Covid-19: Personal Protective Equipment

Lord Bethell Excerpts

Thursday 16th July 2020 Lords Chamber

[Baroness Andrews]

To ask Her Majesty’s Government what steps they are taking to ensure that there is a sufficient supply of personal protective equipment for (1) hospitals, and (2) care homes, in the event of a second wave of cases of COVID-19.

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

My Lords, we have made our supply chains more resilient by massively expanding both our supply from overseas and our domestic manufacturing capability. We are now confident in our supply of PPE to meet the needs of health and social care over the next seven-day and 90-day horizons and are looking further ahead. We continue to model future demand from health and care services to cover the approach of winter and bring resilience to the supply chain.

[Baroness Andrews (Lab) [V]]

My Lords, the Government are being warned, urgently, on all sides to prepare for a second wave of Covid this winter. I hear what the Minister has said but last week, the Public Accounts Committee found that the Government are still not treating the supply of PPE with similar urgency. Will the Minister now commit to publishing a detailed plan by September, as the committee has asked for, explaining what exactly will be different, so that mistakes are not repeated and health and care workers are better protected?

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[Lord Bethell [V]]

My Lords, I completely share the concerns of the noble Baroness, Lady Andrews, about a second peak and we are working to prepare for that. I respect the views of the PAC and emphasise that our approach to PPE is incredibly serious. A huge amount of work has gone into it and a huge amount of progress has been made.

[Baroness Browning (Con) [V]]

Can my noble friend identify what lessons have been learnt so far from both the quantity and quality of the PPE that has been used in homes and hospitals? What action will be taken to minimise cross-infection for those who have to go into people’s domestic homes and who often work in more than one location?

[Lord Bethell [V]]

My Lords, the big lesson from Covid is that the quantity of PPE needed for a disease like this is massively more that could ever have been expected, particularly compared with our past experience. It has hit every country in the world and has hit the global supply chains incredibly hard. A benign lesson is that British manufacturers are capable of stepping up the challenge, and I salute their work. Contamination from itinerant workers was always one of the greatest challenges of the care sector, and we have put in a huge amount of work and financial resources to avoid the need for workers who move from home to home.

[Baroness Coussins (CB) [V]]

My Lords, when I asked the Minister on 24 June to ensure that interpreters in the NHS would not be forgotten when stockpiling PPE in case of a second wave, he very helpfully told the House that he would continue to press the department on this. So, I am mystified that I still have not had a reply to my simple question of 12 May, asking who is responsible for providing PPE for freelance NHS interpreters. Can the Minister enlighten me today?

[Lord Bethell [V]]

The noble Baroness is entirely right to champion the role of interpreters. Their role in the recent Leicester lockdown has been incredibly important: there could not have been an incident that better highlights the importance of language skills in the healthcare setting, and I pay tribute to the noble Baroness for championing those. The care of interpreters is an incredibly complex question and entirely depends on where they are sited. It is the responsibility of individual trusts to look after interpreters in hospital settings but, in other settings, it may be that of other organisations.

[Lord Rooker (Lab) [V]]

Do the Government now accept that there is no further excuse for secret, non-competitive contracts for PPE channelled through the friends of Ministers and special advisers? There are thousands of UK companies ready and willing to bid for contracts to produce PPE—why not use them? China may not be reliable in the future.

[Lord Bethell [V]]

I completely reject the implications of the noble Lord’s question. While British companies have stepped forward and we are pleased to have made many contracts, there are not, I am afraid to say, thousands of domestic producers capable of providing the billions of items we need in the British health service. I pay respect to all the companies that moved quickly and contracted under difficult circumstances for major contracts. I also salute the companies overseas with which we have good relationships, and which remain our trusted partners.

[Baroness Brinton (LD) [V]]

My Lords, alongside PPE we must have a comprehensive test and trace system to prevent a second wave. Today, the Health Service Journal reports that virtually all the top team of test and trace are leaving, and that McKinsey is contracted to review the governance and entire form of test and trace. Why would the Government bring in a multimillion-pound consultancy firm to review a so-called world-beating test and trace system?

[Lord Bethell [V]]

My Lords, turnover of the test and trace team is an inevitable consequence of an organisation that was set up using temporary staff, many of whom are on short contracts and need to return to their previous roles. It is regrettable, but I owe them a huge debt of thanks for the work they have done. The work of McKinsey is focused on governance, not on HR. It was commissioned some time ago and it is an entirely proper and regular appointment.

[Baroness Thornton (Lab)]

My Lords, I refer back to what the noble Lord said about the amount of PPE that is needed. It is actually the case that in the 2016 report it was signalled that we would need a gigantic quantity. I am sure we would all agree that we need better organised and effective preparation if there is to be a second wave, and the centralised purchasing of PPE, managed by local public health agencies, will ensure effective distribution. I want to ask about the care sector. Does the noble Lord believe it is acceptable or wise for care homes to have to pay over the top prices and compete for PPE? Does this not put the wider public health interests at risk? What steps is the Minister taking to end discrimination against the care sector in the supply of PPE and ensure essential protection for care workers, residents and visitors?

[Lord Bethell [V]]

My Lords, it is a reality that the cost of PPE has gone through the roof. There is nothing that I or the Government can do about that. It is something we are going to have to live with and budget for: it is part of the new reality. As to the procurement of PPE, as the noble Baroness knows, within the care sector it was previously the arrangement that local providers would source their own PPE. The Government have stepped in to bring resilience and confidence to that supply chain and to offer alternative sources of supply to local care homes. We have moved emphatically and sought to bring both affordability and resilience to the supply chain.

[Lord Dobbs (Con) [V]]

My Lords, I was going to ask my noble friend about private sector provision of PPE, but I shall move on to something which may be even more significant—the hopeful news of developments in Oxford scientists identifying a vaccine against Covid. Is my noble friend able to offer any update on that news? Can he set out what role the private sector has in the development and, we hope, eventual manufacture of any such vaccine?

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[Lord Bethell [V]]

My noble friend is entirely right: the news from Oxford appears to be incredibly encouraging. Coronaviruses are typically very difficult to provide vaccines for, but the Oxford team is clearly confident that it is making serious progress. It has a contract with AstraZeneca, which is its private sector partner in the UK and globally. The administration of that vaccine, should it be successful, or of any other successful vaccine, is a matter of huge national importance. Thanks to Kate Bingham and the Vaccine Taskforce, we are putting a huge amount of work in to ensure that the administration of that vaccine into the arms of the country will be done in a speedy and efficient fashion.

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

My Lords, the noble Lord, Lord Deighton, was appointed last April, with much fanfare, to resolve a national PPE crisis. Is he now responsible for ensuring adequate PPE, both clinical and other types—particularly for care homes, to deal with any second wave and the expected higher numbers infected through the winter months—for the whole of the UK, or just for England?

[Lord Bethell [V]]

My noble friend Lord Deighton is still in place: I spoke to him recently. His impact has been immense, and I owe him a huge debt of thanks for that. He is particularly focused on the “make” leg of the PPE project, and within that he has recruited firms such as Medicom, Redwood, Photocentric, Ramfoam, Elite and Macdonald & Taylor Healthcare—British manufacturers that are, between them, providing hundreds of millions of items of PPE.

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

My Lords, the time allowed for this Question has elapsed and Question Time has now finished.

Independent Medicines and Medical Devices Safety Review

Lord Bethell Excerpts

Wednesday 15th July 2020 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, on behalf of the Liberal Democrat Benches, I too thank the noble Baroness, Lady Cumberlege, and her team for such an outstanding report. It is not only comprehensive but blunt in its language, so that no one can misunderstand the failings of all levels of the healthcare system, whether in our NHS or other health and research settings, over many years. We too pay tribute to those women, and their children and families, for continuing against all the odds for years when too many ears, including the Government’s, were deaf. I also pay tribute to the many parliamentarians, including Norman Lamb, who over the years supported them. They pushed for this review in Parliament and raised it in any way they could.

Ministers have apologised for these failings, including for the system not listening and for not acting soon enough, over the decades since patients first started to raise the problems with these three medical interventions. Last week, when I asked the Minister about the timetable for implementing the recommendations, he said that

“it will take some time for the Government to study these recommendations … and to come back on the timetable”.—[Official Report, 9/7/20; col. 1224.]

The noble Baroness, Lady Cumberlege, says in her letter introducing the report:

“Over the past two years we have found ourselves in the position of recommending, encouraging and urging the system to take action that should have been taken long ago.”


She also said:

“Implementation needs to be approached with a new urgency and determination, founded on the guiding principle that our healthcare system must first do no harm.”


When the interim report was published, leaving this House in no doubt about the direction in which the review group was proceeding, many people expected action at that point.

I am grateful to Epilepsy Action for its briefing, which demonstrates exactly why urgent action must be taken now. Epilepsy Action, the Epilepsy Society and Young Epilepsy jointly surveyed over 500 women and girls who had taken sodium valproate since the pregnancy protection plan was introduced two years ago. One in 10 were unaware of the possible risks of birth defects. Almost half said that they had not discussed the risks of taking medicine with their health professional in the last 12 months, and only four in 10 said they had signed the annual risk acknowledgement form. For patients and families who have suffered as a result of these interventions, urgent action needs to be taken on government departments such as the DWP regarding the way it assessed the damage caused, and on how government as a whole compensates them for this gross injustice.

So I ask the Minister again: when will the Government return to those affected and to Parliament with clear recommendations and a timetable to do honour to the report and to all those affected? And when will the various bodies in our healthcare sector be set a deadline to publish the list of recommended actions that they will take that will not need parliamentary action? Last week, the Minister told your Lordships’ House that the Government had moved ahead on one of the recommendations—the creation of a patient safety commissioner—but their version is not independent, as asked for in the report.

So much of this report is about changing cultures: we still have not learned from Mid Staffordshire, East Kent and Shrewsbury maternity care, all of which Ministers have rightly been appalled by. For all the excellence and commitment of the individuals who, singly and collectively, provide our unique healthcare in the United Kingdom, there remains an unhealthy culture in some parts that does not listen to patients, does not understand conflicts of interest and resists change. That must change, it must change soon and it must be led from the top by the Government.

The report quotes Professor Ted Baker, chief inspector of hospitals for the CQC:

“I have to say 20 years later it is very frustrating how little progress we have made. It’s clear to me we still have not got the leadership and culture around patient safety right. As long as you have that culture of people trying to hide things, then we are not going to win this.”


Armed with this blunt and excellent report, I hope that the Minister can demonstrate the Government’s support with firm actions and dates, and not just with warm words that will drift away. The hopes of patients and their families and the future safety of our healthcare system depend upon it. When, Minister, when?

