon as possible. Social mobility gains that have given a lift to disadvantaged children over the past decade are at risk of being wiped out by Covid lockdowns. The gap between disadvantaged pupils and their peers has already increased by almost half, with 12% of 11 to 18 year olds not having access to the internet at home. Given that the rollout of the vaccine to the most vulnerable is set to reduce deaths by 88% by mid-February, what steps are Her Majesty’s Government taking to increase NHS capacity to ensure that schools can open as soon as possible?

[Lord Bethell (Con)]

My Lords, it is indeed very good news. I pay tribute to the work of my noble friend and of the Legatum Institute in championing the need to address social inequality. She rightly draws attention to the horrific impact that this pandemic and the associated lockdowns are having on social mobility. It is a massive priority for us. The problem that we are wrestling with is not just hospitalisation but the transmission associated with schools, but I assure her that this is a number one priority for us.

[The Lord Bishop of Gloucester]

I wish to make two points and I draw attention to my interests as listed in the register. First, I am very concerned about prisons. There are reports that about 71 prisoners have died, and the number of prison staff who have tested positive continues to rise alarmingly. There is great flux within a prison, with staff coming and going, and those being released from prison and those coming into prison. Will the Government consider prioritising the vaccinating of prisoners and those who work in prisons? Secondly, I add my voice to those calling for teachers and early years staff to be prioritised. Schools are open and our dedicated teachers and early years staff must be able to continue their work safely and not be off sick, if we are to do the right thing by our children.

[Lord Bethell (Con)]

The right reverend Prelate is entirely right to highlight prisons, and I share her deep concern in this area. I pay tribute to the Prison Service for keeping Covid out of prisons for nearly a year. It has done an amazing job, and we should all be very pleased with the incredible protocols that have been put in place to save our prisons. However, she is entirely right that we have a problem on our hands. It is a major priority for the Prison Service, which is bringing in testing protocols and, if necessary, will look at other measures to ensure that prisoners and those who work in prisons are safe.

[Baroness Donaghy (Lab) [V]]

I want to follow up on the answer that the Minister gave to my noble friend Lady Thornton. I was quite shocked by his reply, because I am quite sure that most people working in the National Health Service who do not have a number are probably the lowest paid, from black and ethnic-minority communities, or temporary staff—the very people who are just as much on the front line as doctors and nurses. I do not think that being assured that there will be a protocol, or a workaround, is adequate. Can the Minister say what protocol there will be, what priority it will have, and how soon all of this will be communicated to the people who are affected?

[Lord Bethell (Con)]

My Lords, I assure the noble Baroness that it is communicated on the front line immediately. I did not have a valid NHS number until a week ago: it took me a couple of days to get one, but it was provided extremely promptly. I am hopeful that anyone who is lacking an NHS number can get one extremely quickly when they apply.

[Baroness Hollins (CB) [V]]

My Lords, I am grateful to the Minister for all his hard work on this subject. As he says, the vaccination rollout rightly aims to prioritise the people who are most vulnerable to Covid, but this mainly focuses on age. On the BBC news yesterday, we heard directly from several people with learning disabilities about their well-founded worries concerning the Public Health England data, which shows that they are six times more likely to die from Covid. Given this, and the fact that only 40% of people with learning disabilities reach the age of 65, does the Minister agree that relying on a strategy of vaccinating them at the same age as other people magnifies their existing health inequalities and discriminates by failing to recognise their increased risk?

[Lord Bethell (Con)]

My Lords, the JCVI looked at this very question in great detail. It is very conscious of discrimination, but its focus is on morbidity. Its judgment, which I entirely back, is that age, more than anything else, is the driver of morbidity. That is why the prioritisation is structured in the way that it is. Those who are CEV are also prioritised. Many of those who are most vulnerable and who also have learning difficulties will qualify under the CEV threshold. However, I have passed her arithmetic to the vaccine taskforce. She makes a very good point that those with learning difficulties and autism have a different life profile and die at an earlier age. I have asked the system to ensure that this arithmetic has been considered in the prioritisation list. I will be glad to reply to her when I have the answer.

[The Deputy Speaker (Baroness Henig) (Lab)]

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

Medicines and Medical Devices Bill

Lord Bethell Excerpts

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Thursday 21st January 2021 Lords Chamber

[Lord Sharkey (LD) [V]]

My Lords, Amendments 1 to 8, in my name and that of my noble friend Lady Jolly, are to correct drafting. None of them, individually or collectively, alters the meaning or substance of the parts of the Bill that they would amend. I beg to move Amendment 1.

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

The noble Lord, Lord Sharkey, made his points cogently on Report. We do not intend to oppose the amendments on the Marshalled List, as they are technical tidying amendments, consequential on those in the name of the noble Lord, Lord Sharkey, that were passed on Report.

[Lord Sharkey (LD) [V]]

I am very grateful to the Minister.

--- Later in debate ---

Moved by

[Lord Bethell]

That the Bill do now pass.

[Lord Bethell (Con)]

My Lords, the Bill before us is quite different from the one we started with, but it is no doubt much better. That is entirely because of the huge value of your Lordships’ challenge and scrutiny. We have held over 50 meetings and considered 249 amendments, and the result is a tribute to the care and patience of noble Lords, for which I give profound thanks. It is also, if I may say so, a tribute to the workings of the hybrid House, which have kept legislation moving under difficult circumstances.

We would not have reached this position without the thoughtful, collaborative and constructive input of noble Lords, to whom, I pay tribute—in particular, to the noble Baronesses, Lady Thornton and Lady Wheeler, on the Opposition Front Bench, together with the noble Lord, Lord Hunt, and the noble Baronesses, Lady Jolly and Lady Walmsley, and the noble Lord, Lord Sharkey, on the Liberal Democrat Benches. I also thank, from the Cross Benches, the noble Lords, Lord Patel and Lord Alton, and the noble Baroness, Lady Finlay. They have all brought their immense experience and wisdom to our debates, to improve this legislation. And when it comes to wisdom and experience, I must also pay tribute to those from these Benches, especially my noble friend Lord Lansley, my predecessor, my noble friend Lord O’Shaughnessy, and my noble and learned friend Lord Mackay of Clashfern, who have all been of enormous help in enabling us to arrive at a consensus across the House. My noble friend Lord Howe has been a generous mentor, and my noble friend Lady Penn is a superlative Whip, both shepherding the process charmingly, discreetly and effectively.

I thank most emphatically my noble friend Lady Cumberlege. She has spoken of the importance of compassion, of the voices she has listened to, and of the paramount importance of patient safety. I have heard her, and I support her endeavour. She has the support of the House in her efforts, and we have collectively made significant progress towards her admirable goal.

I also thank officials on the Bill team, particularly Alice Clouter, and those in my private office, particularly Tilly McEwan. They have all worked tirelessly and expertly. I cannot give thanks to all the other champions in the House who have made influential interventions, but I am definitely very grateful to them.

I cannot hide my excitement about the future. While the Bill process is near its conclusion, we are at the end of the beginning of an exciting new regulatory system—a system that protects patients and enables innovation. It is with that vision of the future, as well as my gratitude to all, that I beg to move.

