Covid-19

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 15th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I hear the noble Lord’s points loud and clear. We are seeking to balance the epidemiological, public health practicalities of trying to limit the spread of the disease through mask wearing with accepting the benefits of the vaccine and the limit that puts on hospitalisations and death and trying to restore confidence in the public that we live in a safe environment.

We will be debating in months to come the challenge of trying to get the country back to work and back to economic activity, to get people back into society and back into their communities. It is not that stage right now—we are going into the winter, so naturally our concerns are about hospitalisations and a possible rise in pressure on the NHS—but we must have sight of the exit from this disease. If we have a society where the Government mandate very intimate parts of people’s everyday life and where the impression given to the entire population is that a deadly disease is an imminent threat to them, I am afraid we will run into a problem in trying to get the economy moving and to get society back again.

What we are seeking to do right now is to get that balance right, and it is proportionate. I acknowledge that mask wearing is down, but people are broadly responsible, as the noble Lord rightly pointed out. Central government cannot make every decision in all of society for all time. We need transport providers to make their own decisions, which does mean that it is complicated and that TfL and overground are different. However, it feels like the right approach for right now.

[Baroness Tyler of Enfield (LD)]

My Lords, I make no apology for pursuing the issue of wearing masks and face coverings, because I feel so strongly about it. My personal experience this morning when coming in on the Tube was that more than 50% of people were not wearing a mask; they were close to me. One man actually took his mask off and sneezed over me. The whole experience made me feel very uncomfortable and very anxious.

I contrast this experience with a recent train journey to Scotland. As soon as we crossed the border, there was an announcement making it quite clear that wearing masks was compulsory on the train. Absolutely every person was wearing a mask, and I felt so much more confident.

I do not really understand the explanation that the Minister has given; I listened to it very carefully. I think he said that it is not a light-touch measure, but, to me, it seems extremely light-touch. It costs very little; it protects others; it does not harm the economy, and ultimately it can save lives, so I genuinely do not understand what the problem is. I think it is about being considerate to others and, frankly and bluntly, not being selfish.

I would certainly add my voice to the comments of the noble Lord, Lord Faulkner. By not wearing masks in the Commons Chamber yesterday, many MPs were sending mixed messages and setting an appalling example to the country.

I want to end by asking the Minister a question asked also by my noble friend Lady Brinton about children who are clinically extremely vulnerable being taken out of that category. Can he explain why that is and what is going to happen to those children, and perhaps write to me and my noble friend on it?

[Lord Bethell (Con)]

My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.

I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.

Social Care: Family Carers

Debate between Lord Bethell and Baroness Tyler of Enfield

Monday 13th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely agree that the carer’s assessment is the building block of our system. It is incredibly important; we do a lot of work to encourage more carers to get it. I do not know specifically about the point that the noble Lord makes on this additional component, but I would be glad to enter into correspondence with him on it. The broad principle of the importance of the carer’s assessment is one with which I wholeheartedly agree.

[Baroness Tyler of Enfield (LD)]

My Lords, research shows that, pre pandemic, 600 people a day had no choice but to leave work to manage their unpaid caring responsibilities and that, since Covid began, an additional 2.8 million workers now juggle work and unpaid care. Having access to carer’s leave would help millions of carers and support many of them to remain in work alongside their unpaid caring responsibilities. When will the Government publish their response to their consultation on carers’ leave, which closed on 3 August last year?

[Lord Bethell (Con)]

My Lords, I recognise the challenge referred to by the noble Baroness. Some 2.9 million carers are employed; that is more than half of all carers. One can only imagine the pressure that they feel trying to juggle their roles as carers and employees. The consultation has been tied up by the pandemic, but we are keen to get a response out soon. Now that we have announced this package, it makes that all the easier. I very much look forward to bringing the response to the House.

Covid-19

Debate between Lord Bethell and Baroness Tyler of Enfield

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the position of the immunosuppressed is one that we have a huge amount of sympathy for. Those who have blood cancer face a particular challenge. I was very grateful to meet Blood Cancer UK and discuss this matter. The PHE report makes the very clear point that those with suppressed immune systems may have a very strong vaccine response, particularly after two weeks after two doses. Just because someone has a suppressed immune system, it does not mean that the vaccine has left them completely unprotected. I completely accept that the responses of one group and another group may be quite different and it is difficult to lump everyone together. That is why we are investing in the OCTAVE study; I am hopeful it will be published by the end of the month. That will provide some, but not all, the information we need to elaborate on that guidance.

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

My Lords, with government scientists predicting that up to 4,800 people a day could be admitted to hospital with Covid if England rushes back to normality at the same time as health experts are predicting a surge in flu and other respiratory viruses likely to lead to severe pressures on the NHS, what contingency plans are the Government putting in place to deal with these pressures without leading to the backlog of other much-needed care and treatment growing ever bigger? Will these contingency plans be published?