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

My Lords, I start by reiterating the tributes from both noble Baronesses, Lady Thornton and Lady Brinton, to my noble friend Lady Cumberlege and her team, who have worked indefatigably on a high-quality report that does justice to this important cause. Most of all, I pay tribute to the patient groups, the specialist groups and those who campaigned on these important issues and who have brought attention and a huge amount of official focus to causes that had been overlooked for years and decades. I pay tribute to their patience, their expertise and their stamina in bringing these important causes to attention. It is entirely right that the Minister, my colleague Nadine Dorries, made an apology to those groups, and I reiterate that apology on behalf of the healthcare system to all the families affected by the report, for the time it has taken to listen and to respond to their concerns.

Both noble Baronesses referred to the culture that led to these issues being overlooked. I think that that is one of the most important learnings from this report. As Nadine Dorries said, I thought very movingly, in her speech in the House of Commons, the system has to learn to listen much more clearly. Listening must happen not just from the top but also at the level at which patients engage with the system itself. I think that trying to change that culture is one of the most important challenges facing us today. It is not just a question of bringing in punishment and retribution for those in the professional world who have failed; it is trying to create a culture where mistakes are recognised and accepted and where people address and take on board the concerns of patients themselves—and on that important cause we are hugely focused.

The noble Baroness, Lady Brinton, asked what we are doing. Already, much has been done. There has been progress in lots of areas. We already have 12 different types of patient safety function in place within the NHS: the Patient Advice and Liaison Service; commissioners of NHS services; the Parliamentary and Health Service Ombudsman; Healthwatch; the NHS Complaints Advocacy service; the CQC; the NHS Friends and Family Test; the professional regulators; the Healthcare Safety Investigation Branch; the Professional Standards Authority; the National Director of Patient Safety; and the complaint systems within individual trusts.

That patchwork quilt of patient safety and patient advocacy is an enormous function within the NHS. The report teaches us that it has not been enough to identify the major themes of failures—in this case, involving medical devices—and there has not been the patient advocacy necessary to see complaints through when they have really mattered. It is that question which we are turning to: how do we make these considerable and important efforts to put patient safety at the heart of the NHS more effective?

The noble Baroness, Lady Thornton, asked about the regulatory implementation of that response. The most important legal implementation is the registry of medical devices, which was in an amendment to the Bill on Report in the House of Commons, and it has enormous support from the Government. That registry, which is an incredibly important source of accountability and of clinical information, is the key to preventing such terrible events concerning medical devices in the future.

The report was published only last week, and it will take some time to focus on all its other recommendations. I can update the House on the specialist centres that the report quite reasonably recommended should be set up: NHS England is assessing bids from NHS providers to be specialist centres for mesh inserted for urinary incontinence and vaginal prolapse.

The noble Baroness, Lady Thornton, also asked about the MHRA regulatory review. The MHRA has begun a comprehensive and far-reaching programme of change, which will include enhancing its systems for adverse event reporting and medical device regulation. The MHRA has taken important steps to put patient advocacy at the centre of the work that it does.

There is nothing we can do today to make good the harm done in the past. However, as both noble Baronesses have rightly pointed out, there is much we can do to put patient safety at the heart of the NHS and to ensure that we have the technology, the systems and the culture to make sure that these mistakes never happen again.

[The Deputy Speaker (The Earl of Kinnoull) (Non-Afl)]

We come now to the 20 minutes allocated for Back-Bench questions. I ask again that both questions and answers be kept brief, so that I may call the maximum number of speakers.

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

My Lords, I first thank the noble Baroness, Lady Cumberlege, for such a wonderful and constructive report, and all the members of the committee, especially Professor Sir Cyril Chantler, whom I have known for many years.

I have just two questions. Will the report encourage clinicians to consult the appropriate royal college before designing a new treatment? Secondly, after introducing a new treatment or a new operation, should the clinician be encouraged to wait for an appropriate interval to ensure that no complications occur?

[Lord Bethell]

I thank the noble Lord for his searching questions. The role of the MHRA on both medical devices and medicines has been massively upgraded, and the review process for new medical devices has been improved. However, medical devices have different criteria from medicines.

One of the most important things that we have sought to do is to include a registry of the medical devices themselves and a registry of the medical devices inserted into individuals. Compliance with both procedures are the most important steps for clinicians embarking on new products.

[Lord Kakkar (CB) [V]]

My Lords, I thank the Minister for answering questions on this Statement and in so doing remind noble Lords of my registered interests. In her excellent report, the noble Baroness, Lady Cumberlege, identifies concerns about the lack of evidence that is required prior to the granting of marketing authorisation for many medical devices, where all that is often required is demonstration of equivalence to an already marketed product. The noble Baroness highlights the striking difference that exists with regard to the situation for medicinal products, where robust evidence of efficacy and safety is required before a medicinal product can be marketed. Are Her Majesty’s Government content with this situation—this difference between the level of evidence required before a product and a device can be marketed as regards patient safety? If there are concerns, what approach do Her Majesty’s Government propose to take with regard to ensuring that there is proper evidence of both the safety and efficacy of a device prior to its broad marketing and use in large populations of patients?

[Lord Bethell]

The noble Lord alludes to an extremely difficult balance that we have to seek to make. He is entirely right that medical devices and medicines operate on different criteria. The most important thing is that the MHRA resources for focusing on the approval of medical devices have been improved and the procedures enhanced. However, medical devices remain an important area of potential innovation, and we are concerned not to suffocate this area of potential improvement as it has been suffocated in other areas. At present, the Government believe that we have struck the right balance, but we remain keenly focused on it and it is under constant review.

[Baroness Kennedy of The Shaws (Lab) [V]]

I add my voice to the tributes that have been paid to those who produced this report, and especially to the women who persisted in having their voices heard. What came through to me very clearly was that the women themselves had not been listened to. It reminded me—I hope it will remind the House—that the complaints of women who were failed by the legal system were very much the same, about not being considered credible and about somehow exaggerating what they were describing and not being heard. It is about changing professional cultures. We have had this in the law and in policing, and we are now having to consider it in the medical professions and probably all our professions. How will the Government deal with embedded attitudes, and how will we change the training of our young medical professionals and change the attitudes inside our teaching hospitals? I want to hear about how you change cultures.

[Lord Bethell]

The noble Baroness is right: we do not listen to our women clearly enough. The medical health of women is more complicated than the medical health of men, and that point has been overlooked for too long. We are working hard to bring this into the education of young medics and to update the attitudes, procedures and knowledge of those who are already in the profession.

[Baroness Jolly (LD) [V]]

The noble Baroness, Lady Cumberlege, recognised the importance of regulation in her excellent report. Our regulation system is in a transitional stage. Regarding the European Medicines Agency and the Medicines and Healthcare products Regulatory Agency, the text of the political declaration accompanying the withdrawal agreement stated only that the UK and EU will “explore” the possibility of co-operation. Can the Minister confirm what exploratory talks have been made to ensure that the EMA and MHRA remain strong and convergent post Brexit, and that the MHRA is adequately staffed?

[Lord Bethell]

The noble Baroness is right that regulation is important, but so is culture. I emphasise the importance placed by the Cumberlege report on a change in attitude in the healthcare service as much as on a change in regulation. I cannot guarantee that the EMA and the MHRA will be aligned on regulation in all matters, but I can guarantee that the MHRA will be given the resources it needs to do the job properly.

[Lord Lansley (Con) [V]]

My Lords, as a former Secretary of State for Health, perhaps I may say that I and all my colleagues who have taken responsibility for the NHS over decades should join in expressing our deep regret at the systemic failures laid bare in the report of the noble Baroness, Lady Cumberlege. Will my noble friend reiterate the point about cultural change? It is not just about implementing the recommendations, important as that is, but about achieving cultural change. I direct that point in particular to patient involvement. By that I mean not just consultation, not just a patient voice, not just decision aids but patient-reported outcomes being a central part of the measurement of the performance of our health service and its accountability.

[Lord Bethell]

I completely endorse the comments of my noble friend. To embellish his point, it has been very interesting to see through Covid how patients have had to track their own symptoms, take advice on 111 for themselves and, in millions of cases, look after themselves at home, possibly with telemedicine to support them. This may an inflection point in the attitude of many people to their health. I certainly welcome a revolution of patient power and putting patients first in our healthcare system.

[Lord Alton of Liverpool (CB) [V]]

My Lords, families and dedicated campaigners such as Marie Lyon have told the All-Party Parliamentary Group on Hormone Pregnancy Tests, of which I am vice-chairman, that they have unequivocal admiration for the noble Baroness, Lady Cumberlege, for compassionately understanding their pain and suffering and allowing them, for the first time in more than 50 years, to have hope. Does the Minister agree with the report’s conclusion that, when the first comprehensive study, in 1967, identified a link between congenital abnormalities and HPTs, Primodos should have been removed from the market and that this regulatory failure has seen justice delayed and denied? Will there now be an independent re-examination of the contested conclusions of the report of the expert working group? In implementing the Cumberlege recommendations without delay, what practical help and redress will be provided for families whose lives were irreparably blighted by Primodos?

[Lord Bethell]

My Lords, I completely share the view of the noble Lord and of the patient groups who have unequivocal admiration for the noble Baroness, Lady Cumberlege, who has done the nation a great service with this report. As he knows, the Primodos case is subject to legal dispute, so I cannot comment on it from the Dispatch Box, but no one can read the report without feeling great disappointment that those hardships were suffered by those women. It is of enormous regret to us all.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, I am pleased to speak today very briefly. I have known the noble Baroness, Lady Cumberlege, for years since I worked in the health scene myself. She is widely experienced, and no one could have done a better report. It is very impressive and certainly not to be ignored. The various points that she has made, including the nine major recommendations, are all sound and people are very aware of them. We must realise that, though the health service is much loved by everyone in the country, there are failings which we have to accept and work on. I congratulate the noble Baroness on this marvellous report and hope that, as she urged in her press conference:

“This report must not be left on a shelf to gather dust.”


I am pleased to commend the report and the remarks passed.

[Lord Bethell]

The noble Baroness is entirely right. The report must not be left on the shelf. We have already done much, and in the Medicines and Medical Devices Bill we will do more. The other recommendations will be taken extremely seriously.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, this wonderful but deeply disturbing report has so many points to make, but one point that has not been brought out in coverage as much as it might have been is the noble Baroness’s recommendation that the responsibility for ensuring transparency of interests should fall not only on the medical profession but also on manufacturers, who must take responsibility for ensuring that, where they are creating potential conflicts of interests with medical professionals and researchers, they show that. Can the Minister tell me what plans the Government have to make sure that manufacturers are being open, honest and transparent in all their dealings and that, should they not act in that matter, action is taken?