[Baroness Thornton (Lab) [V]]

My Lords, at this stage of the Bill, we take a few moments to congratulate ourselves and thank those who have made it possible to get this far. First, I thank my own Bill team, who have worked so hard, particularly Rhian Copple in the Lords Opposition office, and my noble friends Lady Wheeler and Lord Hunt—and, indeed, my noble friend Lady Andrews and others, who popped up here and there to support us.

We should all congratulate ourselves because, despite the conditions in which we have worked this autumn and winter, we have managed to build effective communications which have made it possible to make considerable progress in improving the Bill in many ways, as the Minister said. I think we can say that we did our job, as the revising Chamber.

The fact that we ended up with only three Divisions on Report is a testimony to way in which the Minister, the noble Lord, Lord Bethell, his Whip, the noble Baroness, Lady Penn, and his adviser, the noble Earl, Lord Howe, and the very hard-working Bill team led by Alice Clouter, handled the Bill. They listened, they discussed, they considered and they revised, which is really all that one can ask. This is the Minister’s first Bill, and I congratulate him on leading his team and handling what is always a baptism of fire for any Minister.

I am delighted to agree with the Minister and say that we are sending back a very different, and much improved, Bill. We have managed to address many of the big-ticket items, ranging from data sharing to human tissue, and, ultimately, patient safety. I thank participants across the House. Like the Minister, I mention in particular the noble Lord, Lord Patel, the noble Baroness, Lady Jolly, the noble Lords, Lord Freyberg and Lord Clement-Jones, and the noble Baroness, Lady Cumberlege. I also thank everybody else who has taken part in the many discussions and given us the benefit of their wisdom, particularly the noble Lords, Lord Lansley and Lord O’Shaughnessy.

First Do No Harm paved the way for the creation of an independent patient safety commissioner, and I think that changed the way in which the Bill was handled, because it is now, as it should be, a patient safety Bill. For that, I really wish to congratulate the noble Baroness, Lady Cumberlege.

Finally, I want to thank the organisations who have given us their support and expertise, which is particularly important for those of us in opposition. I am very grateful to the DPRR and Constitution Committees for their insightful scrutiny, which sometimes is painful for the Government but is almost always helpful to us; the Lords Library; and, for us, the University of Birmingham, the British Dietetic Association, Advanced Accelerator Applications, the Association of British HealthTech Industries, Cancer Research UK and, in particular, the BMA. I am very grateful for the expert briefs that they have given us.

Stakeholder engagement will remain key for many years to come, for while the Bill will soon pass—as the Minister said—the task of creating a post-Brexit medicines and medical devices regulatory regime is far from finished. I look forward to working with stakeholders and the Minister to make sure that we move forward in the best possible fashion. We have given ourselves a good start.

--- Later in debate ---

[Lord O’Shaughnessy (Con) [V]]

My Lords, there is not much more to say that has not already been said by other noble Lords. I just wanted to use this opportunity to thank and pay tribute to particular groups. The Bill team and private office, which have worked so hard to produce this legislation, are amazing in what they do and often unsung. It is important we recognise them.

Secondly, I thank those patients and patient groups who have provided so much moving information and testimony that has informed our work. After all, we serve them, and I hope and believe that we have served them through improving this Bill in this House in the way we have.

Thirdly, I pay particular tribute to my noble friend Lady Cumberlege. When I was in government and we commissioned her report, I could not have dreamed that she would have done such a thorough job and carried it with her customary tenacity, to the point where we have, on statute, the commitment to a patient safety commissioner. It is such an important step forward and it will make a massive difference to the lives of hundreds of thousands of people in this country. For that, we should all be proud of this step—and she in particular should be.

Finally, I thank the Minister—my noble friend Lord Bethell—the noble Baroness, Lady Penn, and the noble Earl, Lord Howe, but particularly the Minister; he has performed with absolute aplomb in the difficult 10 months since he became a Minister. He has so much on his plate, yet throughout this process he has listened, engaged and acted in a way that does him enormous credit, and I really want to pay tribute to him for everything he has done.

I share the Minister’s optimism that, having produced this Bill, we can produce a regulatory system for the UK outside Europe that is the envy of the world, that makes sure that every company, every charity and every researcher who wants to bring a transformative therapy into a health system will come to us because of what we are able to do and how we are able to bring them through into mainstream treatment, just as we are doing with vaccines and have done with the recovery trial. That is the template, and I look forward to working with my noble friends and other noble Lords to make that happen in the months to come.

[Lord Bethell (Con)]

My Lords, I am extremely touched by the kind words of noble Lords and pay tribute once again to the hard work of all those concerned. I look forward to the future—to, as my noble friend Lord O’Shaughnessy said, the opportunity for patient safety and innovation to be enhanced by this Bill. In that spirit, I beg to move.

Bill passed and returned to the Commons with amendments.

Covid-19: Vaccination

Lord Bethell Excerpts

Wednesday 20th January 2021 Lords Chamber

[Lord Cormack]

To ask Her Majesty’s Government what plans they have in place to ensure that no one has to wait more than three months for a second dose of a COVID-19 vaccination.

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

My Lords, we are absolutely committed to making sure that everyone gets two doses, so if they have received their Pfizer first dose, they will get a Pfizer second dose within 12 weeks of the first one. Similarly, if they have had their AstraZeneca first dose, they will get their AstraZeneca second dose within 12 weeks. The four UK CMOs and the JCVI agree that prioritising the first vaccine dose will protect the greatest number of at-risk people overall in the shortest period of time.

[Lord Cormack (Con) [V]]

My Lords, naturally I thank my noble friend for that Answer. I have just returned from the very efficiently run county showground vaccination centre outside Lincoln, where I have had my first dose and have been given a date for my second. My noble friend has certainly reassured me on the Government’s determination both to give the same vaccine and at the right time. However, is he aware of the findings in Israel, where there has been an extremely impressive rollout of vaccination, which have cast considerable doubt on the wisdom of delaying the second dose? This has caused a great deal of concern, not least in your Lordships’ House, voiced by the noble Baronesses, Lady Boothroyd and Lady Bakewell, among others. Can he please give us some reassurance that there is no danger of diminishing the efficacy of the vaccine by delaying the second dose?

[Lord Bethell (Con)]

I am extremely pleased to hear the update from my noble friend, and I thank all those in Lincoln who were contributing to his effective vaccination and his second appointment, which is very reassuring. I reassure him that, on the Israeli numbers, Sir Patrick Vallance, the Chief Scientific Adviser, has been very clear—he was on the media round this morning. The Israelis looked at a very specific time period—14 days—and a very specific age group. This is very different to the analysis done by the JCVI and the MHRA, which looked at all age groups over a much broader period. The efficacy of immunity from days 10 to 21 is thought to be 89%. That is a very considerable and impactful effect, and I have spoken to the noble Baroness, Lady Boothroyd, to reassure her on that matter.

[Lord Anderson of Swansea (Lab)]

My Lords, the rollout of the first vaccine has gone fairly smoothly, although there have been glitches or bumps, particularly in terms of regional disparities. What lessons have been learned, and what was the reason for choosing 12 weeks—was it administrative, medical or supply?

