Commonwealth Fund Report: NHS Ranking

Baroness Massey of Darwen Excerpts

Tuesday 14th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we raise taxes with huge hesitation. My noble friend is entirely right to hold the system to account for delivering value for money and to question productivity, but I reassure him that we have one of the most efficient health systems in the world. The money spent by the department on behalf of taxpayers is very wisely invested, and we are extremely grateful to those in social care and the NHS for the incredibly effective way in which they go about their business.

[Baroness Massey of Darwen (Lab)]

My Lords, my noble friend Lady Thornton has asked about the key features which enhance the delivery of healthcare; I am sorry that the Minister was so dismissive of the report. We know that countries differ in how they organise healthcare, and that vulnerable groups in all societies need special attention. What measures will the Government take to ensure that children, for example, especially those identified in the Leadsom report, are given the support that they and their families need to overcome their disadvantage and to thrive?

[Lord Bethell (Con)]

My Lords, I pay tribute to Andrea Leadsom for her report and all those who collaborated in drafting it. The noble Baroness is entirely right that those in the first 1,000 days of their lives are the people we should focus on—that is why we commissioned the report in the first place. We have embraced many of the recommendations and we will continue to see through their implementation.

Covid-19

Baroness Massey of Darwen Excerpts

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we acknowledge the risks. The noble Baroness is entirely right about flu; the relatively low levels of both flu and RSV in the last 18 months mean that many will not have the immune system that they normally would, and flu is a present danger. That is why we are working so hard on the flu vaccine programme and bundling Covid boosters and flu vaccines for those in the right prioritisation lists. I encourage absolutely everyone to make sure they get their flu vaccine when it comes around. Given the range of uncertainties, we are working with the NHS on its plans for this winter. We will ensure that the service has what it needs to meet those challenges.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, what progress is being made in negotiations with the USA for double-vaccinated citizens of both countries to travel between the two countries, with non-NHS vaccines being accepted and without quarantine being required?

[Lord Bethell (Con)]

My Lords, following the G7 we pulled together a joint task force with USA colleagues to address the precise point that the noble Baroness alludes to. That joint task force is working extremely hard to resolve the various practical, epidemiological and virological arrangements for the kind of green-list corridor that we would like to have between our two friendly countries. I am hopeful we will be able to make announcements on that shortly.

Women’s Health Outcomes

Baroness Massey of Darwen Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Massey of Darwen (Lab) [V]]

My Lords, I thank the noble Baroness, Lady Jenkin, for introducing this important debate. I know that many important issues relating to inequalities in health will be addressed. I am delighted that the noble Baroness spoke eloquently about young women’s health; I shall raise concerns about young women’s mental health in particular.

The Association for Young People’s Health, of which I am a patron, has welcomed the proposal to develop a women’s health strategy for England, stating that this must take account of the diversity of young women’s health issues, and that young women and girls must participate in the development and implementation of the strategy. Young women’s experiences of healthcare are affected by general factors, such as deprivation, ethnicity and geography, and by specific issues, such as sexual and certain kinds of reproductive health issues, mental health, and gender-based violence. In general, young women’s health outcomes are less favourable than those of young men.

As the Mental Health Foundation states,

“There is no health without mental health”.


Mental health affects physical health and the data on mental health and well-being, self-harm, suicide and eating disorders show that the link between body image and life satisfaction is twice as strong for girls as for boys. Young women’s mental health gives specific rise to concerns: 43% of young women aged between 16 and 29 experience some depressive symptoms, compared with only 26% of men of the same age. Girls between the ages of 11 and 17 have had more emotional difficulties than boys during periods of school closures. As we know, Covid has had an unequal impact on different groups and individuals. Young people generally have been less likely to become infected with the virus, but have faced enormous upheavals in education, employment and social interaction during what is often a difficult period in their lives.

Given the different mental health needs of boys and girls, the Royal College of Psychiatrists has suggested that, to deal with these needs, different interventions and methods for supporting different young people are required. It recommends that an extra £500 million of investment is needed to address the mental health needs of children and young people. These needs, including treatment, have intensified to an alarming degree during Covid-19.