[Lord Bethell (Con)]

My Lords, we acknowledge the risks. The noble Baroness is entirely right about flu; the relatively low levels of both flu and RSV in the last 18 months mean that many will not have the immune system that they normally would, and flu is a present danger. That is why we are working so hard on the flu vaccine programme and bundling Covid boosters and flu vaccines for those in the right prioritisation lists. I encourage absolutely everyone to make sure they get their flu vaccine when it comes around. Given the range of uncertainties, we are working with the NHS on its plans for this winter. We will ensure that the service has what it needs to meet those challenges.

Covid-19 Update

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

I applaud the noble Lord for his advocacy of mask wearing, but of course this issue cuts both ways. He is right that we need to build back trust in sharing space with one another, but I am not sure that mandatory mask wearing either builds trust or erodes it. If we give people the impression that wearing masks is somehow a panacea that protects everyone on a tube train or in a lift, that is a false impression. Masks are not a panacea. In fact, for some people, they can be a source of grave concern and be enough to send them back home to seek safety. I take the noble Lord’s point that we have to be clear about this, but I am not sure that mandatory mask wearing, or even ubiquitous mask wearing, is either a universal antidote to the spread of the disease or necessarily builds trust in the manner he describes.

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

My Lords, continuing on this theme: “masks work” is the clear message from Public Health England. Both Sir Patrick Vallance and Professor Chris Whitty have said that they will continue to wear a mask in crowded indoor spaces, primarily because it protects others. Critically, it does not hold back the opening up of the economy, but rather provides a safeguard as social distancing rules are relaxed. Can the Minister tell me why there is so little in the Statement about our social responsibility to others, including front-line transport and shop workers, and the clinically extremely vulnerable? In this scrapping of masks, we are condemning millions with poor immune systems to be trapped in their homes, too afraid to go to the shops or their workplace or to use public transport.

[Lord Bethell (Con)]

Since this is the second question on masks, I hope the noble Baroness will not mind if I go off on a tangent. Masks do work a bit; they are not a panacea. What is really important is that when you are ill, you stay at home. That is the big behavioural change that will make a big difference in the year to come. That is where Britain has got it wrong in the past. Too often we have put our workmates, fellow travellers and school friends at risk by heroically going into crowded indoor places and coughing all over them. I hope that is one habit that will stop and that that will be a legacy of this awful pandemic.

Covid-19 Update

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that the Porton Down verification team has looked extremely closely at all lateral flow tests and their sensitivity to the delta variant in particular. There is suggestion and some indication that for very low viral loads, the LFTs are not quite as sensitive, or if they are sensitive, the band is less easy to read. However, for higher viral loads—in other words, the kind of viral loads that the body needs to carry to be infectious—there is no change of sensitivity. Therefore, from that point of view the LFTs continue to perform their original purpose very effectively but we need to keep a very close eye on sensitivity with the new variants.

I pay tribute to all UK companies which are coming forward with LFT, PCR or genomic sequencing tests. I am extremely proud of the progress that the UK diagnostics industry has made. We have extremely high standards and extremely high validation and authorisation protocols through Porton Down. Those standards are very difficult to achieve but we are working extremely closely with UK companies to try to get them over the line so that they can play an important role in our response to the pandemic.

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

My Lords, the Statement places great emphasis on regaining freedoms but has relatively little to say on the specifics of how we learn to live with Covid, as we surely must, given the rising number of new cases and concerns about new variants. Apart from a very brief mention of care workers, there were no other details of how the planned end of restrictions on 19 July will affect care home residents and their families. Can the Minister say what thought is being given to how we learn to live with Covid in care settings and when we can expect to see detailed guidance on this which balances the need for protecting the elderly and vulnerable from infection and improving the quality of their daily lives?

[Lord Bethell (Con)]

My Lords, the noble Baroness’s question is entirely reasonable and I wish I could be more specific on the precise timing. The honest truth is that we look at the data every day; our experience through this pandemic is that our understanding improves every day and therefore the guidance that we provide is often provided at a relatively late stage. It is an unfortunate aspect of this awful pandemic and one that I know noble Lords have commented on with vigour in the past, but it is an unavoidable fact of life. However, the comments made very thoughtfully and persuasively by noble Lords about the conditions in care homes, the restrictions that are put on residents and the pressure that that puts on them and their families have been heard loudly and clearly by all those in the department and across government, and we will seek to address those concerns when the moment is right.

Covid-19: Care Homes

Debate between Lord Bethell and Baroness Tyler of Enfield

Thursday 17th June 2021 Lords Chamber

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

My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?

[Lord Bethell (Con)]

My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.