[Lord Bethell (Con)]

My Lords, there have been glitches; I do not know whether there are lessons learned. However, I can share with the noble Lord that the practicalities of getting the Pfizer vaccine in particular—which, as he knows, requires deep-cold storage—into every part of the country are quite challenging, and we are trying to reach not only the big mass centres but community pharmacies and GP surgeries. The delivery of the vaccine to thousands and thousands of locations will always be a little uneven, and there have been occasions where we have deemed it the correct procedure to have people stood up for their vaccination even though we were not 100% sure of the delivery of the vaccination. That does create concern but I think has been the right approach to take.

[Baroness Jolly (LD) [V]]

My Lords, my question follows that of the noble Lord, Lord Anderson of Swansea. For many in isolation, the appointment for their first jab is all that has kept them going, and the certainty of timing of the second has changed since the introduction of the vaccine regime. Can the Minister tell us whether that is to do with the region—there seem to be problems in the south-west—or is it demand, logistics or science?

[Lord Bethell (Con)]

My Lords, if I understood the noble Baroness’s question correctly, I reassure her that absolutely everyone’s details are registered in the national immunisation database, so everyone will receive an invitation for their second dose, as I mentioned earlier. However, the reason for having this longer period before the second dose is completely pragmatic. Every 250 doses saves a life, so it is absolutely essential that we get the maximum number of first doses out as quickly as possible. The MHRA, the JCVI and others have looked at the safety and efficacy of this approach, and they have found reassuring evidence that this will work extremely well. I take great joy in the fact that we have found a way to get the highest number of doses to the greatest number of people as quickly as we possibly can.

[Lord Ribeiro (Con) [V]]

My Lords, mindful of the impact of Covid-19 on front-line health staff during this pandemic, and given the report in the Times today of reduced supplies of the Pfizer/BioNTech vaccine during January and February, can the Minister say what plans there are to ensure that these front-facing health staff in hospitals and care homes are prioritised as a matter of urgency to protect them from the pandemic? As someone in his late 70s who is waiting for the vaccine, I am happy to forgo mine until such time as the health staff I mentioned are protected.

[Lord Bethell (Con)]

I am enormously grateful for my noble friend’s important gesture and pay tribute to his generosity of spirit. However, it is absolutely essential that he gets his vaccine as soon as he can, because he is at the top of the list. Morbidity is determined by age, not proximity. Healthcare staff are of course of deep concern to all of us, but those who are in PPE and in protected conditions have no greater chance of getting the disease than members of the general public. It is essential that we put those who have the highest risk of morbidity—the oldest—at the front of the queue, which is why we have the prioritisation list that we have.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, I thank the hard-working Minister and his Government for listening to the most clinically vulnerable groups and for reprioritising vaccination for all care workers, ensuring their greater safety. However, I am concerned that people under 65 with learning disabilities who live in care homes are in group 6 rather than in group 1, when ONS data clearly shows that they have been disproportionately affected throughout the pandemic. It is illogical that they now have to wait longer than other people with learning disabilities—older ones—in residential care. What plans do the Government have to ensure consistency and fairness in vaccination allocation to all people in residential care, especially in this category of people?

[Lord Bethell (Con)]

My Lords, the noble Baroness puts her point very well. There is a huge amount of sympathy and concern for those who have underlying conditions, and she is right that ONS data on those with underlying conditions demonstrates a higher hospitalisation and mortality rate. That is why we have put all individuals between 16 and 64 with underlying health conditions that put them at a higher risk of serious disease and mortality higher up the prioritisation list than others. However, it is age more than anything else that is the greatest determinant of morbidity, and that is why the list looks the way it does.

[Baroness Thornton (Lab) [V]]

My Lords, I would like to ask the Minister about those who are housebound and bedbound. If their domiciliary workers, care workers and unpaid carers are vaccinated in centres and with their GPs, what arrangements are in place for home visits to vaccinate this particular cohort of people, who cannot leave their home because of their disability or their particular conditions? It has been rumoured that there is no intention to vaccinate this cohort at present, which I find remarkable. So I would like the noble Lord to assure the House that arrangements are being made for this particular cohort.

[Lord Bethell (Con)]

My Lords, I reassure the noble Baroness that it is absolutely not our intention to leave those who are housebound out of the scheme—not at all. In fact, they are an important priority. They are logistically a big challenge. We are in a numbers game. We are trying to get the greatest number vaccinated as quickly as possible. However, we are working extremely closely with community pharmacists and GPs to try to figure out the way in which we can get the vaccine to people who cannot make their own way to a vaccination centre. Those plans are in advanced progress. I do not have details of them to hand, but I would be glad to write to the noble Baroness with those details.

[Baroness Sheehan (LD) [V]]

My Lords, can the Minister say how concerned the Government are that diminishing efficacy in partially immunised people among a population with high prevalence of the disease, as we have in the UK, will foster ideal conditions for the virus to mutate into vaccine-resistant forms?

[Lord Bethell (Con)]

My Lords, I do not quite agree with the premise of the question, which is the concept of being partially vaccinated. When you get your first vaccination shot, you are vaccinated, your body has been primed, B cells make the antibodies and you learn how to fight the disease. That is categoric. Where the noble Baroness absolutely has a point is that it is an uncomfortable truth that when we lean in to the virus, it will seek to escape and mutate, and that is the moment of absolute highest risk for the country. That is why we are trying to move as quickly as we humanly and possibly can: there is a moment in time, an opportunity to get the vaccine out to as many people as possible to avoid the mutation throwing up variants that escape our vaccine.

[Lord Mann (Non-Afl)]

We heard a few voices last spring and summer suggesting that the National Health Service was not good enough and that a privatised service would have been better in dealing with the pandemic. They are remarkably silent now. Will the Minister join me in the celebrations across this country at the moment of the brilliance of the National Health Service and the fact that people being vaccinated are going in with a smile on their face, being welcomed by people—volunteers and staff—with a smile on their face, all saying how brilliant our National Health Service is?

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the testimony of the noble Lord, but I would probably put it slightly differently. Listen, we are in Act I, and I do not think it is quite the right moment to take curtain calls and bows just yet. The NHS has stepped up to this challenge absolutely magnificently, but there is still a huge amount to do and to get through. In addition to the praise that the noble Lord rightly gave the NHS, I also pay tribute to other parts of government, and particularly to the Army, local authorities and the private sector, which contributed the vaccine in the first place, all of which have worked together in a great spirit of collaboration. It is only through that spirit of collaboration that we have been able to deliver what we have.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed, and we now go back to the third Oral Question.

Health: Brain Tumours

Lord Bethell Excerpts

Tuesday 19th January 2021 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they are taking to encourage research into (1) the causes, and (2) the treatment, of brain tumours.

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

My Lords, I am hugely grateful to noble Lords for bringing this challenge to my attention. It is House of Lords advocacy at its best. We have met interested parties and I am pleased to say that we have a plan. Workshops are being booked, more research is being funded and we are encouraging more researchers to become involved. I am hopeful that this will mean progress and I am watchful to ensure that it delivers.

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

My Lords, I am very grateful to the Minister for that positive response. Can he assure me that, in addition to seeking ways of being able to spend up to the £40 million research money made available, he will comment on the report of the chair of the all-party group on brain tumours, which says that there is greater need because there are no researchers able to undertake much of this research? Can he consider steps to address this imbalance and attract the brightest of medical and scientific minds into this uniquely complex area?

