Residential Social Care: Staff

Debate between Baroness Bull and Lord Bethell

Monday 6th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the average turnover rate in social care is high, as noted by many noble Lords, as it is in some other sectors, including retail and hospitality. However, turnover rates are 8.1% lower in the past year among social care workers, down from 37.2% to 29.1%, which reassures us that many have in fact found it a fulfilling career.

[Baroness Bull (CB)]

My Lords, can the Minister say what improvements have been made to staff training in light of the Out Of Sight—Who Cares? report from the Care Quality Commission, which highlighted the excessive use of restraint, seclusion and segregation in the care of people with learning disabilities and autism in residential settings?

[Lord Bethell (Con)]

We are enormously grateful for that report, which has made a huge impact. I am not sure of the specific impact of the measures the noble Baroness describes, but I would be glad to write to her.

Covid-19 Update

Debate between Baroness Bull and Lord Bethell

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, on the three specific locations the noble Baroness asked about, I understand that those practices will remain in place, but I am happy to check that and write to her. As for going back to where we were before, I think some things will change for ever.

[Baroness Bull (CB)]

My Lords, 120 scientists have written to the Lancet and today come together in an emergency summit to ask the Government to rethink their plans. The editor in chief warned against

“a plan driven more by libertarian ideology than prudent interpretation of the data”

and called for continued mask-wearing, distancing and increased vaccine coverage. A YouGov survey found that two-thirds of people want to continue with masks and an ALVA survey found that three-quarters of people did. So why have the Government decided to end this simple yet effective measure? It costs the economy nothing, but it would be life-changing for the clinically extremely vulnerable, who will be forced back into lockdown by this shift from a public health approach to so-called personal responsibility.

Covid-19 Update

Debate between Baroness Bull and Lord Bethell

Tuesday 18th May 2021 Lords Chamber

[Baroness Bull (CB)]

My Lords, I declare my interests as set out in the register. With the move to stage 3 of the road map, university students can now return to campus. Most of them are too young to have received vaccines so students around the country will form a significant cohort of young people undertaking regular and frequent testing as a matter of course. What consideration has been given to the benefits of sustaining PCR testing and sequencing at scale in universities as a way of rapidly identifying and understanding new variants? Will the Government consider providing funding to support that in future?

[Lord Bethell (Con)]

My Lords, I pay tribute to the vice-chancellors and to the universities and colleges of Britain for the way in which they have embraced campus testing. It has been a salutary lesson in what can be done, and it has helped to keep infection rates down on campuses where there has been a small number of returning students to date. That is done mainly through LFD testing. Positive tests then have a complementary PCR test, and the PCR test is automatically sequenced if it is positive. The combination of LFD, PCR and sequencing is the right one for keeping infection rates down, but we tweak the formula as and when best advice comes in.

Eating Disorder Services: Referrals

Debate between Baroness Bull and Lord Bethell

Monday 17th May 2021 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the change in referrals to eating disorder services since April 2020.

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

My Lords, eating disorders are serious, life-threatening conditions. We recognise eating disorder services are facing increased demand from children and young people, with 719 urgent cases starting treatment in the fourth quarter of 2020-21. That is why we made £10.2 million of additional funding available to mental health charities, including those that address anorexia, at the beginning of the pandemic, we convened a cross-government ministerial group to publish a mental health recovery plan and we are holding a ministerial round table on eating disorders.

[Baroness Bull (CB)]

My Lords, Q4 data on waiting times released last week showed, as the Minister said, 719 patients starting treatment for urgent cases of eating disorders, but this compares to 353 at this time last year. At this point in 2020, 18 people awaited urgent treatment, and 543 awaited routine treatment; those numbers are now 130 and 1,404. While much has been said about the pandemic’s role in driving this spike, most studies into young people’s mental health over the last year were not designed to detect eating disorders so, beyond anecdote, the reason for this increase, and therefore the best way to address it, is not clear. What will Government do to better understand this sharp increase? Does it represent broader and lasting behavioural changes among young people? Will the Government closely monitor the impact of their obesity strategy on referral rates, given that some of the planned measures—calorie labelling on menus, for instance—are shown to exacerbate existing eating disorders and increase the risk of their development in the general public?