Can the Minister say whether the strategy for women’s health will take account of the importance of maintaining and improving research and data collection on young women’s health? Will the views of women and girls be taken into account as the strategy develops? Both these issues are important in ensuring access to services and appropriate, high-quality preventive measures and treatment. I look forward to the Minister’s reply.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Baroness Massey of Darwen Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Baroness Massey of Darwen (Lab) [V]]

My Lords, I thank the noble Baroness, Lady Wyld, and the original mover of this Bill, Laura Trott, MP for Sevenoaks, for bringing this important issue to our attention. In particular, I thank the noble Baroness for setting out the issues so clearly today. I know that Nadine Dorries, Minister for Mental Health, Suicide Prevention and Patient Safety, has already indicated government support for the Bill, which is welcome. The noble Baroness laid out the main concerns set out in the Bill. I will simply emphasise the importance of this legislation and some of the possibilities and dilemmas involved.

The United Nations Convention on the Rights of the Child, along with other domestic legislation, sets out the need to protect children—under-18s—from all kinds of dangers. But children take risks, and hopefully learn from any mistakes. They must also be empowered by parents, schools and society to resist dangerous actions and say no to pressure—and there is a good deal of pressure on young people in relation to their appearance, particularly girls.

Social media exerts huge influence. As Laura Trott said at Second Reading in another place, girls see the attainment of physical desirability as unachievable without cosmetic surgery. This is increasingly available, no questions asked, through DIY efforts at home, despite Botox being a prescription-only medicine which should be administered by medical professionals who have taken account of the person’s age and believe them to be over 18.

It is clear from the evidence that procedures are inadequately regulated and may result in horrific injuries—physical, mental and emotional. Some 100,000 treatments of under-16s have been recorded, and the actual number is probably higher. Reparation of injury is expensive and difficult.

The Bill is very timely. Legislation is clearly needed, but so is a public health approach that informs and persuades people to change their behaviour. Young people may grow out of dangerous behaviour, but that may be too late and much regretted. Will any public health messages about botulinum toxin be directed at young people and parents? Are schools being warned to look out for symptoms? Is counselling available? How will perpetrators of illegal treatments be dealt with?

I see that there are signs that the Bill could result in increased funding for local authorities to carry out enforcement of the law and that the regulations consequential on the Bill could be made by statutory instruments. All that is welcome, but I hope that careful watch will be kept on the impact of the Bill and progress monitored, not only on the number of cases but on interventions to help children keep well away from these dangerous practices.

Covid-19 Vaccines Deployment

Baroness Massey of Darwen Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

I am enormously grateful to the right reverend Prelate for mentioning practice managers. Managers in the NHS are sometimes given a bit of a hard time and are too often overlooked. But, my goodness, if the vaccine deployment has been a success and been run smoothly—and if the constant reports I get of two-minute turnarounds, accurate invitations and appointments made briskly and accurately are correct—it is because of those managers. The NHS practice managers are running a tight ship and delivering huge value for the NHS. They are too often overlooked but, boy oh boy, have they delivered on this occasion.

The right reverend Prelate is entirely right to raise the issue of not only community champions but volunteering overall. It has been one of the toughest aspects of our response to Covid to make use of the hundreds of thousands of people who have stepped forward in various schemes to help with it. There are returning practitioners from healthcare; there are community champions, which he rightly described, along with the faith groups; there is also St John Ambulance and the vaccinating volunteers. Quite often, hygiene protocols and the necessity to put in place measures to avoid transmission of the disease have meant that it has been difficult to mobilise the army of volunteers. One thing that we should look back at, when we do our post-mortem, is how we as a country can deploy civic society more effectively.

Regarding the faith groups the right reverend Prelate specifically mentioned, I pay tribute to their role in the vaccine deployment. The sight of vaccines being given out in synagogues, mosques, gurdwaras and temples up and down the country surely has a huge part to play in their successful deployment among many difficult-to-reach groups.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, may I press the Minister once more on care homes, as mentioned by the noble Baronesses, Lady Brinton and Lady Thornton? The progress on vaccinating residents is indeed impressive. Are there now plans to also vaccinate as a priority, with encouragement if necessary, the staff who work in care homes and to offer the vaccine to relatives who wish to visit, so that family life of some sort can be re-established?