--- Later in debate ---

[Lord Bethell (Con)]

The noble Lord is right: it is extremely complex and one of the challenges we have is that the basic science needed to guide research is an unpredictable and difficult-to-manage process. That is why I have invited representatives of patient groups to try to guide the basic scientific research so that the talented cancer researchers who are available, who can do the more operational and applicable elements of the research, will have the material necessary to get on with their job.

[Lord Taylor of Warwick (Non-Afl) [V]]

My Lords, it is arguable that, of all the human organs, the brain is the main. People from the black community are nearly three times more likely to develop pituitary tumours at the base of the brain than their white counterparts. The reasons for this disparity are still not clear. Will the Government commit to encouraging further research into this issue? Also, only 14% of UK spending on brain tumour research is from the Government; the remaining 86% is from the charity sector. Although more money is not the total answer, will the Government commit to more funding for this vital area of research?

[Lord Bethell (Con)]

My Lords, £40 million was announced in May 2018 for brain tumour research. To date, £9.3 million has been committed and £5.5 million will be committed from April 2018 to 2023. At this stage, as the noble Lord, Lord Hunt, alluded to, the allocation of budget is not the issue. Making sure that the pipeline of applicable research is in place is our challenge. That is why we have worked well with interested parties to put together a plan for trying to ginger along the basic science necessary to get those research projects activated.

[Lord Sharpe of Epsom (Con)]

My Lords, in 2019, my 22-year-old son, Charlie, was diagnosed with a germinoma, which is a rare form of brain tumour. He was referred for proton-beam therapy at the Christie Hospital in Manchester by the excellent Dr Jeremy Rees of the National Hospital in Queen Square. First, I thank the Government for spending the vast amount of money required to establish this capability in the UK, which, I am pleased to say, I think has been successful. Is the second facility at UCLH still on track to come on stream in 2021? Perhaps the Minister might reflect on the clinical expertise that has developed over the last year since the establishment of the facility at the Christie Hospital.

[Lord Bethell (Con)]

My Lords, it is fantastic news that my noble friend’s son has benefited so well from our considerable investment in proton-beam therapy. I wish both him and his son good luck on behalf of all noble Lords. I am not aware of any current plans to open a PBT site in Birmingham, but I can reassure him that the UCLH site in London is due to open this year and we look forward to that very much indeed. It was hoping to open in 2020 but plans were impacted by the pandemic. As with any ground-breaking technology, clinical expertise in PBT will continue to increase as our hard-working frontline radiological staff treat more and more patients.

[Lord Patel (CB) [V]]

My Lords, I am most encouraged by the opening statement from the Minister and the Answer he gave to the noble Lord, Lord Hunt of Kings Heath. That goes a long way to answering my question, which was whether he agrees that to improve the outcome for patients with brain tumours, we need a strategy that addresses the clinical and research workforce; basic and clinical research, including genetics; research funding; and diagnostic and treatment centres of excellence—a strategy similar to one that dramatically improved outcomes for patients with breast cancer and leukaemia. Does the Minister agree that the director of the National Institute for Health Research—or anyone else that he feels appropriate—should be asked to develop such a plan?

[Lord Bethell (Con)]

My Lords, the noble Lord makes an excellent suggestion. Indeed, I am pleased to report that exactly such a strategy is in place by working with the Tessa Jowell Brain Cancer Mission, to which the department, the NIHR, NHS England and NHS Improvement are all active contributors. As part of the mission the department is funding new research through NIHR, encouraging new researchers to become involved, and we will be supporting the delivery of research as a key part of the new Tessa Jowell centres of excellence.

[Baroness Pitkeathley (Lab) [V]]

My Lords, many experts conclude that without new discoveries the outlook for patients with brain tumours is bleak. Given that many sufferers are in their teens or twenties and reliant on the support of their parents or carers, do the Government see it as a priority to support families, both during treatment processes and during the all-too-frequent bereavements?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right that brain tumours and brain cancer are some of the most awful situations, particularly because they so frequently affect the young. That is why infrastructure spend on brain tumour research has increased. I am pleased to say that we received 62 applications for research funding between May 2018 and 2020, 10 of which have been funded so far, but more can be done in that area. Supporting families is, of course, part of the responsibility of the charities and trusts involved, and I wish the best to all those families who have been hit by this awful condition.

[Baroness Jolly (LD) [V]]

My Lords, when this issue was raised at Questions on 19 November last year, the Minister suggested that the quality of applications needed improving. He kindly offered to meet research charities working in this area to facilitate this. Can he tell the House which of these charities he has met or has an appointment to meet and how many applications have since been received?

[Lord Bethell (Con)]

My Lords, I have had three meetings, particularly with the Tessa Jowell Brain Cancer Mission, which has been extremely constructive and brought with it clinical expertise, patient groups and policymakers. Together we have worked on a plan, which I articulated in my opening remarks. It has emerged that it is not a question of the quality of the research applications. The quality of research in this area is fantastic. The problem is that we need to have better basic science at the very early stage of the pipeline in order to guide the later operable research suggestions. That is why we have organised the workshops, are feeding back to the applicants in the previous round of research and are actively engaged in this area.

[Lord O'Shaughnessy (Con) [V]]

My Lords, I declare my interest as a patron of the Tessa Jowell Brain Cancer Mission. I thank my noble friend for his sincere engagement with the challenge of improving the quality of brain cancer research since my Oral Question last year. He has taken the bull by the horns and I think we have a plan that is going to make a difference. I wonder if he might also comment on the difficulties that medical charities, which are such an important part of the funding landscape, are having at the moment because of the Covid crisis. This particularly affects hard-to-treat cancers such as brain tumours. Are the Government willing to give more support to these charities to ride out the difficult times they face at the moment?

[Lord Bethell (Con)]

My noble friend alludes to a situation that is grave and concerning. Hundreds of millions of pounds have disappeared from medical research charity income, particularly through the closure of second-hand clothes shops, which provide an enormous amount of income for British medical research. I pay tribute to the massive contribution of medical research charities in trying to move forward the science of medical research. This is an area we are deeply concerned about, and colleagues at BEIS and the Treasury are actively engaged with it. My noble friend is right that this a knotty situation to solve that we need to look at very carefully indeed.

[Baroness Wheeler (Lab) [V]]

My Lords, I was very privileged to be present in the Chamber when my noble friend Lady Jowell made her plea to improve brain tumour treatment, research and survival. The work since her death of the Tessa Jowell Brain Cancer Mission, referred to by the Minister and other noble Lords, on the new national strategy has been inspirational. The mission has developed clear practical steps and pathways to build the quality, quantity and diversity of research that the UK needs, such as addressing delays in opening clinical studies, programmes to train the UK’s first generation of brain tumour-specific positions, and dedicated brain tumour centres. What steps are the Government taking to make sure that the NIHR, the MRC and the UKRI work together to ensure that the progress we need comes about? What will happen to the NIHR funding money put aside for brain tumour research in 2018 that remains unallocated at the end of the five-year window announced three years ago?

