Women’s Health Outcomes
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Baroness Walmsley (LD) [V]
My Lords, I am delighted to take part in this debate on women’s health issues, so ably introduced by the noble Baroness, Lady Jenkin.
A common issue coming out of all the briefings, and particularly from the report by the noble Baroness, Lady Cumberlege, First Do No Harm, published last year, is the need to listen to women when they talk about their health. We all heard the noble Baroness talking movingly in this House, when we first debated her report, about how upsetting it was when she really listened to the women who had been damaged, or whose babies had been damaged, by valproate, Primodos or vaginal mesh and how relieved the women were to be listened to at last. Can the Minister say when the Government will implement all her recommendations?
Information is vital because, without it, women cannot exercise proper choice. In the case of the anti-epilepsy drug valproate, we heard from women with epilepsy when we debated the report last year that women were still not being fully informed of the risks in case they become pregnant. Let us remember: about half the pregnancies occurring in the UK are unplanned.
So information is key, but so is listening. I am horrified when I hear that women who eventually get a diagnosis of endometriosis have usually been to their GP 10 times before they finally get a proper investigation, diagnosis and treatment—just one example of where women’s pain is not taken seriously. I recognise that the non-specific symptoms are of course difficult to diagnose, but I would like to know what training trainee doctors get in actively listening to women.
As we just heard, women are also underrepresented in clinical trials, even for drugs specifically aimed at women. This is completely unscientific when you understand the differences between women’s and men’s biology. Can the Minister say why the regulator allows this?
I am, like the noble Baroness, Lady Massey, very concerned about women’s mental health services, particularly since the pandemic has isolated so many women in their homes with sole responsibility for caring for their children and sometimes elderly relatives. A listening ear has been more important than ever during the pandemic and many kind members of the community have stepped up, but they are no substitute for clinical services. Asking questions and listening to the answers is particularly important in antenatal clinics, where mental health issues and domestic violence can often be detected early. I ask the Minister: will women’s mental health be specifically included in the new Secretary of State’s plan for mental health?
Another factor of women’s health which has worsened over the past year is nutrition and obesity. We have seen an increase in poverty, which is linked to obesity, and an increase in eating disorders. When will we get Henry Dimbleby’s long-awaited national food strategy? This is really important for women themselves and for those they feed and care for.
Covid-19: Wuhan Institute of Virology
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, I have written to the commissioner for standards in response to that precise question and I should be glad to share that correspondence with the noble Lord.
Baroness Walmsley (LD) [V]
It is believed that given the slow rate of mutation of Covid viruses, Covid-19 would have taken around 35 years to evolve from its nearest known relative. What has been done to identify any intermediaries in which it may have lived during that period and any knowledge useful for preventing future pandemics that may arise from that knowledge?
Lord Bethell (Con)
I entirely agree with the noble Baroness. It is extremely frustrating that we do not know the steps of evolution that this virus went through. It has come to us completely out of the blue. That leaves us in a vulnerable state when we are preparing for the next pandemic. It is absolutely essential, as any epidemiologist will say, that one knows and understands where the virus came from—whether that is the water pump handle for an outbreak of cholera or a virus from China.
Social Care and the Role of Carers
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Baroness Walmsley (LD) [V]
My Lords, it is a pleasure to support my noble friend, Lady Jolly, who laid out so well the importance of social care to all of us. It is clear that the crisis in social care must be addressed urgently and a cross-party consensus reached on a fair system of funding. That will happen only if the Government liaise with other parties, not just the Chancellor. The pandemic has highlighted the interdependence of social care and the NHS, but there has been a damaging shortfall in social care funding over the past few years—currently at £6.1 billion—and local authorities have struggled to subsidise social care from other funds.
The social care workforce is dedicated, but its pay is on average 25% less than that in the NHS. No wonder some are moving into retail and agriculture: the Brexit shortages in those workforces has meant that they can earn a lot more if they work in those sectors. There were 112,000 vacancies before the pandemic, and a shortfall of half a million care workers is predicted by 2035 unless something is done. The public support parity of esteem with NHS staff. I agree with the noble Baroness, Lady Hollins, that we need a social care people plan similar to that for the NHS. What is the Government’s plan for this?
Domiciliary care workers are particularly hard hit as they are not paid for travel between clients and have too short a time to carry out their duties. They are in some respects even more important than those working in residential care because they contribute to keeping clients out of hospital and preventing their move to more expensive residential care. Related to this but slightly beyond the scope of the Minister’s department—but just as crucial to the objective of keeping elderly people safely at home—is housing design and adaptations. Can the Minister tell the House who in government takes responsibility for this?
The shortfall in funding means that the burden of care has fallen on the shoulders of 11.5 million unpaid carers, family and friends. Their care allowance is a pittance and must be increased. Although their rights to support were laid down in the Care Act 2014, they have not been met because of the requirement that local authorities remain within their budget. Can the Minister say when those rights will be fulfilled?
Many people are unaware that half the cost of social care is for working-age adults with physical and mental disabilities. During the pandemic there has been even more pressure on services for them. Is the Minister aware that, although the emergency powers to modify entitlement to services have not been overtly used, organisations that speak for these groups report that their services have indeed been curtailed? Will he look into that?
