NHS: Nursing Workforce

Debate between Lord Bethell and Lord Clark of Windermere

Wednesday 8th September 2021 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to retain the nursing workforce in the National Health Service following their experiences during the COVID-19 pandemic.

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

My Lords, we owe a huge debt of gratitude to the nurses in all parts of our healthcare system, who have done an amazing job through the pandemic. We are on track to deliver our manifesto commitment to have 50,000 more nurses by the end of the Parliament. This includes a focus on retaining nurses already working in the NHS and social care. We are taking action through the NHS People Plan to improve nurse retention by prioritising health and well-being, supporting flexible working and improving NHS workplace culture. The signs are that these efforts are paying off.

[Lord Clark of Windermere (Lab)]

My Lords, the training of these new, welcome recruits to the nursing profession will take some time. Immediate improvements will depend on the current staff, who feel battered and bruised following the intense pressure of Covid. Daily, nurses end up in tears at work and many are contemplating leaving. What specific plans—I stress “specific”—do the Government have to retain nurses to meet today’s growing problems in the NHS?

[Lord Bethell (Con)]

My Lords, I completely acknowledge the phenomenon of burnout that the noble Lord rightly points out; the NHS people recovery taskforce, appointed to tackle exactly that problem, is very much focused on it. It works in conjunction with the NHS retention scheme and has led to the appointment of new well-being guardians, which have made a huge impact. The statistics suggest that the leaving ratio, previously at 10.3%, has now been reduced to 8.3%. That is an encouraging sign, but we have a number of other measures in place to ensure that retention remains upward at a time when, as he pointed out, nurses are under huge pressure.

Covid-19 Update

Debate between Lord Bethell and Lord Clark of Windermere

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

The right reverend Prelate puts it extremely well. I pay tribute to all the community groups which have an influence on the thinking of the nation. I encourage them to use that influence to engender and support a spirit of community consideration so that we can try to come together as a nation and approach public health in a way that is considerate to each other.

On the specific point of singing, as I took my place, I noticed that the Secretary of State for the Department of Digital, Culture, Media and Sport was in the process of making a Statement, and I refer the right reverend Prelate to that. I am afraid I have not had a chance to read it.

[Lord Clark of Windermere (Lab)]

My Lords, as the Government have already admitted, one result of their new controversial policy will be an extra 100,000 cases a day of Covid-19, possibly within the next month, which will lead to further heavy demands on an overpressed NHS. How do the Government intend to retain the already overworked and burned-out health workforce going into this battle on an offer of £1 a week pay rise after all the effort they have put in?

[Lord Bethell (Con)]

My Lords, I pay tribute to the NHS, but the rise in infections among mainly very young people will not necessarily lead immediately to a large increase in the demands on the NHS. An extraordinary aspect of this disease is that it targets the elderly and those with comorbidities and leaves the young largely alone. The proportion of people who have the disease in the months to come will mainly be the unvaccinated. Those are mainly the young and our modelling, which is supported by the NHS, suggests that our resources in healthcare can support that kind of situation.

Covid-19 Update

Debate between Lord Bethell and Lord Clark of Windermere

Tuesday 15th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness that many are curious about whether they have antibodies, but I warn her that the presence of antibodies does not necessarily correlate with immunity. Some people have strong immunity and no antibodies, and some have antibodies but not immunity. This is one of the mysteries of the body’s response to the disease and one of the reasons why it has been such a confounding disease to fight. But if anyone does want an antibody test, they should ask their GP and it can be arranged.

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

My Lords, very bluntly, we are facing this unpalatable Statement today because of the Prime Minister’s inability to take decisions. The Government learned of the arrival of the Indian variant as early as 25 March, yet took no action for 30 days, allowing 20,000 people to enter the UK. The result is that they put the public’s health at risk. As a consequence, we now face a further four weeks of restrictions, with accompanying hardships. Have the Government learned their lesson?

[Lord Bethell (Con)]

My Lords, I am not sure whether I accept the characterisation presented by the noble Lord. We have worked incredibly hard to bring in a managed quarantine system that is a novel, new introduction into the UK. We have done extremely well in fighting off many of the variants that have come to our shores, including the Manaus variant, the South African variant and others. We have strong links with Pakistan, India and Bangladesh, which means there is a lot of traffic between our countries. I am not sure whether it would ever have been possible to prevent this variant making landfall in the UK at some point. But we have done an enormous amount in the UK to delay and prevent the arrival of these variants, and for that I am enormously grateful to those involved.

