Public Health Grant to Local Authorities

Lord Bishop of London Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The public health grant will be maintained in real terms over the spending review period, and we will confirm local authority allocations in due course, but this is not the only money going to public health. In addition to the grant, the Government are investing £300 million over the SR period to tackle obesity and £500 million over the SR period to improve the “best start in life” offer available to families. The NHS is spending over £1.3 billion on national public health services.

[The Lord Bishop of London]

My Lords, during my time as the Government’s Chief Nursing Officer for England I witnessed the unique value of public health nurses in the community. The pandemic has further highlighted the importance of such roles and the significance of a whole-system approach. Given this, will Her Majesty’s Government consider increasing funding specifically to build up or rebuild the capacity of public health nurses to tackle localised health inequalities?

[Lord Kamall (Con)]

The Government have allocated more money for local authorities but we think that it is best left to local authorities to decide how to spend that portion of their grant, for they are closer to the people in the communities that they serve.

Covid-19: Obesity

Lord Bishop of London Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely agree with my noble friend that obesity has been a sad and tragic driver of death from Covid. Overweight people are 67% more likely to need intensive care from Covid than those who are not overweight. The list of the measures that we have in place is extensive—there are 17 in number before me—and we are not going to stop there. This is a really important project for the Government. It is not our business to shame those who are overweight, but it is our business to enable those who seek to lead fit and healthy lives to take the necessary steps to reach that objective.

[The Lord Bishop of London]

My Lords, the reduced use of school space during lockdown highlighted an opportunity for us to make use of school kitchens as community kitchens. This holds real potential for addressing multiple issues such as poverty, obesity, lack of food or loneliness, all at one time. Will the Government consider supporting school kitchens to become community kitchens when not in use by students in order to tackle obesity in underserved neighbourhoods where people often have limited choices in their nutritional options?

[Lord Bethell (Con)]

The right reverend Prelate puts the case extremely well. The community kitchen measures she describes are beyond my brief. I do not have the details to hand, but I should be glad to follow this up and write to her.

Covid-19: Update

Lord Bishop of London Excerpts

Tuesday 20th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, our thoughts are with the people of India at a time when they are fighting the disease in very difficult circumstances. I acknowledge that, for families in the UK with family and business ties with India, the arrangements under the red list are extremely inconvenient, and we are doing it only because it is absolutely necessary.

[The Lord Bishop of London]

I am sure the Minister knows that those from deprived communities are more likely to catch Covid-19, be admitted to ITU and to die from the disease. They are also less likely to take up a vaccination. Could the Minister update us on action by the Government to ensure that Covid-19 does not continue to be a disease of poverty?

[Lord Bethell (Con)]

The right reverend Prelate hits the nail on the head. It is extremely sad, frustrating and hard to acknowledge the fact that those who live in deprivation are often those who are hardest hit by this awful disease. We have worked extremely hard to get the vaccine, and testing and tracing, into those communities and to support them with whatever education and community support we can. But the fact remains that this country has an unequal health outcome for too many families, and it is part of our levelling-up agenda that we try to address that. The obesity strategy is one way in which that we can do that, but there are a great many others that we need to look at.

Covid-19

Lord Bishop of London Excerpts

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend’s observation is entirely right. In Manchester alone there have been more coronavirus infections already in October than in July, August and September combined. The average daily hospital admissions in Greater Manchester are now higher than they were on 26 March, and there are now more Covid-19 patients in Greater Manchester hospitals than in the whole of the south-west and the south-east combined. These are illustrative of one region but it is a story that has already played out in others, and we naturally fear that it will play out in others in the future.

My noble friend’s advice on the mixing of households is very perceptive. One thing with that we cannot do anything about is the kind of infection that the noble Baroness, Lady Thornton, described among her friends, where it spreads within a household. That is something that no household can reasonably fight against. However, stopping the spread of disease between different households is something that we can lean into. It requires an enormous amount of social distancing and a return to the kind of lockdown measures that we had at the beginning of this year. That is something that we are extremely anxious to avoid because it has enormous social impact, it is disruptive to our way of life, and it has an economic impact because it has implications on social distancing and on some businesses. Still, my noble friend is entirely right that that is exactly the kind of area that we will need to look at if we are to contain the spread of the virus.

