Independent Medicines and Medical Devices Safety Review: Sodium Valproate

Debate between Lord Bethell and Lord Bates

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord puts it extremely well and I totally agree with the thrust of his point. For patients to have the right information about the risks of the medicines that they are prescribed is essential. However, if I may stray into a different subject, there is also patient choice. For many patients, sodium valproate provides an incredibly valuable relief from epilepsy and mental illness. It is a drug that continues to be prescribed because some have no choice and there is no valid alternative to the drug. The number of people being newly prescribed the drug—new starters—is down dramatically from previous years, but for some it really is an important part of their therapy. The decisions that they make are personal ones, and we should respect those.

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

With apologies to the noble Baroness, Lady Browning, the time allowed for this Question has now elapsed.

Future of Health and Care

Debate between Lord Bethell and Lord Bates

Tuesday 23rd February 2021 Lords Chamber

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

My Lords, I thank the two noble Baronesses enormously for those thoughtful and helpful questions. We are at a very early stage in the process of this important legislation, and the questions from both the noble Baronesses, Lady Brinton and Lady Thornton, are extremely helpful and make a good challenge. I will attempt to answer them as best as I can.

I reassure the noble Baroness, Lady Thornton, that we have all read the debates around the Lansley Bill carefully and learned an enormous amount from them. We greatly look forward to reminiscences from all those who were there in those days. There are some things that the Lansley Bill did that left an important and lasting legacy, and it would be wrong to overlook those. The establishment of Healthwatch and a focus on outcomes was a cultural inflection point in the history of the NHS. The overall importance of commissioning will not be lost in any changes introduced by this Bill. Lastly, this Bill massively builds on the establishment of NHS England in its measures. These are some examples of where the Lansley reforms made huge advances.

However, as the noble Baroness, Lady Thornton, rightly pointed out, some of those reforms have had their day and it is now important to move on to the next round, building on those reforms while fine-tuning some of them. One of the most important areas of development is around collaboration. By that, I mean that the challenge of modern healthcare is to bring a huge amount of expertise and extremely complex resource to bear on individual patient challenges. The sheer complexity of some of the treatments and therapeutics that can benefit the patient requires not just simple clinical analysis by an individual but teams across many disciplines, sites and, sometimes, institutions. It is the bringing together of that huge amount of collaboration that the Bill focuses on.

The noble Baroness is right that we face massive challenges in the period ahead. The vaccination programme is absorbing a huge amount of resource. There is a tremendous backlog in almost every area of the NHS and getting through it is a great challenge. NHS staff themselves are tired and exhausted; they deserve a break. This should not hold us back from doing exactly what the NHS had planned to do before the Covid epidemic, what stakeholders in the NHS repeatedly tell us that they want to do and what the huge amount of engagement that we have done tells us is right to do. I remind her that the core of the White Paper is the proposals made by the NHS to the Government in September 2019 to help the NHS deliver its long-term plan.

NHS England and NHS Improvement carried out a huge engagement process before making those recommendations. That exercise had over 190,000 written responses from individuals and organisations representing different parts of the health and social care system. Those recommendations were supported and endorsed by key leaders across that system, including NHS Providers, UNISON, Healthwatch, the Local Government Association, the Royal College of Nursing and many others. The recommendations made by NHSEI also built on recommendations made by the Health and Social Care Select Committee in June 2019.

The Bill will have been thought about and prepared for over many years. It is the thoughtful application of important reforms and therefore deserves the close analysis and support of noble Lords. There are tremendous benefits to patients. The noble Baroness, Lady Thornton, specifically asked what the tangible benefits are, and I will pull out three in particular.

First, there are some specific public health measures in the Bill. As the noble Baroness, Lady Brinton, rightly raised—I will come back to it, in a moment—public health is central to the outcomes of the Bill. Fluoridation is the iconic measure, but a thick red thread of public health runs throughout the Bill. Secondly, the constitution of the Healthcare Safety Investigation Branch—HSIB—will, with statutory muscle, bring about the important investigatory element to promote the patient safety agenda, which my noble friend Lady Cumberlege wrote about in her report. Thirdly, the bringing together of GP and social care services into integrated care systems will bring much closer the decisions about patients which often cross barriers that, I am afraid, are huge obstacles to effective care today.