Folic Acid
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, I agree with the noble Lord. Can I just take a moment to bear testimony to his patient and determined campaigning on this issue? He has held the Government’s feet to the fire on it, and I am grateful for his focus. He is right that we are hopeful that there should not be any substantive delay with the industry. A huge amount of work has gone on in the consultations and the dialogue we have had, and I am grateful for that. However, the Senedd and Scottish parliamentary elections in May meant that new personnel were at the top of government. We hope that they are as supportive as the noble Lord so rightly pointed out, but there is a process to get the official endorsement that we need to take this forward and we are waiting for that paperwork to come through.
Baroness Walmsley (LD) [V]
My Lords, is the Minister aware that 50% of pregnancies are not planned? Therefore, while the Government consult and procrastinate, what communication is being planned with women of childbearing age to tell them that they need to take a folic acid supplement before they start a pregnancy to avoid NTDs in their babies?
Lord Bethell (Con)
My Lords, this Minister is very aware—personally extremely aware—of the fact that 50% of pregnancies are not necessarily planned. As the noble Baroness knows very well, that is one of the reasons for this policy and that is why we are so supportive of it. The education that goes to new mums and dads on folic acid is done through GPs, and we are always looking at ways to enhance that. But I think there is no better of way of ensuring that folic acid gets to the right people at the right time than through this measure, and that is why we are supporting it as energetically as we are.
Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021
Baroness Walmsley Excerpts(3 years, 6 months ago)
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Baroness Walmsley (LD) [V]
My Lords, I support the postponement of the easing of restrictions and reject the fatal amendment from the noble Lord, Lord Robathan, as daily cases have now jumped to 9,000. We need more time to continue the vaccination programme before it will be somewhat safer to ease restrictions.
However, people are still suffering economically, so can the Minister say whether the furlough scheme will be extended, as well as the ban on domestic evictions, now that the Government have extended the ban on commercial evictions? Can he also tell us about the border restriction system? New variants will arise wherever large amounts of virus circulate and some may be resistant to the current vaccines. Have the Government learned from their disastrous mistake in not red-listing India three weeks earlier, when the information indicated they should? Have the criteria been adapted to prevent such a mistake happening again?
Clearly, Covid will continue to circulate in the UK for a long time after we ease restrictions, so an effective test, trace and isolate system is as important as ever. The weak link is the isolation system. An internal Whitehall assessment, seen yesterday by the media, of the financial support for those who need to isolate gave the system a low to medium effectiveness rating. Barriers and disincentives exist, particularly for those on low incomes or in precarious work, so more needs to be done.
Every time my noble friends and I have raised this over the past 15 months, the Minister has referred to the £500 grant, ignoring the fact that it is not available for most people who apply for it because they believe they really need it. I heard yesterday about a pilot scheme for increasing this support. We do not need more pilot schemes; we need immediate action. We will be living with this virus for a long time and, if nothing is done to improve isolation rates, the restrictions that the noble Lord, Lord Robathan, so abhors will have to be reintroduced in the winter.
One thing that should be done straightaway is to increase sick pay. The current sick pay rates are not enough for a mouse to live on. No wonder people go into work coughing, spluttering and spreading germs of all sorts—they cannot afford to stay at home. In the end, encouraging people to stay at home could increase the country’s productivity by reducing the number of fellow workers catching transmissible infections. We need a culture change on that.
However, coughs and colds are by the by. We have not yet conquered Covid-19. The Government must use these extra few weeks well, not just to vaccinate more people but to transform the isolation rate for the better. Can the Minister therefore tell us how the Government plan to achieve this?
Care Homes: Insurance Indemnity
Baroness Walmsley Excerpts(3 years, 7 months ago)
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Baroness Walmsley (LD) [V]
My Lords, the Minister will be aware that the financial viability of many homes has become precarious during the pandemic. What mechanism is in place to monitor the level of premiums and any homes in danger of closing because of this problem? What contingency measures are in place to care for the residents who might lose their homes as a consequence?
Lord Bethell (Con)
My Lords, in terms of monitoring, Care Quality Commission data indicates that pressures are being felt by the insurance industry, but these are not translating into reduced capacity, service closures or quality concerns. There is, in fact, a growth in the number of home care agencies since March 2020; for instance, in the east Midlands, there has been a growth in capacity of 9.4%. These are reassuring figures and we are monitoring the situation extremely closely.
Social Care: Person-centred Dementia Care
Baroness Walmsley Excerpts(3 years, 7 months ago)
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Lord Bethell (Con)
My Lords, I completely acknowledge the pressure the pandemic put on both formal and unpaid carers. That is why we put £6 billion into local authorities, to help support them in the care they gave to carers. However, I acknowledge the concerns of the noble Baroness about the pressure of the last year and reassure her that the full spectrum of social care will be considered in the forthcoming review.
