HIV: Ending Transmissions
Baroness Tyler of Enfield Excerpts(3 years, 11 months ago)
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Lord Bethell (Con)
The noble Lord speaks with great humanity and compassion, but I perhaps need to give a bit of perspective. I am not sure if our UK aid budget is enough to solve all the problems that he describes. The UK remains extremely committed to international aid. In the Covid epidemic and recession, we have reduced our commitment in a small way and have promised to revisit it at a later date. That commitment is very clear, and we will do that in due time.
Baroness Tyler of Enfield (LD) [V]
My Lords, cuts to local authority public health budgets of some £700 million in real terms over the last five years have led to sexual health budgets being cut by 25% in this period. The King’s Fund has estimated that restoring spending to the former level
“would require additional investment of £1 billion.”
Given the Government’s commitment to zero new HIV transmissions by 2030, will the Minister tell the House what plans they have to increase investment in HIV preventive services delivered by local authorities? Can the Minister also confirm that there will still be national funding for a prevention programme?
Lord Bethell (Con)
The Covid epidemic has disrupted things, but I reassure the noble Baroness that in the spending review 2020 we have confirmed that the public health grant will be maintained into next year, enabling local authorities to meet pressures and continue to deliver important public services. DHSC will confirm final allocations in the coming week, including the position on HIV PrEP. I reassure the noble Baroness that PrEP has proved to be an enormously valuable contribution to our fight against transmissions, and we continue to back it.
Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020
Baroness Tyler of Enfield Excerpts(3 years, 12 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, removal of the mental health provisions from the Coronavirus Act, which represented a significant reduction in protection and safeguards for people subject to the Mental Health Act is, as the noble Lord, Lord Blunkett, said, very welcome. Serious concerns have been raised about whether it would ever be human rights-compliant to enact the provisions. Even before the Covid-19 crisis hit, mental health services were severely stretched, with waiting times and barriers to access which would be considered unacceptable in any other area of medicine.
Turning to the scale of need, psychiatrists have reported an increase in patients needing urgent and emergency care during the crisis, and the latest NHS Digital figures show the highest recorded figures for mental health contact. According to the Centre for Mental Health, there are approximately 10 million extra people with mental health needs due to the pandemic. A survey conducted in late spring by the charity Rethink showed that almost 80% of people with pre-existing mental illnesses reported that their mental health had got worse or much worse as a result of the pandemic, and the ONS found that almost one in five adults in Britain experienced depressive symptoms in June 2020—roughly twice the number before the pandemic. Against this backdrop, it is crucial to the nation's Covid-19 recovery that existing mental health funding commitments in the NHS long-term plan are delivered in full and that services are resourced to support those who had new or worsening mental health difficulties because of the crisis. It is not either/or, it is both/and.
It is of course welcome that eventually an extra £500 million was promised in the mental health winter plan, published on Monday, to help with discharge to community care, workforce issues and addressing waiting times. This is a good start, but unlikely to be sufficient and, crucially, does not come onstream until the next operational year, leaving a gaping hole in the tough winter period ahead. What commitments can the Minister give that some of this new money will be spent on preventive work and early intervention to stop mental health issues escalating to crisis point and putting additional pressures on expensive police, A&E and in-patient services?
In the long term, it is not just a case of mental health services surviving the pandemic; they will need drastically to expand and improve to deal with the long-term impact of social isolation, mass unemployment and pandemic-induced anxiety.
The powers we are debating weakened an Act that was already in need of major reform. The independent review of the Mental Health Act put forward proposals to improve the system and increase patient rights. Can the Minister update the Committee on when the Government will provide a full response to the independent review and publish their proposals to take forward reform of the Mental Health Act, with a clear implementation timescale? The two-year anniversary of the publication of the Mental Health Act review will be 6 December 2020. I strongly hope that the Government’s response will not be delayed beyond that point.
Face-to-Face Medical Appointments
Baroness Tyler of Enfield Excerpts(4 years ago)
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Lord Bethell (Con)
My noble friend makes a very good point. Diagnosis is phenomenally difficult and, quite often, patients who present with seemingly one condition have something altogether different. It may be that a face-to-face appointment will be the moment when that difference is spotted and caught. She is entirely right to say that we cannot omit that format for the right circumstances, but a great many patients see their GPs very regularly. Their journeys may be onerous, uncomfortable and stressful, and telemedicine might offer them an alternative opportunity. There are others for whom speed is of the essence, and having telemedicine, particularly when it is supported by apps that provide essential information about their condition, can be an important and urgent alternative.
Baroness Tyler of Enfield (LD) [V]
My Lords, according to the June edition of the British Medical Journal, the biggest change for mental health services has been the rapid adoption of video and phone consultations, an approach that had rarely been used in a field where relationships and trust between clinicians and patients are vital and where body language and eye contact are often a key part of the assessment. Many in the sector have reported that virtual appointments are at best inferior, particularly with young people, those with learning disabilities and the elderly. What assurances can the Minister give that face-to-face appointments will continue to be made available for those who need them in this field?
