Covid-19 Update

Baroness Bull Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful to my noble friend for looking forward. She is entirely right: the experience of this vaccination programme cannot stop when we have finished the initial rollout and we have to look to the future. As I said in my opening remarks, I am extremely hopeful that this can be an inflection point where we double-up on our commitment to rid the country of as much contagious disease as we possibly can. That will include booster shots, to which my noble friend alluded. It will also include a greater commitment to flu shots, and we very much hope that we can increase dramatically the take-up of flu shots at all ages, to stop not only illness itself but transmission.

[Baroness Bull (CB)]

Following on from the noble Baroness’s question and the importance of overall and ongoing vaccination coverage, can the Minister say how many people living in the UK are not registered with an NHS GP and therefore cannot be contacted for vaccination? We know that socially excluded groups, such as rough sleepers, Gypsy, Roma and Traveller communities and vulnerable migrants, are less likely to be registered, and there will be people registered only with a private GP. What assessment have the Government made of the scale of this challenge—how many people are affected—and what efforts are under way to find them and offer them vaccination?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes her point extremely well. It is an area that we have looked at extremely carefully. The proportion of people who are not registered is remarkably small, but the phenomenon does exist. For this particular vaccination round, we have put in procedures so that those who turn up at a GP or vaccination centre who are not registered can be registered on the spot, and I thank colleagues at NHS D, who have put the necessary arrangements into the NIMS programme to make that possible. There are also others who do not know their NHS number—well, an enormous number of them now do know it. That is one of the blessings of this vaccination programme. We are also working extremely hard to reach out to the people the noble Baroness alludes to—the homeless, the Roma community and those who are recent arrivals in the UK—to make sure that the vaccination is offered to absolutely everyone in the UK, whatever their immigration status, whatever their living arrangements and whatever their medical history.

Osteoporosis: Treatment

Baroness Bull Excerpts

Tuesday 9th February 2021 Lords Chamber

[Baroness Bull (CB)]

My Lords, the Minister has rightly pointed to fracture liaison services and the vital role they play, but only half of the population in England currently has access to an FLS, compared to 100% in Scotland and Northern Ireland. Is the Minister aware of the recent economic analysis that suggested that upscaling provision to cover all over-50s in the UK could prevent an estimated 5,686 fragility fractures every year, with net cost savings of £1.2 million? Will the Government commit to 100% coverage for fracture liaison services and if not, why not?

[Lord Bethell (Con)]

The noble Baroness is entirely right. There is significant regional variation in the rates of fragility fractures within the older population with the lowest incidence observed in London, the east of England and the south-east and the highest in the south-west of England, Northern Ireland and Scotland. To reduce variation in osteoporosis services in 2017, NHS England’s RightCare programme published cases studies and pathways for the management of osteoporosis and fragility fractures. The noble Baroness is right that we should have high aspirations in this matter. I am not sure that I can commit to 100%, but I will return to the department and see if we could be doing more.

Covid-19 Update

Baroness Bull Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

I am afraid to say that the noble Lord’s point makes no sense to me whatever. We are not going to go around the country asking people whether they refused to take the vaccine. We have a dialogue with the whole country, and we wait patiently for people to step forward. I cannot give statistics on people who have refused because it would make no sense at all to ask people whether they are in that category.

[Baroness Bull (CB)]

My Lords, can the Minister tell the House what assessment the Government have made of the risks presented by aerosols, which, unlike droplets, are small enough to remain suspended in the air for hours and which expose individuals at distances beyond 2 metres? New evidence is emerging all the time, the latest just this week from the University of Bristol. Does he agree that we need a clearer position and stronger messaging on the risk of aerosol transmission indoors and the importance of ventilation, particularly as the vaccination programme rolls out, which will inevitably lead to calls to release restrictions and to reduce the 2-metre rule? We may need to add a fourth word, “ventilate”, to the mantra “hands, face, space”.

[Lord Bethell (Con)]

The noble Baroness is entirely right that understanding of the role of aerosols is growing. Frankly, I find it quite terrifying. She is right that we need to look particularly at the way our office spaces are ventilated. The statistics I have seen on the potential cost of rebooting the ventilation of the UK’s workspaces in order to make them Covid-friendly are that it would cost tens of billions of pounds. Our focus is therefore on vaccine deployment, but work is going on to reimagine and envisage how workspaces could be made safer, not just for this pandemic but for the future. I can imagine a world where ventilation is given greater hygienic priority in future.