Baroness Walmsley (LD) [V]
My Lords, Alzheimer’s disease has been described as a future epidemic. Without a known cure, research into causes of and treatments for Alzheimer’s and other dementias is vital. At the last election, the Government committed to a dementia moonshot, which would double research funding to over £160 million a year. Can the Minister say when this funding will become available?
Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021
Baroness Walmsley Excerpts(3 years, 7 months ago)
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Baroness Walmsley (LD) [V]
My Lords, it is of great concern that we are moving today not to step 2 but to step 3 of the road map, while the more transmissible Indian variant is spreading—Professor Whitty expects it to become predominant in the UK. I make no apology for repeating the concerns of other noble Lords. While the vaccine will provide a high level of protection to those who have received it, unvaccinated people could now be at high risk of serious disease and the NHS again of being overwhelmed.
The Prime Minister finally put India on the red list on 19 April, a few days before he was due to fly to India to discuss the trade deal he so desperately needed after Brexit. Many commentators believe the two facts are linked. Will the Minister give a clear answer to the following questions about India?
Why was India not put on the red list on 2 April, at the point when it had the same level of incidence as Pakistan and Bangladesh? By 9 April, cases in India were four times higher than in Pakistan, yet the Government waited another 10 days to act. During those three weeks’ delay, around 20,000 people came here from amber-listed India. Do the Government know whether they all quarantined for 10 days, as required, and had the necessary tests?
When red-list powers were announced in mid-February, the Government said they could be implemented in hours. Why, then, did they wait four days before implementation, allowing 900 people per day to come in from India without red-list restrictions? Why, when travellers arrived from India, were they forced to mingle at immigration with hundreds of people coming in on flights from other countries? Why have the Government not insisted on dedicated arrival facilities for passengers arriving from red-list countries? What support is being given to those people arriving from India who find it difficult to quarantine?
Why have the Government not learned that the characteristics of variants of concern are not the only reason to put countries on the red list? The cases in India had been rising exponentially for weeks before 19 April. There were more than 100,000 cases a day in India on 5 April, and the cemeteries were overflowing. Why did the Government not act when that level of cases was being reported?
The BMA and several scientists are seriously concerned about the further lifting of restrictions while this highly transmissible variant is spreading. It is one of the Government’s own tests. In Scotland, the First Minister has postponed the easing of restrictions in the south of Glasgow and in Moray, where cases of the Indian variant are growing. Will the UK Government do the same?
Alcohol Harm Commission: Report 2020
Baroness Walmsley Excerpts(3 years, 7 months ago)
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Baroness Walmsley (LD) [V]
My Lords, alcohol harm requires a cross-departmental response because of the range of harms that alcohol can cause. That is why I support the call of the noble Baroness, Lady Finlay, for a coherent, cross-government strategy.
The commission says, “It’s everywhere”, and it is. Drama can often explore complex issues in real life. The writers of Radio 4’s “The Archers” know that, hence their recent storyline about Alice’s struggles with alcoholism.
There are parallels with the obesity crisis, and there the Government have at last recognised that regulation has a part to play. The same goes for alcohol. We live in an obesogenic and alcogenic environment, and regulation can help. For example, people often do not know how much they are drinking or how strong a drink is. I have been asking for two decades for all alcohol to have its calories and alcohol units clearly labelled, but that still does not happen. I hope that will change now.
Services are thin on the ground. When police are called to an event of domestic violence, they should be able to link the perpetrator to therapeutic services and the children to social services. But this does not happen because the services are not there. This is crazy because, putting aside the human cost, money could be saved if they were. Are GPs and antenatal clinics confident to ask questions and refer people to alcohol services, where appropriate? Probably not.
Finally, the report says that, in Scotland, deprived groups are six times more likely to be admitted to acute hospitals and 13 times more likely to be admitted to psychiatric hospitals for alcohol problems than the least deprived groups. So the matter is often related to poverty. However, poor people can afford alcohol—because it seems to make things better; it is an escape from the misery of people’s lives. If we banish poverty, introduce minimum pricing and provide services, we can go a very long way to solving alcohol harms.
Covid-19: Obesity
Baroness Walmsley Excerpts(3 years, 8 months ago)
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Lord Bethell (Con)
My Lords, I agree with the correlation pointed out by the noble Baroness. We must acknowledge and address the fact that areas of deprivation undoubtedly have higher levels of obesity. However, we have to be careful about taking away people’s sense of agency. It is possible to buy affordable healthy foods at any price point. Food has never been cheaper than it is today. We must put into people’s hands the knowledge and inspiration to take the steps necessary to shed the pounds that need to be shed.
Baroness Walmsley (LD) [V]
My Lords, can the Minister assure me that the Government will not renege on their promise to ban the advertising of high-fat, high-sugar and high-salt foods online? Will he ignore the objections of junk food producers and advertisers, and remind them of the similar ban on Transport for London when the amount of advertising actually went up? Reformulated and low-calorie options generate revenue too.
Lord Bethell (Con)
My Lords, the Government take the advertising of unhealthy foods seriously, which is why we have commissioned this consultation. It has not finished yet so it is not possible for me to pronounce on its findings, but I assure the noble Baroness that we are looking at this issue extremely carefully indeed.