[The Lord Bishop of London]

My Lords, from my background as a former Chief Nursing Officer, I am aware of the difficult decisions that Her Majesty’s Government are required to make, as well as of the importance at this specific time of good public health action. However, I have heard the concerns expressed by my colleagues in the north-east and the north-west of England, including some of my right reverend friends in your Lordships’ House: Covid-19 is disproportionately affecting the vulnerable and, unfortunately, so are the restrictions. There are significant concerns about their compliance with regulations that they do not feel are fair. The Government have frequently made assertions about public health behaviour and science without publishing the evidence or properly engaging with people in the communities affected. The interventions may well be right but the implementation seems to be failing. The Government must genuinely engage with, listen to and learn from people affected at a local level. Without such local buy-in, public health actions will not happen.

There is also some concern that the restrictions are impacting on those least able to manage the health and economic impact. There are concerns that movement into tier 3 will continue to exacerbate matters such as child poverty, deprivation, economic and health inequalities and poor mental health. If the perception is allowed to grow that certain sections of the economy or society can be allowed to bear the substantive weight of fresh regulations without levels of financial support, the consensus will not hold. Will the Minister reassure your Lordships’ House that, as areas move to tier 3, local voices will be listened to and everything will be done to ensure that the risk to the most vulnerable is minimised?

As I have already said in your Lordships’ House, the local public health nurse can inform top-down rules with local experience. What is being done to ensure that when the ring-fencing of funding that was passed to local government for public health comes to an end at the end of this financial year, it does not lead to further disinvestment in public health?

Lastly, faith communities, like public health nurses, are part of local populations and areas, and should be used more as experts to help leverage insights that they gain on the ground to support the public health action and interventions needed. I again encourage the Government not to neglect the whole-system approach to public health, as we work together on the challenge of Covid-19.

[Lord Bethell (Con)]

The right reverend Prelate puts it extremely well. We completely recognise that not only does the virus attack the most vulnerable, but those who are least fortunate bear the huge brunt of the lockdown and the measures needed to crack down on the virus. In these matters, I emphasise that it is worth stepping back and reminding ourselves that the Government are not the source of the problem; the virus is. All the Government can do is take measures to save lives, protect our healthcare service and keep our schools open. In that way, it is not right to demonise central government for taking measures.

Central government can take measures to help protect the vulnerable, and I acknowledge the right reverend Prelate’s point on this. I reassure her that we have put in place the Job Support Scheme to ensure that those affected by business closure are still paid; we have made £465 million available to help local authorities implement and enforce restrictions; we have provided £1 billion of extra funding to local authorities across the country; and we are committed to working with local authorities to allocate testing and tracing locally.

On the message the Government deliver, I recognise the phenomenon described by the right reverend Prelate, but I reassure her that there is no intent by government to make an association between poor behaviours and results. The data is there. We have published every piece of data we can and, to an extent, it does not lie. It is an uncomfortable truth, but some communities have consistently higher prevalence and infection rates. There is some responsibility on those communities to address the causes of that. It is an intent shared by government, local authorities, communities and individuals. There is no avoiding the fact that you cannot pin responsibility on any one of those four pillars.

Lastly, the right reverend Prelate is entirely right that faith communities pay an important role. I pay testimony to those faith communities in cities such as Leicester and Bolton, which have worked with us to great effect. We continue to put our relations with faith communities at the centre of our outreach to communities.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020

Lord Bishop of London Excerpts

Tuesday 20th October 2020 Lords Chamber

[The Lord Bishop of London]

My Lords, I am grateful to the Minister for the work that he and others are doing to make decisions at this very challenging time. The regulations we are debating relate to health protection restrictions and fines. However, I wonder whether our approach to public health protection and restrictions during the pandemic needs to pay more attention to a bottom-up approach of wisdom, rather than simply relying on top-down pragmatism and the push and pull of financial incentives. Last week, the right reverend Prelate the Bishop of Manchester highlighted how policies, such as fines, are out of touch with many. It has led to frustration and resentment nationwide.