Food-related Crime

Debate between Lord Bethell and Lord Clark of Windermere

Monday 22nd February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I bow to the noble Baroness’s great expertise on the correlation between poverty and crime. But that makes no excuse for the kind of crimes we are talking about here. Many are either brutal—as the noble Baroness, Lady Jones, referred to—or crimes of fraud, for which there is no excuse.

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

My Lords, I am encouraged by the Minister’s response today, and I am sure that many Members of the House will wish him well in persuading his colleagues to give more power to the NFCU. As he does so, will he ensure that the new system is integrated completely with the more established direct farm-related food regulations and crimes?

[Lord Bethell (Con)]

My Lords, the NFCU has done an enormous amount in working with stakeholders. Although it is a relatively small unit, with just 80 individuals, it works extremely closely with trading standards officers in local authorities and with policing authorities up and down the country. It leverages its expertise, and we hope to be able to augment that expertise with investigatory powers so that it can relieve police forces from some of the application of justice in this area.

Covid-19: Self-Isolation

Debate between Lord Bethell and Lord Clark of Windermere

Wednesday 10th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the surveys are not crystal clear about practice, but on the whole the UCL survey and our own interrogation of those isolating suggest that compliance is much higher than the noble Lord implies. I pay tribute to local councils, which are doing an enormous amount to provide the kind of economic support that the noble Lord quite rightly alludes to. Blackburn with Darwen, for instance, provides an enormous amount of support for those with annual earnings under £21,152. In Colchester, applicants must not have more than £16,000 in capital, but the council provides a substantial discretionary payment. It is this kind of targeted local support that we believe can make an enormous difference.

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

My Lords, Yvette Cooper, the chair of the Commons Select Committee on Home Affairs, has reiterated that there is no testing at airports, with incoming passengers able to leave the terminal and go directly to public transport. This has been reinforced on television with passengers leaving Heathrow without any checks whatever, having flown in from South Africa via Dubai. Does the Minister believe that such slackness keeps the British people safe?

[Lord Bethell (Con)]

My Lords, I do not accept the accusation of slackness. Testing should happen before the flight, not at the airport. All those who seek to avoid the red list protocols will be interviewed by the police, and the kinds of fines ascribed to that offence have been made crystal clear in the Statement by my right honourable friend the Secretary of State for Health.

Hotel Quarantine for Travellers

Debate between Lord Bethell and Lord Clark of Windermere

Wednesday 3rd February 2021 Lords Chamber

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

The next speaker is the noble Baroness, Lady Masham of Ilton. Is the noble Baroness with us? We will come back to the noble Baroness. Let us go to the noble Lord, Lord Clark of Windermere.

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

My Lords, the Minister said that he believed there was a basic right to travel. I put it to him that there is an even greater right to live, yet we have the highest death rate per head of the population of any country in the world. Should we not put the right to live at the top of our agenda?

[Lord Bethell (Con)]

I could not agree with the noble Lord more: the right to live trumps all other rights. It is a sad fact that, while we would normally do everything we could in a liberal democracy to protect rights such as the freedom to travel, under current circumstances these are trumped by the right to live, and that is why I call on all people to limit their travel wherever they humanly can. There is simply no excuse for going to Dubai, taking Instagram photographs of yourself and claiming that that is business travel. You are putting your friends and loved ones at risk, and this Government will not tolerate it.

Covid-19: Vaccines

Debate between Lord Bethell and Lord Clark of Windermere

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

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

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

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

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

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

Coronavirus Vaccine

Debate between Lord Bethell and Lord Clark of Windermere

Thursday 3rd December 2020 Lords Chamber

[Lord Bethell (Con)]

I thank my noble friend for his kind words. I reassure him that everyone in Britain who wants a vaccine will get one. In fact, we are going to do everything that we can to encourage everyone in Britain to have a vaccine. We believe that prevention is better than cure, and that vaccines such as the ones coming down the pipeline offer the best possible fightback against this horrible disease. With regard to the different properties of the vaccine, his observation is entirely right: it is likely that the different vaccines have different properties, not least that some are much easier to transport than others, but some might work better, for example, with children or with those susceptible to other conditions. We do not have full data on the other vaccines so it is impossible to make those comparisons at this stage, but I assure him that when we have the data we will make sensible decisions along those lines.

