Social Care: Family Carers

Debate between Baroness Wheeler and Lord Bethell

Monday 13th September 2021 Lords Chamber

[Baroness Wheeler (Lab)]

On behalf of my noble friend, and with her permission, I beg leave to ask the Question standing in her name on the Order Paper.

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

My Lords, we recognise that family carers play a vital role. When we announced an additional £4.5 billion over three years for social care, it included a commitment to take steps to ensure unpaid carers have the support, advice and respite they need. We will publish a White Paper later this year with more detail. The Health and Care Bill also places a duty on integrated care boards to promote the involvement of unpaid carers.

[Baroness Wheeler (Lab)]

My Lords, the Minister has acknowledged that our 1.6 million unpaid carers are reporting high levels of fatigue and stress and are worn out and exhausted by caring during Covid-19. On average, carers have lost 25 hours a month of crucial support over the past 18 months, and 81% are providing more care. Essential daily support services for them and their loved ones are still not up and running in many areas. Was it not therefore reasonable for carers to have expected immediate funding support from the Prime Minister’s health and social care funding announcements last week? The situation is desperate and needs addressing now, not just with more kind words and another “White Paper tomorrow” promise.

[Lord Bethell (Con)]

My Lords, I do acknowledge the pressures on unpaid carers and pay tribute to the incredible contribution they have made during these very difficult 18 months. We are continuing to work with local authorities, in collaboration with ADASS and MHCLG, to support local authorities in meeting their duties, particularly in the area of respite, which the noble Baroness rightly pointed out. We have also made contributions to Carers Trust, Carers UK and to “See, Hear, Respond” services to support unpaid carers. In the long term, our commitment is to social care reform and the financial proposition that we will bring forward in the White Paper.

Residential Social Care: Staff

Debate between Baroness Wheeler and Lord Bethell

Monday 6th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.

[Baroness Wheeler (Lab)]

My Lords, while we await the announcement of the Prime Minister’s social care plan, after two frustrating years of non-action and delay, the continuing crisis in care homes needs to be dealt with now. With a possible 68,000 jobs now predicted to be lost in the light of the Government’s 11 November deadline for all care staff to be vaccinated, feedback from care providers shows that both care workers and the most senior and experienced staff are leaving the care workforce, with registered nursing staff constituting a much higher proportion than other care staff. What action have the Government taken to address this potential crisis in both the staffing and the management of care homes, particularly since the number of nursing jobs, for example, has decreased by 17,000, or 33%, over the past year?

[Lord Bethell (Con)]

My Lords, I do not completely recognise all of the noble Baroness’s figures, but I acknowledge that recruitment in many sectors of the economy is tough at the moment, and that is why we are putting in the measures that I mentioned to the noble Baroness, Lady Brinton. I add that we are doing an enormous amount to fund: we have put £1 billion of additional funding into social care for 2021-22, on top of the significant support provided to the sector during Covid-19 over the last year. This is money directly to address the issues that she is concerned about.

Health: Dementia

Debate between Baroness Wheeler and Lord Bethell

Monday 5th July 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, not only are there deep concerns about the sharp drop in memory clinic referrals during the pandemic; the Alzheimer’s Society also has very real fears that the virtual assessments currently taking the place of attendance at memory clinics run the risk of exacerbating inequalities in treatment and excluding large cohorts of patients. What is the Government’s overall strategy for ensuring that vital day care and hospital services are reopened and that the backlogs in referrals are addressed, for providing the rehabilitation that people with dementia need to counteract the effects on their cognitive and physical function, and for providing support for their mental health and well-being?

[Lord Bethell (Con)]

My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.

Social Care Reform

Debate between Baroness Wheeler and Lord Bethell

Tuesday 29th June 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, in last week’s very powerful debate on social care, noble Lords from across the House made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, but instead of a firm date for the Prime Minister’s clear plan, we had the usual reassurances from the Minister that it was still absolutely under way, we would see some social care foundations in integrated care systems under the NHS and care Bill but that it would still be the “end of the year” before the Prime Minister reveals his clear plan to all.

Over these nearly two wasted years we have had delays and broken promises. Almost 42,000 care home residents have died from Covid-19, 2 million people have applied for support but had their request refused, tens of thousands have had to sell their home to pay for care, millions of families have hit breaking point and staff have been appallingly let down. Even after all the horrors of this pandemic, nine out of 10 councils say that they face care budget cuts this year.

While the Government dither and cancel key meetings and the Prime Minister blocks various funding options, the social care funding crisis deepens. Now we see in the Daily Telegraph that the new Secretary of State considers that we are completely at the wrong stage of Parliament to launch a new social care strategy. What is going on?

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

My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

Covid-19: Care Homes

Debate between Baroness Wheeler and Lord Bethell

Thursday 17th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.

[Baroness Wheeler (Lab)]

My Lords, can the Minister explain why the Secretary of State continues to justify himself by quoting the seriously underestimated PHE January to October 2020 data assessment on hospital discharges to care homes of 286 Covid deaths? The National Care Forum of care providers has repeatedly made clear how fundamentally flawed and incredibly partial that data is. Only limited numbers of symptomatic patients in hospitals and care homes were tested, and cases not tested before death are not included. Even the chair of the House of Commons Science and Technology Committee has said that relying on this for a full picture of the situation is a stretch of the imagination. We owe it to the people who have died, their relatives and care home providers to have full, accurate and independent information. How is the Minister going to ensure that it is urgently provided, so that we can genuinely learn from what happened?

[Lord Bethell (Con)]

My Lords, I acknowledge the noble Baroness’s concerns, but the PHE report is extremely thorough. I am not aware of it being revised, but if it is, I would be glad to share that information with the noble Baroness.

Carers: Support

Debate between Baroness Wheeler and Lord Bethell

Thursday 10th June 2021 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking to ensure that carers get the support and breaks they need.

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

My Lords, the love, commitment and sheer hard work of Britain’s unpaid carers have saved lives and made a huge difference to the country’s most vulnerable. The nation is hugely grateful. I completely recognise the impact the pandemic has had on access to support and breaks. Local authorities have an important responsibility to assess carers’ needs, and I pay tribute to the efforts of local authorities as we work together to reopen day and respite services.

[Baroness Wheeler (Lab)]

My Lords, I commend to the Minister Carers UK’s excellent 40-page report produced for Carers Week. In it, we hear from carers themselves, not just on the lack of essential breaks and respite but on caring during the pandemic, their own health and their worries about when key day care and other services vital to the loved ones they care for, and suspended during lockdown for over a year now, will be reinstated. If he reads the report carefully, he will see the reality of everyday life for thousands of carers. Funding given to councils during the pandemic has not been anywhere near enough for the vital role they have been expected to play, and the funding the Minister repeatedly refers to has simply not reached carers. How will the Government address this appalling situation and ensure that unpaid carers are given the funding and support they need and deserve?

[Lord Bethell (Con)]

My Lords, I too pay tribute to the Carers UK report. I read the very moving personal testimonies in that report and for that reason I took a call with Carers UK this morning in order to understand the recommendations it has made. There is an enormous amount to do. The practical role of the department is to work with local authorities to ensure that day centres and care services are reopened. There are massive infection control issues, but we are working extremely hard with local authorities to ensure that that reopening can happen quickly so that carers get the support they need.