Covid-19: Proof of Vaccination

Debate between Lord Bethell and Baroness Tyler of Enfield

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am very alive to the concerns of the disabled. We have to balance the need to limit the spread of this virus to save lives, but in a way that is fair and just to all people. We are very much engaged with disability and other charities to ensure that that works. The noble Baroness is right that there will be some people for whom the vaccine does not work and who could yet catch the disease. We need to make provision for those people, and we are working on that.

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

My Lords, I am concerned for the significant numbers of people with existing mental health problems who often do not feel comfortable with smartphone devices, as the information overload such phones can provide can exacerbate their feelings of stress and anxiety. I am pleased to hear the Minister say that other channels will be available to these people, but what arrangements are the Government putting in place to ensure that they are aware that options other than smartphones exist that they will be able to use?

[Lord Bethell (Con)]

My Lords, all the promotions for vaccine certificates through travel agents and GPs make very substantial reference to the availability of paper letters and the channel of being able to call 119 to receive them. I completely sympathise with those who do not want to use their mobile phones for everything, and some will prefer a letter in the pocket to an app on their phone.

Care Homes: Insurance Indemnity

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 19th May 2021 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the merits of underwriting insurance indemnity for all care homes on an equivalent basis to the National Health Service.

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

My Lords, the differing indemnity and insurance arrangements for the NHS and for care homes reflect the different systems of securing health and adult social care. For the NHS, there are established indemnity schemes, administered by NHS Resolution. In the care sector, providers purchase insurance from commercial insurance markets. This is a requirement of registration with the Care Quality Commission.

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

My Lords, due to Covid, many care homes have found insurance prohibitively expensive, hard or even impossible to find, and that which is available often not covering Covid. Yesterday, I spoke to a care home manager who was told that renewing his existing insurance would cost 880% more than the previous year, and just one Covid claim could result in the care home having to close its doors, causing great distress and disruption to residents and their families. Against this backdrop, can the Minister say what plans the Government have to extend indemnity to all care homes for a reasonable period, not simply the small number now covered as part of the designated care site schemes, to put them on an equal footing with the NHS and ensure that they are able to help the NHS during any third wave? Will the Minister agree to meet me to discuss the options?

[Lord Bethell (Con)]

My Lords, I acknowledge the challenge faced by care homes on the insurance market, but CQC statistics suggest that, in fact, the insurance industry has done an enormous amount to meet the needs of care homes and that many of the pressures on care homes have been the result of Covid outbreaks. We have brought in the designated settings indemnity support, as the noble Baroness knows, and we have given £6 billion to local authorities to support care homes. Putting care homes on the same footing as the NHS would not meet the needs of the care home sector, so that is not something we are looking at currently.

Covid-19 Update

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am a big supporter of the “fast and hard” principle. In our response in Bolton, Bedford, London and elsewhere, we have demonstrated that principle in our handling of the Indian variant. I point out that the use of testing and social distancing measures in schools has been enormously effective. One of the remarkable aspects of the infection rate so far is that transmission levels among school-aged children have not increased in the way that SAGE and others, including myself, once feared. We should take a “glass half-full” moment to applaud that fact. I reassure the noble Lord that we will absolutely make these decisions on the data. Space has been put in between the steps for exactly that reason, and we are not going to rush it.

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

My Lords, could the Minister outline the Government’s plans for test and trace as lockdown is lifted, particularly in areas such as Bolton and Bedford where surge testing is currently being deployed? With former centrally based Public Health England staff being disbanded and senior civil servants returning to their own posts, what financial resources are being passed to the local resilience teams, run by local directors of public health, to operate test and trace, which will be so critical to controlling the spread of the virus alongside the vaccine rollout?

[Lord Bethell (Con)]

My Lords, the outbreak in Bolton, Bedford, London and elsewhere has demonstrated, if that were needed, the paramount importance of keeping resources for test and trace at a critical level, and that is what we have done. Since the national infection rate is lower, there is a much greater emphasis on the kind of surge activity and outbreak management that the noble Baroness describes. Sequencing has proved to be an essential part of that process, and we have brought sequencing from the back of the laboratory to the front line of test and trace operation. Every single positive case is now treated as though it were a VOC, with the same amount of tracing and sequencing that a VOC would have had a few weeks ago. We have the full operation on standby. Should another wave of infections arrive, as it may well do with the relaxing of social distancing, we have the systems in place to be able to deal with it.

Care Home Occupancy Rate

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 28th April 2021 Lords Chamber

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

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

[Lord Bethell (Con)]

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

Care Homes: Guidance

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

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

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

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

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

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

[Lord Bethell (Con)]

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

Covid-19: Update

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 20th April 2021 Lords Chamber

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

Covid-19: Vaccination Programme

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 24th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I recommend that my noble friend and the Daily Telegraph look at the large amount of conditional material that the Prime Minister articulated in his Statement. There were no firm dates. He made it clear that data would drive decisions and he made a lot of his indicative programme remarks reliant on passing the four key tests that he laid out very clearly in his programme.