Health: Eating Disorders

Baroness Bull Excerpts

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we recognise the contribution of charities to this mental health challenge, and £10.2 million of additional funding has been allocated to mental health charities. We also recognise the importance of keeping schools open: no Government could have tried harder to keep schools open than this one. However, the allocation of the vaccine is based on morbidity—we have to protect those whose lives are most threatened and that is why the JCVI has put the prioritisation list in the form it has.

[Baroness Bull (CB)]

My Lords, a recent literature review found that many GPs feel unequipped to identify and manage eating disorders, meaning that patients who could benefit from primary care are often passed on to specialist services and face long waiting lists. Given the importance of early intervention, can the Minister say what is being done to train and support primary care professionals in diagnosing and treating people with eating disorders, and to improve shared care across the primary and secondary care interface?

[Lord Bethell (Con)]

My Lords, NHS England is working with Health Education England to procure training courses that will increase the capacity of the existing workforce, to allow them to understand these challenging issues better and allocate people to the right course of treatment. It is a problem that we recognise, and resources in training are being put in place to address it.

Care Quality Commission Report

Baroness Bull Excerpts

Tuesday 15th December 2020 Lords Chamber

Asked by

[Baroness Bull]

To ask Her Majesty’s Government what steps they are taking in response to the report by the Care Quality Commission Out of Sight—Who Cares?, published on 22 October.

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

My Lords, the Government are clear that in-patient care should be high quality, therapeutic and for the shortest time possible, and that any kind of restraint should be used only as a last resort and in line with strict protocols. That is why the evidence in the CQC report of poor care and excessive use of restrictive practices is so unacceptable. Our response to the report from the Joint Committee on Human Rights in October outlines many of the measures that we are already taking. We will respond formally to the specific recommendations in the CQC’s report at the earliest opportunity.

[Baroness Bull (CB)]

My Lords, this report details an horrific culture of restraint, seclusion and segregation in the care of people with learning disabilities and autism. NHS data seems to show around 3,400 in in-patient care, some in isolation for 13 years, with no meaningful activity, outdoor space, natural light, furniture or belongings—their food served through hatches and their only human contact via intercoms and screens. Does the Minister agree that, while that number is unacceptably high, it is low enough that the development of pathways individualised to support community living should be possible? The costs might be high, but the cost of hospitalisation is higher. When will government deliver those long-promised solutions and end these abuses of human rights and human dignity?

[Lord Bethell (Con) [V]]

I am not sure that I completely recognise the numbers given by the noble Baroness. In August, there were 365 instances of seclusion and 10 instances of segregation of those with autism and learning difficulties, but I would be glad to correspond with the noble Baroness to clarify those things.

I reassure the noble Baroness that the progress that we are making to create the pathways to which she rightly alludes is very much the focus of the department. Earlier this morning, the Minister for Social Care chaired the first Building the Right Support delivery board, in which she brought together representatives of the NHS, LGA, ADS, DfE and MHCLG to make progress on exactly what the noble Baroness is talking about. I reassure her that funds of £74 million have been put in place to help those with autism and learning difficulties who are being discharged into the community.

Covid-19: Dental Services

Baroness Bull Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, one area where the Government have made a big commitment to dentists is in PPE. As of Wednesday 4 November, over 5,000 dental and orthodontic providers in England had registered with the PPE portal and over 36 million items of PPE had been delivered. In terms of the commitment to workers, I will have to come back to the noble Baroness.

[Baroness Bull (CB)]

My Lords, I declare my interests as set out in the register. Reduced clinical capacity not only impacts on patients but massively disrupts the education of dental students, who typically treat over 400,000 volunteer patients each year as part of training. Since March, many schools have been unable to provide any patient-facing education at all. Will the Government respond to requests from dental schools and hospitals to invest in high-quality simulation facilities, to mitigate the impact of this reduced clinical experience and ensure that students can graduate and provide the workforce of the future?

Health Protection (Coronavirus, Restrictions on Gatherings) (North of England) Regulations 2020

Baroness Bull Excerpts

Friday 25th September 2020 Lords Chamber

[Baroness Bull (CB)]

My Lords, the recent rash of debates on health protection regulations is indicative of the speed at which this situation is evolving, and it underlines the importance of effective communication strategies to help people understand the changes and distinguish rumour from truth. Technology and social media are clearly valuable in this effort, but this week the World Health Organization warned that they are also enabling an infodemic that undermines the public health response and jeopardises measures to control the pandemic.

Fake news spreads fast and it has real and life-threatening consequences. By promoting fake products, spreading misleading information and encouraging suspicion of official guidelines, it can increase anti-masks, anti-lockdown and anti-vaccination demonstrations and campaigns that can seriously compromise the attempts to fight Covid-19. Research from King’s College London, in which I declare my interest, has found a clear link between beliefs in conspiracy theories and mistrust of government, authority and science, and the likelihood of rejecting a Covid vaccination when it arrives.