Care Homes: Insurance Indemnity

Debate between Baroness Wheeler and Lord Bethell

Wednesday 19th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I acknowledge the challenge faced by care homes on the insurance market, but CQC statistics suggest that, in fact, the insurance industry has done an enormous amount to meet the needs of care homes and that many of the pressures on care homes have been the result of Covid outbreaks. We have brought in the designated settings indemnity support, as the noble Baroness knows, and we have given £6 billion to local authorities to support care homes. Putting care homes on the same footing as the NHS would not meet the needs of the care home sector, so that is not something we are looking at currently.

[Baroness Wheeler (Lab)]

My Lords, the Financial Times warned in January that care homes were having to turn away new patients as they struggled and failed to get liability insurance to cover Covid-related claims. There is also huge speculation that a flood of claims is coming as pre-existing claims management companies and many set up purely to deal with Covid-19 cases are vying for business for personal injury claims and compensation for the loss of a loved one. What assessment has the Minister made of the risk that Covid-related litigation poses to the sustainability of the whole social care sector?

[Lord Bethell (Con)]

My Lords, in the year from March 2020, the number of patients has in fact increased from 457,000 to 458,000. The CQC is monitoring the situation extremely closely and its data from the insurance industry suggests that, although there has been some pressure on some companies, there have also been new entrants and the amount of support available to the social care sector is resilient.

Social Care: Person-centred Dementia Care

Debate between Baroness Wheeler and Lord Bethell

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I entirely agree with the extremely touching way the noble Lord put that. To take a glass-half-full approach for a moment, I have been struck in the pandemic by the huge amount of public support for the protection of those who are older and vulnerable, including those with dementia. It has been a very touching feature of the national response to the pandemic that the country has come together to protect the most vulnerable, and I think there has been a national rethink about how we relate to those in that condition.

[Baroness Wheeler (Lab)]

My Lords, we know that the costs for families of caring for those with dementia can be long-lasting and catastrophic, as the Commons Health and Social Care Committee has emphasised in setting up a new inquiry, and from our excellent Economic Affairs Committee report on social care, which found that the typical cost of an individual’s dementia care is £100,000. According to the Alzheimer’s Society, two-thirds of this cost is currently being paid for by people with dementia and their families, either in unpaid care or in paid-for private social care, in contrast to other conditions, such as heart disease and cancer, for which the NHS provides care free at the point of need. People with dementia should not bear the sole responsibility for saving and paying for their care. When will this Government address this key parity of esteem issue, end this disparity and protect people with dementia from the catastrophic costs of care?

[Lord Bethell (Con)]

My Lords, the Prime Minister has made it very clear that he is committed to bringing forward proposals to address this issue before the end of the year. He stands by that commitment. I look forward to the kind of cross-party and cross-society collaboration that will be necessary to address that massive generational challenge.

Care Home Occupancy Rate

Debate between Baroness Wheeler and Lord Bethell

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness makes a good point. There is always a tension in having enough beds in care so that those who need somewhere to be supported are not sent to hospital, thereby occupying valuable beds that should be used for elective surgery or other more complex and important procedures. We are working closely with the CQC to ensure that the right strategies are in place to deal with that.

[Baroness Wheeler (Lab)]

The Minister knows we have continually raised our strong concerns about the financial stability of care homes. Now, the possibility of increased closures due to falling occupancy rates and the extra costs stemming from the pandemic have exacerbated the precarious situation the sector is in. With the downward trend in the registration of new care homes and the upward trend in closures, is not the resulting net reduction in the number of beds available deeply worrying at a time of known growth in the need for social care provision for older people? Can the Minister reassure the House that in the Queen’s Speech we will, at last, find out about the Prime Minister’s plans for how he is going to fix all this and what is going to be done to deliver long-term funding and sustainability for the social care sector?

[Lord Bethell (Con)]

My Lords, I have heard the noble Baroness and others express their concerns about the sector, but I reassure noble Lords that it is not in overall long-term decline. In fact, the number of care home beds has remained broadly constant over the last 10 years, with 460,000 in 2010 and 458,000 in April 2021. But I recognise the noble Baroness’s question, and it is right that we are going to bring forward recommendations for social care reform by the end of the year.

Care Homes: Guidance

Debate between Baroness Wheeler and Lord Bethell

Wednesday 21st April 2021 Lords Chamber

[Baroness Wheeler (Lab)]

Can the Minister explain why the visiting out guidance is not aligned with the road map for the national lockdown? Is there not a gaping discrepancy between the advice for care home residents, who are advised to keep the number of contacts to a minimum, and the advice for care workers, who can go to the hairdresser’s, sit outside a pub, meet up in groups of six and then go back into a care home to provide personal care?

[Lord Bethell (Con)]

My Lords, these protocols are not tied to the road map because we hold them under constant review. We hear loud and clear the case made by the noble Baroness and others who make the case for change. We are open to making that change when the evidence says that the situation is ready. We expect care home workers to behave in a way that is responsible and keeps infections to a minimum, but we cannot have protocols for every aspect of their lives.

Crohn’s Disease and Ulcerative Colitis

Debate between Baroness Wheeler and Lord Bethell

Thursday 15th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness. A lot of late diagnoses are caused by the kind of delicacy the noble Baroness refers to. My noble friend talked about the challenge of diagnosis, which is made more complex by patients finding a lot of these subjects extremely delicate. The approach taken in primary care to handling such delicate issues has improved dramatically over the years. We are working with GPs and clinicians to make their bedside manner more delicate, so that they are able to broach such delicate issues more sensitively. That, I believe, is at the heart of the problem.

[Baroness Wheeler (Lab)]

My Lords, Covid-19 has widened the huge cracks in the quality of IBD care, with patients facing even longer waits for elective care, surgery, investigations and a personalised care and support plan to support their daily lives. Surveys have shown nearly one in five IBD patients have suffered a flare-up crisis during the pandemic because they were unable to obtain specialist advice. We know that many have had to continue shielding because Crohn’s disease compromises the immune system and they have to wait for their two vaccines. What recognition and support of their particular care needs is being given at primary care and community level?

[Lord Bethell (Con)]

I completely sympathise with all those with IBD and associated conditions. The situation the noble Baroness described is exactly right and it is extremely challenging. I have particular concern for those shielding for a very long period, although I hope many of them will not be waiting long for their second vaccine. Those with all conditions have endured some waits because of Covid, but the NHS is working incredibly hard on the catch-up. Huge progress has already been made and there is a massive focus on diagnosis in particular, to ensure that we catch up with all those presenting with problems who need diagnoses.

Folic Acid

Debate between Baroness Wheeler and Lord Bethell

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

[Baroness Wheeler (Lab)]

My Lords, last year, a year after the consultation deadline closed, the Minister repeated his promise that, despite seriously delayed government decision-making, major efforts were being made to step up the raising of awareness of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20. Can the Minister tell the House what actions have been taken? What measurable impact has awareness raising had among these at-risk groups and on ensuring that women whose pregnancies are unplanned—as we have heard—are not missing out on these vital nutrients in the early stages of their pregnancy?

[Lord Bethell (Con)]

I am grateful to the noble Baroness for reminding me of my words on that matter. I will endeavour to find an answer to her very particular question. I worry that the very large amount of engagement we have had to do on Covid, particularly around marketing, has drowned out some of the messages that we have put through to people on these very specialist issues. I will find out from the department what progress has been made and will be glad to update her.