[Lord Bethell (Con)]

My Lords, we have done an enormous amount to prioritise care home staff, for the entirely pragmatic reason that it would make no sense at all for vulnerable care home residents to be infected by the staff who come and serve them. It is not always possible to put care home staff in exactly the same queue as those residents, sometimes because they are the ones delivering the vaccines. There is in fact a hugely sophisticated NHS route for care home staff to get their vaccine. However, I hear loud and clearly the concerns of noble Lords on this area. Let me please look at it more closely and I will correspond with the noble Baroness, Lady Massey, if I can provide her with any more details that would be helpful.

Osteoporosis: Treatment

Baroness Massey of Darwen Excerpts

Tuesday 9th February 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness alludes to a point slightly beyond the reach of the junior Minister in the department; we have a degree of federalisation, as she knows. However, I completely agree with and applaud the sentiment. We need more comprehensive coverage of fracture liaison services. We believe in the principle of 100% coverage, to which the noble Baroness, Lady Bull, alluded. I will look into whether we can do more in Birmingham to get a wider service.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, the Royal Osteoporosis Society points out the enormous cost to the NHS of osteoporosis-related fractures and the distress of those who suffer. This implies that prevention should be improved. Will the Minister say how diagnostic services will be enhanced in relation to, for example, bone density scans and GP practices?

[Lord Bethell (Con)]

My Lords, we do a lot of work on prevention. Vitamin D is made available and we have fracture liaison services to look at those who present themselves with a fracture to diagnose osteoporosis. A vast amount is already done. I am sure that more could be done, but this is an elusive and difficult to diagnose condition, which relies on those who fear that their bone density may be low presenting themselves to their GP for diagnosis.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Massey of Darwen Excerpts

Monday 8th February 2021 Grand Committee

[Baroness Massey of Darwen (Lab) [V]]

My Lords, the Minister described the purpose of the regulations very clearly, so I will not repeat that. I thank the House of Lords Library for its additional information and the secretariat of the Joint Committee on Human Rights for its comments. Thanks are also due, of course, to the statutory instruments committee.

I am also delighted at the success in developing and rolling out the vaccines. It has been efficiently and thoroughly launched, as the noble Lord, Lord Blencathra, said, thanks to many people, including those appointed to oversee it by the Prime Minister. I am aware that the regulations have had many stages and many consultations, and that the Government have used the affirmative procedure so that, according to the Explanatory Memorandum,

“public health measures can be taken in response to the severe and imminent threat to public health.”

Apart from the amendments under discussion, there are pressing concerns that should be aired and resolved by the Government to avoid a preposterous assertion of slowness and confusion. I will briefly refer to some of those issues.

Problems remain with the amendment to the power to use and disclose information in relation to the police. Can the Minister say whether the Department of Heath will reverse plans to allow police access to NHS Test and Trace data to reassure the public of medical confidentiality? I remember discussing the concerns about confidentiality when test and trace was brought in—a long time ago now. Those concerns now seem to be disregarded.

I still have concerns about levels of Covid among disabled people and about the situation in care homes. I do not see the legislative clarity needed for relatives, residents and those running care homes. I realise that this is a wider concern than these regulations, but it is urgent and worth discussing.

Last week, I asked the Minister a question about the situation in care homes. I should have given him that question in advance, and I apologise for not doing so, as he was not able to answer it adequately, and I hope that today he will be able to, because I gave him prior notice of what I shall raise. Briefly, I seek clarification on whether, for a relative to be able to visit a loved one in a care home, it will be necessary for all the residents and all staff of the care home to have been vaccinated. If so, is it to be once or twice, and what priority can they expect? Many families have been unable to have other than distant contact with relatives in care homes for a very long time.

This issue is relevant to the human right to family life, and the Joint Committee on Human Rights has expressed concern. Have discussions taken place in the Department of Health with this in mind? I ask the Minister to clarify that as residents in care homes and their relatives are confused and distressed and, of course, longing to get back together again. It is a public health issue; it is also a human rights issue. I hope the Minister will give me a good response.

Covid-19 Update

Baroness Massey of Darwen Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend is right. The story of convalescent plasma is heartbreaking. I had extremely high hopes that it would be a rather wonderful way in which those who had been hit hard by Covid could be agents in the recovery of those who were newly in hospital. Convalescent plasma has a very successful record throughout history of being a source of therapeutic help, but the science is the science and we have to be respectful of the clinical trials, however heartbreaking the news is. We have massively downgraded our expectations. There is hope that convalescent plasma could be used in primary care in a very early intervention, but there are problems with the delivery of that medicine and primary care is not in great shape at the moment to be plugging blood into people just because they show some symptoms of Covid. We are continuing our collection until the last clinical trials in primary care are finalised, but I am afraid to say that our expectations in that area are much less than they were a few weeks ago.