I will address the question of social care directly because the noble Baronesses, Lady Brinton and Lady Thornton, challenged me on this point: why have we not in the Bill brought about a wholesale financial rebooting of adult social care? The measures on adult social care in the Bill are just one aspect of a wider reform agenda. Our wider objectives for social care are to enable an affordable, high-quality and sustainable adult social care system that meets people’s needs while, supporting health and care in joined-up services around people. The Prime Minister has been crystal clear about his agenda for reform. A broad range of options are being explored on how best to accomplish these reforms and we want to ensure we get that reform right. Engagement with the sector and the public will be an important part of that.

We are still considering a number of funding reform options. However, the leading options, such as a cap and floor, are already provisions in the Care Act so they require only secondary legislation to enact. For this reason, we do not require anything on charging reform to be included in the Bill. However, the Bill should be considered as an important paving stone to wholesale social care reform.

I entirely agree with the noble Baroness, Lady Brinton, that culture is important. We are absolutely committed to putting social care in exactly the same hierarchy as the NHS. We believe that local authorities have a central role in the provision of social care; that is envisaged to remain the same. The noble Baroness, Lady Thornton, asked specifically: who will sit on the boards? That is exactly the kind of question that I look forward to debating here in the House and engaging on with noble Lords.

The noble Baroness, Lady Thornton, asked about competition, and she and the noble Baroness, Lady Brinton, raised deep-seated and heartfelt concerns about cronyism and corruption. I take those concerns very seriously. Huge amounts of taxpayers’ and voters’ money have been employed during the pandemic in the fight against Covid, and very large sums of money were spent on PPE in circumstances where there was a huge rush and difficult arrangements were being put in place. However, I remind both noble Baronesses that when they attack the Government and make accusations of cronyism, chumocracy and corruption but have no foundation for those attacks, they are interpreted as attacks on the very NHS and social care staff who have worked extremely hard to procure the right services and products, who have the interests of patients in mind, and who are working so hard to save lives. Attacks on the integrity of the system are extremely damaging to their morale and the integrity of that system. I kindly ask the noble Baronesses, Lady Thornton and Lady Brinton, who have made these attacks repeatedly over the last few months, to think very carefully about the way in which they make these accusations.

In particular, I will address the question raised by the noble Baroness, Lady Brinton, of PPE being taken from lorries that was destined for social care and sent instead to the NHS. If she indeed has evidence that such a thing happened, I would be very grateful if she would write to me. But if she does not, I would be extremely grateful if she did not raise this anecdote again, because it is a damaging image which hurts very much those who work in social care and the NHS, and is not necessarily fit for a debate such as today’s.

In terms of the PPE contracts that were the subject of a recent action in the law courts, I will repeat the sentiments expressed by my right honourable friend the Secretary of State for Health. Every waking moment of every day for everyone involved in the procurement of PPE was dedicated to getting the right kit to people on the front line to save their lives. If the paperwork was done two weeks late, that is an entirely proportionate and reasonable consequence of a very difficult situation, and seeking to make political capital out of an administrative oversight does not seem at all proportionate to the situation.

This is an extremely exciting Bill we have before us. I very much look forward to debating it in this Chamber. I am extremely grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for their questions.

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

My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call a maximum number of the 16 speakers who have asked to ask questions in response to this Statement.

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[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness that there is a challenge around parity of status. The pandemic has vividly brought alive the challenging circumstances of those who work and live in social care. It is a tremendous tribute to the British people that they have given the lives of the elderly and the vulnerable such a high priority by putting the life of the country on hold to protect the health of the vulnerable and elderly, and that they have thought carefully and thoughtfully about those who live in either residential or domiciliary social care, for instance. It has brought alive for the whole nation the circumstances of those who live in social care.