Osteoporosis: Treatment

Debate between Baroness Wheeler and Lord Bethell

Tuesday 9th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the CMO has recently issued new guidance on the consumption of vitamin D and there has been widespread discussion about its dosage level. My understanding is that we are leaving the matter at that for the moment. I am not aware that the mandatory application of vitamin D to food is on the runway at the moment, but I am happy to check that point and write to the noble Baroness.

[Baroness Wheeler (Lab)]

My Lords, your Lordships’ House recently discussed the importance of medical research and government financial support for the fundraising and work of key charities on new brain tumour research treatments. With an estimated 3.5 million people aged over 50 currently affected by osteoporosis, many suffering chronic pain and disability, research on this is also vital. What resources does the NHS currently spend on osteoporosis research? Will the Minister undertake to consider the financial support, including match funding, that the Government can provide to the Royal Osteoporosis Society’s newly launched research academy and its potentially game-changing road map, which charts the key steps for researching a cure for this extremely debilitating disease?

[Lord Bethell (Con)]

My Lords, I do not have the figures for the precise amount that the Government spend on osteoporosis research at the moment, but I am happy to write to the noble Baroness with them if they are available. We are enormously grateful to the Royal Osteoporosis Society for its contribution to medical research. I can confirm that it has received a grant of £258,000 to support important work providing support for the vulnerable during the pandemic. That comes out of the package of £750 million that the Chancellor of the Exchequer announced to support the charity and voluntary sector during the Covid pandemic.

Hotel Quarantine for Travellers

Debate between Baroness Wheeler and Lord Bethell

Wednesday 3rd February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s pride in that measure and concern that we extend a warm hand of friendship to those from Hong Kong. He raises the point extremely well. I would like to think that any system we put in place would be resilient to surge demand of the kind he indicates, but I will take his point back to the department and check that everything is being done accordingly.

[Baroness Wheeler (Lab) [V]]

My Lords, UK borders have knowingly been left open and potentially exposed people to new strains of the virus, rather than the implementation of the prompt, concerted action advised by SAGE and a comprehensive hotel quarantine system brought in for all UK arrivals. Does the Minister accept that the current 10-day self-isolation system has failed? If so, why is the policy still being pursued for the majority of travellers? We have been promised that hotel quarantine will be implemented for some countries as soon as possible, with some reports suggesting that this will not be enforced until the week of 15 February. Can the Minister confirm whether this is the target date? Will additional measures be in place for travellers from the red list of countries in the interim? Finally, does he accept that a partial quarantine is doomed to fail, given that global travellers may move across many countries during their journey, passing through multiple travel hubs and departure lounges while encountering and spending time close to many other travellers along the way?

[Lord Bethell (Con)]

My Lords, I acknowledge the detailed and perfectly reasonable questions raised by the noble Baroness, but I am unable to answer them all in detail. A Statement will be forthcoming from the Government on exactly those questions. I remind her that travel has come down by 90% in a comparative period. She is entirely right that travel patterns are complex; any measures we put in place will recognise that many travellers leapfrog from one country to another, brushing against others, and that the spread of the virus cannot be narrowly contained to travel corridors in the way one would sometimes like to hope.

International Year of Health and Care Workers

Debate between Baroness Wheeler and Lord Bethell

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

[Baroness Wheeler (Lab)]

My Lords, I express our strong support for the WHO statement in recognition of the selfless dedication of health and social care staff to providing care during and despite Covid-19. Following on from the comments of my noble friend Lady Pitkeathley, the WHO statement draws attention to the importance of workforce readiness, education and learning to manage the pandemic and its consequences. Will the Minister explain how the Government are ensuring that both health and social care staff on the front line of social care—particularly care staff, providing vital domiciliary care in the home and in the community—are being given this key support?

[Lord Bethell (Con)]

The noble Baroness is right. Those involved in domiciliary care, particularly part-time, make an extremely important contribution. We are naturally concerned about how they are contracted and their educational needs supported. We would like to think more about how part-time domiciliary care staff in particular, who make such a valuable contribution, can be further supported.

Health: Brain Tumours

Debate between Baroness Wheeler and Lord Bethell

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend alludes to a situation that is grave and concerning. Hundreds of millions of pounds have disappeared from medical research charity income, particularly through the closure of second-hand clothes shops, which provide an enormous amount of income for British medical research. I pay tribute to the massive contribution of medical research charities in trying to move forward the science of medical research. This is an area we are deeply concerned about, and colleagues at BEIS and the Treasury are actively engaged with it. My noble friend is right that this a knotty situation to solve that we need to look at very carefully indeed.

[Baroness Wheeler (Lab) [V]]

My Lords, I was very privileged to be present in the Chamber when my noble friend Lady Jowell made her plea to improve brain tumour treatment, research and survival. The work since her death of the Tessa Jowell Brain Cancer Mission, referred to by the Minister and other noble Lords, on the new national strategy has been inspirational. The mission has developed clear practical steps and pathways to build the quality, quantity and diversity of research that the UK needs, such as addressing delays in opening clinical studies, programmes to train the UK’s first generation of brain tumour-specific positions, and dedicated brain tumour centres. What steps are the Government taking to make sure that the NIHR, the MRC and the UKRI work together to ensure that the progress we need comes about? What will happen to the NIHR funding money put aside for brain tumour research in 2018 that remains unallocated at the end of the five-year window announced three years ago?

[Lord Bethell (Con)]

My Lords, I also pay tribute to the Tessa Jowell Brain Cancer Mission and all its work in putting together a really thoughtful strategy for tackling this most difficult issue. NIHR cancer research expenditure has risen from £101 million in 2010 to £138 million in 2019-20, and its settlement in the recent spending review was generous. I am optimistic that there are more resources there. I reassure the noble Baroness that, although the £40 million for brain tumour research has not all been allocated yet, it is not going anywhere and we are working as hard as possible to ensure that the right kinds of research project are put forward for that money. I would like to see it allocated as soon as possible.

Medicines and Medical Devices Bill

Debate between Baroness Wheeler and Lord Bethell

Report stage & Report: 2nd sitting (Hansard) & Report: 2nd sitting (Hansard): House of Lords
Thursday 14th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am enormously thankful for that constructive debate. This change to the Devices Expert Advisory Committee should be welcomed. It provides for if not equivalence then equality between the medicines and medical devices regimes. It provides for transparency, which we value enormously, and it indicates our direction of travel, the step change and the commitment to patient safety that the MHRA will enshrine.

As has been noted, the committee already exists. It currently meets, and it has an impact and an effect, but these measures mean that it will be strengthened. This change is put forward not solely by the Government; it was a recommendation in the review authored by my noble friend Lady Cumberlege. It adds to the collective picture of improvements that we are making, from future regulation of devices to the medical devices information system. I reassure my noble friend Lord Lansley that we have a profound commitment to creating a regulator in the MHRA that has international influence. I say to the noble Lord, Lord Hunt, that patient representatives are already on the DEAC. As Dr June Raine made clear in her briefing to noble Lords, she and the MHRA are massively committed to the patient safety agenda and to mobilising the patient safety voice through instruments such as the DEAC but not solely through it.

It is a delegated power, but one that I hope noble Lords agree is contained. It will allow us to ensure that the structure and focus of the committee can be kept under review to make best use of its impact, and the regulations will be subject to public consultation and all the steps therein.