[Lord Bethell (Con)]

My Lords, I also pay tribute to the Tessa Jowell Brain Cancer Mission and all its work in putting together a really thoughtful strategy for tackling this most difficult issue. NIHR cancer research expenditure has risen from £101 million in 2010 to £138 million in 2019-20, and its settlement in the recent spending review was generous. I am optimistic that there are more resources there. I reassure the noble Baroness that, although the £40 million for brain tumour research has not all been allocated yet, it is not going anywhere and we are working as hard as possible to ensure that the right kinds of research project are put forward for that money. I would like to see it allocated as soon as possible.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the time allowed for this Question has now elapsed. I apologise to the noble Lords, Lord Carlile of Berriew, Lord Polak and Lord Jones of Cheltenham, that we did not have time for their questions.

Health: Eating Disorders

Lord Bethell Excerpts

Tuesday 19th January 2021 Lords Chamber

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

My Lords, eating disorders are serious, life-threatening conditions, and we are committed to ensuring that people have access to the right support when they need it. We are growing our investment in community healthcare for adults year on year—almost £1 billion extra by 2023—with specific funding to transform adult eating disorder care and, for young people aged 16 to 25, to accelerate provision beyond existing growth and to transform plans.

[Baroness Parminter (LD) [V]]

The NHS health survey suggests that the prevalence of eating disorders is significantly higher than previously assumed, so will the Government commission a national, population-based study to accurately identify the number of people with eating disorders, as the Public Administration and Constitutional Affairs Committee recommended, to inform research and service-level provision?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right: the statistics on eating disorders are shocking. The Mental Health of Children and Young People in England Survey identified 0.4% of 5 to 19-year-olds and 1.6% of girls aged 17 to 19. The NHS Digital Adult Psychiatric Morbidity Survey showed 6.4% of adults displaying signs of an eating disorder. There is the survey by Beat, and I could go on. I do not think it is an issue of surveys; we have to address the underlying statistics with measures that make a difference.

[Lord Winston (Lab) [V]]

It is very helpful that the Minister recognises the seriousness of anorexia nervosa and other conditions. It remains puzzling, and the causes are not fully understood, but the long-term risks—for example, infertility or the loss of a child during pregnancy or childbirth—are very serious. Given that some of these patients require almost forced admission to hospital, is there any scope for reviewing this issue when we come to consider the mental health provisions that are due next year?

[Lord Bethell (Con)]

The noble Lord puts it extremely well. Instances of those in pregnancy who have eating disorders are particularly heartrending and disturbing. He is right: sometimes, the condition is so extreme that it needs virtual full admission. We have put six new beds in the south-east, five in the Midlands, five in the east of England and 10 in the north-east. We are putting a massive amount into mental health budgets and this provision covers exactly this kind of disorder because we recognise that more resources are needed. I look forward to further announcements of spending in this area.

[Lord Truscott (Ind Lab) [V]]

My Lords, as the Minister said, the statistics outlined by the health survey are of obvious concern, but the survey, published last December, does not cover the period of the Covid pandemic. Has the Minister any evidence that eating disorders have increased during the pandemic? If so, what is Her Majesty’s Government’s response?

--- Later in debate ---

[Lord Bethell (Con)]

The noble Lord is right: the pandemic will have added pressure, particularly on young girls. In-patient units are experiencing tremendous pressure, so it is difficult to see those instances working their way through primary care at the moment. We are studying the situation very carefully, but the noble Lord is entirely right: it is quite possible that incidents will increase, and we will put resources in place to address that.

[Lord Lingfield (Con)]

My Lords, is my noble friend aware that around a quarter of all sufferers of eating disorders are men, and that the number of males seeking help has gone up by 70% in the last decade? With the increasing emphasis on young men to attain a certain body type, does he agree that more males might need support in the coming years?

[Lord Bethell (Con)]

My noble friend is right to remind us that this is not a gender-specific condition and that many men have eating disorders of one kind or another. The culture we live in does nothing but encourage that and I think we have to address the underlying causes, both psychiatric and the pressure of social media. We will be putting in place the resources necessary to support that kind of initiative.

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

My Lords, NHS Digital has reported that admissions for eating disorders have almost trebled since 2007, but there has been very little investment into in-patient treatments since then. With only 400 NHS beds for adult eating disorder sufferers in England, and capacity currently further reduced by the pandemic, what are the Government doing about this chronic shortage of in-patient beds for those suffering from serious eating disorders, which particularly affect young women?

[Lord Bethell (Con)]

The noble Baroness may not have heard my answer to the previous question, where I cited the large number of beds opened in the last year, totalling more than 30 across the country. I recognise that more beds are needed for those who have particularly acute disease, but the large prevalence of the disease among hundreds of thousands of young girls and boys also means that community care has to be at the heart of our response to this condition.

[Baroness Fall (Con) [V]]

My Lords, this autumn, charities such as Place2Be have recorded a notable increase in issues of self-harm, suicidal thoughts and eating disorders. The impact of shutting schools has been huge, and we will not know the legacy of that for a long time to come. I am reassured to hear the Minister say that he is as concerned as I am to look at ways to deal with this, but will he and others consider making school teachers the first priority for receiving the vaccine, after the most vulnerable and aged in our population, so that schools can open as soon as possible?

[Lord Bethell (Con)]

My Lords, we recognise the contribution of charities to this mental health challenge, and £10.2 million of additional funding has been allocated to mental health charities. We also recognise the importance of keeping schools open: no Government could have tried harder to keep schools open than this one. However, the allocation of the vaccine is based on morbidity—we have to protect those whose lives are most threatened and that is why the JCVI has put the prioritisation list in the form it has.

[Baroness Bull (CB)]

My Lords, a recent literature review found that many GPs feel unequipped to identify and manage eating disorders, meaning that patients who could benefit from primary care are often passed on to specialist services and face long waiting lists. Given the importance of early intervention, can the Minister say what is being done to train and support primary care professionals in diagnosing and treating people with eating disorders, and to improve shared care across the primary and secondary care interface?

[Lord Bethell (Con)]

My Lords, NHS England is working with Health Education England to procure training courses that will increase the capacity of the existing workforce, to allow them to understand these challenging issues better and allocate people to the right course of treatment. It is a problem that we recognise, and resources in training are being put in place to address it.

[Baroness Thornton (Lab) [V]]

My Lords, following on from the last question, hospital admissions for bulimia rose 75% during lockdown, amid fears about the mental health impact of the pandemic. For children and young people, we also know that these figures have been rising every year for several years. We also know that there are regional disparities in waiting times for eating disorder services. What will the Government do to respond to what seems like an increase in eating disorders and rising regional disparities?

[Lord Bethell (Con)]

My Lords, I recognise the issue of regional disparities, but I reassure the noble Baroness that our ambition is to deliver swift access to treatment for 95% of children and young people with suspected eating disorders within one week. The good news is that in the second quarter of 2021, 83% of urgent cases were seen within one week and 89.6% of routine cases were seen within four weeks. Those figures can be improved but I think that they are impressive. They show that progress is being made and that we are taking this issue seriously.

[Baroness Walmsley (LD) [V]]

My Lords, the eating disorder faculty at the Royal College of Psychiatrists has recently reported that eating disorder teams are being asked to ignore the NICE guidelines for treatment as being unrealistic and too expensive. Will the Minister either justify this or condemn it?

[Lord Bethell (Con)]

The noble Baroness brings to my attention something concerning. I would be grateful if she would write to me with the details and will be very happy to look into it in more detail.