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

My Lords, at Monday’s Downing Street press conference, Professor Chris Whitty expressed his view that front-line health and care workers had what he termed a “professional responsibility” to get vaccinated to reduce the risk that Covid poses to patients and care home residents. With studies indicating that in many care homes well in excess of 30% of care workers have not yet taken up the vaccine, what plans do the Government have to make getting vaccinated a condition of employment?

[Lord Bethell (Con)]

My Lords, the Chief Medical Officer was entirely right. As the noble Baroness probably knows, there are already important requirements on health care workers who, for instance, do surgery or are in certain risky clinical situations to have the right vaccines, hepatitis being one in particular. Having up-to-date vaccines is a condition of engagement for some medical staff. The noble Baroness is right to raise the question of social care. We are looking at the right policy in that area. We want to tread carefully and to take social care workers with us. We are aware of the risks in social care, but we do not want to provide barriers for employment. Getting that decision right will be one of the most important things that we do.

Covid-19 Vaccines Deployment

Debate between Lord Bethell and Baroness Tyler of Enfield

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right that there are many mysteries of immunity that we do not fully understand. While we have some strong evidence on the transmissibility of the disease after vaccination, it is not crystal clear. The evidence we have is that it reduces infection by two-thirds, but that still means that a third of people who have the vaccine might get the disease and be able to pass it on. That is an extremely serious risk when the vast majority of the population have not been vaccinated at all. We do not want a situation where a small minority of the population might be spared sickness and death, but a very large amount of the population become infected with a disease that might hospitalise them or lead to other infections. That is why we are cautious. We are also conscious of variants of concern, which remain a potent threat as long as the vaccine has not been rolled out.

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

My Lords, I will press the Minister a little further on the low take-up of the vaccine by some care home staff, which has already been raised by other noble Lords. Recent research from the National Care Forum has shown that some of the significant factors accounting for this low take-up include vaccinators coming to homes with enough vaccines only for residents, and staff being expected to travel to vaccination centres if they are not vaccinated in the home, but not being given time off. Those not on shift when vaccinators come, such as night shift staff, are missed, and some fear having to take unpaid time off if they develop a reaction to the vaccine. Could the Minister say what steps the Government are considering taking to tackle these very specific barriers?

[Lord Bethell (Con)]

My Lords, I do hear the noble Baroness and I would be happy to look into this matter further. However, my understanding is that the vaccination rates among care home staff are much higher than she describes. It is not unusual for care home staff to have their health provided for by the local NHS, and for them to be required to travel to receive that support. That is quite normal for anyone getting a vaccine, even if they work in social care. It is entirely in our interests to make sure that social care staff are vaccinated, so there is no way that there is any kind of policy or deliberate effort to avoid vaccinating care home staff. However, I will be glad to look into this further and, if I may, I will copy the noble Baroness into the correspondence that will clearly result from this debate.

Covid-19 Update

Debate between Lord Bethell and Baroness Tyler of Enfield

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure whether we are completely stepping back from the production of monoclonal antibodies. I am extremely grateful to the noble Lord for the briefing that he shared with me last month and for the opportunities to look at how we can onshore the manufacturing of monoclonal antibodies. He is entirely right: this is a critical area of life science production where Great Britain is frustratingly massively behind. In the resilience of our healthcare supply chains, we have a huge gap in this country, and it is one that we are keen to address. The Therapeutics Taskforce is looking at monoclonal antibodies as a way of supporting our response to Covid and we have, through Project Defend, a workstream to look at how we can encourage onshore manufacturing of these essential healthcare supplies.

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

My Lords, recent laboratory tests by scientists at Cambridge University show that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s, leaving them at risk of catching the South African variant. Will the Minister say what assessment the Government have made of these findings and what plans they have to speed up the second dose of the Pfizer vaccine for the over-80s and all care home residents?

[Lord Bethell (Con)]

My Lords, I am grateful for the reminder from the noble Baroness. The analysis we have done of the Pfizer vaccine, and indeed of all vaccines, is extremely encouraging and the impact it has on the body’s antibody production rate is profound. In fact, for many vaccines it might be that a longer delay, of 12 weeks, to the second dose might have an improved impact on the body. The second dose is really important for longevity rather than for efficacy, and therefore, with the data we have at the moment, we do not have any plans to change the pace of the rollout, but we are making sure in absolute terms that the second dose is delivered to all those who have had a first dose, promptly and on time.

Health: Eating Disorders

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

Mental Health Act Reform

Debate between Lord Bethell and Baroness Tyler of Enfield

Monday 18th January 2021 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HIV: Ending Transmissions

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 1st December 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord speaks with great humanity and compassion, but I perhaps need to give a bit of perspective. I am not sure if our UK aid budget is enough to solve all the problems that he describes. The UK remains extremely committed to international aid. In the Covid epidemic and recession, we have reduced our commitment in a small way and have promised to revisit it at a later date. That commitment is very clear, and we will do that in due time.