[Lord Bethell]

The noble Baroness is entirely right that transparency is essential in order to have a fair and equitable healthcare system. The GMC has already considered these areas and has moved a long way. The world has changed considerably since many of these horrific events took place, but I am sure there is more to be done and this recommendation, like others, will be considered seriously by the Government.

[Baroness Bryan of Partick (Lab) [V]]

My Lords, there is so much to be said about this excellent report, but I shall quote one devastating sentence on mesh implants, where it raises the question

“whether the modification of a device so that it required less skill to insert should have been the preferred option rather than improving the surgical skill base.”

Does the Minister agree that there is an urgent need for a robust surgical training programme for inserting mesh devices and, just as importantly, for their removal? Will resources be put in place for such a programme?

[Lord Bethell]

The noble Baroness is right to emphasise the dangers of the insertion of mesh. It is a procedure that is still taking place within the NHS. We are looking at bids for specialist units in relevant trusts to build up the kind of specialist skills necessary to deal with the problems that have emerged from mesh procedures that have gone wrong.

[Lord Greaves (LD)]

My Lords, this is yet another outstanding report from the noble Baroness, Lady Cumberlege. The beginning of the “Implementation” section reads:

“Our recommendations are designed to pave the way for a future healthcare system that looks and feels very different.”


This is not only an outstanding report; it is a revolutionary report. Do the Government accept that this is not just another committee of inquiry but an investigation that found the facts and came back with recommendations? Are they going to set up the task force?

[Lord Bethell]

I completely agree with the noble Lord, Lord Greaves, that this is an important report. I pay tribute to my predecessor my noble friend Lord O’Shaughnessy, who commissioned it. We take it extremely seriously. No one could possibly read about the hardships suffered by the women described in this report without wanting to move swiftly on it. It has only been a few days so I cannot announce a strict timetable for every measure, but I assure the noble Lord that it is taken seriously and we will be moving on it in the very near future.

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

My Lords, this important report must become core in every curriculum, because patients must be listened to. It is correct to say that there must be a culture change, but I would like to focus on the third recommendation about establishing a redress agency. How quickly will the Government progress that? Without that, and without changing the whole culture of compensation and complaints, we will not get the openness and listening whereby if somebody comes forward with something they should expect the answer, “Thank you for telling us,” not “Oh well, we’ll look into it.” Until that changes and every comment is welcomed and patient- reported and family-reported outcomes are used to move services forward, we will not get the culture change that is needed.

[Lord Bethell]

The noble Baroness is right about culture change, but we are aware that having a big, clunking fist of financial threat hanging over individuals who are considering the admission of mistakes is not the right combination to create a culture of self-awareness and acknowledgement. We have to move extremely delicately to encourage people and make them feel safe enough to acknowledge the mistakes that might have happened and to embrace the kind of dialogue with patients that is necessary to deal with these results. That delicate balance is one of the most important things to get right in our reaction to this report.

[Lord Harris of Haringey (Lab) [V]]

We have heard some of this before. Thirty-four years ago, I submitted to the then Secretary of State—now our Lord Speaker—a patients’ charter prepared by the association of CHCs, which talked about listening to patients, putting them at the centre of every decision, and having a proper system of redress. Since then, every White Paper published by every successive Secretary of State has paid lip service to those principles, as the Minister has today. But the noble Baroness, Lady Cumberlege, has shown how shallow the commitment has been. The Minister talked about a patchwork quilt of safety mechanisms; can he convince us that this time it will be different? When will the Government say not only that they accept her recommendations in full, but what robust arrangements there will be to make sure that action and culture change actually follow?

[Lord Bethell]

Let me reassure the noble Lord that this report is taken seriously. But I acknowledge the fact that some of these issues are extremely complex, and when dealing with issues such as sexism, bullying, racism and a failure to engage with patients, there are not single-shot solutions like patients’ charters that will somehow transform the ecosphere. We have to look at it in the round, and that is why there will be major interventions like the HSIB, the people plan and the focus on fairness in the workplace that will ultimately make a big difference.

[Lord Hussain (LD) [V]]

The excellent report from the noble Baroness, Lady Cumberlege, puts patient safety at the heart of everything. I welcome the proposal in theme 3 on patient-informed consent to ensure that patients really understand and are able to co-sign their patient aid decision with the clinicians. Will the NHS ensure that professional translators able to assist patients who have English as a second language will be there at meetings and to discuss consent with them?

[Lord Bethell]

The noble Lord is right to focus on this. We have put in place enormous measures to address the issue of translation. Technology is being used in a much more thoughtful way to make sure that translation services can be put into a great many environments. One-to-one translation is also important, and that is why we have emphasised it.

Medical Teaching and Learning: Ethnic Diversity

Lord Bethell Excerpts

Tuesday 14th July 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what steps they are taking to ensure that ethnic diversity is fully reflected in all aspects of medical teaching and learning.

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

My Lords, the Government understand the importance of racial equality and diversity within the NHS and are committed to ensuring that this is reflected in medical training. We think we could do better, which is why the General Medical Council sets standards to ensure that students and doctors in training have the opportunity to understand the needs of patients from diverse social, cultural and ethnic backgrounds. That is why Health Education England provides a learning module on equality, diversity and human rights for all health and social care staff.

[Baroness Thornton (Lab) [V]]

Thank you, my Lords. I thank the Minister for that Answer. We live in a multiracial society; our NHS serves everyone and is staffed by everyone. However, the training of our doctors, nurses and medical technicians appears not to reflect this fact. We do not know whether current clinical language and learning has exacerbated the dangers to patients from a BME background during the pandemic, for example.

I pay tribute to Malone Mukwende, a student at St George’s, University of London, who published Mind the Gap as guidance for healthcare professionals, showing how skin conditions manifest on darker-skinned patients. This is a question of medical training, not a question of options that people might opt in to. We have to integrate these issues into our medical training to ensure that all healthcare professionals are able to recognise, diagnose and treat all our citizens from all ethnic backgrounds. Are the Government going to act on that?

[Lord Bethell]

My Lords, I welcome the noble Baroness’s point. She is entirely right that we live in an extremely diverse community, and this has an impact not only on the way people present their disease but on how they could and should be treated. This is why we build diversity awareness into our training and why we will build extra programmes into the People Plan that will be published shortly, and that is why we remain committed to this agenda.

[Lord Boateng (Lab) [V]]

[Inaudible.] Disparity in any part of the healthcare system is a threat to public health. In health education, there is underrepresentation of the black British community in student entry, among academic staff and in attainment. What specific actions do the Government intend to take to address this fact in each of those areas?

--- Later in debate ---

[Lord Bethell]

My Lords, the recruitment of 50,000 new nurses, more GPs and new trainees into our medical colleges is being done in a fresh and, importantly, exciting new way, with a much greater focus in the marketing and advertising on attracting those from BME communities. This recruitment programme will, I hope, present a little bit of an inflection point in our approach to recruitment.

[Baroness Jolly (LD) [V]]

My Lords, the Medical Schools Council is steered by an executive committee of 42, which is elected from its membership. Of these, only four are of an ethnic minority background and 11 are women. Apart from encouragement, can the Minister tell the House what the Government are doing to ensure that, across medical and other health professional training, there is proportional representation of both ethnic and gender minority teachers?

[Lord Bethell]

The noble Baroness is right; the representation of BAME communities at the higher echelons of the medical establishment is not good enough. In too many areas, the representation is not fair and does not reflect the much higher proportion of BME workers at other levels of the health service. We are working hard on a variety of agendas: the People Plan, which I have already mentioned, and the NHS workforce race equality standard. These measures are taken seriously and we are working hard to change the balance of representation.

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

Does the Minister agree that, in considering this important subject, there is certainly no room for complacency? However, we do need to know accurately the extent of the problem. Certainly, in all my years in medicine, I have always had this subject very much in mind in selecting and teaching students, selecting doctors and management generally.

Incidentally, I have been very close to members of ethnic minorities who have done much better in life than I have: fellows of the Royal Society, members of the Order of Merit, knights of the Order of the Thistle, presidents of royal colleges and even one who became a king.

[Lord Bethell]

My Lords, I completely agree with the noble Lord, Lord McColl, that complacency is our enemy. I recommend to him the NHS workforce race equality standard publication, which is very detailed in its analysis of the problem and is a guide to the challenge we face and a measure of how far we have come. I completely commend the achievements of those in the BAME community who often far outperform those of us who were born in Britain.

[Baroness Prashar (CB) [V]]

My Lords, we all know that incorporating diversity into medical school curricula is an effective way to develop culturally sensitive responses by medical practitioners. However, does the Minister agree that we need medical curricula where diversity is integral and understood in all its dimensions, including institutional and personal biases? Would he also agree that the current guidance, while welcome, is full of good intent but lacks conceptual clarity, and that more effective work is needed to develop a meaningful and more rounded curriculum and means to evaluate its efficacy?

[Lord Bethell]

The noble Baroness put her point well, although the broadband deficiencies meant that I did not get all of it. I emphasise that this area of policy work is very much the focus of the drafting of the People Plan, which will put a spotlight on a number of the areas of our human resources, including BAME people, and we look forward to the publication of that plan.

[Baroness Blackstone (Ind Lab) [V]]

My Lords, while the curricula of medical schools are for them to determine, could the Minister tell the House whether any meetings between the Medical Schools Council and Ministers have taken place recently? Will he ensure that a meeting is arranged in the near future to hear from the medical schools what they are doing, first, to improve the representation of Afro-Caribbean staff and students and, secondly, to ensure that teaching and research properly explore those conditions to which the BAME community is especially susceptible? Black lives really do matter.

[Lord Bethell]

The noble Baroness asks a very specific question; I cannot, I am afraid, answer precisely on what meetings there have been with the medical councils, particularly during the busy Covid period. All I can say is that there is ongoing and regular engagement with the medical schools that focuses very much on the key issues that she describes. Diversity and Inclusion: Our Strategic Framework 2018-2022, from Health Education England, is a very explicit and specific programme of works in which we engage all those in health education. As I mentioned, we are working extremely hard on our recruitment campaigns to ensure that they reach communities otherwise not reached.

[Baroness Hussein-Ece (LD) [V]]

My Lords, while reflecting diversity in medical training and learning is critical, needed alongside that is a change in the culture in the NHS. Evidence shows that racism, bullying and harassment are not diminishing. Is the Minister satisfied that the clinical leadership across NHS services is committed to learning from the research evidence on the impact of racism and discrimination on health, life chances and mortality?

[Lord Bethell]

I am not satisfied; the statistics are not good enough. Twenty-nine per cent of BAME staff experienced harassment. That is not good enough; we must work harder.

[Baroness Falkner of Margravine (Non-Afl) [V]]

Perhaps I might take the Minister upstream a little to the choices made by different communities about entering medical school. What work is being done at 15 and 16 year-old level in schools? Has his department had any conversations with Ofsted about the career choices that kids from diverse communities are making? Many realise that they want to go into medicine when it is too late and they have missed the appropriate A-level subjects so to do.