[Baroness Wheatcroft (CB) [V]]

My Lords, parents of adult children suffering from the most extreme eating disorders say they are often desperate to help but powerless because of an insistence on patient confidentiality. The desire to give autonomy to patients too often extends to those whose sickness with eating disorders makes them unable to take sensible decisions for themselves. Will the Minister agree to examine the conflict between these two wishes and how it could be resolved?

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a conflict for which there is no easy answer. I completely sympathise with any parent whose child is exhibiting eating disorder issues. It is the most awful and frustrating situation for any parent to see their child in a self-destructive loop for which there seems to be no intervention possible, but patient safety is patient safety, and this is the conundrum that faces any mental health situation. The Mental Health Act is undergoing review at the moment—I am grateful to Sir Simon Wessely for his report, which we debated yesterday—and these are exactly the kinds of issues that we are looking at. I express profound sympathy for all those who find themselves in this awful situation.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the time allowed for this Question has now elapsed. I apologise to the noble Lord, Lord McColl of Dulwich, that there was not time for his question.

Mental Health Act Reform

Lord Bethell Excerpts

Monday 18th January 2021 Lords Chamber

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

My Lords, there is much to be welcomed in this White Paper, for which we have waited so long. I am pleased to see patient voices being put front and centre of plans and proposals to address the current shocking disparities in the rates of detention of people from black and minority-ethnic backgrounds. However, the issues that were highlighted in the Wessely review two years ago have continued to scar the lives of too many people during the extremely long gestation period of this White Paper.

The original legislation is 40 years old now and out of date. It is shocking, frankly, that it has taken us so long to amend archaic processes, such as an individual’s father automatically being their advocate in a mental health crisis, whatever the nature of the relationship or preference of the individual patient.

I understand the importance of getting the details right. However, I was concerned by the lack of urgency shown by the Secretary of State when responding to questions from MPs on the Statement last week. Why do we have to wait another year before the legislation can even begin? Can the Minister give us a concrete timeframe for the further consultation? What is the timetable for taking forward the non-legislative reforms in the Wessely review, not least to achieve wholesale cultural change in mental health services?

I am similarly very concerned about workforce issues facing this sector. Many of the workforce aims laid out in the NHS Long Term Plan are not on track to be met, with 12% vacancy levels in many mental health services. Between 2016 and 2019, demand for services increased by over 20%—and that takes no account of the exponential growth in mental health problems during the pandemic. Recent forecasts suggest, for example, that only 71 additional consultant psychiatrists will be added to the NHS workforce by 2023-24, against a requirement of more than 1,000 to deliver the long-term plan. What measures are the Government taking to address the additional workforce requirements of reforming the Mental Health Act?

We then come to the issue of funding. The short-term injection of £500 million is, of course, welcome, but it is sustainable and long-term investment in services—covering the full spectrum from preventive to crisis care—that we so badly need. We need a comprehensive plan for funding all existing and new mental health services, rather than one-off injections of short-term funding. Above all, this means investment in community services. In a survey of Royal College of Psychiatrists members, insufficient access to community health services was cited as the greatest cause of increases in formal admissions. The best way to prevent people being detained under the Mental Health Act is to prevent them reaching crisis point in the first place.

Like the noble Baroness, Lady Thornton, I am deeply worried about the impact of the pandemic on the nation’s mental health. In October last year, the Centre for Mental Health estimated approximately 10 million extra people with mental health needs due to the pandemic—a staggering figure. While it is understandable that we have been focusing on the physical threat of the pandemic and protecting our acute services, when will the Government come forward with proposals to address what some are now calling a mental health emergency?

It is an unpalatable fact that black people are currently 10 times more likely to be placed on a community treatment order. In these situations, patient voices become even more important, ensuring that culturally appropriate services can be provided. The patient and carer race equality framework is a good start; I look forward to hearing more on this issue. I note that cultural advocates are currently being recruited, but can the Minister confirm how many patient and carer advocates will be involved in both the advancing mental health equalities task force and the patient and carer race equality framework steering group? Also, why are the Government not proposing to legislate for a CTO to have a maximum duration of two years or to allow tribunals to change the conditions imposed on an individual by the order, as recommended by the Wessely review?

I end by returning to the issue of prevention. The courses of action covered by this legislation represent the worst-case scenarios for individuals experiencing severe mental health problems. We have so much evidence telling us that investments in preventive measures are highly cost-effective interventions and avoid the trauma of crisis scenarios for patients. While we debate this White Paper, it is vital that we do not lose sight of the bigger picture.

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

My Lords, I thank both noble Baronesses for their incredibly perceptive, thoughtful and detailed questions, some of which I am afraid are beyond the brief in front of me. I reassure them, particularly the noble Baroness, Lady Tyler, that I will write with detailed answers to some of their more perceptive and searching questions.

We are all enormously grateful to Sir Simon Wessely for his thoughtful, persuasive and thorough report. It has taken some time to work on it, but now that it has arrived we will act on it. I reassure the House that it is an enormous priority.

I reassure both noble Baronesses that funding is absolutely in place for mental health. If I may briefly run through that, an extra £2.3 billion a year for mental health services is committed by 2023-24. Some £500 million in mental health investment in the NHS workforce was announced in the spending review, and it will go towards addressing waiting times for mental health services.

The noble Baroness, Lady Tyler, referred to the challenge of recruiting psychiatrists. As she knows, that area is extremely challenging. The employment brand of mental health services is not as strong as it is for, say, surgeons, but we have done an enormous amount through HR and the people plan to find new ways of attracting people to rewarding and challenging roles in psychiatry, and those investments are beginning to pay off.

We have invested more than £10 million this year in supporting national and local mental health charities to continue their vital work in supporting people across the country. I will move on to the mental health effects of the pandemic in a second. We have invested £8 million in the Wellbeing for Education Return programme, which will provide schools and colleges all over England with the knowledge and resources to support children and young people, teachers and parents. We have announced more than £400 million over the next four years to refurbish mental health facilities to get rid of dormitories in such facilities across 40 trusts.

The noble Baroness, Lady Tyler, asked me about urgency and whether the Government were truly committed to moving quickly. I reassure her that money has already been announced and plans are in place to address some of Sir Simon’s most urgent recommendations.

Both noble Baronesses asked about the timetable for legislation. I reassure them that the consultation began last Wednesday; it is a 14-week consultation and we have committed to responding to it this year. If I may advertise to noble Lords, this is a terrific opportunity for all those with views on mental health to contribute to that important engagement. It is our plan to publish the Bill next year on the back of that consultation and for legislative scrutiny to take place next year. The question of whether that will be joint legislative scrutiny is not clear to me right now, but I undertake to both noble Baronesses to inquire and press the case for joint scrutiny when I return to the department. I shall write to both of them accordingly.

The noble Baroness, Lady Thornton, raised the impact of the racial dimension highlighted in the report. The numbers in Sir Simon’s report are incredibly striking and it is crystal clear that this is an issue that we absolutely have to deal with. Will we go far enough? Yes, indeed we will. The framework recommended is extremely powerful and we are already putting it into place. We have learned an enormous amount from the report. The ability for those with mental health issues to nominate their own advocate is an extremely powerful innovation that I think will have a big impact on this issue, but we still have further to go. We are engaged with those who are both representative and expert in this area to ensure that we are challenged to go far enough.