The noble Baroness, Lady Thornton, has tabled Amendments 51 to 53 to the government amendment, which would change the nature of the regulations such that they “must” rather than “may” be made. However, as I have set out, the committee already exists; it functions now. It will be strengthened by the regulations. We are committed to a more structured decision-making process that improves transparency. There is no equivocation or doubt; these regulations will be made.

The powers provided by Amendment 50 in my name will enable movement towards a more transparent, proactive, whole-life cycle approach to vigilance. Fundamentally, they will make a difference in the oversight of medical devices to the benefit of patients and patient safety.

I am grateful to noble Lords who have continued to shine a light on the importance of device safety. I hope that this additional tool in the arsenal demonstrates continued commitment and that I have provided sufficient reassurances for the noble Baroness to feel able to withdraw the amendment.

[Baroness Wheeler (Lab)]

I thank the Minister for his response and all noble Lords and noble Baronesses who have taken part in this useful debate. The points made by my noble friend Lord Hunt and the noble Lord, Lord Lansley, about the future role of regulation were particularly pertinent, and we look forward to seeing how it develops.

I understand the Minister’s response in relation to “may” or “must” and heard loudly his reassurance that there is no doubt that the committee will be established or be upgraded. That being the case, I am happy to withdraw the amendment.

Care Quality Commission Report

Debate between Baroness Wheeler and Lord Bethell

Tuesday 15th December 2020 Lords Chamber

[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.

[Baroness Wheeler (Lab)]

My Lords, the 66 case studies across hospitals and community settings in this very shocking report were of extremely vulnerable people who have all been badly let down by the health and social care system. Most depressing of all is that the actions promised after Winterbourne View and similar appalling situations in the past, which we hoped would lead to major changes in treatment and understanding in the care and support of autistic people and those with learning difficulties, have just not happened. Once again, there is a litany from the patients themselves, and from their families and carers, saying that, if they had received help and support earlier, or when in crisis, they may not have needed hospital care. What are the Government doing to ensure that the right community support is in place for people with autism or learning difficulties in every local area?

[Lord Bethell (Con) [V]]

I completely endorse the noble Baroness’s observations. She is entirely right that the 66 case studies in the report make very harrowing reading. That is why the report was commissioned in the first place, as an acknowledgment that the current state of affairs is not acceptable and needs to improve. Overall, £4.5 billion is going to primary care and community health services, and that is additional money to be committed by 2023-24. It is part of the Government’s overall commitment in this area, and we look forward to publishing a White Paper on mental health shortly.

Puberty-blocker Drugs

Debate between Baroness Wheeler and Lord Bethell

Thursday 10th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, I salute the court’s thoughtful and lengthy judgment, which brought enormous clarity to an area which is very important but which has also caused concern and ambiguity. The court has made it clear that children under a certain age are not ordinarily able to make the kind of decisions that have previously been asked of them, but there are openings. No one under the age of 16 can now be referred on to puberty blockers unless a court rules that it is in the child’s best interest. These are helpful clarifications and we look forward to further work to clarify this area.

[Baroness Wheeler (Lab)]

My Lords, the mental health and well-being of young children and teenagers who present with gender dysphoria are paramount. Given the NHS England announcement on puberty blockers, what support are the Government giving to children and teenagers affected by the revised guidelines and their families and schools? On medical matters, will a young person under 16 concerned about gender dysphoria who approaches a GP continue to be covered by the duty of doctor-patient confidentiality?

[Lord Bethell (Con) [V]]

I reassure the noble Baroness that patient-doctor confidentiality remains paramount and is respected. To update her, the Tavistock has immediately suspended new referrals for puberty blockers and cross-sex hormones for under-16s. In future, they will be permitted only where a court specifically authorises it. I reassure the noble Baroness that those already on the programme will continue their medication until the review has been finalised.

Medicines and Medical Devices Bill

Debate between Baroness Wheeler and Lord Bethell

Committee stage & Committee: 6th sitting (Hansard) & Committee: 6th sitting (Hansard): House of Lords
Tuesday 17th November 2020 Grand Committee

[Baroness Wheeler (Lab)]

I thank the Minister for his extensive and helpful response, particularly on the comments made by my noble friend Lord Hunt about the groups that are consulted. This has been an excellent debate and I have little to add, as noble Lords put forward the issues so ably, in particular on the importance of listening to patients and patient representatives so that the consultation is meaningful and well thought through, given the enormous powers that are in the Bill and will be set out in the regulations. It is timely for my noble friend to remind us of the context of the DPRRC and Constitution Committee reports. I asked the Minister to consider whether Clause 41 should specifically include reference to consultation with the devolved authorities. If he could come back to me on that, that would be helpful. I also asked some questions about his correspondence, which I hope he will agree to follow up.

[Lord Bethell (Con)]

On the question why the government amendment is being made to Clause 41 rather than Clause 16, which I think is what the noble Baroness is asking about, Clause 41 is concerned with consultation. It is important that consultation requirements are provided for in one place, as that assists with clarity and understanding. The legal effect is the same, irrespective of where in the Bill the obligation to consult the devolved Administrations when making regulations under Clause 16 is found.

Medicines and Medical Devices Bill

Debate between Baroness Wheeler and Lord Bethell

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, our Amendment 106, which I am speaking to on behalf of my noble friend Lady Thornton, is in this group on reporting requirements under the Bill. Specifically, it would add a new clause providing for an annual report to Parliament on medical devices information systems established by NHS Digital under the powers conferred by Clause 16. I am grateful to the noble Baroness, Lady Bennett, for her support for this amendment.

Clause 16(1) gives the Secretary of State the power by regulations to make provision for NHS Digital to establish and operate

“one or more information systems”

for medical devices. Under the Bill, these relate to the safety, performance and

“clinical effectiveness, of medical devices … placed on the market; … the safety of individuals who receive or are treated with a medical device”,

or who have one implanted in them, and

“the improvement of medical device safety and performance through advances in technology”.

The annual report proposed in our amendment would provide for the operation of these information systems to include information on the overall data in relation to

“the number of patients who receive or are treated with a medical device, or into whom a medical device is implanted; … any safety concerns received; and … any regulatory action taken.”

Finally, the amendment would ensure that the Secretary of State provided a copy of the report from the information centre on these related areas to the devolved Administrations in Scotland, Wales and Northern Ireland.

The Government’s own Amendment 131, providing a new clause after Clause 41 on consultation provisions and requirements, limits itself to the provision of a biennial report to Parliament starting:

“As soon as reasonably practicable after”


the Bill has passed on the operation of regulations laid on human medicines, veterinary devices and medical devices. The amendment is part of the Government’s response to the Delegated Powers and Regulatory Reform Committee. It also provides for regulations to be subject to public consultation before they can be made and requires the Secretary of State to include in the biennial report, as part of a consultation process, a summary of the concerns expressed or proposals put forward and, in consulting, to set out how the key issues of safety, availability and attractiveness have been taken into account.

The Minister’s letter to Peers of 13 October, which, as my noble friend Lady Thornton has already pointed out, we did not receive until after the amendments had been laid, underlines the importance of the Government’s amendments in providing a reporting obligation on the Secretary of State which

“will inform Parliament of the outcome of consultations on regulation made under Clauses 1, 8 and 12 during the two-year period under consideration, and provide a look ahead to expected regulatory change in the future”.

While consultation before the preparation of the report and information on the consultation, concerns and proposals are welcome, we do not accept that Amendment 131 fully meets the concerns of the DPRRC. We consider that an annual report to Parliament is essential, given the vital importance of the scrutiny and accountability that Parliament must be able to exercise.