Lord Bethell (Con)
The noble Baroness has raised an important point. I saw the BMJ article to which she has referred; it was a very interesting warning shot, whereby we should not overshoot in this area. But perhaps I can also emphasise that other interesting evidence shows that some mental health services have been better provided by online consultations. For instance, some young people do not like visiting clinics, where they feel uncomfortable, and prefer video conferences. I think it is too early to call it on this one, because we need to analyse closely the benefits and disbenefits in the area of mental health. We must ensure that we have the right format for the right occasion, but I completely take on board the warnings of the noble Baroness.
Suicide
Baroness Tyler of Enfield Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
The noble Baroness refers to recent statistics, which are, as she rightly points out, subject to change, as coroners’ investigations land on the desk at PHE. I reassure her that the statistics suggest a difference between stress and anxiety, and clinical mental health issues. It seems that one aspect of the coronavirus pandemic is that it has not translated into a massive mental health tsunami, as feared. This is hugely encouraging and a great relief. None the less, we are committed to the mental health support that the Government provide, and continue to support charities such as the Samaritans and CALM, including through the £9.2 million recently given to them for suicide prevention and support.
Baroness Tyler of Enfield (LD) [V]
My Lords, sadly, self-harm is a major risk factor for future suicide and is growing among young people. Later this month, the All-Party Parliamentary Group on Suicide and Self-Harm Prevention will be publishing a report of its inquiry looking at the support available for young people who self-harm. Having been closely involved in this inquiry, I ask the Minister whether he will commit to the Government looking seriously at its findings, which were informed by young people who had self-harmed, and to responding in due course.
Lord Bethell (Con)
The noble Baroness is entirely right that self-harm is an alarming, distressing and rising phenomenon among young people. I welcome the report that she describes, and commit to having a good look at it, when it is published.
Childhood Obesity
Baroness Tyler of Enfield Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
The noble Baroness has a point on the importance of targeting the right populations and there are certainly some demographics that incur higher incidences of obesity and for which the health disbenefits of obesity are higher. For these, we have special programmes to support them in schools with vouchers and medical interventions. However, obesity is a national problem that affects all parts of society. In Britain we have got it wrong and we need to address this issue as a nation.
Baroness Tyler of Enfield (LD) [V]
My Lords, the noble Baroness, Lady Massey, rightly emphasised the link between deprivation and childhood obesity. Therefore, while welcoming the announcement of the Government’s obesity strategy, I ask the Minister: what specific steps are the Government taking to address the links between deprivation and obesity; how will this be funded; and what plans do they have to introduce policies with a more explicit focus on early years to reduce childhood obesity rates?
Lord Bethell (Con)
My Lords, there are individual programmes specifically targeting those from deprived backgrounds. I emphasise the childhood obesity trailblazer programme, which has funding for several councils to pioneer forward-thinking ideas to address childhood obesity among those target populations.
The other area that I emphasise is exercise in school. Of course, obesity is linked to intake, not exercise, but exercise helps to get the disciplines right around looking after one’s mind and body. The £320 million going into school sports facilities is a massive bonus in this area.
Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020
Baroness Tyler of Enfield Excerpts(4 years, 3 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, we are debating these regulations very late in the day and on the last day before Recess, although they were introduced on 4 July. We are doing this at a time of growing concern about a second wave of the pandemic, both at home and abroad, and when new measures have been introduced in Oldham, Rochdale, Blackburn and Pendle to address localised flare-ups.
The link between the prevalence of Covid infections and levels of deprivation is becoming ever clearer, as the noble Lord, Lord Ribeiro, explained so well. What systems have been put in place to ensure the sharing not just of data but of good practice, and the effectiveness or otherwise of localised measures both at national and local government level?
While I welcome today’s news that the Government will fund studies into why people from black and ethnic-minority backgrounds are more likely to die from Covid-19 than the white population—that is highly relevant to the diverse population of Leicester—why have we waited until now to do this, when the link has become increasingly clear since the early differential death rates first became apparent? I repeat my call for a full debate in this Chamber at the earliest opportunity on urgent action needed to tackle inequalities before a second wave, and before it is too late to act.
Relaxations had been made to these regulations, which came into force on 18 July—including to the areas covered—before they were even laid before Parliament. I join my noble friend Lady Jolly in asking the Minister to explain what process will be in place over the Recess to inform the House of the outcome of the review of regulations, which happens every 14 days, with the next one tomorrow.
Finally, looking ahead, what extra financial help will be given to people affected by local lockdowns such as in Leicester when the Government’s furlough scheme ends in October? Will the Government also think again about a temporary lifting of the benefit cap for the duration of the pandemic for those affected by local lockdowns or indeed any further national lockdown required?
Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020
Baroness Tyler of Enfield Excerpts(4 years, 4 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, I find it deeply troubling that, yet again, we are debating regulations that came into effect weeks before they received scrutiny in either Chamber. They have often been repealed or overtaken already. It makes a mockery of the parliamentary process and gives the unfortunate impression that Ministers are actively trying to avoid in-depth scrutiny. At the start of this pandemic, it was easy to understand why it was not possible to debate these regulations straightaway, but that is no longer the case. It follows a disturbing pattern of regulations and guidance coming far too late, with too little scrutiny. I cite the guidance that came out yesterday on face coverings, 12 hours before it came into effect, and to care home visiting, which caused such distress because it was so late. Like the noble Baroness, Lady Anelay, I want to know when and how this Chamber will be informed of the next review of these regulations. It is due on 30 July, when we will be in recess.
Independent Residential Care
Baroness Tyler of Enfield Excerpts(4 years, 4 months ago)
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Lord Bethell [V]
My Lords, it is not the role of a junior Minister to speak on behalf of the Prime Minister, but I can say that the Prime Minister, the Secretary of State and I are all enormously grateful for the huge amount of work that social care staff have put into this epidemic. I have seen with own eyes the commitment and expertise that they have provided during these very difficult days. We are, as a nation, enormously grateful for their hard work and skill.
Baroness Tyler of Enfield (LD) [V]
My Lords, the pandemic has placed a very harsh spotlight on the resilience of the care system, with 30,000 excess deaths in care homes in England and Wales in a three-month period. At the weekend Sir Simon Stevens made it crystal clear that we just do not have a fair or properly resourced social care system with proper workforce support. With some homes already running close to bankruptcy due to the additional costs and occupancy rates slipping below 87% when many smaller homes become financially unviable, what immediate steps are the Government taking to protect these smaller homes?
Lord Bethell [V]
The noble Baroness is entirely right that the issue of excess beds is an unfortunate and unwelcome added pressure on an already pressured system. Sir Simon Stevens was echoing the sentiments of the Government and the Secretary of State when he said that we need to move towards a long-term settlement for social care. That was very much the commitment of the Prime Minister during the election and in the manifesto. Steps have been taken towards working on that but we have been interrupted by Covid-19. It remains a number one priority for the Government. In the meantime, we will be putting in the financial resources necessary to provide the resilience for those smaller homes of which the noble Baroness speaks.
Covid-19 Update
Baroness Tyler of Enfield Excerpts(4 years, 4 months ago)
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Lord Bethell
My Lords, I remember the incident well and I intended no discourtesy whatever. I reassure the noble Lord that I left the Chamber and instructed my officials to draft that letter; on leaving today, I will chase it down and ensure that it goes to him speedily.
Baroness Tyler of Enfield (LD) [V]
My Lords, local lockdown plans in Leicester and elsewhere are vital to ensure that a proper place-based response takes full account of existing health inequalities. At an all-party group meeting yesterday, Sir Michael Marmot explained that Covid-19 has exposed existing inequalities in society and amplified them, with Covid-19 mortality rates closely linked to health inequalities and deprivation more widely. Does the Minister agree that, before the Summer Recess, your Lordships’ House must have a full debate on tackling inequality before a second wave hits us, with a sharp focus on the disproportionate impact on specific groups, particularly the BAME community?
Lord Bethell
My Lords, it is beyond my reach to instruct the House on its debates, but I would entirely agree with the noble Baroness that one of the saddest and most challenging aspects of Covid is that it hits society where it is weakest. It has undoubtedly hit those with health issues the hardest and has exacerbated health inequalities. It is my sincere hope that this Covid epidemic will be an inflection point, when this country embraces a strong public health agenda and addresses those health inequalities with energy.
Covid-19: Mental Health
Baroness Tyler of Enfield Excerpts(4 years, 4 months ago)
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Lord Bethell
The noble Baroness is entirely right to emphasise the importance of longitudinal studies. The UK household longitudinal study data, which analyses the GHQ-12 scores, has been upgraded. We will continue to invest in that, and Public Health England has been tasked with monitoring the development of mental health issues across the country.
Baroness Tyler of Enfield (LD) [V]
My Lords, research shows that the pandemic has had a disproportionate impact on some of the most disadvantaged, particularly those from BAME communities. During this period, many mental health and community services have moved online. While that is an appropriate first response, charities are now expressing concern that it is not an effective response for many, including the elderly, those with learning disabilities and those with severe mental illnesses. Can the Minister say what urgent steps the Government are taking to restore effective treatment and care for all, including face-to-face services, with all necessary PPE and testing in place?
Lord Bethell
My Lords, we are feeling our way in this area. There have been benefits from some of the moves online. People have been able to see more of their consultants, they have found that some of the content provided has been helpful, and the reach has gone up. However, I completely agree with the noble Baroness that it will not work for everyone. I pay tribute to mental health professionals who have maintained face-to-face contact during the epidemic, with all the threats associated, and we continue to look closely at how to fit appropriate technology and digital access to the right people and in the right format.