Our current crisis highlights the need for a whole-systems approach to public health. We need to reinvest in our public health practitioners on the ground, working in and with communities, such as public health nurses, who understand and work with their community to ensure that health and well-being are maintained. They can provide grass-roots insights, learning the needs of local people and business owners and, therefore, how to bring about change in behaviour. In this way, rules that come down from the top are informed by real experiences from those on the ground, from the bottom up—public health professionals, with their knowledge, skills and relationships, working with people and the population to promote well-being. This approach is often seen in those countries doing far better with Covid-19 than we are.

In times as fractured as these, we must extend trust and power to those most familiar with their situations and best equipped to bring about change and rely less on disengaged push-and-pull financial incentives to influence behavioural responses. What is being done to ensure that future restrictions are better informed by local wisdom as well as science?

Covid-19: Mental Health

Lord Bishop of London Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to focus on the Roma community, which, like many communities who are outside the mainstream, is hard hit by the results of Covid. Many such families live near me in Wiltshire. I reassure her that local authorities have continued to mobilise both digital and face-to-face mental health services in an entirely exemplary way, and I pay tribute to their hard work in this area.

[The Lord Bishop of London [V]]

My Lords, the Government are providing NHS staff with free access to online therapy and group counselling sessions, among other things, which is much needed and very welcome. Can the Minister say whether the same quality of care, recognition and access to mental health support is being given to parts of the social care sector such as nursing homes, care homes and home care workers, who have faced similar traumatic experiences to those of NHS staff?

[Lord Bethell]

The right reverend Prelate is entirely right to be focused on the support offered to both NHS and social care staff. There is considerable potential trauma in this area, and those who have been on the front line are under more pressure than one could possibly imagine. We have put in place schemes specifically targeted at both NHS and social care staff, and I reassure the right reverend Prelate that there is parity between the two sectors.

Hospitals: Patient Safety

Lord Bishop of London Excerpts

Thursday 21st May 2020 Lords Chamber

[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.

[The Lord Bishop of London]

The report recently published by the Institute for Public Policy Research, Care Fit for Carers, found that half our healthcare workers have said that their mental health has deteriorated since the Covid-19 crisis began. What supplementary provision is being put in place to deal with the mental health needs of NHS staff?

[Lord Bethell]

My Lords, I acknowledge the expertise of the right reverend Prelate the Bishop of London, who, in a former life, was the Chief Nursing Officer. She raises an important point; the mental health of staff is of enormous and grave concern to the NHS, to the department and to social care. We are investing money in providing additional mental care support and are working closely with the colleges to find out how best we can provide that important support.

NHS and Social Care: Staffing

Lord Bishop of London Excerpts

Wednesday 15th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness will know that appropriate staffing levels are already a core part of the CQC’s registration regime and that the law already requires hospitals to employ sufficient numbers of suitably qualified, skilled and experienced staff at all times. It is also mandatory for staff to provide monthly reports on the average number of care hours per patient per day, which is considered a better measure than staff numbers. However, we recognise the proposals that have come forward regarding staff safety and legislation; they are being considered at the moment.

The NHS surcharge is being considered to make sure that it is at an appropriate level to ensure that we continue to recruit at an appropriate level. At the moment, the rate of recruitment from non-EU countries has increased significantly by more than 150%.

[The Lord Bishop of London]

My Lords, I am sure the Minister knows that safety is about not just numbers but the continuing development and supervision of nurses and midwives. Can she comment on what the Government are doing to ensure that both nurses and midwives are funded properly for clinical supervision and professional development?