We also consider that the government amendment should make a specific commitment to consultation with the devolved Administrations in Scotland, Wales and Northern Ireland, and not just to the Secretary of State consulting such persons as he/she considers appropriate. We will take up the key issue of consultation with the devolved Administrations in our later amendment and I look forward to the Minister’s response to the question of the noble Lord, Lord Patel, on these areas.

Finally, I strongly support Amendments 67A and 67B from the noble Baroness, Lady Jolly, which call for reviews to be laid before Parliament of the regulation of veterinary devices and the Bill’s impact on veterinary medicines after the Act is passed. The noble Baroness made a pretty convincing case for these amendments. The delegated powers in Part 2 of the Bill to amend the Veterinary Medicines Regulations 2013 are wide-ranging. Close scrutiny of the impact on animal welfare, human safety and the environment, together with full consultation with key stakeholders and recommendations on the need for further regulation, will be crucial. Similarly, the review of the Act’s impact on veterinary medicines, to be published one year after it is passed; on safety in relation to animals, humans and the environment; on availability in the UK; and on the UK’s participation in the development and supply of veterinary medicines would ensure full scrutiny of how the provisions in Clauses 9 and 10 were working in respect of these key issues.

I have two further points. During the Commons Committee on the Bill, we raised the importance of the availability of veterinary medicine services, as well as medicines across the country, and of ensuring that they are available in rural and urban settings. This would ensure that we do not have a two-tier system whereby there is better access to veterinary medicines and services in certain communities. We also called for a full assessment of the capacity of the veterinary industry to meet the regulatory and other requirements set out in the Bill. These are key issues which the review process set out in the amendments of the noble Baroness, Lady Jolly, would address. Can the Minister tell the Committee what work is being undertaken with veterinary sector stake- holders, including the British Veterinary Association and the Royal College of Veterinary Surgeons, on these issues —particularly to ensure that, post Brexit, we have the sustainable, diverse and modernised UK veterinary infrastructure and skilled workforce that we need to ensure a safe environment for humans and animals?

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

My Lords, Amendment 67A, put forward by the noble Baroness, Lady Jolly, relates to veterinary devices. This is a proposed new clause seeking to ensure that the Secretary of State sets up a working group to review the regulation of veterinary devices within six months of this Act passing.

There is currently no specific legislation for veterinary medical devices. The market is small and manufacturers may choose to market their products for dual use—for humans and animals. The medical devices regulations are intended only for human devices. However, we consider that the regulatory framework is also suitable for ensuring the quality and safety of equipment for veterinary use. The Bill allows us only to amend or supplement the existing veterinary regulations in the manner described in Clauses 9 and 10. Those clauses do not provide authority for regulations to introduce substantial new standalone requirements for veterinary medical devices. If a medical device is packaged with a veterinary medicine, the marketing authorisation application would need to set out relevant information on that device. The device would therefore be assessed together with the veterinary medicine before a marketing authorisation is granted. Therefore, this type of medical device falls under the regulation of veterinary medicines.

Medicines and Medical Devices Bill

Debate between Baroness Wheeler and Lord Bethell

Committee stage & Committee: 4th sitting (Hansard) & Committee: 4th sitting (Hansard): House of Lords
Wednesday 4th November 2020 Grand Committee

[Lord Bethell (Con)]

I welcome the challenge from the noble Lord, but the examples we have given are also more recent, from the 2009 swine flu attack. The protocols were also used in the Salisbury Novichok attack. I know from my own experience that public health disasters can throw up extremely unexpected hurdles and barriers to action, in the form of legislative surprises. Therefore, these powers are not considered to be frequently used. In fact, they are never used—noble Lords will all breathe a sigh of relief—but public health challenges are likely to be a feature of the future, and it is prudent to put in place the protections we need in order to provide for them.

[Baroness Wheeler (Lab)]

I thank noble Lords for their contributions in supporting the amendment—the noble Lord, Lord Hunt, reinforced by the noble Lord, Lord Patel, and the noble Baroness, Lady Jolly. I was particularly interested to hear the quote from the Leader of the House on this matter, and I am glad that that has now gone on record. I certainly echo the comments by the noble Lord, Lord Patel, about what he calls smokescreens, and his underlining of the powers the Government already have for dealing with such situations.

I thank the Minister for the very detailed explanation he offered on this issue, and for telling us why the Government feel that they do not need to address the DPRR Committee’s concern and table amendments. He also talked about protocols being a last resort, and I was grateful for that—and also for the fact that they would be time limited. I note those two things. This is a complex issue, not least for me. I need to look carefully at the Minister’s response, and, if necessary, come back to this issue on Report. I beg leave to withdraw the amendment.

Social Care

Debate between Baroness Wheeler and Lord Bethell

Wednesday 28th October 2020 Lords Chamber

[Lord Bethell (Con)]

The noble and right reverend Lord is entirely right. There has been a large number of reports on social care, but they have not in themselves brought us closer to a new deal. That is why the Government’s commitment is not necessarily to launch new reviews but to engage in consensus building across the political parties. That consensus building has been lacking in the past and has continually proved to be the stumbling block to reform. The commitment of both the Government and other Benches to those talks is the essential building block of any major reform. I completely pay tribute to the Leader of the Opposition and the Prime Minister for their commitment to those talks.

[Baroness Wheeler (Lab)]

My Lords, the CQC’s report, The State of Health Care and Adult Social Care in England, was published earlier this month. Last year’s report described social care as being at a “tipping point”, and this year’s makes it clear that Covid has not only exposed but exacerbated existing social care problems and thrown into stark relief the long-standing need for reform, investment and workforce planning, including a new deal for care staff. The CQC stresses that the legacy of Covid for social care must be that these crucial issues are tackled now. Why can this not be a priority for the Government and why can we not have at least a timetable for the publication of the social care reform proposals that the Government keep promising but failing to deliver on?

Social Care Workers

Debate between Baroness Wheeler and Lord Bethell

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

This is a very important piece of communication. We have sought to work through the colleges and through the CQC system in order to make sure that employers make knowledge of these funds available to those in social care. I will look at the department to see what we are monitoring and what the take-up rates have been, and if I have any further information I will be glad to write to the noble Baroness with that data.

[Baroness Wheeler (Lab)]

My Lords, on agency staff, according to workforce statistics from the Department for Education in February, the number of agency social workers grew by 10% last year. Cheshire East Council, for example, spent more than £1.3 million on agency social workers last year, and these costs also include the fees that the authority has to pay to the agencies. What funding and other support has been provided to local councils specifically to enable them to reduce the reliance on agency staff and to ensure that the money spent on temporary staff in social care departments, care homes and domiciliary care can instead be used to increase the number of permanent, full-time and part-time staff in social care that are so desperately needed?

[Lord Bethell (Con)]

My Lords, the use of agency staff in itself is not something that we are fighting against. Agency staff, although often denigrated, provide an incredibly valuable contribution to the social care efforts of the country. That said, the main way in which we can address the dependence on sometimes expensive employment practices is to ensure that there is a really large pool of people taking the kinds of jobs offered in social care. That is why we are marketing those roles heavily, improving the employer brand around social care and improving the financial arrangements for those seeking training in social care.