--- Later in debate ---

[Lord Bethell]

The noble Baroness is entirely right that decisions on careers are often made at school and if we do not get to people then we may miss them for ever. That is why we have built a major schools component into our recent recruitment campaign. It started in April, but it has been delayed by the Covid epidemic; it will restart shortly. I have commended it a couple of times already, but I reassure the noble Baroness that it has a hefty schools component to it, which I understand is working extremely well.

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

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

Independent Medicines and Medical Devices Safety Review

Lord Bethell Excerpts

Thursday 9th July 2020 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the report by the Independent Medicines and Medical Devices Safety Review, First Do No Harm, published on 8 July.

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

While the NHS is a beacon of brilliant care and safety in the majority of cases, we must do better, as this report demonstrates. I apologise in full on behalf of the healthcare system to all the families affected in this report for the time it has taken to listen and respond to their concerns. I salute their courage and persistence in coming forward to make these concerns known. Much has already changed. We are introducing major advances in legislation, but we will respond further. In the meantime, I pay tribute to patients who bravely shared their experiences to inform this important report.

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

My Lords, I thank the Minister for his fulsome apology on behalf of the Government to all the victims—all the women and all the families. The first duty of any healthcare system is to do no harm, and the damning report from the noble Baroness, Lady Cumberlege—whom I congratulate—into the use of these medical devices and medicines, including pelvic mesh, reveals shocking failures in this duty of care. What further urgent action will the Minister, along with his colleagues in the department of health, now take to implement the review’s nine recommendations, including a task force and an exhortation to the devolved nations to implement and act on those recommendations?

[Lord Bethell]

My Lords, much has already happened, and I point to the appointment of a national patient safety agency, run by Dr Aidan Fowler, whom I know and to whose fine work I bear testimony. Much is due to happen shortly: I emphasise the introduction of a registry amendment to the Medicines and Medical Devices Bill, which is due to be debated in this House shortly. But there is more to be done. The Government must consider the report’s recommendations, on which we will return shortly.

[Baroness Kennedy of The Shaws (Lab) [V]]

Does the Minister agree that this scandal is about something much deeper than damaging medicines and inadequate healthcare products? Just as the law for generations dismissed the experience of women who were abused and raped and gave little credibility to their testimonies, the medical profession too has to examine its own culture, which as this report shows—

--- Later in debate ---

[Baroness Brinton (LD) [V]]

My Lords, the country owes an enormous debt of gratitude to the many campaigners who have fought tirelessly over decades to get their issues raised and to ensure that this never happens again. It is good that the Government have apologised on behalf of many Governments, and it is reassuring to hear that there will be some amendments to the Medicines and Medical Devices Bill, but the people who are affected need redress urgently. Can the Minister give us an indication of when this will happen?

[Lord Bethell]

I share with the noble Baroness, Lady Brinton, my personal respect and admiration for the campaigners, who are described in the report as having lived through the most awful experiences and who, through personal commitment and determination, have brought attention to these huge failures and have pursued their cause with enormous patience. We owe them a huge debt of gratitude. In terms of commitments on the individual recommendations, I have mentioned what we have done so far and what we have on the near horizon. However, it will take some time for the Government to study these recommendations—to understand from my noble friend Lady Cumberlege herself her detailed recommendations—and to come back on the timetable that the noble Baroness requested.

[Baroness Cumberlege (Con) [V]]

I will be brief; I could talk about this report for a very long time but I will not, as I am very conscious of other people who want to ask questions. I start by thanking Members of both Houses who have supported us throughout this review and indeed the report. I particularly thank the patient groups, of course. We met them on Tuesday and they were fulsome in their support for this report, which means a great deal to us. We called our report First Do No Harm because that is the principle that should start good-quality care—it is about not only doctors but the whole of the healthcare system—but too often we found that it has not.

First do no harm, but then do some good, because the report also looks to the future. Our report is comprehensive and is built on what patients and patient groups have told us. We listened to them—over 700 women and their families face to face, and many others through telephone calls and emails—we heard them, and we believed. Their stories were harrowing and heart-wrenching: the relationships that were broken, the careers lost, the financial ruin that resulted. Terrible harm has been done to them. It showed us that the healthcare system, as a system, has been failing. I am very pleased that the fulsome apologies made today by our Minister and the Secretary of State have acknowledged that.

Our first recommendation has already been fulfilled and I am sure that the patient groups will be warmed by that. I ask my noble friend the Minister: will the Government seriously study our nine recommendations? Some are about the current situation, some the future. They are all really important. The patient safety commissioner is a new idea and Jeremy Hunt, who commissioned our report, has described it as a very bright and good idea to have someone who will fill the gaps that we have found in the whole of the healthcare system. Will the Minister please ensure that our recommendations are implemented? Implementation is key. We do not want this report to sit on a shelf and gather dust, though I am sure that the patient groups will not allow that to happen. It is really up to the Government to grip this issue and make a real difference in the lives of so many people, suffering not only now but in the future. Will he ensure that the patients, who are the experts, will be closely involved in the implementation group—the task force? Will he recognise the knowledge and experience of the task force? Can he also ensure that the experience of the review team, which has worked so hard, is included?

[Lord Bethell]

My noble friend Lady Cumberlege has put it incredibly well and I endorse her testimony about the courage and expertise of the patient groups who informed this report. I am only sad that they cannot be here to share this important moment. I pay tribute to the work of my noble friend and her team working on this. Patient safety is uppermost now in the mind of health carers. She is absolutely cutting with the groove. The words of Jeremy Hunt are very well made, and we are utterly committed to looking seriously at these recommendations.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I add my apologies to the patients and their families and acknowledge the superb work done by the noble Baroness, Lady Cumberlege, and her team. The report makes very salutary reading. Are we going to make sure that we keep central records relating to any type of implant in future, including mesh used in hernias, so that we can follow up individual cases as appropriate? Will the Government consider returning to the Health Service Safety Investigations Bill, which was delayed and abandoned as a result of the recent general election?

[Lord Bethell]

Health records are absolutely key—that is why we have tabled an amendment on them. That amendment enjoys the support of the Government and of me personally.

[Baroness Thornton (Lab) [V]]

I think we can see that we need a longer discussion on this report. It is quite clear that some of its excellent recommendations will require primary legislation and I hope the Minister may have identified them already. We on these Benches are keen to co-operate with the Government and across the House to bring forward the necessary amendments to the Medicines and Medical Devices Bill.

[Lord Bethell]

The HSSI Bill is an incredibly important part of our agenda. It is not currently on our schedule, but we hope to bring it back at some date, or incorporate its contents in another vehicle.

[The Deputy Speaker]

I call the noble Lord, Lord Willis of Knaresborough. No? In that case, I call the noble Lord, Lord O’Shaughnessy.

[Lord O’Shaughnessy (Con) [V]]

My Lords, as a former Health Minister I add my apologies to these women on behalf of the Government I served. They were let down over many years and I pay tribute to their courage in coming forward for this review. I also pay tribute to my noble friend Lady Cumberlege and her review team for a superb, landmark piece of work. I want to press my noble friend the Minister on one issue: he mentioned that Aidan Fowler is the national director of patient safety in NHS England. That is quite right and very welcome, but the report recommends that somebody from outside the system—someone whose first loyalty is to patients themselves, not to the NHS—should be the gateway, the representative on behalf of patients. I know my noble friend wants to consider these recommendations carefully, but will he not rule out the idea of a new, patient-focused commissioner simply because there is someone leading on patient safety in NHS England already?

[Lord Bethell]

I thank my noble friend for his comments and for his role in commissioning this important report. His point on the safety commissioner is extremely well made. I am not ruling out anything whatever, but we need time to study the report before we can make any commitments.

[Lord Patel (CB) [V]]

My Lords, I thank the noble Baroness, Lady Cumberlege, and her team for what is a hard-hitting report, and rightly so. Reading it, I felt anger and shame—anger that so many women patients were treated with such disdain and felt that they were not listened to; and ashamed that members of a profession I belong to showed such ignorance, arrogance, duplicity and callousness towards the very people who put trust in them. As a member of that profession, I apologise wholeheartedly to women who suffered and I hope that the profession takes heed of them. Much of the report draws on narratives from women, and I was struck by one who called herself

“an unsuspecting, unwilling participant in a cruel experiment”.

No patient should ever feel that. I hope this report is a wake-up call for the professional organisations too, to take charge and become more patient-focused, rather than professional-focused, and to deliver the care that patients deserve. I am a long-time supporter of the charity Epilepsy Action. It has welcomed the report and hopes that action will be taken soon, particularly for women and mothers in relation to sodium valproate. I support the questions asked of Ministers and I hope we will soon see action.

--- Later in debate ---

[Lord Bethell]

My Lords, no one who reads the report can help feeling anger and shame; the noble Lord puts it well. I completely endorse his feelings and the Government will be looking at these recommendations closely and acting on them in the spirit he describes.

[Baroness Bryan of Partick (Lab) [V]]

My Lords, I ask this question on behalf of some of the women campaigners. The report states:

“The removal of transobturator tape is technical and complex surgery and there are very few surgeons in the UK capable of undertaking this”.


While this remains the case, will the Minister consider banning these mesh tapes until women can be sure that any post-operative problems can be fully and safely treated?

[Lord Bethell]

My Lords, one cannot read the descriptions of the consequences of some of the surgery around mesh, and the pain and suffering that some of the women endured, without feeling huge anger and shame and instinctively wishing to ban such a thing. However, mesh offers a solution to some women whose prolapse is profound and who have run out of options. There are women for whom mesh has been a great saving and where there has been a successful procedure. Procedures around mesh have improved dramatically. We are reluctant to apply a blanket ban, but we take the recommendations of the report very seriously and will be looking at this procedure extremely closely.

[The Deputy Speaker]

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

Social Care

Lord Bethell Excerpts

Wednesday 8th July 2020 Lords Chamber

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

My Lords, we all agree that social care needs to be put on a sustainable footing where everyone is treated with dignity and respect. That is why the Prime Minister made clear commitments in the manifesto and the election, and why the Secretary of State wrote to other parties to begin the process of cross-party talks. We must now come together to find a common solution to this challenge: a long-term plan for social care that enjoys cross-party support.

[Lord Dubs (Lab) [V]]

My Lords, will the Minister confirm that the Prime Minister, said in his first speech in office that

“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … I will take personal responsibility for the change I want to see”?

Is that still the policy, or will the Prime Minister again claim that he has been misunderstood, as with his recent unpleasant attack on social care, for which he has refused to apologise?