[Baroness Blackwood of North Oxford]

The right reverend Prelate is quite right. Ever since the tragic events in Mid Staffordshire, the NHS and our nation have been on a journey to make sure that the NHS is one of the safest healthcare systems in the world. This is based broadly on three policy strands: better regulation; greater transparency; and a culture of learning. HSIB is part of that. We hope to move forward in putting legislation in place to ensure that there can be learning without blame, and we hope to ensure that the appropriate training is in place. The people plan, which the noble Baroness, Lady Harding, is in the process of finalising, will ensure that specific proposals on how that will be delivered come forward imminently.

Queen’s Speech

Lord Bishop of London Excerpts

Thursday 9th January 2020 Lords Chamber

[The Lord Bishop of London]

My Lords, I am grateful for the opportunity to speak during this debate on Her Majesty’s gracious Speech. I note my interests, which I have declared, and I will limit my comments purely to health and social care.

I welcome Her Majesty’s Government’s focus on the NHS: health, social care and the workforce. I also welcome the additional funding. However, we must not be misled into thinking that this is a funding bonanza; it will serve only to stabilise NHS services. Between April and September, for all nine NHS cancer targets the lowest percentage of patients was treated on time since the standards were introduced. All 118 A&E units fell below the 95% threshold in November as the NHS posted its worst performance since targets were introduced more than a decade ago. We have a long way to go simply to stabilise the status quo. Are Her Majesty’s Government confident that the action outlined will make up the ground that is required?

The NHS is only as good as its workforce, and I am glad to see the focus on recruitment, training and immigration. However, issues related to immigration must be acted on as soon as possible. The new NHS visa is welcome, but it is a limited response to the need to recruit international staff to meet pressing workforce shortages. Health workers coming to the UK still need to pay the immigration surcharge, which is set to increase to £625 per person every year, on top of £464 for a visa. I wonder whether more needs to be done.

The Her Majesty’s Government’s commitment to bring forward draft legislation to support the implementation of the NHS long-term plan is to be commended. As already mentioned, this should be based on the targeted proposals NHS England has developed. This will make it easier for NHS organisations to collaborate with not only each other but their partners in local communities to improve services for the people they serve. However, as any nurse working in a hospital today knows, too often patients, many of them vulnerable, cannot be discharged, despite being medically fit, because they have nowhere safe to go. A strategy for social care and its workforce is also needed.

The additional £1 billion is welcome, but in a sense it may give only a short-term boost to social care services for adults and children. I wonder whether it is enough to meet the rising demand for care while maintaining quality and accessibility of services. I am reassured to see that there is a cross-party approach to seeking consensus on social care reform, but it will take tremendous commitment, tenacity and creativity if the Prime Minister is going to honour his promise to fix the social care system once and for all and to bring forward meaningful proposals for reform. I look forward to lending my support to this work.

Would Her Majesty’s Government consider bringing forward proposals for health and social care integration? As the British Medical Association states:

“Challenges for Britain’s health do not end in GP surgeries or hospitals and the Government needs a credible long-term plan on how to care for people at home and in communities.”


Given the scale of the task of merely maintaining the current situation and the combined demands on healthcare needs, such a plan is increasingly important. Plans should be there to see health in its wider community context.

The diocese of London is collaborating on a pioneering project with Health Education England to place mental health students in faith communities in the Grenfell area to enable mutual learning. We need more such initiatives. They free up capacity, relieve pressure on various parts of the NHS and also contribute to the health of the community. I wonder whether more progress could be made to commission, partner and champion with local charities and churches to provide services to support the vulnerable and at-risk groups and to look at health and well-being in broader terms.

Finally, I hope that the implications of the European Union withdrawal Bill on policy and legislative business do not distract from improving the NHS, health and social care. Improving health and social care is good not just for the individual but for the nation.

Health Service Safety Investigations Bill [HL]

Lord Bishop of London Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[The Lord Bishop of London]

My Lords, I am grateful for the opportunity to speak at this Second Reading. I declare my interests as set out in the register. I too am grateful for briefings from the Library, the Royal College of Nursing, the Royal College of Surgeons and the Parliamentary and Health Service Ombudsman.