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

My Lords, cuts to local authority public health budgets of some £700 million in real terms over the last five years have led to sexual health budgets being cut by 25% in this period. The King’s Fund has estimated that restoring spending to the former level

“would require additional investment of £1 billion.”

Given the Government’s commitment to zero new HIV transmissions by 2030, will the Minister tell the House what plans they have to increase investment in HIV preventive services delivered by local authorities? Can the Minister also confirm that there will still be national funding for a prevention programme?

[Lord Bethell (Con)]

The Covid epidemic has disrupted things, but I reassure the noble Baroness that in the spending review 2020 we have confirmed that the public health grant will be maintained into next year, enabling local authorities to meet pressures and continue to deliver important public services. DHSC will confirm final allocations in the coming week, including the position on HIV PrEP. I reassure the noble Baroness that PrEP has proved to be an enormously valuable contribution to our fight against transmissions, and we continue to back it.

Face-to-Face Medical Appointments

Debate between Lord Bethell and Baroness Tyler of Enfield

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

My noble friend makes a very good point. Diagnosis is phenomenally difficult and, quite often, patients who present with seemingly one condition have something altogether different. It may be that a face-to-face appointment will be the moment when that difference is spotted and caught. She is entirely right to say that we cannot omit that format for the right circumstances, but a great many patients see their GPs very regularly. Their journeys may be onerous, uncomfortable and stressful, and telemedicine might offer them an alternative opportunity. There are others for whom speed is of the essence, and having telemedicine, particularly when it is supported by apps that provide essential information about their condition, can be an important and urgent alternative.

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

My Lords, according to the June edition of the British Medical Journal, the biggest change for mental health services has been the rapid adoption of video and phone consultations, an approach that had rarely been used in a field where relationships and trust between clinicians and patients are vital and where body language and eye contact are often a key part of the assessment. Many in the sector have reported that virtual appointments are at best inferior, particularly with young people, those with learning disabilities and the elderly. What assurances can the Minister give that face-to-face appointments will continue to be made available for those who need them in this field?

[Lord Bethell (Con)]

The noble Baroness has raised an important point. I saw the BMJ article to which she has referred; it was a very interesting warning shot, whereby we should not overshoot in this area. But perhaps I can also emphasise that other interesting evidence shows that some mental health services have been better provided by online consultations. For instance, some young people do not like visiting clinics, where they feel uncomfortable, and prefer video conferences. I think it is too early to call it on this one, because we need to analyse closely the benefits and disbenefits in the area of mental health. We must ensure that we have the right format for the right occasion, but I completely take on board the warnings of the noble Baroness.

Suicide

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 8th September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness refers to recent statistics, which are, as she rightly points out, subject to change, as coroners’ investigations land on the desk at PHE. I reassure her that the statistics suggest a difference between stress and anxiety, and clinical mental health issues. It seems that one aspect of the coronavirus pandemic is that it has not translated into a massive mental health tsunami, as feared. This is hugely encouraging and a great relief. None the less, we are committed to the mental health support that the Government provide, and continue to support charities such as the Samaritans and CALM, including through the £9.2 million recently given to them for suicide prevention and support.

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

My Lords, sadly, self-harm is a major risk factor for future suicide and is growing among young people. Later this month, the All-Party Parliamentary Group on Suicide and Self-Harm Prevention will be publishing a report of its inquiry looking at the support available for young people who self-harm. Having been closely involved in this inquiry, I ask the Minister whether he will commit to the Government looking seriously at its findings, which were informed by young people who had self-harmed, and to responding in due course.

[Lord Bethell (Con)]

The noble Baroness is entirely right that self-harm is an alarming, distressing and rising phenomenon among young people. I welcome the report that she describes, and commit to having a good look at it, when it is published.

Childhood Obesity

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness has a point on the importance of targeting the right populations and there are certainly some demographics that incur higher incidences of obesity and for which the health disbenefits of obesity are higher. For these, we have special programmes to support them in schools with vouchers and medical interventions. However, obesity is a national problem that affects all parts of society. In Britain we have got it wrong and we need to address this issue as a nation.

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

My Lords, the noble Baroness, Lady Massey, rightly emphasised the link between deprivation and childhood obesity. Therefore, while welcoming the announcement of the Government’s obesity strategy, I ask the Minister: what specific steps are the Government taking to address the links between deprivation and obesity; how will this be funded; and what plans do they have to introduce policies with a more explicit focus on early years to reduce childhood obesity rates?

[Lord Bethell (Con)]

My Lords, there are individual programmes specifically targeting those from deprived backgrounds. I emphasise the childhood obesity trailblazer programme, which has funding for several councils to pioneer forward-thinking ideas to address childhood obesity among those target populations.