[Lord Bethell]

My Lords, that is very much the policy, but I emphasise the following. No plan can succeed unless it gains the support of a wide number of stakeholders, including cross-party support. Attempts to foist a plan from one group on to another simply will not work. That is why a bridge-building exercise is needed and why the Secretary of State has invited others to cross-party talks. I invite all those players to go into that process with a spirit of collaboration.

[Baroness Pitkeathley (Lab) [V]]

It is good to hear that the Minister now accepts that piecemeal reform of social care will not do. Can he confirm that the Government will consider finally putting social care on the same level as the NHS and creating a national care service in which risks and costs are shared? Sharing costs must apply to the whole population for the whole of their lives, not just when they are in need of care—in fact, from the cradle to the grave.

[Lord Bethell]

My Lords, the Covid epidemic has been a vivid experience for me personally. I have seen how the Department of Health and Social Care prioritises the care for those in social care. I completely endorse the noble Baroness’s view: piecemeal reform is not on the cards. The Government have made it clear that a holistic solution is needed. That is what we are working to achieve.

[The Lord Bishop of Carlisle]

My Lords, following on from the previous question, given that a long-term settlement for social care is one of this Government’s top priorities, and that there is general agreement that this should involve cross-party consensus and a significant measure of integration with the NHS, does the Minister agree that, in the continuing absence of a White Paper, the time has come to establish a Select Committee or perhaps a parliamentary commission with a specific timescale to make recommendations that might finally resolve this complex issue?

[Lord Bethell]

The right reverend Prelate is entirely right that we will need some kind of formal structure to go about cross-party talks and achieve a solution. That formal structure will need to be agreed in cross-party conversations. Those conversations have been ongoing during the epidemic and are now very much the focus of the Government’s attention.

[Lord Hunt of Wirral (Con) [V]]

My Lords, in the light of the surge in support from neighbours, family and friends for older people who have been shielding at home during the pandemic, would my noble friend agree that it is still the policy of Her Majesty’s Government to encourage people to remain receiving care in their own homes for as long as possible?

[Lord Bethell]

My Lords, the role of carers during the epidemic is one of the great stories of commitment and sacrifice. I pay tribute to all those who have given up their time and taken the risks necessary to perform this important community role. On encouraging people to stay home, there are clear guidelines on who is recommended to stay at home. It depends on clinical need and people’s precise circumstances, according to their GP’s recommendations. I urge all people to follow those guidelines.

[Baroness Brinton (LD) [V]]

My Lords, I remember that there was cross-party support 10 years ago for the Dilnot review’s proposals. I support warmly the comments of the noble Baroness, Lady Pitkeathley, about the need for a national care service. Will this review and White Paper also look at matters that are often forgotten in a care setting: housing standards for life, and sheltered and community settings, to make sure that we do not yet again end up looking at just adult social care and care homes?

[Lord Bethell]

The noble Baroness is quite right to shine the spotlight on those who are in social care but not necessarily aged over 65. Half of all social care costs are now dedicated to those under 65. Housing standards is an important question. The stock of housing for social care will be considered in any forthcoming review. It is imperative that we have a modern and up-to-date industry.

[Lord Balfe (Con) [V]]

This policy could lead to literally unlimited costs and a bottomless pit that would make the National Health Service look like a modest outfit. When we devise this policy, we must make sure that adequate contributions are made by those affected and we do not fall into the trap of saying that inherited potential wealth is somehow to be exempted. People must pay a fair share.

[Lord Bethell]

My noble friend is entirely right: there is a massive potential liability. We are acutely aware of the intergenerational implications of social care reform. It is only right that we treat both those in social care and future generations fairly. Those considerations will be uppermost in our minds.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, can the Minister assure the House that any reform of the social care system will be accompanied by a comprehensive workforce strategy and fundamental improvements to employment conditions by moving away from zero-hours contracts, perhaps to an annualised hours system, to guarantee social care workers regular incomes?

--- Later in debate ---

[Lord Bethell]

My Lords, the precise remit of any review will be the choice of those doing the review when it comes, but I entirely endorse the noble Baroness’s sentiments that the social care workforce is worthy of our respect, particularly for its hard work and commitment during the epidemic. Workforce remuneration has improved since the introduction of the national living wage in 2016. Flexible contracts suit many workers, so a blanket commitment to annual wages is not necessarily suitable, but I endorse a focus on solutions that encompass all aspects of the social care industry, including the workforce.

[Baroness Thornton (Lab)]

My Lords, following on from what the noble Baroness, Lady Brinton, said, the Minister’s party has form for not honouring cross-party co-operation on this issue. To mitigate that, given that the Prime Minister has said that he is currently finalising plans, perhaps the Minister could commit the Government to setting a firm date and a timetable that could be published before the House rises for the Summer Recess? Does he accept that we need a plan to be delivered within a year?

[Lord Bethell]

The noble Baroness is kind to think that I am in a position to articulate a timetable from the Dispatch Box—that is beyond my abilities. However, she is entirely right to focus on the urgent need to focus on this area. The Prime Minister and the Secretary of State could not have been plainer that when the time is right and we have dealt with the epidemic, social care reform will be uppermost in our mind and will be the focus of our attention.

[Baroness Bowles of Berkhamsted (LD) [V]]

My Lords, since 1998 there have been 12 Green Papers, White Papers and other consultations, and five independent reviews, and like the Economic Affairs Committee, they all say that the system needs to be properly funded. Will the Government do that for immediate needs so that the White Paper can go on to do real good for the long term?

[Lord Bethell]

The noble Baroness is quite right to allude to the very large number of White Papers, think tank reports and amount of documentation in this area. All I can say is that I have never seen such acute political will and focus on social care reform. Nor have I seen a Prime Minister, a Secretary of State and a chief executive of the National Health Service to be so focused on the matter and to have raised it as a major priority in all their communications.

[The Deputy Speaker (Lord Alderdice) (LD)]

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

Covid-19

Lord Bethell Excerpts

Wednesday 8th July 2020 Lords Chamber

[Baroness Thornton (Lab)]

Last Wednesday, the Minister advised noble Lords that the lockdown in Leicester was being carried out under the Public Health (Control of Disease) Act 1984 and that regulations would not be brought to the House. However, on Friday, Leicester regulations were laid. Can the Minister clarify that and explain why there was some confusion and whether this has any practical consequences for implementation and enforcement in Leicester? Will this apply to other cities such as Bradford, Barnsley or Oldham? At Prime Minister’s Questions just now, the Prime Minister stated that the risks associated with asymptomatic transmission were unknown until recently. This is not the case. I am very happy to provide the Minister with SAGE minutes from 4 February, for example, when precisely that was recorded. Can the Minister clarify that statement for the House?

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

My understanding regarding the 1984 Act is that the regulations are published under the appropriate section. They have been published as is appropriate, but they are not brought to the House for debate. If I am wrong, I will be happy to write to the noble Baroness.

[Baroness Brinton (LD) [V]]

Today, the Public Accounts Committee has reported real concerns that the Government have no realistic plan for supplying PPE in the event of a second wave. Can the Minister comment on that? I know I ask this regularly, but can the Minister tell the House when all NHS and social care staff, including those working in people’s homes, can get regular, repeated testing that is not dependent on symptoms? Yesterday, Matt Hancock said that, finally, some day centres, sheltered living and non-care home settings will be able to access tests. Which ones and when? I noticed that, on Monday, the Covid data dashboard was changed, removing posted-out but not returned tests. Does that mean that, in future, posted-out tests will not be counted unless they are returned?

[Lord Bethell]

On PPE, I pay tribute to my noble friend Lord Deighton, who has performed an amazing task in providing an enormous supply of PPE. There is sufficient PPE in the NHS, social care and other parts of the healthcare system for all those who need it. There is a PPE hotline for those who would like to order it directly and, at this stage, stockpiles are being created to get us through the winter months. On tests, a testing portal is available to all of social care. It can be accessed either by social care employers or, if employees or residents want a test, they can order one themselves through the public testing portal. It is my understanding that posted tests are no longer counted in the same way: they are counted not on dispatch but when they are processed. The “test and trace” programme initiated this change in the recent change of data, which I think was 10 days ago.

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

My Lords, last week I understated the figures on the deadly combination of Covid-19 and obesity. House of Commons Library figures show that 72% of UK people are either obese or overweight. What is even more tragic, 33% of 10 year- old children are overweight or obese. These appalling figures may help explain the high mortality from the coronavirus in the United Kingdom, so will the Minister endorse the urgent need to persuade people to lose weight? To save lives, we should follow the advice of the Prime Minister himself, who said, “Don’t be a fatty in your fifties”.

[Lord Bethell]

I think my noble friend and I need to have a chat about statistics, because the statistics I have differ from his. Mine suggest that 28% of the public are either obese or overweight, and it does defy common sense that 72% the public are obese or overweight. Maybe he and I can have a chat about that offline: I would be glad to clear it up. However, my noble friend makes a really important point that I and the Government completely endorse: the Covid epidemic has been a wake-up call for the country—in that, he is right. There is an urgent need to address the obesity epidemic and the Government are looking at ways to do so. The Prime Minister is personally vested in it and my noble friend’s points are extremely well made and supported on these Benches.

[Lord Bilimoria (CB) [V]]

My Lords, it is very good to see the Statement saying that new cases are at their lowest since the lockdown began. Will the Minister confirm that 30,000 excess deaths have taken place in care homes, and that almost 20,000—almost 50%—of all the sad deaths have been in care homes? Are care home staff, the 1.6 million people who work in the care sector, as well as the 1 million patients in care homes and at home, being tested every week? Just today, we heard that the accident and emergency department at a London hospital has closed because of infection among the staff. Are all staff at NHS hospitals around the whole country being tested regularly, every single week? Looking ahead, will there be a large-scale flu vaccination campaign as an extra precaution leading up to this winter?

[Lord Bethell]

The noble Lord is entirely right to emphasise the importance of flu vaccination. We are very focused on getting the right amount of flu vaccination stocks and encouraging take-up once the WHO has nominated the right vaccination and we have stocks of it in this country.

[Lord Mann (Non-Afl) [V]]

Small sports clubs are particularly vulnerable to the lack of people paying to go in. When will the Government come forward with plans to allow small numbers of people to pay to be spectators at sports such as football or rugby league, socially distancing in the same way as is now allowed in cinemas, pubs and restaurants?

--- Later in debate ---

[Lord Bethell]

I welcome the start of cricket, which I understand began today. I correct the noble Lord on one small thing: cinemas are not open, nor are they likely to be in the near future. The CMO, under the advice of SAGE, is considering the provision of new guidelines for spectators at sports. I do not know exactly when that will be, but it is certainly under review.