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

I thank the Minister for being so frank and admitting that the initial rollout will not be uniform throughout the country this year. I want to ask him about those individuals prioritised for the vaccine on the grounds of age or having weaker immune systems—specifically, who will identify those individuals? Initially the role of GP surgeries was highlighted for that task. Is that still the case? What will happen in those GP surgeries—there are quite a number of them—that have no GPs? Will the nurse practitioners be able to perform the role of identifying those individuals? I would like a specific answer to that because it is important in the longer term for a great many people.

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

I remind noble Lords of the request for brevity.

Covid-19 Update

Debate between Lord Bethell and Lord Clark of Windermere

Thursday 12th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am afraid I cannot offer a firm schedule or confirmed dates for the rollout because they depend on the independent judgment of the MHRA, the CMO and the JCVI. These important decisions are out of our grasp, but it is clear that the progress made by Pfizer, AstraZeneca and other companies in the vaccine’s pipeline has been dramatically quicker than had initially been expected. We are making preparations to have the NHS ready for the beginning of December in case a vaccine is available by then.

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

My Lords, this just highlighted the key role of GPs in any vaccine rollout, but in parts of the country there is a dire shortage of GPs with, on occasion, surgeries being run by nurse practitioners and other specialist nurses to great effect. Will the Minister check that, in the absence of GPs, nurse practitioners will have, first, full authority to activate any initial planning; secondly, empowerment to undertake the necessary continuing administration for the vaccination rollout; and thirdly, current authorisation to prescribe and vaccinate applicable in any national rollout?

[Lord Bethell (Con)]

I thank the noble Lord for his championing of nurse practitioners, because we are going to rely on all qualified healthcare workers to administer an injection to support this huge project—one of the largest of its kind in recent national history. I also emphasise the role of pharmacists who will, where appropriate, deliver the vaccine as well. We need a massive, mass-scale effort to deliver this vaccine. We will be empowering all those qualified to deliver the injection to do so and we are extremely grateful to them, including nurse practitioners, for their help in this matter.

Nurses: Recruitment

Debate between Lord Bethell and Lord Clark of Windermere

Thursday 18th June 2020 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have to facilitate the recruitment of nurses onto degree courses beginning in September 2020.

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

My Lords, the health and education sectors are working jointly to increase applications and places. The Government announced 5,000 more healthcare places from September. In England, nursing students can access more funding worth at least £5,000 per academic year. During July in clearing, there will be marketing campaigns aimed at students considering nursing.

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

My Lords, one reason why we were so ill prepared for Covid-19 was that the NHS was short of over 40,000 nurses. Will the Government ensure that the number of nursing places available at universities this coming September will significantly begin to reduce that dire shortage of nurses?

[Lord Bethell [V]]

I reassure the noble Lord, Lord Clark, that from September 2020 eligible pre-registration students in English universities studying nursing, midwifery or one of the many allied health professional courses will benefit from additional funding of £5,000 per academic year. The correct number of places will be made available to hit our objective of 50,000 more nurses by 2025.

Exercise Cygnus

Debate between Lord Bethell and Lord Clark of Windermere

Tuesday 9th June 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is right—if I understand her correctly—that the needs of PPE for a flu pandemic were quite different from those for Covid. It is also true that the planning did not anticipate a breakdown in global trade and a failure of the business-as-usual supply of PPE. No one could have imagined that flights would be grounded and factories shut and that the global supply chains for these key and vital products would have ground to a halt in the way that they did.

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

Is it true that Exercise Cygnus reported a shortage of ventilators, critical care beds and PPE in the National Health Service? If so, why were we singularly unprepared in all these spheres three and a half years later, at the beginning of Covid?

[Lord Bethell [V]]

My Lords, I admit that my briefing is not entirely specific, but it is my impression that operation Cygnus did not address the question of ventilators. One of the distinctive characteristics of Covid was the pneumonia response, which required an unanticipated and dramatic increase in our need for ventilators. That is one of the reasons why there was a global shortage of this key equipment. I have addressed this with the notes I have before me and will be happy to correct it if I have misunderstood.

Hospitals: Patient Safety

Debate between Lord Bethell and Lord Clark of Windermere

Thursday 21st May 2020 Lords Chamber

[Lord Bethell]

My Lords, I acknowledge that people’s concerns have led to a decline in attendance at A&E. That is why the NHS is running an “Open for business” media campaign, encouraging all patients in need of urgent or emergency medical care to seek appropriate treatment, including, where appropriate, attendance at A&E.