The other area that I emphasise is exercise in school. Of course, obesity is linked to intake, not exercise, but exercise helps to get the disciplines right around looking after one’s mind and body. The £320 million going into school sports facilities is a massive bonus in this area.

Independent Residential Care

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 7th July 2020 Lords Chamber

[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.

Covid-19 Update

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

My Lords, I remember the incident well and I intended no discourtesy whatever. I reassure the noble Lord that I left the Chamber and instructed my officials to draft that letter; on leaving today, I will chase it down and ensure that it goes to him speedily.

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

My Lords, local lockdown plans in Leicester and elsewhere are vital to ensure that a proper place-based response takes full account of existing health inequalities. At an all-party group meeting yesterday, Sir Michael Marmot explained that Covid-19 has exposed existing inequalities in society and amplified them, with Covid-19 mortality rates closely linked to health inequalities and deprivation more widely. Does the Minister agree that, before the Summer Recess, your Lordships’ House must have a full debate on tackling inequality before a second wave hits us, with a sharp focus on the disproportionate impact on specific groups, particularly the BAME community?

[Lord Bethell]

My Lords, it is beyond my reach to instruct the House on its debates, but I would entirely agree with the noble Baroness that one of the saddest and most challenging aspects of Covid is that it hits society where it is weakest. It has undoubtedly hit those with health issues the hardest and has exacerbated health inequalities. It is my sincere hope that this Covid epidemic will be an inflection point, when this country embraces a strong public health agenda and addresses those health inequalities with energy.

Covid-19: Mental Health

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of longitudinal studies. The UK household longitudinal study data, which analyses the GHQ-12 scores, has been upgraded. We will continue to invest in that, and Public Health England has been tasked with monitoring the development of mental health issues across the country.

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

My Lords, research shows that the pandemic has had a disproportionate impact on some of the most disadvantaged, particularly those from BAME communities. During this period, many mental health and community services have moved online. While that is an appropriate first response, charities are now expressing concern that it is not an effective response for many, including the elderly, those with learning disabilities and those with severe mental illnesses. Can the Minister say what urgent steps the Government are taking to restore effective treatment and care for all, including face-to-face services, with all necessary PPE and testing in place?

[Lord Bethell]

My Lords, we are feeling our way in this area. There have been benefits from some of the moves online. People have been able to see more of their consultants, they have found that some of the content provided has been helpful, and the reach has gone up. However, I completely agree with the noble Baroness that it will not work for everyone. I pay tribute to mental health professionals who have maintained face-to-face contact during the epidemic, with all the threats associated, and we continue to look closely at how to fit appropriate technology and digital access to the right people and in the right format.

Covid-19: Mental Health

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 16th June 2020 Lords Chamber

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the report The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK, published by the Institute for Fiscal Studies on 10 June; and what steps they plan to take in response.

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

My Lords, the noble Baroness raises an important issue, and I am grateful to the IFS for this thoughtful report. It is too early to know for certain the mental health consequences of Covid, but we are deeply concerned about those who suffer from isolation, young people, those who have fears of economic uncertainty, and those with existing mental health vulnerabilities. I give thanks to mental health professionals, who have worked hard during the epidemic, despite difficult circumstances.

--- Later in debate ---

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

My Lords, last week’s report by the IFS reveals how Covid-19 and the lockdown has had a major negative impact on mental health across the population, with women and young people particularly badly hit. Pre-existing inequalities in mental health have widened yet further. The report states that the scale of deterioration in mental health is of a magnitude unlike anything seen in recent years. What immediate steps are the Government taking to prevent this looming mental health crisis turning into an epidemic in its own right?

[Lord Bethell [V]]

My Lords, the report is extremely helpful and throws a spotlight on an issue that we are deeply concerned about. Immediate help includes a £4.2 million support fund for mental health charities, and a £5 million fund for Mind, specifically to support charities dealing with Covid-related mental health issues. We will continue to invest in mental health in the long term, to support this important area.

Covid-19: Obese and Overweight People

Debate between Lord Bethell and Baroness Tyler of Enfield

Thursday 4th June 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.

[Baroness Tyler of Enfield (LD)]

My Lords, given the Prime Minister’s welcome recent statement that a more interventionist stance is needed to tackle obesity, is the Minister aware of a recent poll by the Obesity Health Alliance showing that 72% of those surveyed supported restrictions on shops promoting unhealthy foods in prominent areas, including checkout areas, and 63% wanted the sugar tax on soft drinks extended to other sugary foods? What plans do the Government have to introduce these measures, working collaboratively with supermarkets and other food retailers?

[Lord Bethell]

The noble Baroness is entirely right to suggest that Covid might be the infection point—the intervention necessary to wake up the nation to the dangers of obesity. We are keen to use that moment to make progress on this important issue.