Food Hygiene Rating Displays

Debate between Baroness Wheeler and Lord Bethell

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is probably too early to make an accurate analysis, but one impact that has happened in the food industry is the move to online deliveries. That is why we are considering the application of mandatory rating for online deliveries as well as for restaurants. Online deliveries are a terrific benefit to society, but it is important that they also have regulatory scrutiny, and we will bear that in mind in any future review.

[Baroness Wheeler (Lab)]

My Lords, the consumer magazine Which? has warned that customers are at risk of being left in the dark or misled about food hygiene standards and that the regulator and local councils need to take strong action against businesses that fail to display ratings, or display incorrect ratings that mislead customers. What action are the Government taking to address this? Would he agree that England following Wales and Northern Ireland in the mandatory display of food ratings, as well as restoration after the savage cuts to local council food hygiene budgets and local environmental health services and staff, would help to tackle this problem?

[Lord Bethell (Con)]

The noble Baroness puts the case very well. I completely acknowledge that the FSA favours extending mandatory display ratings to England and that in June and November last year the National Audit Office and the Public Accounts Committee respectively recommended that the FSA pursues this ambition as soon as possible. We very much take on board the views of all these public bodies and will consider the advice given to Ministers as soon as possible.

Mental Health Services: Young People

Debate between Baroness Wheeler and Lord Bethell

Thursday 24th September 2020 Lords Chamber

[Lord Bethell (Con)]

My noble friend Lady Fall is right that the plight of students is tough; going to college will not be like it was in our days. That is why the DfE is putting together a Covid catch-up package of £1 billion, which will include support for universities and for the mental health of students.

[Baroness Wheeler (Lab)]

My Lords, may I return to the issue of counselling? The criteria of the Children’s Commissioner, Anne Longfield, of a counsellor in every school for every child who needs one would help relieve pressure on struggling CAMHS services. Does the Minister acknowledge that the children’s mental health system will struggle to cope as long as we are failing to provide early help to tackle problems before they become crises, and will the Government commit to ring-fence funding for mental health in schools, colleges and universities to enable them to provide mental health support to all young people who need it?

[Lord Bethell (Con)]

My Lords, we are rolling out our response to the Green Paper on mental health for young people. That has included the implementation of mental health support teams, which will make a big impact. In addition, and in response to recent circumstances, on 8 September we launched a mental health well-being campaign specifically for children and young people through the PHE website. It encourages a personal mind plan and the use of a quick and easy interactive tool, and 2.5 million mind plans have been completed since its launch.

Health Care: Guidance

Debate between Baroness Wheeler and Lord Bethell

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness puts it extremely well: all treatments should be individualised and tailored to the patient’s needs and requirements. I applaud the work of the forum. We are committed to continuing that work, and it is an important part of our correspondence with trusts that these standards are upheld and advertised.

[Baroness Wheeler (Lab)]

My Lords, the Minister will be aware of widespread concern that NHS measures introduced in response to Covid-19 are having serious consequences, with patients denied basic healthcare. Almost half of the 102 million GP consultations between March and July were delivered by phone or video, in line with government guidance to deliver a predominantly remote service. What steps are the Government taking to ensure that vulnerable people, especially the elderly, are not shut out from surgeries under measures introduced to stop the spread of the virus this winter? The reality is many are not online, they struggle with complex information systems and will face further difficulties if they are once again advised to isolate.

[Lord Bethell (Con)]

The noble Baroness is right that half of consultations have been done by telephone or on the internet. Some of those have been successful, but I agree with her that we have to keep GP surgeries open for those who either choose or need face-to-face consultations. That is why the NHS chief executive has written to CCGs and trusts urging them to be open and to have fair access to face-to-face consultations where necessary.

Folic Acid

Debate between Baroness Wheeler and Lord Bethell

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I entirely endorse the noble Lord’s appeal for us to eat our greens. The concern with this specific matter is unplanned pregnancies, and the suggestion of putting folic acid into flour is to target those mothers who may need the additional supplements at a time when they do not realise they need them.

[Baroness Wheeler (Lab)]

My Lords, we on these Benches and across the House share the deep frustration of my noble friend Lord Rooker about the delay on this vital issue. When the consultation was announced in June last year, the Government also promised that the results would be dealt with speedily and would go hand in hand with major efforts to step up awareness raising, particularly among at-risk groups, such as Afro-Caribbean women and women under 20 years old. What actions have been taken? What assessment has been made of the reason for the stubbornly low take-up of folic acid supplements? What measurable impact has awareness raising had on reaching at-risk groups or ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

[Lord Bethell (Con)]

My Lords, the noble Baroness did, in part, answer her own question. Work to improve the diet of pregnant mothers has progressed impressively, particularly among at-risk groups. However, it is those mothers who do not know that they are pregnant that this measure particularly targets, and that is where its inherent value is. This is why we have conducted a consultation and are looking to make a decision on it in the near future.

Pharmacies

Debate between Baroness Wheeler and Lord Bethell

Monday 20th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is right that pharmacies can play an enhanced role, particularly in providing the kinds of services that mean that people do not have to visit their GP. If we have learned one thing from Covid-19, it is that GP surgeries can be a source of infection and that GPs can sometimes be much more impactful working away from home. That is why we support exactly the kind of initiative that the noble Baroness outlines.

[Baroness Wheeler (Lab)]

My Lords, we know that the health service faces the herculean challenge of dealing with pent-up demands caused by the coronavirus pandemic, including for postponed elective surgery and delayed preventive interventions. Community pharmacists have proved themselves a key element of assistance during the crisis and should have an important role to play in future in helping to clear the backlog by bringing more care into the community. What plan do the Government have to expand the clinical role of pharmacies and what steps are they taking to ensure that pharmacies are far better integrated into the primary care system?

[Lord Bethell [V]]

The noble Baroness is entirely right. We have introduced a new framework—the community pharmacy contractual framework—which has down- played some services that were not offering value for money but has enhanced some services that have made a huge impact, many of which are of a clinical nature. The settlement also includes a transitional payment, which will help to secure the financial resilience of the pharmacy sector. We could not be more committed to the community pharmacy sector. I believe that the future of healthcare in this country will depend much more on the role of pharmacies delivering the kinds of services that the noble Baroness outlines.

Ultra-processed Foods

Debate between Baroness Wheeler and Lord Bethell

Thursday 2nd July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is right to say that the consultation is an important one and we take it very seriously. Covid has been disruptive, but I reassure her that we will respond to the consultation on extending advertising restrictions as soon as we can.

[Baroness Wheeler (Lab) [V]]

My Lords, I will focus on food labelling. Does the Minister share my concern that it can be difficult to recognise ultra-processed foods in the supermarket? Even a sugary multicoloured breakfast cereal can state that it is a good source of fibre and is made with wholegrains. What consideration have the Government made of improving the food labelling process by adding the NOVA system of food classification, which divides the foods we buy into four groups ranging from unprocessed to ultra-processed? Would this not help to foster consumers’ awareness of how much processed food they and their families eat?

[Lord Bethell [V]]

My Lords, I agree completely with the noble Baroness that labelling is absolutely critical in this area. We have made huge progress already and it is eye-opening to study the labels on some foods. I agree with her that while some supermarket products can look healthy, they are often anything but. We continue to expand and improve our labelling arrangements and we are looking at the responses to the consultation and considering them carefully.