I have heard loud and clear those in this House who have made the case for those who work in social care, often in low-paid roles but with a huge amount of responsibility and a massive task ahead of them, to receive better training, have clearer career paths, and, as the noble Baroness rightly points out, have a higher status. However, I do not agree with her that the sequence should be financial reform followed by structural reform. With this Bill, we are trying to put in the correct structural circumstances for social care so that it has parity with the NHS and a collaborative jigsaw fit with those in clinical and public health roles. Therefore, when the financial reforms are put in place, they will be done most effectively and with the largest impact.

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

My Lords, I am afraid that the time allowed for Back-Bench questions has now expired, with apologies to the noble Lord, Lord Vaizey, and the noble Baronesses, Lady Barker, Lady Stuart, Lady Donaghy and Lady Jolly, that I was not able to call them.

Covid-19 Vaccines Deployment

Debate between Lord Bethell and Lord Bates

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses. They are entirely right to applaud the progress of the vaccine. I start by sharing some pretty formidable statistics on that. An absolutely remarkable 95.6% of those aged 75 to 79 have received their first dose. I have never seen a government statistic quite like that. It is an astonishing figure. Such a very large proportion of a target population have come forward, have been efficiently vaccinated and are now protected from the worse effects of this awful disease. It is an enormous success story. Of those over 80 years old, 91.3% have received their first dose and 74% of 70 to 74 year-olds have received their first dose. Up to 9 February, an astonishing 13,580,298 people received their vaccine. These are extraordinary figures. It will have a huge impact not just on the personal lives of those who have been vaccinated and their families but on the workings of the entire NHS. It is a massive game-changer and will dramatically reduce the amount of hospitalisation for and deaths from Covid. We are determined to take full advantage as a country of this enormous success story.

We are enormously pleased with the WHO readout on the AstraZeneca vaccine. It is exactly what we hoped for and what we understood from the clinical trials of the vaccine, and it is pleasing to see worldwide recognition that a 12-week gap between the two doses is the right approach and that the AstraZeneca vaccine is good for over 65 year-olds. I greatly thank those at the WHO who have done that. We are completely committed to the vaccine rollout and we will not take our foot off the pedal in any way.

I completely understand the point of those who are concerned about the impact of the lockdown. The noble Baroness alluded to the words of Charles Walker, who is entirely right that the lockdown has a huge impact on the economy, the public mood and particularly on those who cannot make it to school. However, the approach we are taking—a slow and steady approach of not rushing into anything—is exactly the one that will pay the greatest dividends for the economy. It is hugely supported by the general public and it will mean that, when we release the lockdown and return children to school, we can do it with the confidence that we will not have to go back again.

We are concerned about the lag in take up, particularly in black African communities. There are clearly, among the really good stories of take up, one or two areas where we are concerned. The work of the communications team on anti-vaxxers’ stories and the support we have got from social media firms has been really good across the board, but this is one area where we are enormously focused. The data is not always crystal clear, and we have not published it all yet, but this is one area where the noble Baroness is entirely right and we are very concerned.

The noble Baroness asked for reassurance on the second dose: will everyone get a second dose, and are there enough supplies in the warehouses for everyone? I reassure her and all noble Lords who may be concerned on that point that we are absolutely committed to the second dose. Everyone will get it, and they will get it on time. The supplies are in place.

The noble Baroness, Lady Brinton, asked about whether it was our policy to give a difference second dose to the first. I will be crystal clear: this is not our policy. If you are given a dose of “A” then your first dose will be “A” and your second dose will be “A” as well, and not “B.” We are looking into clinical trials that seek to understand whether an “AB” combination might be safe and may even be better. There are examples in other spheres where mixing two different vaccines can have a benign effect on the body and can stimulate a greater antibody response. We are looking at this very carefully. The COM COV clinical trial has been given £7 million to look into this. It is a long-term clinical trial and we are not expecting a readout any time soon but, if there are benefits, we will chase those down.