Mental Health Services

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 19th May 2020 Lords Chamber

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

My Lords, the NHS has issued guidance to services to support them in managing demand and capacity across in-patient and community mental health services. Services have remained open for business as usual as a result. We remain committed to the additional investment in mental health services set out in the NHS long-term plan. We have provided an additional £5 million to mental health charities to support their work during the pandemic.

[Baroness Tyler of Enfield (LD)]

My Lords, the Royal College of Psychiatrists warned last week that the nation faces a mental illness “tsunami”. Those on the front lines of our health and social care services have gone above and beyond to tackle this dreadful virus, but now may themselves face significant mental health problems. Thousands have lost colleagues, endured serious illness or experienced major trauma. Will the Government commit to investing in a world-class mental health response to Covid-19, including by setting up specialist support services for those on the front line of our NHS and care services, mirroring the services available to our armed services personnel?

[Lord Bethell]

I join the noble Baroness in paying tribute to those working in mental health in the NHS. They have kept services running in extremely difficult circumstances and their impact has been extremely powerful. Although we are aware of the deep threat of a mental health tsunami, as was warned, the evidence to date is that these people have done an amazing job of addressing the concerns of those who are suffering under coronavirus and the lockdown.

Covid-19: Vulnerable Populations

Debate between Lord Bethell and Baroness Tyler of Enfield

Tuesday 12th May 2020 Lords Chamber

[Lord Bethell]

I share the noble Baroness’s celebration of Florence Nightingale Day, which is an important day for the nursing profession and for all of us. We have made huge progress on testing in care homes in the last three weeks. The new portal was made live on Monday and care homes are now massively supported by satellite care home facilities manned by the Army. I am not sure about the 6 June date of which she speaks, but I reassure the House that care home testing is the number one priority of our testing facilities and is benefiting from the large increase in capacity.

[Baroness Tyler of Enfield (LD)]

My Lords, over the course of this crisis we have seen substance misuse and mental health services adapt their provision to better support homeless people facing multiple problems. Could the Minister say what the Government, in particular the new homelessness task force, will do to ensure that these flexibilities remain in place?

[Lord Bethell]

The noble Baroness is right to raise concern for the homeless—surely one of the groups suffering the most in the current epidemic. We are putting in place facilities for testing, housing and mental health support for the homeless. We envisage that these will continue for the length of the epidemic.

Social Mobility

Debate between Lord Bethell and Baroness Tyler of Enfield

Wednesday 29th January 2020 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I am delighted to open this debate on social mobility and by the level of interest it has generated among noble Lords whose contributions I look forward to hearing, particularly the maiden speech of the noble Lord, Lord Choudrey.

I start by declaring an interest as co-chair of the All-Party Parliamentary Group on Social Mobility. It has been a privilege to have served as an officer of this APPG since 2011. A general debate on social mobility is long overdue. To be frank, it feels as if there has been something of a deafening silence on this issue of late. There were scant references to social mobility in the recent party election manifestos, and the few there were felt less than positive in places. I feel sure that I am not alone in your Lordships’ House in viewing taking action to improve the life chances of all our citizens, whatever their background or the circumstances of their birth, as a primary responsibility of any Government.

How do we get this subject high up on the political agenda where it should be? Let us hope that this debate helps. As a starting point, I do not think we could do much better than looking at the Sutton Trust’s Mobility Manifesto, which was published last November, and the Social Mobility Commission’s State of the Nation 2018-19. Both reports contains important recommendations which must not be lost simply because of the political machinations we have been living through. I look forward to hearing how the Government plan to respond to them and about their overall thinking on boosting social mobility.

I shall first say a few words about why I think social mobility is such a pressing issue. I shall try to go easy on the stats, but a little theme-setting is required. The stark reality is that it is becoming harder to be socially mobile. A recent study of ONS data found that only one in eight men in professional jobs who was born in the late 1970s and early 1980s was highly socially mobile, compared to one in five in the late 1950s.

Let us next look at the economic case. According to the World Economic Forum’s Global Social Mobility Report, which was published this month—so it is hot off the press—the UK ranks 21st out of 82 countries. It is the third-lowest G7 economy and is followed by the United States and Italy, so there is no room for complacency. Low social mobility is estimated to cost the UK many billions a year, not least in terms of low productivity. It has been estimated that even modest increases in social mobility could increase GDP growth by 2% to 4% a year, so it matters for economic prosperity as well as for social justice.

It is also highly instructive to look at public attitudes to social mobility. We are lucky to have the Social Mobility Barometer, which was published earlier this month. It found that 77% of people in the UK feel that there is a large gap between the social classes. This is unchanged from previous years and suggests that people feel the gap is not closing. Almost half of people feel that where you end up in British society is still mainly determined by your background and who your parents were. Tellingly, more than half of those questioned felt that the Government should do more to help the least well off, and 76% of people felt that there were large differences in opportunity across the country, with the greatest difference being between London and the north-east.