Covid-19: Test and Trace App

Debate between Baroness Wheeler and Lord Bethell

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, our plans for the winter are in development and I look forward to their publication. The noble Lord is entirely right to prioritise antibody screening. We have invested considerably in antibody testing from a number of suppliers, including Roche and Abbott. As he knows very well, the science remains ambiguous, but we are optimistic. That is why we are putting our best minds to understand it better, and we are world-leading in that respect.

[Baroness Wheeler (Lab) [V]]

My Lords, the PNQ refers to the lessons learned. One key one—[Inaudible]—launch of a system that was not ready and serious IT—

--- Later in debate ---

[Lord Bethell]

I pay tribute to the KCL symptom tracker app. I have been a subscriber since the early days of its launch. The data it provides has been extremely useful to the Government and is used regularly. I also pay tribute to my noble friend, who has spoken before about the need for diaries. The work on diary keeping in South Korea and New Zealand has proved important.

[Baroness Wheeler [V]]

My Lords, the PNQ refers to lessons learned. A key one from the sorry story of the NHS app is that the Government should have involved local councils in the trace and contact system from the outset and used the decentralised local PHE expertise and knowledge of infection control already in place. Instead, we had a chaotic government launch of a system that was not ready, with serious IT problems experienced by many of the 25,000 new staff recruited by the NHS to carry out manual contact tracing, as well as training problems and many staff literally not having anything to do. Current figures show that they are doing just 11% of the total work while the vast majority of manual contact is being completed by trained PHE officials. Can the Minister reassure the House that the Government will make sure that councils have the necessary powers they are calling for to be able to fully respond to local outbreak hotspots, and ensure that PHE directors and local infection officials have the funding and support they need?

[Lord Bethell]

The noble Baroness is entirely right that local councils are pivotal to our response to Covid-19. I pay tribute to Tom Riordan, CEO of Leeds City Council, for the important work he is doing to stitch together the alliance of councils which is working closely with the joint biosecurity centre to organise that response. However, I do not agree with the noble Baroness on the role of the tracing teams—it has been incredibly important. There has not been the capacity in the decentralised PHE teams to provide the response necessary to this national epidemic. A central team was necessary and is proving to be effective. We have put PHE expertise at the heart of that programme.

Covid-19: Track and Trace System

Debate between Baroness Wheeler and Lord Bethell

Thursday 18th June 2020 Lords Chamber

[Lord Bethell [V]]

I pay tribute to the perseverance of the noble Baroness on the issue of interpreters. She is entirely right that marginal communities are incredibly important in this process and can be like rockpools when the tide recedes—left as areas of infection if we do not focus on them effectively. That is why we are working extremely hard to identify those communities that might be left behind and to use resources such as interpreters to ensure that the message gets through.

[Baroness Wheeler (Lab) [V]]

My Lords, the ambition of the Minister, reported yesterday, to get a national “track and trace” system going before the winter is in marked contrast to the hype and promises of the test trial launched in May, when Matt Hancock promised that where the Isle of Wight leads, Britain follows—though obviously now not until Christmas. Does the Minister acknowledge that the failure to have an effective system up and running this summer will have a huge impact across vital services, including residential and nursing care homes? Do the Government expect care homes not to open for regular and routine visits from family, friends and others until the end of the year?

[Lord Bethell [V]]

I do not agree with that analysis. I am afraid that areas such as care homes are where the app is least effective, because the residents are static and therefore the app is not really the facility for identifying infections. This is where the manual “test and trace” process is the most effective. That is why we are super-focused on getting it right. We are working very closely with the social care community to ensure that the “test and trace” systems are working well. We are flooding social care with tests and ensuring that our tracing agents are well trained to handle local outbreaks in care homes and to deal with care home staff.

Social Distancing: Two-metre Rule

Debate between Baroness Wheeler and Lord Bethell

Tuesday 16th June 2020 Lords Chamber

[Baroness Wheeler (Lab) [V]]

My Lords, the National Audit Office is the latest in a long line of independent organisations and care bodies to conclude that people and staff in care homes are an afterthought in the Government’s planning for Covid-19. We know that hundreds of thousands of vulnerable people who are shielding from the disease were not warned or included in the last-minute government decision on 30 May to lift shielding. Will the Minister please reassure the House that the impact of any change to two-metre social distancing in care homes, social care and for people whose shielding periods are coming to an end will be fully considered in the review and that advice to them will be a key part of the revised guidelines in good time for any 4 July announcement?

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

The noble Baroness highlights an incredibly important consideration in the review on the two-metre rule. Clearly, those who are vulnerable or in social care deserve the best protection necessary. SAGE has been extremely clear that two metres provides emphatically more protection than one metre, and the protection of our vulnerable people will be an important consideration in any review.

Exercise Cygnus

Debate between Baroness Wheeler and Lord Bethell

Tuesday 9th June 2020 Lords Chamber

[Lord Bethell [V]]

I assure the noble and right reverend Lord that operation Cygnus happened in 2016 and the recommendations were completed by spring 2018. However, it is possible that nothing could have prepared us for the ferocity of Covid. Operation Cygnus prepared us for a flu pandemic and not for something with the savagery of Covid-19.

[Baroness Wheeler (Lab) [V]]

The Secretary of State for Health said in relation to Cygnus and the failure to implement key recommendations and warnings on PPE stocks, ventilators, testing and tracing, and scaling up the public health system, that

“everything that was appropriate to do was done.”

To demonstrate this clearly and with evidence, why are the Government not prepared to be open and transparent and to publish the report and recommendations, or to show what action they took on findings of two subsequent major planning exercises with similar warnings: Exercise Iris in 2018, covering a possible pandemic in Scotland, and last year’s crucial national security risk assessment?

[Lord Bethell [V]]

My Lords, it is necessary for the preparations for such civil emergencies to be made in a confidential fashion so that the unthinkable can be thought and plans can be made in a trusted and benign environment. Publication of these reports is not in the national interest and we do not have plans to publish them in the future.

Covid-19: Care Homes

Debate between Baroness Wheeler and Lord Bethell

Wednesday 20th May 2020 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, this Urgent Question taken yesterday in the Commons on coronavirus and care homes covered much of the ground in the Statement taken by us last night. Sadly, it is clear that Ministers’ claims to have thrown a protective ring around care homes ring hollow in the light of the latest ONS figures on deaths in care homes: 9,495 residents in England and 480 in Wales. These figures are still ringing alarm bells, as the number of deaths involving Covid-19 as a percentage of all care home deaths continues to rise this week. As Martin Green of Care England told MPs yesterday, most care home residents should have been prioritised from the start. He also stressed that there are still huge issues with testing, with results lost and staff waiting eight to 10 days to find out whether they have coronavirus.

I ask the Minister about reports on the PHE study on genome tracking to investigate outbreaks in care homes, which last month found that bank and temporary agency care workers, often employed on zero-hours contracts, had unwittingly transmitted Covid-19 between care homes as cases surged and they were moved from home to home to cover staff vacancies. Does this not raise even further doubts and questions about this ring of protection? Why was this issue not recognised early on as a crucial factor in any infection-control strategy?

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

My Lords, the issue the noble Baroness raises was recognised in the very early stages. The problem of itinerant staff who move from one resident or patient to another was always going to be one of the most difficult to tackle. They perform an absolutely vital role in the care of non-domiciliary patients. That is why we put more money in to pay for more staff, provided PPE for the staff who were working and continue to upgrade the testing arrangements for both staff and patients, to ensure that they are protected.