Like most noble Lords, I welcome the Bill’s proposal to create an independent body which will investigate serious patient safety incidents. The NHS is to be congratulated on the way in which it has sought over the years to develop as a learning organisation. Florence Nightingale said:

“Let us never consider ourselves finished nurses ... We must be learning all of our lives”.


The Bill comes as part of the wider changes which we have seen undertaken over many years. I recognise those who work day by day in the NHS seeking to do their best and to provide safe, effective and compassionate care.

At the heart of my clinical practice when I was a nurse, a manager or even the Government’s Chief Nursing Officer, and latterly a non-executive director, was my desire to improve the quality of care that people receive. I believe that that is the intention of the majority of the people who work in our NHS, but things go wrong, and when they go wrong, it is often the result of a systems failure, at the root of which is culture. The 2013 Francis report into the Mid Staffordshire NHS Foundation Trust was mentioned by the Minister. It found that misaligned goals and behaviours in a plethora of agencies led to the tragic failure in patient safety. A system failed. It failed people and their families, and the report declared that regrettably it was a preventable tragedy.

The Francis report pointed to the need to develop a culture which was more open and transparent across the healthcare system. Professor Don Berwick, an international safety expert, called on us to embrace a culture of learning, particularly of learning from mistakes, but we have to recognise that when things go wrong, there is often a place deep within us where there is a tension between seeking to learn and wanting to apportion blame. So developing a culture in which we truly seek to learn must be a steel thread which runs through everything, including this legislation.

The stated intention of this legislation is to bring about a whole-system change to how the NHS investigates and learns from healthcare error. However, as the noble Lord, Lord Hunt, said, there is concern that the current drafting fails to do that and that there seems to be a disproportionate focus on the individual person or people involved in the incident. This could be overcome by any process of investigation, starting with reviewing the wide range of the system context, the factors and the conditions in which an incident occurred, well before any discussions with individuals involved take place.

Furthermore, to bring a whole-system change means having a collective understanding of dangerous activity across the board, with NHS and non-NHS patients. I join the noble Lords, Lord Hunt and Lord O’Shaughnessy, in saying that we ought to consider powers to investigate non-NHS patient issues in the independent sector. We should do this for the benefit of not just NHS patients but the non-NHS patients in our care.

I also welcome that the HSSIB must review the criteria, principles and processes of the investigation procedure within three years of their publication and subsequently within each five-year period, but I wonder whether the criteria, principles and processes ought to be co-produced with clinical and non-clinical health service leaders. I also wonder whether they should be reviewed in consultation with not just healthcare professionals but families and patients.

The opposite of a learning culture is a culture of fear. Again, I refer to Florence Nightingale, who said:

“How very little can be done under the spirit of fear”.


Therefore, I welcome the proposals for the development of safe spaces. The present draft of the Bill, I believe, has resolved some of the concerns of the nursing profession, particularly around the concept of safe spaces, but they will be safe only if the new organisation is able to build trust, as already mentioned. Trust is built only in part by legislation; it will need to be built by those recruited, as part of the HSSIB, to implement legislation. Therefore, I hope that the Minister can reassure the House that everything is being done to ensure that people of the right character are recruited to this new body.

I know that some have asked that the prohibition on the HSSIB disclosing information held within safe spaces to the Parliamentary and Health Service Ombudsman be removed. I would be very unhappy with that. Removing this prohibition will do little to create a culture where people working in the NHS feel safe to speak up when things go wrong. However, I think that further work is required to clarify how the HSSIB relates to and co-operates with the Parliamentary and Health Service Ombudsman and with other national bodies, such as the Care Quality Commission, which hold power and responsibility for reporting on patient safety incidents and the causal factors that impact patient care.

Finally, I know that the relationship between staffing levels and patient outcomes is contested, but it strikes me that an independent body such as the HSSIB may be best placed to begin to shed light on this. I hope that the Minister will ask the new body to consider this as part of its focus.

I support many of the intentions set out in the Bill and I look forward to working with other noble Lords as it progresses through the House. I thank officials and the Minister for bringing this Bill forward for our scrutiny.