All this is reinforced by recent polling commissioned by the Sutton Trust, which shows that people have become considerably more pessimistic about opportunities to be successful in life, with just 35% of respondents agreeing that people had equal opportunities to get ahead.

In short, this stuff really matters. So what do we need to do? The Social Mobility Commission’s State of the Nation report found that social mobility had “stagnated” over the last four years, at

“virtually all stages from birth to work”.

It contained a wide range of recommendations, including on childcare, the pupil premium in schools, support for disadvantaged 16 to 19 year-olds, financial support for undergraduates, university-contextualised offers, and government investment in skills and jobs in areas of low social mobility and low pay.

The Sutton Trust manifesto was equally wide ranging, covering early education and childcare, school admissions, open access to independent schools, support for the highly able from disadvantaged backgrounds, essential life skills, apprenticeships, university contextual admissions and post-qualification applications, and student maintenance grants and internships. There is no shortage of ideas. I am sure that other contributors to this debate will cover many of these specific areas, although the acute time constraint—I fully understand the frustration that many noble Lords feel—is going to make it tricky. Of course, we heard only today on the news about the need for the top universities to increase places for disadvantaged youngsters.

In big-picture terms, what both reports clearly demonstrate, and my main message today, is that improving social mobility requires the Government to take action across the life course: early years, primary and secondary school, careers education, further education, universities, apprenticeships, access to good employment opportunities—and so it goes. It requires a sustained cross-government approach, with strong political will and clear delivery mechanisms.

Let me pick up briefly on a couple of these issues. There is abundant evidence that a child’s first years play a major role in determining their chances later in life, and that good early years education is critical to reducing the gap in school readiness between disadvantaged children and their better-off peers at the age of five. In summing up, could the Minister say what plans the Government have to review their 30 hours of free childcare to shift the entitlement from high-income families to those on low incomes? Could she also say what plans the Government have to give early years teachers qualified teacher status, with the increase in pay and status that that would entail?

Moving up the age range, countless reports highlight the potential of further education and apprenticeships to be effective vehicles for social mobility, with disadvantaged students significantly more likely to enter FE than their more advantaged counterparts. However, this route has suffered from years of historic underfunding. Funding per student for 16 to 19 year-olds fell by 12% between 2011-19 and was 8% lower than for secondary schools. The Lords Select Committee on Social Mobility, which reported in 2016—and on which both the Minister and I were lucky enough to serve—also pointed out the simply huge disparities in funding levels between universities and further education colleges, meaning that those studying at FE colleges were getting a raw deal.

Last August, building on the two key reports of the APPG on Social Mobility—The Class Ceiling and Closing the Regional Attainment Gap—as co-chairs we wrote to the Chancellor asking him to prioritise social mobility in the spending review, and particularly to increase spending for further education. Of course, we welcomed the Chancellor’s announcement last September on increasing FE funding by £400 million, but this was only a one-year package and focused on some very specific areas of funding. Therefore, I am calling on the Government again today to prioritise long-term sustainable increases for further education in this year’s spending review.

Allied to this, the APPG, along with others, also called on the Government to introduce a student premium of at least £500 per year for disadvantaged 16 to 19 year-olds. This premium would mirror the current pupil premium funding in schools and would be used to raise the attainment of disadvantaged students. Today, again, I call on the Government to introduce a student premium for 16 to 19 year-olds.

I have one final question for the Minister. I am aware that I have asked a lot of questions and would be very happy for him to write, setting out the Government’s full response. What is happening to the socioeconomic duty introduced in Section 1 of the Equality Act 2010? It is described as requiring public bodies to adopt

“transparent and effective measures to address the inequalities that result from differences in occupation, education, place of residence or social class.”

As I understand it, it currently sits idly on the statute book and has yet to be enacted. What plans do the Government have to bring this duty into force?

I would be delighted if the Minister would agree to meet me to discuss the next steps on these and many other issues, including how to turbocharge this whole agenda—something that I know that she, like me, feels passionate about.

To conclude, from birth to the workplace a young person’s life chances are heavily shaped by how much their parents earn and where they grow up. It is critical that this new Government act now to put a stop to this tragic waste of talents that blights both our economy and our sense of fairness. Although the main levers for improving social mobility lie within the education system, we cannot just look at schools in isolation; we need a cross-departmental strategy that combines big-picture thinking with genuine local understanding. I very much look forward to hearing the contributions of other noble Lords.

[Lord Bethell (Con)]

My Lords, I should like to say a word about this very important and very heavily subscribed debate. As has been mentioned, there is a tight constraint of two minutes on speaking times. I ask all noble Lords to stick to that time. There is a maiden speech, and the time limit will not apply to the noble Lord following that.