Likewise, on learning difficulties and autism, noble Lords will remember that we have had powerful and moving debates in this Chamber in the last few months on that very issue. I reassure the noble Baroness, Lady Thornton, that we note Sir Simon’s recommendation in his report for a 28-day cap on the detention of those with learning difficulties and autism. It is just not good enough for those with learning difficulties and autism to be detained under a Mental Health Act restraint for an interminable period. That point is thoroughly recognised, and the report’s recommendations are extremely well made.

On the question of the pandemic, the noble Baroness, Lady Thornton, put it extremely well: there has been a shift in many people’s response to the pressures and the isolation of lockdown, from being stressed and anxious to having genuine clinical challenges. The full effects of that have not worked their way through the system so it is difficult to get a nuanced and complete view from the numbers today, but we are very much on the balls of our feet to understand and react to the pressures

If I may draw out one issue, young girls seem to be a demographic who have particularly felt the loneliness, anxiety and uncertainty around the pandemic and lockdown. We are particularly concerned to ensure that support goes to families and individuals who present clinical mental health issues as a result of the pandemic.

On the other, very detailed questions asked by the noble Baroness, Lady Tyler, I undertake to answer them in writing at the earliest possible opportunity.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

We now come to the 20 minutes allocated to Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of the 15 remaining speakers on the list.

[Baroness Hollins (CB) [V]]

My Lords, I welcome the focus of the consultation and the White Paper on prevention, along with the new duties on local commissioners to ensure that they understand and monitor the risk of crisis for individuals—for example, when a family member dies—and to ensure an adequate supply of community services for people with learning disabilities and autistic people as an alternative to admission. Does the Minister agree that for these duties to have teeth, the descriptor “adequate” will have to be defined and subject to legal enforcement?

[Lord Bethell (Con)]

The noble Baroness asks a very perceptive question. I pay tribute to her work in this area and the challenge and scrutiny that she has given to the Government, which have helped lead to the position we are in at the moment. This is exactly the kind of area that we will be presenting for consultation, and I very much look forward to the noble Baroness’s contribution to that consultation.

[Lord Holmes of Richmond (Con) [V]]

I welcome the White Paper, which represents a once-in-a-generation opportunity. Allied to that, can the Minister confirm whether the Government will commit to prioritising permanent and immediate mental health support for all our NHS front-line workers in ICU, in the emergency room and beyond—immediate lifelong prioritised mental health support for all those who have given so much support and continue to give it to all of us through this pandemic?

[Lord Bethell (Con)]

My Lords, I live opposite University College Hospital. Every night I hear the ambulances arriving and I think of the staff on the front line working so hard night after night in such difficult circumstances, dealing with people in agony. The mental health of our NHS staff is paramount. Some £50 million has been invested in strengthening mental health support for staff. We have put in place the mental health hotline, practical support, financial advice and specialist bereavement and psychological support. I have no doubt that more could be done but this is very much an area that, as my noble friend rightly points out, is worthy of more investment.

[The Lord Bishop of Bristol [V]]

My Lords, I join fellow Members in welcoming the Statement and the response to the significant report by Sir Simon Wessely. As the noble Baroness, Lady Thornton, noted and as the Minister commented, the evidence is that minority ethnic individuals are 40% more likely than white Britons to come into contact with mental health services through the criminal justice system. Will the Minister explain how the proposed framework will address the underlying attitudes and practices that led to this statistic, which at best are described as a failure to understand the culture and at worst are a reflection of racist views?

[Lord Bethell (Con)]

The right reverend Prelate is right to allude to the importance of culture. No amount of bureaucracy or guideline-writing can ultimately address the basic attitudes, backgrounds and mental starting point of those involved in these decisions. I reassure the House that at the moment we are processing the people plan, which addresses at a fundamental level the hierarchy, racism, homophobia and misogyny sometimes found in some parts of the NHS. We are acutely aware that culture is fundamental to the safe provision of services to patients. The framework itself is not wholly directed at culture, but it will be supplemented by these kinds of reforms.

[Lord Winston (Lab) [V]]

I congratulate the Government on getting Sir Simon Wessely to help them bring about this much-needed reform and will welcome seeing how it progresses in the next year. I want to draw attention to one of the problems about sectioning patients. Two members of my team at different times have been sectioned; both were psychotic and severely depressed at the time. One phoned me at 5 am to say that people had come for her; it was clear that this was highly scary and very damaging. The other patient was left in a police station after being found on a moor for many hours before eventually a bed could be found, miles from where she lived or where anybody could visit her. Also, the premises available for such patients when they have been sectioned seem quite inadequate. The Minister has mentioned the dormitory system, but when I visited both those women, I felt that I would be very depressed myself if I were in those circumstances. We need to do much more to make premises more homely if we are to be more successful in encouraging a return to normal health.

[Lord Bethell (Con)]

The noble Lord is entirely right: when people experience a mental health crisis, they should be treated with consideration. Unfortunately, the police are sometimes at the front line of dealing with those with mental health difficulties. It is a stretch for them, and they should have the right training to be able to deal with a situation sensitively and they should have the right premises to be able to give people safe and secure environments. It is at the outer limits of their professional responsibilities, but we are doing as much as we can to put the training in place.

I remember from my own personal experience, when my father and my mother were sectioned, the consideration and thoughtfulness of those involved in both those processes. It is not all bad, but I take the noble Lord’s point.

[Baroness Jolly (LD) [V]]

My Lords, I welcome the White Paper and the commitment to deliver person-centred care. Many health and social care professionals will need to change the way they work, which is both necessary and welcome. What is the national budget for training over the next five years and how soon will those being treated for mental health conditions expect to notice a difference in their care?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right: the training is critical in this area; it could not be more important. We have invested £500 million in mental health services and support for the NHS workforce to address this. I cannot give her the precise number that she has asked for, but I shall write to her if I can track it down. However, we recognise the urgency of the situation and we hope that the impact of this money will be felt as quickly as possible.

[Baroness Meacher (CB) [V]]

My Lords, I too welcome this White Paper based on the Wessely review. However, without real increases in spending on mental health, the anticipated Bill will not be able to fulfil its potential. I was not reassured by the Minister’s comments on funding.

If we become physically ill, we can expect to be treated within a reasonable timeframe; that is not so in mental health. If the Minister agrees that that is not acceptable, will he challenge the £2.3 billion figure, which, as I am sure he knows, will do nothing to rectify the ongoing imbalance and will leave people detained in hospital because of the absence of adequate community services?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, the noble Baroness is right that community support for those with mental health challenges is critical—we are supporting community health in addition—but I slightly disagree that the £2.3 billion will make no difference. It is a phenomenal commitment and it demonstrates that the Government have recognised that mental health services have lagged behind primary care and physical services, as the noble Baroness rightly points out, and we are working hard to make up the difference.

[Baroness Sanderson of Welton (Con) [V]]

My Lords, I too welcome the White Paper and in particular one of its key aims, which is to address the disparities that exist in relation to those from black, Asian and minority-ethnic backgrounds. The data from the race disparity audit played an important role in revealing those disparities. Can my noble friend the Minister confirm that the Government will continue to utilise the work of the Race Disparity Unit as we continue on the path towards the first new mental health Bill in 30 years?