I completely agree with the noble Baronesses, Lady Thornton and Lady Brinton, on variants of concern. We have all been alerted to the grave danger that a mutation might have enhanced transmissibility, increased severity and escapology. Should such a variant emerge that could somehow jeopardise the Ming vase of our massive vaccination success story, we would be extremely concerned to address it. We are shortly having a debate on borders, and I shall save my comments for that debate, but I completely endorse the concerns of both noble Baronesses.

The noble Baroness, Lady Brinton, mentioned Professor Chris Whitty. To all those who missed it, I mention the presentation he gave yesterday on the investment in therapeutic drugs and antivirals, which was unbelievably impressive. We are enormously lucky to have someone like Chris as our Chief Medical Officer. Indeed, the Deputy Chief Medical Officers, Jonathan Van-Tam and the others, have all served us extremely well. I also praise others who have stepped up to public life in our time of need, including Kate Bingham and the noble Baroness, Lady Harding. They have both done an enormous public service and deserve enormous praise.

The noble Baroness, Lady Brinton, asked about disabled people. She is entirely right: there are those who are disabled or who have learning difficulties, and we are concerned about the impact of Covid on them. Many who are clinically extremely vulnerable are already in the priority level 4 and will already be in the prioritisation list. Others will be in prioritisation level 6. We are looking at whether we should change the prioritisation system in any way, and the JCVI keeps a running watch on this. I reassure the noble Baroness that all those in a high-risk group will be prioritised in a reasonable fashion. We will be reaching prioritisation level 6 very soon indeed.

The noble Baroness, Lady Brinton, talked about the importance of sharing vaccine with other countries. Tedros is absolutely right: we are not safe until everyone is safe. Britain has taken leadership role in CEPI, Gavi and ACT; we continue to support the global distribution of vaccines through our contribution of IP, our massive financial contribution and our diplomatic leadership. We remain committed to that, and we will continue to use our chairmanship of the G7 to influence other nations to step up to their responsibilities.

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

My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

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[Lord Bethell (Con)]

My Lords, the honest truth is that I cannot lay out a timetable for my noble friend. That will happen in the week of 22 February and the Prime Minister has made that clear. He is entirely right that the vaccine dramatically reduces hospitalisation and death. Target groups 1 to 4 account for nearly 90% of the deaths, so this is a dramatically improved situation. However, it does not remove the threat of Covid altogether. At the moment we have an infection rate of around 2% in the country. Were we to open up tomorrow, that infection rate might lead to a much higher rate: 10% or 20%. If we ran at a rate of 20% we would have a very large number of young people who would end up in hospital one way or the other, and who might experience long-standing damage from the Covid disease. We would also increase the rate of mutations in our own country and we would have a great displacement of that effect on the rest of the NHS system.

So this is not a binary game in which we have suddenly hit the moment where we can lift everything. We have to tread cautiously on that. However, I agree with my noble friend that the mental health impact of the lockdown is intense. I reassure him that two members of the SAGE subgroup SPI-B are members of the British Psychological Society. SPI-B presents the independent expert behavioural science to advise the top SAGE—the Scientific Advisory Group for Emergencies—and it brings to the debate a very clear insight on mental health and brings to our awareness the impact of lockdown, which, as my noble friend quite rightly points out, is immense.

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

My Lords, the time allowed for Back-Bench questions on this Statement has now elapsed. I apologise to those whom I was unable to call. There will now be a short pause to allow for some changes before taking the second Statement.