[Baroness Jones of Moulsecoomb (GP) [V]]

My Lords, when our Prime Minister was Mayor of London and I was on the London Assembly, part of my job was to keep a close eye on what he said and did. It is my informed opinion that when he spoke about care homes and the 20,000 deaths, he was intending to pass criticism and blame away from himself and his Ministers. Is the Minister prepared to disagree with my informed opinion?

[Lord Bethell]

I completely understand the history of the noble Baroness’s role at City Hall, but I completely push back against her characterisation of the Prime Minister’s intentions. He has made it very clear that he is incredibly grateful for the hard work and sacrifice of those who work in the care homes sector, and I think we can take him at his word on that.

[Baroness Neville-Rolfe (Con) [V]]

There is a real degree of confusion about masks. Originally, Ministers said that they did not do much good; now, the President of the Royal Society claims they are essential. A study at Jena, west of Leipzig in Germany, underlines their value. Will my noble friend clarify the position and explain his reasoning?

[Lord Bethell]

The Government’s approach to the epidemic is to emphasise the three main pillars of our strategy: hygiene, social distancing and isolation. They are based on clear science and evidence. The issue of masks is highly contested. There is possibly a benefit from wearing masks—that is why we have put in place the requirement to wear masks on public transport—but the science remains clear that they are not a replacement for hygiene, social distancing or isolation. On that, we are clear.

[Lord Truscott (Ind Lab) [V]]

My Lords, the fall in cases is welcome, but is it not becoming clearer that in aiming to create spare bed capacity in the NHS at the expense of the elderly, Her Majesty’s Government ended up putting saving the NHS ahead of saving lives? Another example of that is the strict criteria applied to hospital admissions. Should these criteria not be immediately relaxed to save lives?

[Lord Bethell]

The noble Lord make his point well; however, I did not hear all of it. We are working extremely hard to increase the number of admissions in hospitals and all parts of healthcare. We are trying to restore confidence in the healthcare service to address public concerns, and I appeal to all those who have appointments or who are feeling poorly to take the opportunity to phone 111 and book themselves into hospitals or into the appointments they need, because we desperately need people to return to the NHS.

Independent Residential Care

Lord Bethell Excerpts

Tuesday 7th July 2020 Lords Chamber

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

My Lords, this disease has targeted the vulnerable, and those working and living in social care have faced daunting threats. The Government have intervened with £3.7 billion for local authorities, including specific funds such as the £600 million infection control fund and the £500 million announced on 2 July. Delivery is being supported by our social care Covid-19 task force.

[Lord Laming (CB) [V]]

My Lords, I am grateful to the Minister for that reply, but he will know that, nowadays, residential care homes are provided not by local authorities but by thousands of independent organisations. It is now thought that some of these organisations may be in financial difficulties. Can the Minister tell the House what plans are in place to protect the residents of a home which ceases to operate, especially as these residents are not only very vulnerable but, frankly, have nowhere else to go?

[Lord Bethell [V]]

My Lords, the noble Lord is entirely right. The protection of residents is our number one priority and our responsibilities under the Care Act 2014 remain in place. The care home economy is mixed. We are looking very carefully at the financial resilience of all the providers involved. We are providing the funds necessary to see them through this epidemic and we will do whatever it takes to protect residents.

[Baroness Armstrong of Hill Top (Lab) [V]]

My Lords, given the unfortunate words of the Prime Minister last night, where he seemingly blamed care homes for high rates of Covid-19, when will the Government actually produce the long-promised proposals for the future of social care, which will guarantee quality through acknowledging the need for a skilled, stable and trained workforce, properly valued?

[Lord Bethell [V]]

My Lords, we are enormously grateful to all those working in the care home sector, who have protected residents through this awful epidemic, and we continue to support them. We have increased recruitment in the area, and are in the midst of an enormous recruitment marketing campaign to bring new, qualified people into the care home sector. The Secretary of State wrote to relevant stakeholders on 14 May, inviting them to cross-party talks on the care home sector. We are continuing those conversations and hope to bring them to a head at the earliest opportunity.

[Baroness Brinton (LD) [V]]

Yesterday, our Prime Minister said that

“too many care homes didn’t really follow the procedures”.

In March, the care sector asked for testing for patients discharged from hospital. The Government’s reply—not necessary. The sector could not get the promised PPE as government supplies failed to appear. All our amazing 1.6 million care home workers needed testing from March—it took the Government three months. Complex government guidance changed frequently, sometimes even daily. Our care homes have had to cope with 30,000 excess deaths in three months and massively increased costs. Does the Minister agree with our Prime Minister, or with the National Care Forum, which said that Boris Johnson’s remarks were, “frankly, hugely insulting”?

[Lord Bethell [V]]

I thank all those who work in the care home sector for the enormous amount of sacrifice and commitment that they have shown to protecting residents. The noble Baroness, I think, portrays the situation unfairly. Guidelines have changed quickly because the situation changed quickly. PPE demand could never have been expected at the levels it reached; the Government responded incredibly quickly to move PPE into both NHS and social care. On testing, we started from a very low base; testing has now been introduced in care homes for both patients and staff. The Government will continue to be committed to protecting both staff and residents in the care sector.

[Lord Mackay of Clashfern (Con) [V]]

My Lords, is the money that the Government give to local authorities for social care ring-fenced for that purpose?

[Lord Bethell [V]]

My Lords, the money that my noble friend refers to is not currently ring-fenced. Local authorities have been written to, to explain that the money should be prioritised for Covid—but, at the request of the local authorities themselves, the money was not ring-fenced.

[Baroness Hollins (CB) [V]]

My Lords, the Vivaldi project found that, in care homes where staff received sick pay, there were lower levels of infection in residents. During the next pandemic, will our priority to be to save the NCS—the new national care service—as well as the NHS, or will we have an integrated NHCS national health and care service, or, what other urgent measures are Her Majesty’s Government considering to protect care?

[Lord Bethell [V]]

The noble Baroness puts her question extremely well, but I am afraid it is beyond my ability to predict as she asks exactly what the shape of the national care provisions will be. What I can say is that the role of agency staff was always, from the very earliest stage, one of the gravest concerns we had. The CMO flagged it very early, and we moved as quickly as we could to tackle the difficult issue of itinerant staff, and to put in place both the funding and the procedures to anticipate problems of infection around staff who move from one home to the next.

[Baroness Thornton (Lab) [V]]

My Lords, I return to the question raised by my noble friend Lady Armstrong and the noble Baroness, Lady Brinton, because, while it is obviously welcome for the Minister to thank those who work in care homes for the sacrifices that they have made, he needs to acknowledge the hurt that the Prime Minister has caused with his words. Will the Minister clarify which procedures care homes are accused of disregarding? Are they procedures related to the Government’s policy of allowing hospital patients to be discharged without testing, to the failure to provide the required PPE or, perhaps, to setting up the testing programme so late?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, it is not the role of a junior Minister to speak on behalf of the Prime Minister, but I can say that the Prime Minister, the Secretary of State and I are all enormously grateful for the huge amount of work that social care staff have put into this epidemic. I have seen with own eyes the commitment and expertise that they have provided during these very difficult days. We are, as a nation, enormously grateful for their hard work and skill.

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

My Lords, the pandemic has placed a very harsh spotlight on the resilience of the care system, with 30,000 excess deaths in care homes in England and Wales in a three-month period. At the weekend Sir Simon Stevens made it crystal clear that we just do not have a fair or properly resourced social care system with proper workforce support. With some homes already running close to bankruptcy due to the additional costs and occupancy rates slipping below 87% when many smaller homes become financially unviable, what immediate steps are the Government taking to protect these smaller homes?

[Lord Bethell [V]]

The noble Baroness is entirely right that the issue of excess beds is an unfortunate and unwelcome added pressure on an already pressured system. Sir Simon Stevens was echoing the sentiments of the Government and the Secretary of State when he said that we need to move towards a long-term settlement for social care. That was very much the commitment of the Prime Minister during the election and in the manifesto. Steps have been taken towards working on that but we have been interrupted by Covid-19. It remains a number one priority for the Government. In the meantime, we will be putting in the financial resources necessary to provide the resilience for those smaller homes of which the noble Baroness speaks.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, does my noble friend think it reasonable that, 12 months after the Economic Affairs Committee produced the report Social Care Funding: Time to End a National Scandal, we have not had a debate on the report or a response from the Government? He talks about providing resources for social care. That report identified an £8 billion gap just to get back to the standards we had in 2010. Does he not think that instead of the occupants of Nos. 10 and 11 Downing Street standing on their doorsteps and putting their hands together to clap the achievements of social care workers, their hands should be put in the Treasury’s pocket to find the money now urgently needed to prevent the collapse of nursing homes and to prevent us continuing to rely on the good will and hard work of people who are being pressed beyond endurance? This delay cannot go on longer and longer, which has been the pattern for the last decade.

[Lord Bethell [V]]

My noble friend asks the question extremely well. The Lords Economic Affairs Committee report is an extremely thoughtful and respected piece of work. Under normal circumstances we would certainly have had that debate and moved forward on this incredibly important issue, which was flagged both in the election and in the manifesto as a major government priority. However, I cannot hide from my noble friend that the Covid epidemic has disrupted progress, particularly on this delicate issue, which requires a huge amount of management time by senior healthcare officials, who are utterly consumed by Covid at the moment. Please be under no illusion that this is a major priority for the Government. Once the preparations for winter are in place, it will be at the top of the list.

[Lord Harries of Pentregarth (CB) [V]]

The Covid crisis has revealed the crucial role that care homes and care workers play in our national life. Does the Minister agree that it is high time to take a radical look at the role of care homes and of social care more generally, especially the status and the pay of care workers, who have revealed their worth so wonderfully over these last few months?

[Lord Bethell [V]]

The noble and right reverend Lord is entirely right: the value and contribution of care home workers to society and to the communities that they work in go way beyond the actual monetary value of their salary. We completely respect and pay tribute to the contribution that they have made, particularly during this epidemic. We have sought during the epidemic to run recruitment campaigns to bring in new workers and to help plug any skills gaps, but this is the kind of issue that needs to be addressed in a long-term plan. We have already started work on that plan and look forward to bringing it to Parliament when the kind of cross-party support that is needed is in place.

[Baroness Falkner of Margravine (Non-Afl) [V]]

My Lords, I welcome the initiation of cross-party talks. The Minister will know now that more than two-thirds of the public want to fund health and social care through higher taxation. Will he now accept that as a principle if that is the result of the cross-party talks, instead of his Government ruling out tax increases?

[Lord Bethell [V]]

The noble Baroness makes her case well. There are a large number of considerations in this matter—my noble friend Lord Forsyth has already made a strong case for the recommendations of the Economic Affairs Committee—and we need to look at all of them. It is an extremely complicated area. We need to get buy-in from cross-party support and from a wide number of stakeholders and the businesses involved. Once we are in that position, we will be able to make a plan that delivers a long-term solution to this knotty problem.