[Lord Bethell (Con)]

My Lords, I have met the Race Disparity Unit and can share my noble friend’s testimony to the critical work that it does. The statistical collections managed by NHS Digital have shone a light on the extent of the disparities illustrated by Sir Simon, most notably that black people are more than 10 times more likely to be made subject to a community treatment order after discharge from hospital. That is an astounding number. We are determined to take action; we will introduce a new patient and carer race equality framework which will support NHS mental health care providers to work with their local communities to improve the ways in which patients access and experience treatment. The Race Disparity Unit will continue to play a key role.

[Lord Bradley (Lab) [V]]

My Lords, while I welcome the White Paper, it is unlikely that the legislation will be enacted until 2023. Many reforms can be made before that date to implement some of Sir Simon’s recommendations, including the development of community facilities to support people with learning disabilities and autism so as to hugely reduce the use of in-patient beds and, crucially, alternative provision to finally stop the use of prison and police custody suites as places of safety. I therefore press the Minister again to assure the House that sufficient capital funds are available within the NHS long-term plan to implement such key recommendations.

[Lord Bethell (Con)]

The noble Lord is 100% right: we can definitely start work on the recommendations of the report. As I said earlier, we have already done so: committing £400 million to end dormitories in 40 trusts. That sort of parallel processing can be done for other elements of the report. The consultation began last week, which shows our determination to get moving. Some recommendations of the report are spellbindingly obvious; we will work on them immediately. The role of police suites in safe refuge, cited by the noble Lord and by the noble Lord, Lord Winston, is exactly such an example.

[Baroness Barker (LD) [V]]

My Lords, this is yet another NHS document which makes not a single mention of the needs of LGBT people. The Statement is in effect an admission that the Mental Health Act 2007 was deeply flawed and, as a result, thousands of people have been subject to wrongful treatment. Will the Government act now to stop the abuse of community treatment orders and other elements of that Act that have led to the position that is so accurately described by Sir Simon Wessely?

[Lord Bethell (Con)]

My Lords, I confess that the noble Baroness has me on the hop there, because I had not noticed that LGBT issues are not mentioned in Sir Simon’s report. I share the noble Baroness’s surprise about that. Let me return to the document and I will address her point in correspondence.

[Baroness Wheatcroft (CB) [V]]

My Lords, Sir Simon found excessive use of restrictive practices in mental health institutions. Many of us will be familiar with the appalling case of Bethany, the autistic teenager who spent three years in what can be described only as a cell, in an appallingly inhumane regime that kept her locked up in solitary confinement and with no physical contact with other people. Only when her father went to court did she escape, and she is now living happily in an open-plan institution. Can the Minister assure us that such treatment will never be condoned again? We cannot wait for legislation on this.

[Lord Bethell (Con)]

My Lords, I certainly do not condone that treatment in any circumstances, but I acknowledge the noble Baroness’s point: there have been some instances in the past—reasonably rare but consistent—where those with autism and learning difficulties have been subject to the most inappropriate regimes and where a completely different type of support, therapy and accommodation from the kind found in mental health institutions was needed. The campaign to which the noble Baroness alluded is entirely right and we are moving quickly to address those points.

[Lord Davies of Brixton (Lab) [V]]

My Lords, the White Paper is certainly to be welcomed, as there is much to be done. The number of people being detained in hospital under the current Mental Health Act has increased over the past few years. One reason is the lack of resources to provide the support needed in the community and respite care. While we are told that there has been investment, the resources often do not reach hard-pressed mental health trusts. More resources will be needed, not only to grow the workforce but for the workforce to receive education and training in the values and practices needed to deliver the radical changes envisaged in this review. We should also ensure that the workforce better reflects the communities it serves. Again, while I welcome the promise of further investment in mental health services, will the Minister give a commitment that this will be new money and that it will reach mental health trusts, to provide the workforce growth, and Health Education England, to provide the workforce training essential for delivering the aims of the White Paper?

[Lord Bethell (Con)]

The noble Lord is right; the numbers are inappropriate. Fifty-one thousand detentions under the Act in 2019-20 seems far too many. Detentions under the Act rose by 40% in the 10 years to 2015, and we thought of this Act to try to address that injustice. The £2.3 billion is new money, and it will make a huge impact on the mental health trusts he describes.

[Baroness Sheehan (LD) [V]]

My Lords, sadly, I have personal experience of having to invoke the Mental Health Act. It is a dreadful process. It concerns me that one of the reforms proposed is to tighten the criteria for civil patients’ detention by raising the threshold for risk of harm. Does the Minister agree that this reform risks increasing harm to the person who is ill and their family?

[Lord Bethell (Con)]

My Lords, that is not the intention of the report, and I confess to struggling to understand how that would be the case. I would welcome correspondence from the noble Baroness to detail her concerns so that they can be taken on board.

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

I call the noble Lord, Lord Singh of Wimbledon. No? Lord Boateng.

[Lord Boateng (Lab) [V]]

My Lords, the Minister is to be commended for calling out racism, because that is what many black and south Asian patients experience. Will he ensure that commissioners in the field, with this new money given to them, fund local, community-based advocacy groups? And will he ensure the health review tribunals reflect the communities on which they are adjudicating and recognise racism in the mental health service?

[Lord Bethell (Con)]

My Lords, the role of health review tribunals is critical, and more needs to be done to ensure that they reflect the communities they represent. I am not sure it is the role of mental health trusts to finance local advocacy groups, but he is right that they make a difference and hold the system to account. The broader issue of racism in the NHS is a cross-institutional challenge that must be addressed by all parts of the NHS, and we are committed to doing so.

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

My Lords, I warmly welcome the Government’s proposals. A key area of concern for me is the length of time people spend waiting in emergency departments for assessment, even after being referred by their GPs. Will the Government guarantee, as others have mentioned, that sufficient resources in staffing will be made available to ensure that these warmly welcomed reforms are carried out and the quality of care increases?

[Lord Bethell (Con)]

My Lords, I can reassure the noble Lord only by saying we have put an ambitious report on the table. We will follow it up with a detailed consultation process that will engage Parliament in due course and lead to an ambitious Bill. That will be backed by substantial financial investment; thereby, we hope to make a major impact on the issues he describes, which I recognise and acknowledge.

[Lord Adonis (Lab)]

My Lords, Sir Simon’s report makes no reference to international best practice and gives no internationally comparative statistics—for example, on sectioning. I gave the noble Lord notice of a question I would like to ask about what international best practice the Government have in mind. Will he be able to make available to me, perhaps in correspondence, internationally comparative, population-adjusted statistics for sectioning? This will be important for putting the reforms he suggested in context before we proceed to legislation.

[Lord Bethell (Con)]

I am enormously grateful to the noble Lord for sending me his question, but I am embarrassed to say that I did not receive the correspondence. I would love to have the figures to hand, but I will write to him with details. If I could gently push back: this is not an easy issue to make international comparisons on, and we are not necessarily led by what other countries do in this area. We have to own this problem ourselves and find an approach that fits the NHS and people in Britain, and we have to be accountable to the people of Britain for our performance.