Mental Health Act Reform

Debate between Lord Bethell and Lord Bates

Monday 18th January 2021 Lords Chamber

[Lord Bethell (Con)]

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

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

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

[Lord Boateng (Lab) [V]]

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

Covid-19 Vaccine Rollout

Debate between Lord Bethell and Lord Bates

Wednesday 9th December 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the precise status of each vaccine in the pipeline is a subject for dialogue between the vaccine manufacturers and the MHRA. I can tell the noble Baroness that we are extremely encouraged by the substantial number of vaccines in the pipeline. The safety data for all those for which we know the response is also extremely encouraging. AstraZeneca—the one that most eyes are on—is making good progress, but I am afraid that I cannot give a clear or confirmed time for when, or if, it will be authorised. As for doses, as the noble Baroness probably knows, we have committed to more than 320 million doses overall. The precise details of those are published on the Vaccine Taskforce website, and I would be glad to send her a link to that, so that she can get all the details.

[Lord Bates (Con)]

I thank my noble friend for this very good news, and for his tireless work in keeping us informed. Throughout this crisis, we have been given an object lesson in who are truly the key workers in our society, such as those working on farms and in supermarkets, and those servicing utilities, cleaning streets, organising deliveries and keeping us safe. Will he ensure that this lesson is remembered when ordering the front of the queue for the rollout of the vaccine?

[Lord Bethell (Con)]

I am grateful to my noble friend for his kind comments, and endorse his tribute to all those who have worked hard on the front line of healthcare during this pandemic, at times putting themselves at risk, and all of them under great stress. We owe them enormous gratitude. The JCVI has made a clear priority list and advised that the first priorities for any vaccination programme should be the prevention of mortality and protection of healthcare staff and systems. Therefore the vaccine is being rolled out to the priority groups, including care home residents and staff, people over 80, and healthcare workers. They are the ones who will be at the top of the list, and that seems to me proportionate, fair and right. As we work through the later prioritisations, others in the population will have access to the vaccine.

Covid-19: Test and Trace App

Debate between Lord Bethell and Lord Bates

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right that local councils are pivotal to our response to Covid-19. I pay tribute to Tom Riordan, CEO of Leeds City Council, for the important work he is doing to stitch together the alliance of councils which is working closely with the joint biosecurity centre to organise that response. However, I do not agree with the noble Baroness on the role of the tracing teams—it has been incredibly important. There has not been the capacity in the decentralised PHE teams to provide the response necessary to this national epidemic. A central team was necessary and is proving to be effective. We have put PHE expertise at the heart of that programme.

[The Deputy Speaker]

My Lords there are no more supplementary questions.

Coronavirus

Debate between Lord Bethell and Lord Bates

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, the introduction of face masks is something that has been recommended by the Government, but the mandatory wearing of them is not. We are looking at the various recommendations from SAGE to inform the proposals that might come after the lifting of social distancing, but our focus remains on hygiene, social distancing and isolation. Those are the three most effective measures and we remain committed to them for the moment.

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

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

Covid-19: Mental Health

Debate between Lord Bethell and Lord Bates

Tuesday 16th June 2020 Lords Chamber

[Lord Bethell [V]]

The noble Lord is entirely right to focus on the impact of the pandemic on young people. It is not yet clear how that mental health impact will take effect. The natural concern is that it will be long standing. One thinks back to the major economic shocks of the past, which often led to long-term mental health issues for those who found economic insecurity. The struggle to find jobs left them with damaged confidence and concerns about the future. With that in mind, we are very much focused on addressing young people’s mental health and the impact of the epidemic.

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

My Lords, I am afraid that the time allowed for that Question has now elapsed. That also concludes the hybrid proceedings on Oral Questions.

Social Distancing: Two-metre Rule

Debate between Lord Bethell and Lord Bates

Tuesday 16th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, I pay tribute to the British public, who have remained sensible and thoughtful to others, have largely borne the cost of social distancing and have abided by the rules of the lockdown. I express gratitude to all members of the public who have gone along with this incredibly impactful regime—a regime that continues to have a huge amount of support among the broader general public.

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

My Lords, I am afraid that the time allowed for questions on this Urgent Question has now elapsed. I call on the Whip to move that the House be adjourned until 1.30 pm for the Committee stage of the Corporate Insolvency and Governance Bill.