[Lord Bethell (Con)]

My Lords, undoubtedly, the increase in referrals is something of concern. It is something we are monitoring closely, with the round table and the ministerial group dedicated to looking at this. That shows the seriousness with which we regard it. The reduction in the impact of community services, which is the best way of addressing these kinds of issues, has undoubtedly had an effect on urgent needs. During this period, there has also been a large increase in the number of young people who have started treatment, which is encouraging. If the noble Baroness has evidence that measures such as nutrition information on packaging has an effect on anorexia, I would welcome correspondence from her.

Office for Health Promotion

Debate between Baroness Bull and Lord Bethell

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, consultations are there to have an honest conversation. It would be wrong for me to try to pre-empt the outcome of that consultation from the Dispatch Box.

[Baroness Bull (CB)]

My Lords, the Government have pointed to Singapore’s health promotion board as a model, citing its digital public health schemes such as the national steps challenge or the “Eat, Drink, Shop Healthy” challenge. Is the Minister aware of the risks that gamification and incentivisation of what for many of us are healthy behaviours present to people living with eating disorders? With its responsibility for both obesity and mental health, will the office ensure that eating disorder experts are always involved in planning obesity interventions so that the complex relationship between the two is taken into account?

[Lord Bethell (Con)]

I completely take the point of the noble Baroness. We are extremely conscious of the challenge presented by social media in particular to identity and sense of body image. I know that there is much liaison between Public Health England and obesity and anorexia charities about its marketing to ensure that it hits the right note. We are investing in digital technology to try to get people moving and change their lifestyles; I pay tribute to the team behind Couch to 5K, who have used apps and digital engagement to encourage millions of people to take important steps towards a more active lifestyle.

Covid-19 Update

Debate between Baroness Bull and Lord Bethell

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

Debate between Baroness Bull and Lord Bethell

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

Debate between Baroness Bull and Lord Bethell

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

Debate between Baroness Bull and Lord Bethell

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

Debate between Baroness Bull and Lord Bethell

Tuesday 15th December 2020 Lords Chamber

[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

Debate between Baroness Bull and Lord Bethell

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?

Anti-obesity Strategies

Debate between Baroness Bull and Lord Bethell

Monday 14th September 2020 Lords Chamber

[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.

Folic Acid

Debate between Baroness Bull and Lord Bethell

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.

Covid-19: Response

Debate between Baroness Bull and Lord Bethell

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, it is put to me week in, week out that our relationship with directors of public health is in some way troubled. I reassure noble Lords that, every single day of the week, we are in contact with dozens of directors of public health in amicable, constructive dialogues that lead to concrete action, local interventions and sharing of data. These conversations happen in a cordial and friendly fashion. The message may have got through to some noble Lords that there is some huge acrimony and difficulty between us, but that is not the perspective that I have. The data has got through. It is a hell of a thing to have put up a huge track and trace system in a few months. That we can get such detailed data to a large number of people within the envelope of reasonable data security legislation is nothing short of a miracle. I am extremely proud and pay tribute to those involved.

[Baroness Bull (CB) [V]]

My Lords, I want to follow the noble Lord, Lord Reid of Cardowan, in pointing to ONS data, this time data showing that 60% of all deaths from Covid-19 have been among those living with disabilities. A recent report from Oxford University and the Bonavero Institute of Human Rights found a failure of government to embed social and human rights models of disability in its response to the pandemic, and a failure to support people with disabilities to make the adjustments required to comply with fast-changing regulations and to continue to live flourishing lives. Will the Government commit to an immediate review of the impact on disabled people of legislation passed during the coronavirus crisis, and will they put in place a disability-inclusive Covid-19 response and recovery action plan which involves people with lived experience of disabilities in decisions on economic and social recovery as well as ongoing healthcare guidance?

[Lord Bethell [V]]

My Lords, it is a horrible truth that this disease hits hardest those with vulnerabilities. We have put in place a massive national programme to seek to protect the most vulnerable, and those with disabilities have been very much the focus of our attention. I cannot make the commitments that I know the noble Baroness wants me to make, but I reassure her that those with disabilities are the focus of what we are trying to do.