[Lord Desai (Lab) [V]]

My Lords, we must welcome Sir Simon Stevens’ promise to help independent care providers, but will we make sure that when the money goes to those providers they pay their staff properly, give them protective equipment and do not let them go on working in an unsafe and underpaid profession?

[Lord Bethell [V]]

My Lords, the role of the staff is essential. We have put in place an infection fund of £500 million to help to provide a safe working environment for staff, and we are looking at mobilising a huge PPE effort, led by my noble friend Lord Deighton. The protection and payment of staff are essential. However, a long-term solution for staff will depend on a long-term deal. We are working on that but I cannot give any assurances until the important work of building cross-party support has been fulfilled.

Medicinal Cannabis

Lord Bethell Excerpts

Monday 6th July 2020 Lords Chamber

[Baroness Meacher]

To ask Her Majesty’s Government what action they plan to take to improve access to cannabis for medicinal purposes for (1) patients, and (2) research, in the United Kingdom.

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

My Lords, I thank the noble Baroness, Lady Meacher, for her Question. There is no legal impediment to prescribing medicinal cannabis where clinically appropriate, and the Government are keen to make progress in this area. However, these are largely untested, unlicensed products. To support further NHS funding decisions, we have committed public funds to develop the evidence base. I thank NHS England, NHS Improvement and the National Institute for Health Research for their work to establish much-needed clinical trials and call on the industry to support clinical trials in refractory epilepsy and other treatment areas.

[Baroness Meacher (CB) [V]]

My Lords, from 1 November 2018 consultants have been able to prescribe medical cannabis as an unlicensed medicine, as the Minister implies, yet NHS doctors remain unwilling to prescribe, partly because medical cannabis remains on the list of controlled drugs. Hundreds of thousands of patients with severe and chronic conditions who find that cannabis is the only medicine that controls their symptoms without unpleasant side-effects continue to risk arrest every day by growing or buying their medical cannabis at exorbitant prices. Does the Minister agree that this is contrary to the patients’ human rights? How can we criminalise patients for saving the NHS huge sums of money by looking after themselves and doing harm to no one? Will the Minister appeal to Matt Hancock to write to the Home Secretary, urging her to remove medical cannabis from the list of controlled drugs?

[Lord Bethell]

There is a difference between the issue of controlled drugs and that of access to regulatory approved drugs. The noble Baroness is right that medicinal cannabis offers huge hope to those in pain and with severe symptoms. However, it is only through the process of regulation, clinical trials and scientific proof that we can guarantee that the benefits of this important medical opportunity are truly exploited.

[Lord Howarth of Newport (Lab) [V]]

My Lords, is the Minister aware of the predicament of the person who suffers chronic and unbearable pain from degeneration of the spine, the only effective relief for which is medicinal cannabis in the form of Bedrocan? Is he aware that her medication is not allowed to be prescribed by a GP on the NHS, that it costs her an unaffordable £750 a month to obtain it on private prescription, that she can obtain it at an affordable price in Holland, that due to the circumstance of the pandemic she cannot make that journey, but that she is none the less expected to pay the Dutch pharmacist for the medication being held for her? What is she to do, and how will the Minister help?

[Lord Bethell]

My Lords, I cannot comment in detail on the specific situation the noble Lord refers to. I recognise the high costs of medicinal cannabis, and we have done an enormous amount to bring those costs down and to regularise the transport and regulation of those drugs, but this is the way our medical arrangements are made in this country. Private prescriptions are an option for those who can seek them, and we are working hard to get more of these medical cannabis treatments on the NICE schedule, but they require clinical trials.

[Baroness Walmsley (LD) [V]]

My Lords, will the Minister accept that the existing protocols and regulatory mechanisms suitable for most pharmaceutical medicines are not capable of handling medical cannabis, which has multiple active ingredients and is therefore not suitable for the usual randomised control trials? Does he therefore agree that a new regulatory system is required for medical cannabis, as there is in many other countries?

[Lord Bethell]

I do not think the noble Baroness is right. There are always groups advocating that their medicines are different from every other type of medicine, but the processes of clinical trials have served medical science extremely well. I share her frustration that the process of medical trials around cannabis has not moved quickly enough. That is why NIHR is looking again at the way these trials are funded; I have spoken to it about how this can be accelerated.

[Baroness Fookes (Con) [V]]

Given the importance my noble friend attaches to tests, may I ask whether any have started, the dates on which they started and when we might expect results?

[Lord Bethell]

The noble Baroness is very specific in her questions, and I am afraid I am not able to answer them specifically because they are subject to restrictions and confidentiality. Where I agree with the thrust of her question is that we have been in a bit of a cul-de-sac in this area, but the department is working hard to unblock the problems that have existed. Despite Covid, we appear to be making some progress on this.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, two cannabis medicines have MHRA approval. One of them, Sativex—prescribed within the NHS for multiple sclerosis—has a high level of the active cannabinoid THC, so we know cannabis has medical value. There is no doubt that many more cannabis medicines will be licensed in the coming years. Does the Minister therefore agree that while we are reviewing our current trials, we should evaluate whether it is justified to regard cannabis, in a medical way, as a controlled drug in the long term?

[Lord Bethell]

The noble Baroness will not be surprised to learn that I have just spent three and a half months looking at drugs that might make a difference to Covid, only to find that many of them are not helpful and often quite dangerous, so I do not share the optimism bias that many have towards unlicensed drugs. We remain conservative in our approach to clinical trials. I agree with the noble Baroness and others who have suggested that progress on this should be quicker, and I am leaning into the subject to try to bring that about as soon as we can.

[Baroness Thornton (Lab)]

My Lords, it is deeply concerning that no new NHS prescriptions for full extract cannabis oil have been issued since the medicinal use of the drug was legalised more than 18 months ago. This leads to a health inequality: 313 private prescriptions for unlicensed cannabis medicine items, including full extract oil, have been issued. Does the Minister share my concern that only wealthy families and those who can successfully raise funds in the region of £2,000 a month have access to cannabis medicines, while children from poorer families who are unable to afford the prescription are going without? What does he think needs to happen next?

[Lord Bethell]

The noble Baroness shines a spotlight on an uncomfortable but realistic fact of life in our medical service: those with money are able to pay for treatments beyond the reach of those who rely on the NHS for absolutely everything. Another area that concerns me is that those who have relied on fundraising have found that Covid has restricted the amount of money coming from donors. That is why we have put money into medical research charities and support charities that can help support those fundraising for their medicine.

[Baroness Brinton (LD) [V]]

Since the law changed in 2018, only two children with severe epilepsy have accessed whole-plant cannabis medicine via the NHS. Recently, a child ended up in intensive care in the middle of the Covid pandemic and almost died because her parents could not fundraise the money to buy her medicine privately. Does the Minister accept that this is a complete failure of the policy and that a new regime for the regulation and control of access to medical cannabis is now required?

[Lord Bethell]

The noble Baroness’s point on fundraising is well made, and I think I answered it in my previous answer. We are looking at it closely. On policy-making in this area, it is extremely tough to regulate innovative drugs that simply do not have clinical trials and evidence bases behind them. We have put a huge amount of effort into this area. We are working closely with industry; I call on industry to do everything it can to help this process. We are trying our hardest to provide the right regulatory environment. As the noble Baroness pointed out, we have already made important changes to the law.

[Lord Norton of Louth (Con) [V]]

My Lords, the report of NHS England and NHS Improvement, commissioned by the Secretary of State, was published last year. Very little appears to have been done to implement its recommendations. Can my noble friend say which recommendations have been implemented and what plans he has to ensure that they are all met?

[Lord Bethell]

The noble Lord is right to point out the importance of that report, which we have taken very seriously. We have worked closely with industry to find a suitable product to take into the trial process, and it is a great shame that we have not found the right combination. We are looking at how to address that cul-de-sac and I hope to unblock it shortly.

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

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

Food: Fruit and Vegetables

Lord Bethell Excerpts

Monday 6th July 2020 Lords Chamber

[Baroness Boycott]

To ask Her Majesty’s Government what steps they are taking to increase the consumption of fruit and vegetables by (1) children, and (2) adults.

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

The Government are committed to encouraging children and adults to eat at least five portions of a variety of fruit and vegetables every day. Healthy Start vouchers enable low-income and disadvantaged families to purchase fruit and vegetables. Mandatory school food standards and the School Fruit and Vegetable Scheme also encourage fruit and vegetable consumption. Public Health England encourages the eating of fruit and vegetables through the Eatwell Guide, catering guidance and marketing campaigns, including Start4Life, Change4Life and One You.

[Baroness Boycott (CB) [V]]

My Lords, I thank the Minister for his Answer and declare my interests, as set out in the register. As noble Lords know, diets low in fruit and vegetables are now directly associated with 20,000 deaths a year in the UK. Despite the Government’s costly Five a Day campaign, our vegetable consumption is steadily declining and now equals what it was in the 1970s, with only 28% of adults eating the recommended amounts. First, what are the Government’s new plans to promote fruit and vegetables to adults?

Secondly, Professor Greta Defeyter, a colleague of mine at Feeding Britain, has discovered a dramatic reduction in disadvantaged children’s daily fruit and vegetable intake since the suspension of the School Fruit and Vegetable Scheme. Can the Minister give both a date for the scheme’s return and a figure for the money that would have been spent on the scheme since March this year, but has not?

[Lord Bethell]

My Lords, I pay testimony to the hard work of the noble Baroness in this important area. The schemes she mentions have been incredibly impactful and this subject is very important. The progress made by the Start4Life, Change4Life and Eatwell programmes has been encouraging, as it has raised awareness of options for children and adults. The battle they face against decisions people make about their diet is extremely tough, but we remain committed to those programmes and will continue to invest in them.

[Lord Duncan of Springbank (Con) [V]]

I ask the Minister what work the department has undertaken to explore the impact of fresh fruit and vegetables on the development of mental health in young people. In particular, what impact has there been from their being deprived of that during this period of home-schooling?

[Lord Bethell]

My noble friend touches on an interesting area. I cannot answer it precisely. I am not sure that we have taken any assessment of the effect of eating vegetables and fruit during the lockdown, but I will find out from the department and write to the noble Lord.

[Baroness Bull (CB) [V]]

Can the Minister clarify where responsibility lies for overseeing the nutritional quality of food delivered to children eligible for free school meals? During Covid, reports have circulated on social media of packages containing crisps, chocolate biscuits and a block of fat marked “for cooking only”. In response to a letter by leading food policy experts, sent to both Defra and Public Health England, each body seemed to indicate that the other should be held responsible. Does the Minister agree that, without clarity on this, the focus on good nutrition is at risk and accountability too easily sidestepped?