[Baroness Massey of Darwen (Lab) [V]]

My Lords, the Joint Committee on Human Rights has expressed concern about the lack of clarity in the rules for visiting care homes and the impact on the right to family life. Who must be vaccinated in a care home before relatives can visit? Is it all residents and all staff? If so, does that not seem unrealistic?

[Lord Bethell (Con)]

My Lords, I have huge sympathy with those looking at the human rights of those who cannot visit care homes. We have taken a huge hit to our civil liberties in our fight against this pandemic; no one can be under any illusion about that. However, I must say that the noble Baroness is wrong to hope that the vaccination gives any short-term hope that this will be changed. At the moment we are still living in a world where not enough people are vaccinated in order to stop the transmission through society, and where the rules on the transmissibility of the disease by those who are vaccinated have not been fully clarified. Therefore, even those who have been vaccinated should be staying at home.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Massey of Darwen Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Massey of Darwen (Lab) [V]]

My Lords, I will focus on school education in lockdown. Education has had a poor deal during this crisis. Education is vital for children and young people to thrive and prosper, yet those involved have suffered U-turns—sometimes almost instant—a lack of equipment, and mixed messages about exams and assessments. This has left them confused and distressed.

I ask the Government to put in place a long-term strategy for education, with transparent options if things need to change. They should work with local authorities, unions, parents and children to develop and share a strategy now.

This strategy should include the following. All those working in schools should be vaccinated and treated as a priority. They should have reliable supplies of protective equipment and a safe environment, as they are very special. Testing for all in schools must be established. A broad and balanced curriculum must be maintained and guaranteed as far as possible. Children need not only academic education but structure, routine, socialising, activities such as art, sport and exercise, and the chance to discuss how best to cope in challenging times. Exam assessment systems need to be firm and clear. Families must be guaranteed computer equipment for each child when working at home. Services such as mental health services must be geared up to cope with present and future demand. Where is such a strategy?

Parents also face a crisis. The Government need to listen to parents, who may have the challenge of coping with work, running a household and supporting children who are not at school. Those who cannot work due to childcare commitments must be guaranteed flexible job retention. Confusion and anxiety about the basic needs of children and parents must be addressed urgently by the Government; otherwise, we risk long-term problems in mental health and inequalities, with services that cannot cope.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

The noble Lord, Lord Robathan, has withdrawn, so I call the noble Lord, Lord McNally.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020

Baroness Massey of Darwen Excerpts

Thursday 22nd October 2020 Lords Chamber

[Baroness Massey of Darwen (Lab) [V]]

My Lords, individuals will be required to isolate for specified periods in specified places. This implies that such periods will vary. On what does that depend? Failure to isolate will incur a fine ranging from £1,000 to £10,000. That is quite a range. What criteria will determine the amount of a fine? It is not clear, even among professionals, such as the police.

The virus is now evident among younger people, such as students. They may be asymptomatic but infectious. How will any proposed system of isolation work for them? Handing out massive fines to students having parties may be a deterrent, but would it not be better to persuade and involve young people in behaving differently than to deal out punishment? We have powerful examples of working with young people to change health behaviour, perhaps the most striking being the highly successful teenage pregnancy strategy, introduced in 2000. Why do the Government not build on good practice?

I agree with the noble Lord, Lord Moynihan. Mental health charities and services warn of serious and expensive consequences if mental health in isolation is not given more attention. Will the Minister say whether mental health services, which were underequipped before Covid, will be expanded, with more staffing and resources, including helplines, which are already dealing with huge increases in demand?

What about older people in isolation? They may be suffering loneliness and stress. I recognise and admire the efforts made by local communities through phone calls and practical help. Will local authorities have the resources to check that elderly people do not fall through the net? Most importantly, if the Government continue to hand out confusing information without strategies to involve individuals and communities—strategies best funded to be carried out at local level—the objective of defeating Covid will be more difficult.