Food: Fruit and Vegetables

Debate between Baroness Bull and Lord Bethell

Monday 6th July 2020 Lords Chamber

[Lord Bethell]

My noble friend touches on an interesting area. I cannot answer it precisely. I am not sure that we have taken any assessment of the effect of eating vegetables and fruit during the lockdown, but I will find out from the department and write to the noble Lord.

[Baroness Bull (CB) [V]]

Can the Minister clarify where responsibility lies for overseeing the nutritional quality of food delivered to children eligible for free school meals? During Covid, reports have circulated on social media of packages containing crisps, chocolate biscuits and a block of fat marked “for cooking only”. In response to a letter by leading food policy experts, sent to both Defra and Public Health England, each body seemed to indicate that the other should be held responsible. Does the Minister agree that, without clarity on this, the focus on good nutrition is at risk and accountability too easily sidestepped?

[Lord Bethell]

The noble Baroness is right to cast a spotlight on an apparent area of policy confusion. Labelling is normally associated with Defra, and the provision of school meals with the Department for Education. If there is ambiguity about that, I would be happy to chase it down for the noble Baroness.

Covid-19: Response

Debate between Baroness Bull and Lord Bethell

Tuesday 19th May 2020 Lords Chamber

[Lord Bethell]

I am afraid I did not hear the full question from the noble Baroness, but if I understood her correctly, she referred to track and trace. I reassure her that we are putting a huge amount of resources into that surveillance. It is true that surveillance does not currently exist. We do not have the facilities that some Asian countries, such as Taiwan and South Korea, had following SARS, about which we now know so much. We are putting the correct resources in place, and we hope very much to have a detailed local and demographic understanding of where and how the disease is progressing. That information is essential to beating it.

[Baroness Bull (CB)]

My Lords, many people in learning disability care services have very complex care needs that make them vulnerable to Covid-19. Indeed, recent numbers from the CQC showed that the provisional number of deaths reported across all settings where autistic people and/or people with learning disabilities may live was 175% greater than expected over the month from 10 April. When will the welcome extension of testing to all care settings announced today roll out? Can he confirm that regular testing will be available, given the potential of the virus to be spread between care homes by so-called bank staff filling temporary vacancies?

[Lord Bethell]

The noble Baroness is entirely right that the deaths of those with learning difficulties have been one of the most disturbing and sad aspects of this disease. We are focused very much on ensuring that we protect those with learning difficulties, such as those with autism, in whatever way we can. With regard to recurrent testing, the tests that we have are not a limitless resource and we have to prioritise them. Although we have massively increased the number of tests that we have, it is not possible to test millions of people on a very regular basis with hundreds of thousands of tests. However, we are using them intelligently and prioritising areas where there are infection control problems. We believe that that is the most effective way of using our resources.

Covid-19: Vulnerable Populations

Debate between Baroness Bull and Lord Bethell

Tuesday 12th May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, social distancing and shielding measures are in place to protect vulnerable and clinically extremely vulnerable populations. Those identified as clinically extremely vulnerable are advised to stay at home with no face-to-face contact until at least the end of June. Our approach is under continuous review. The Government’s position on shielding and social distancing reflects the latest SAGE and clinical advice from the Chief Medical Officer.

[Baroness Bull (CB)]

My Lords, every person with a learning disability has the right to be supported to live in their community, but Covid-19 is putting already-delayed in-patient transfers at risk. In March some 1,900 adults and 200 children were still locked away in in-patient units, the majority sectioned under the Mental Health Act and staying for five years in facilities intended to be short-term. Can the Minister share his department’s updated assessment of whether the Mental Health Act easements provided for in the Coronavirus Act will be required, now that the peak in infections has been passed and a plan for lifting restrictions is taking shape? Does he share concerns that these easements, if enacted, would risk the delivery of the care needed to support community living and the achievement of the goals set out in Transforming Care?

[Lord Bethell]

The noble Baroness, Lady Bull, asks a searching question. On whether the Mental Health Act easements of which she speaks have already been enacted, I will have to find out exactly what those arrangements are and write to her. However, I assure the House that the care of the most vulnerable is absolutely the Government’s number one, top priority. It is true that some of those caring and providing important pastoral care for the most vulnerable have been worst hit by Covid—the examples she gives are really good ones—but we are absolutely putting the care of the most vulnerable at the top of our priorities.