[Lord Bethell]

The noble Baroness is right to cast a spotlight on an apparent area of policy confusion. Labelling is normally associated with Defra, and the provision of school meals with the Department for Education. If there is ambiguity about that, I would be happy to chase it down for the noble Baroness.

[Baroness Blower (Lab) [V]]

My Lords, the School Fruit and Vegetable Scheme is a good scheme. My limited research suggests that children in year groups not currently eligible for the scheme miss their fruit and vegetables. Will the Government therefore consider extending it to all primary-age classes on reinstatement? Will the Minister undertake to work with teachers and the Royal Horticultural Society to promote gardening to grow vegetables, on school sites, for consumption by children?

[Lord Bethell]

I also pay tribute to the School Fruit and Vegetable Scheme. However, it falls outside the remit of the Department of Health, so I do not have details about the scheme to hand, but I would be glad to track them down and throw my weight behind it.

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

My Lords, in the past we have seen government-sponsored television advertising on specific themes. The Covid-19 pandemic is an excellent example. Diabetes is on the increase and, in extreme cases, leads to limb amputations, which are at a frightening rate. Given the proven links between the consumption of fruit and vegetables and good health, would the Minister sponsor such a scheme of television advertising for healthy eating, among his government colleagues?

[Lord Bethell]

The noble Baroness is right about the effects of diabetes, and the impact of Covid on those with diabetes has been profound. It is described well in the PHE report and is a source of enormous sadness. The Government are looking at ways to react to the Covid pandemic, but my instincts are to regard it as an inflection point for the nation’s health. The Government will look at ways to mark this moment with a suitable campaign to encourage healthy eating.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the Minister may be aware of the pioneering work of the American nutritionist Clara M Davis, in the 1920s, who found that just-weaned infants, allowed to choose their own food from a range of healthy natural options, chose a balanced highly nutritious diet and enjoyed it. But our children see a continual parade on their screens and in the shops of highly processed food of low nutritional quality. Does the Minister not think that we need to create space, in their stomachs and minds, to allow the healthy fruit and vegetables in?

[Lord Bethell]

The noble Baroness does me a great service to point out the good work of Clara M Davis, who I was not aware of previously. She makes a very good point: the effect of advertising on children in school is profound—and not just on children but on adults, as well. The danger of ring-fencing children is that they do not learn how to make proper choices in the long term. That is why the emphasis of our work is on ensuring that children learn the difference between good and bad food, learn how to make the right decisions and learn the habits that can set them up for a lifetime.

[The Earl of Caithness (Con) [V]]

My Lords, this subject is one of many covered in the House of Lords report published today by the Food, Poverty, Health and Environment Committee, called Hungry for Change. I hope my noble friend has already been briefed by his civil servants on this. Will he work with his fellow Ministers in Defra to get the food industry to make available a wider range of vegetables—not just pre-packaged carrots and other vegetables, all of the same size, shape and colour—and at a more affordable price?

[Lord Bethell]

I thank my noble friend for reminding me of the important Hungry for Change report; I pay tribute to it and to its recommendations. If I understand his question correctly, the food given to schoolchildren falls within the realm of the Department for Education. He makes an important point about offering variety and a wide range of foods, and I am sure that that is on the department’s agenda.

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

My Lords, home production of both fruit and vegetables is declining, with last year being the lowest for 20 years in vegetable production. If we do achieve an increase in consumption, much of that food will come from increased imports from countries that are water deficient. Will the Minister reassure the House that the Government have a cross-departmental strategy to address this, leading to increased consumption matched by increased production?

[Lord Bethell]

The noble Lord is quite right about the home production of food. During the Covid epidemic, Project Defend was put together to ensure that, as a country, we have resilient supply chains for key products, including food. The project will look at this area to assess whether interventions are necessary and will co-ordinate cross-governmental action.

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

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

Covid-19: Mental Health Services

Lord Bethell Excerpts

Thursday 2nd July 2020 Lords Chamber

[Baroness Barker]

To ask Her Majesty’s Government what steps they are taking to ensure that mental health services are available in (1) acute, and (2) community, care settings (a) during, and (b) after, the COVID-19 pandemic.

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

My Lords, the mental health challenge of Covid is a serious matter, and I pay tribute to NHS mental health services in both acute and community care settings, which have remained opened for business throughout this time, including delivering support digitally, over the phone and, where possible, face to face. There are no plans to stand down that support after the peak of the pandemic and we remain committed to our NHS long-term plan ambitions for increasing mental health services in acute and community care settings.

[Baroness Barker (LD) [V]]

In July 2019, the Government committed £2.3 billion for services for 370,000 people with severe mental illness. Will the Minister give an undertaking that if, as expected, Covid-19 causes greater demand for mental health services, that money will be increased?

[Lord Bethell [V]]

My Lords, we are investigating the long-term implications on our services from Covid-19. We are engaging with counterparts across Whitehall and, if necessary, we will invest further money. However, the mental health impact of Covid is not clear yet, and we await the final implications of that.

[The Lord Bishop of Coventry]

My Lords, at least one of the churches in my diocese recently set up a mental well-being centre, providing support groups, a helpline and signposting to professional services. Has the Minister considered inviting churches and other faith communities, with their knowledge of, trust within and connections to the local community, including networks of young people, to participate in the response to the mental health needs caused by Covid-19?

[Lord Bethell [V]]

The right reverend Prelate makes a good point, and I thank very much indeed those from all faith groups who have provided important pastoral support during this difficult time. On a practical matter, the funding for the mental health projects from our £5 million fund has gone to 130 different charities through the coronavirus mental health response fund. We are assessing the impact of those and we look forward to the recommendations of the Mind and mental health consortia which are behind that fund.

[Baroness Redfern (Con) [V]]

Mental health community projects are supporting people during coronavirus, and the Government’s announcement in May of £5 million of additional funding marked the first round of funding to be allocated to the sector. When will the second wave of projects receive funding, and will that include extra training for staff and to recruit more to service the 24/7 helplines?

[Lord Bethell [V]]

I pay tribute to charities and other community projects which have contributed to a wide range of projects across mental health, learning disabilities, dementia, isolation, befriending, domestic abuse, women’s issues and BAME groups. As I mentioned earlier, the Mind and mental health consortia are making recommendations about the progress of the fund. I look forward to their recommendations and we will act on them wherever we can.

[Baroness Greengross (CB) [V]]

My Lords, one consequence of the pandemic has been increased rates of violence or harm against old, young and other vulnerable people. Increased pressure on people’s mental health during the lockdown will likely have contributed to that. Should the Government make it obligatory for threats of violence, which could be bravado but which could also be dangerous, to be reported to the police as well as to social services, and would such measures help reduce domestic and other forms of abuse and ensure early intervention when someone is having a serious mental health episode?

[Lord Bethell [V]]

My Lords, threats of violence under any circumstances are reprehensible, and those aimed at the old and the vulnerable are in a category of their own. It is up to the clinical judgment of those involved in social care to decide whether the involvement of the police is of benefit and worth. I would not want to apply a blanket ruling on that, but the noble Baroness makes an extremely important point, which we are constantly reviewing.

[Baroness Blackstone (Ind Lab) [V]]

My Lords, there is increasing evidence that the mental health of children and young people has been badly affected by the Covid-19 lockdown. Given that the provision of mental health services to this age group was already inadequate, why has progress in implementing plans in the Green Paper on child mental health been so poor, particularly in the rollout of child mental health teams? What steps will the Government now take to rectify that?

[Lord Bethell [V]]

The noble Baroness is likely correct that the epidemic has had a particular effect on children and young people. The evidence on this is not crystal clear, but that is the strong instinct of all those in the field. I personally welcome the reopening of schools, which will have a particularly beneficial effect on those children who at present are stuck at home and do not have the support of the school system. Mental health services for young people are part of our long-term plan, with the additional £2.3 billion of spending on mental health. Our ambitions in that area remain enormous.

[Baroness Jolly (LD)]

My Lords, the Mental Health Act is no longer fit for purpose. With outdated legislation, both children and adults are at risk while either at home or in a care setting. In the aftermath of the Covid epidemic, there is no time for delay. When should we expect a Bill here in Parliament? If that is not in the Minister’s brief today, would he write to me?

[Lord Bethell [V]]

My Lords, we remain committed to publishing a White Paper that will set out the Government’s response to Sir Simon Wessely’s independent review of the Mental Health Act 1983 and pave the way for reform of that Act. We will publish it as soon as possible. The Covid epidemic does nothing but incentivise us to move as quickly as possible on this.

[The Earl of Sandwich (CB) [V]]

My Lords, does the Minister share my concern that the data he kindly supplied in Written Answer HL5619 on 22 June shows an 11% increase in March in prescriptions for anti-depressants over the same month last year? Is he therefore considering urgent measures to increase the funding and availability of psychological therapies instead?

[Lord Bethell [V]]

My Lords, I am as concerned about the over-prescription of anti-depressants as the noble Earl and would much prefer people to take cognitive therapies than drugs wherever possible. As I mentioned earlier, we have invested in two major rounds of support for community groups to help those struggling with their mental health, and we are reviewing additional funding for those schemes. We will keep a careful eye on the prescription of anti-depressants, which we are all concerned about.

[Baroness Thornton (Lab)]

My Lords, health and social care workers battling through the coronavirus pandemic are paying a heavy mental and emotional toll and will continue to do so. Yet the current mental health support available is not adequate. Will the Government commit to appointing a new independent national well-being guardian to co-ordinate and oversee a proper mental health support package for all NHS and care staff?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, the work on the NHS people plan continues during the epidemic and we look forward to making the first announcement on that shortly, which will cover many of the concerns of the noble Baroness. I also remind the House that, on 15 June, Public Health England unveiled its psychological first-aid training course, developed by PHE, which has proved extremely helpful, as has the confidential helpline that was unveiled on 8 April, which we continue to support.

[Lord Rennard (LD) [V]]

My Lords, people with diabetes are twice as likely to experience depression as those without, and a third of Covid-19 deaths in England are linked to people with diabetes. A survey by Diabetes UK shows that three-quarters of people with diabetes who have felt that they needed specialist mental health support cannot access it. How can the Government help to ensure that more people are tested for diabetes and that those with the condition receive comprehensive check-ups, including screening and support for mental health issues?

[Lord Bethell [V]]

My Lords, we are investing in new and additional diabetes testing arrangements. Testing is essential for the diagnosis and management of this affliction. The noble Lord is entirely right that the connection between Covid deaths and diabetes appears profound. It is a wake-up call for the whole country and puts a spotlight on the large amount of diabetes in the UK. We will unveil plans in the future for refocusing on this important public health issue.

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

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