[Lord Clark of Windermere (Lab)]

Is the Minister aware that North Cumbria Integrated Care NHS Foundation Trust has confirmed that for five weeks 100 staff working in its operating theatres had to use respiratory face masks that had not been individually fitted, putting patients and staff at risk? The regulatory-fit test had not been applied. Can the Minister look into this and check that all the other trusts in England are not making the same error?

[Lord Bethell]

The noble Lord raises a question about north Cumbria, which I do not know about specifically, but I reassure him that the arrangements for PPE in hospitals have been made extremely professionally and thoroughly. Billions of items of PPE are available, and training on the fitting, wearing and changing of PPE is provided for all front-line clinical, support and other staff.

Influenza: People with Learning Disabilities

Debate between Lord Bethell and Lord Clark of Windermere

Tuesday 1st October 2019 Lords Chamber

[Lord Bethell]

The noble Baroness makes a very important point. The question of the learning difficulty register is undoubtedly one that affects this area enormously. Each GP should have a learning difficulty register where the names of those with learning difficulties are recorded, but it is recognised that those registers are not necessarily always up to date. At their board meeting on 27 June 2019, NHS England and NHS Improvement made a commitment to improve the quality of registers for people with learning disabilities for precisely that reason.

[Lord Clark of Windermere (Lab)]

My Lords, as it stands, one of the major overseas suppliers of anti-flu vaccine is experiencing delays in getting the vaccine through to the UK. Is that likely to have any major impact on the supply of vaccinations?

[Lord Bethell]

The noble Lord makes an excellent point, and this is an area of concern, but I should like to reassure him that these are not delays; they are in fact phasing. What we learned from last year is that the identification of which particular flu strain is likely to hit the northern hemisphere is not always clear at the beginning of the season, so we have learned to phase the delivery of the vaccines in case the strain of the influenza virus changes or is not as anticipated. This is interpreted by some pharmacologists as a delay, but in fact it is a pragmatic decision made at the very highest levels.

Health Infrastructure Plan

Debate between Lord Bethell and Lord Clark of Windermere

Monday 30th September 2019 Lords Chamber

[Lord Bethell]

I thank the noble Earl for his helpful question. Members of my family have benefited from the work of health visitors and I share his concerns about their role and their funding. The decline of health visitors is not part of the Statement given by the Minister earlier, but I will be sure to pass on the noble Earl’s comments, as requested.

[Lord Clark of Windermere (Lab)]

My Lords, the title of the Statement, “Health Infrastructure Plan”, is a slight exaggeration, but let us welcome it for what it is. The Government have a woeful record, so anything they bring forward on the health service has to be welcomed. Can I press the Minister on some of the figures? I accept that these are quite difficult. Is there agreement that six hospitals will be rebuilt, or modified to that extent, and that the cost will be somewhere in the region of £2.7 billion? I think that was the figure. If that is the case, what about the other 34 hospitals? If they were all found to be suitable, are the Government guaranteeing that they will be funded for the same level of rebuild as the six announced today? If I do the maths very quickly, I believe that will cost in excess of £20 billion. Will the Government give an assurance that the money is there? The Prime Minister has promised us 40 new or severely modified hospitals, so the House is justified in asking this.

My second question is about the interim people plan. We desperately need not an interim plan but a fully fledged work plan on people. We are short of not only nurses but doctors and almost every single profession in the health service. This means it is very difficult for the service to continue. Looking at the issue of nurses—

[Lord Clark of Windermere]

There is plenty of time; there are 20 minutes. I want to ask this question. I know it is uncomfortable, but the Government are responsible for the reduction in and the shortage of nurses. Will the Minister apologise and say that they got it wrong when they cut the number of nurses in training by in excess of 10,000 after 2010? We have not made up for that. I finish by suggesting to the Minister that he reinstate the nurse training bursary scheme, so that we do not have to rely completely on the international recruitment of nurses but have our own nurses indigenous to this country.

[Lord Bethell]

My Lords, the noble Lord raises an important question about how infrastructure spending is approved and green lit. He is quite right that today’s announcement sees the final green light given to six hospitals and a further 21 projects—some of which are multisite projects—are on the runway but are not 100% green lit. That is because their plans are not yet ready, but there is a full intent by the Government to work with the trusts involved to develop those plans to final proposals and to have the money available to finance those plans in their current form. It has been publicly put out by NHS England that the rough current estimated cost of those projects is around £10 billion and that that money is put aside and allocated for those projects, as long as they meet the requirements of infrastructure scrutiny.