So while clear messaging based on accurate, evidence-based information is vital, it is not in itself enough. We also need effective strategies to combat the spread of misinformation and disinformation. Can the Minister say what the Government’s counter-disinformation unit is doing to tackle this infodemic and does he agree with the Democracy and Digital Technologies Select Committee of this House that the delay to the online harms legislation means that the UK currently lacks the appropriate laws to tackle the spread online of misleading and harmful content related to Covid-19?

As infection rates rise and regulations change, uncertainty and anxiety increase, so there is an urgent need for the Government, media platforms and civil society to work together to combat misinformation and disinformation and mitigate the risks they pose to the efficacy of regulations such as those we are debating today.

Anti-obesity Strategies

Baroness Bull Excerpts

Monday 14th September 2020 Lords Chamber

Asked by

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the impact of anti-obesity strategies on people suffering, or recovering, from eating disorders.

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

My Lords, eating disorders are serious life-threatening conditions, and it is important that people have access to the right mental health support in the right place and at the right time. We carefully consider all views on our measures to reduce obesity. This includes feedback from a wide range of experts in response to our public consultations on specific policy proposals.

[Baroness Bull (CB)]

My Lords, as the Minister says, eating disorders are indeed serious mental health issues, but their relationship with obesity is complex. Many obese people also live with eating disorders, which means treatment is not always as simple as rebalancing calories in and out. Does the Minister accept the expert advice that elements of the new strategy, like food labelling and calorie counting, are dangerous triggers for eating disorders, and that slogans emphasising personal responsibility stigmatise people whose obesity has more complex roots than a failure to get a grip? Will he agree to meet with me and eating disorder specialists to discuss how this important strategy can be more effective for its intended audience and avoid collateral damage for those people for whom “Eat less, exercise more” is a dangerous message?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Baroness that serious eating disorders are complex, and we need to resource the medical attention required by people with serious mental health issues. However, I do not completely align with her view that all obesity is not a matter of personal responsibility, nor that the education of people about the content of their food through labelling cannot be an important part of our battle against obesity. Covid has spelt it out clearly to all of us. Some 67% of the country is overweight in some way or another. But this is a policy that we are determined to get right, and I would very much welcome the opportunity to meet with the noble Baroness and her team.

Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Baroness Bull Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Bull (CB)]

My Lords, the statutory guidance to these regulations is clear that, prior to issuing a direction, local authorities must have due regard to the Equality Act 2010 and should consider carrying out an equalities impact assessment to determine whether the measure might disproportionately affect people with protected characteristics. However, the guidance makes no provision for those with impaired mental and decision-making capacity, which means it is unclear whether and how these regulations apply to people who cannot fully understand them, or what the consequences are of them not following them.

It is therefore not clear whether someone with reduced mental capacity would be subject to criminal sanction for unwittingly breaking local lockdown rules. Nor is it clear what is supposed to happen in a case where this new power is used to remove someone with impaired capacity from a restricted area or a mass gathering. Can the power also be used to return the person to their home, or does it seize as soon as they are outside?

Expanding the statutory guidance would help local authorities to meet their obligations to those people with reduced mental capacity, while clear, unambiguous guidance would help those people and the people who care for them to comply more easily with the regulations. It would also reduce the potential for unintended contravention, avoiding the messy question of whether criminal prosecution could follow. Can the Minister commit to reviewing the statutory guidance to include the need for local authorities to take into consideration reduced mental capacity, in accordance with the Mental Capacity Act, when exercising their power to impose restrictions?

Folic Acid

Baroness Bull Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Bull (CB)]

My Lords, the 2006 SACN report Folate and Disease Prevention found that there was insufficient human data to say conclusively whether increased levels of blood folate from fortification might impact on the efficacy of anti-folate medication, which acts in chemotherapy by blocking the action of folic acid. The 2017 update is silent on this issue. Can the Minister clarify whether the absence of a reference to this issue is because there is still insufficient data, or is it because research has ruled out any adverse impact of mandatory fortification on those patients taking anti-folate medication?

[Lord Bethell (Con)]

My Lords, I am not aware of any conclusive scientific evidence that contradicts the benefits of folic acid. As I said, the demographic data would seem to suggest that experiences in other countries have been benign. Longitudinal studies take a very long time to emerge and, therefore, we are not expecting a massive change in that data. However, back at the department, I will ask if any science has emerged and I will write to the noble Baroness if I can put my hands on anything.