Covid-19: BAME NHS Staff

Debate between Baroness Wheeler and Lord Bethell

Tuesday 19th May 2020 Lords Chamber

[Lord Bethell]

As I mentioned in my previous Answer, arrangements have been put in place for local trusts to risk-assess all employees, including BAME nurses, and to assess whether they are at a higher risk and, if necessary, to change their rotas and staffing arrangements accordingly. I understand that some trusts have already taken these measures.

[Baroness Wheeler (Lab)]

My Lords, I pay tribute to my noble friend Lady Lawrence for the leading role she is playing in finding out why BAME communities and health workers are disproportionately bearing the brunt of Covid-19.I understand that the Public Health England review of ethnic minority health records and data is due to report at the end of May. It is looking into how factors such as ethnicity, deprivation, age, gender and obesity can affect the impact of Covid-19. People from ethnic minorities may also be at a higher risk due to the prevalence of co-morbidities such as diabetes, cardiovascular conditions and sickle cell disease. Overall, black people are dying with Covid-19 at almost double the rate of white people. Can the Minister say what the next steps will be after the PHE review and what are the Government’s plans, remits and timescale for the more in-depth analysis and inquiry that is needed to better understand entrenched health inequalities and to respond to the needs of BAME communities and health staff?

[Lord Bethell]

The noble Baroness put this very well. We are deeply concerned about genetic differences between groups. This virus is like malaria and other viruses in that it affects different ethnic groups differently. We are concerned about behavioural issues such as diet and environmental issues such as urban versus rural living arrangements. We have already invited health trusts to put in place arrangements to protect our BAME NHS workers. We are also inviting other academic studies, of which there is a large number, to look at the various concerns about how the virus has hit different groups. We will be commissioning a very large amount of medical research into this important area.

Care Homes: Covid-19 Testing

Debate between Baroness Wheeler and Lord Bethell

Thursday 14th 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, I assure the House that the provision of tests for care home staff and patients is a number one priority for the Department of Health and Social Care. We are currently making available 30,000 tests a day through satellite, mobile and at-home channels. By early June we aim to have offered tests to all care home residents and staff specialising in the care of older people and those living with dementia.

[Baroness Wheeler (Lab)]

My Lords, the Minister will be aware that there have been stark warnings from across the sector that, unless testing of staff and residents in care homes is urgently and significantly improved, there could be a second peak in deaths, potentially coinciding with the autumn flu season. Lives are being put at risk and conditions for dementia sufferers have worsened because of the continued failure to test hundreds of thousands of staff and residents. While the DHSC, the CQC and Public Health England will squabble over who is responsible and what each has or has not done, the Government’s own recovery strategy document now admits that they cannot even guarantee that every care home will be offered testing until 6 June, so we have yet another false and misleading promise. The Government themselves admit that only tens of thousands of tests have so far been done in care homes, and over 1.5 million are needed to cover staff and residents. Will the Minister explain to the House how he plans to get to grips with the total and tragic chaos that currently prevails?

[Lord Bethell]

My Lords, I completely acknowledge the threat of a second peak. It focuses the mind and is very much a priority for the Government, but there is no squabble of the kind the noble Baroness describes. I pay tribute to colleagues at the CQC, Public Health England, the NHS and the private care providers with which we work. Care home testing is offered to all care home staff and patients who need it. We are prioritising those who ask for it first and working through the list for any who need it by early June.

Covid-19: Care Home Deaths

Debate between Baroness Wheeler and Lord Bethell

Wednesday 22nd April 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, the need for daily figures means that there are two official publications: first, the daily figure that is used in the No. 10 presentation, which includes deaths of care home residents in hospitals but not those who die in the home; and, secondly, a weekly figure produced by the ONS which covers all locations of death, including care homes, but which has an 11-day lag.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Both Care England and the National Care Forum report an alarming increase in the number of care home deaths, with estimates of more than 6,000 deaths above this week’s official ONS figure of 1,043; we already know that these figures are 12 days out of date when they are published. The National Care Forum has called for the Government to build a ring of steel around care homes to safeguard the most vulnerable among us, with providers suggesting that doctors and nurses should be urgently deployed to fight Covid-19 in homes for older people. They rightly stress that an unprecedented situation calls for an unprecedented plan, as we have had in hospitals. What is the Minister’s response?

[Lord Bethell]

The noble Baroness is entirely right. This is an evil disease which strikes the elderly and those with pre-existing conditions the worst, and those who live in care homes are the most vulnerable. The Government have sought to put a ring of steel in place. We have resourced care homes enormously. Testing is now being focused on care homes to try to reduce the prevalence of the disease, and we will continue to focus on protecting our care homes.

Dementia: Accident and Emergency

Debate between Baroness Wheeler and Lord Bethell

Wednesday 11th March 2020 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking as a result of the analysis published by the Alzheimer’s Society on 22 January showing a 34.5 per cent increase in the number of people with dementia being admitted to accident and emergency departments in 2017–18.

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

My Lords, we are implementing our Challenge on Dementia 2020 commitment to make this the best country in the world to live with dementia. The NHS long-term plan commits the NHS in England to improving the care provided to people with dementia and their carers, including through supporting people in the community and avoiding unnecessary admissions to hospital. People should receive high-quality care in hospital and be discharged in a timely and appropriate way.

[Baroness Wheeler (Lab)]

I thank the Minister for his response and congratulate him on behalf of these Benches on his confirmation in his post. We look forward to continuing the good and constructive working relationship we have had with him since he took up this brief.

These findings from the Alzheimer’s Society research are truly shocking. The 34% increase in emergency admissions of dementia patients to A&E departments represents an increase of 100,000 patients over five years—the equivalent of over 1,000 patients each day. Much of this is the result of the scarcity of appropriate care support in the community or of care home places able to provide the specialist dementia care that is needed. Does this not also underline the scale of the problem the NHS faces in freeing up hospital beds to address demands from future coronavirus hospital admissions? What is the Government’s strategy for ensuring the continuing care for people with dementia in the coming months and in the longer term? Will further guidance and funding be issued to hospitals and care homes specifically to deal with this situation?

[Lord Bethell]

The noble Baroness will be aware that the identification of dementia patients in England has risen dramatically from 42% to 67%, which more than accounts for the increase in the Alzheimer’s Society’s numbers. We are, however, concerned about this issue and remain focused on pulling together a new challenge on dementia strategy for the next five years and on ensuring that beds are liberated in a timely and reasonable fashion.

Coronavirus is naturally a matter of high concern in our preparations. Care of existing vulnerable and lonely people and the elderly is a massive priority, and we are putting in place plans to provide that care.

NHS: Data

Debate between Baroness Wheeler and Lord Bethell

Tuesday 28th January 2020 Lords Chamber

[Lord Bethell]

I wish all noble Lords a happy Data Protection Day, and it is a wonderful day to celebrate it. On the questions raised by the noble Lord, I reassure the House that the Government are absolutely concerned about the interests of patients and patients’ concerns about their own data, but the frameworks that have been put in place by the Government guarantee both transparency and the confidentiality of the data. The data shared with Amazon is freely available. It is provided through an API to 2,000 firms and does not represent anything like the confidential data implied by the noble Lord. Regarding O2, the data has not left the servers of the Birmingham and Solihull trust and it is not being used outside the remit of the pilot arranged by that project.

[Baroness Wheeler (Lab)]

My Lords, the NHS patient database holds the medical records of 65 million people and has an estimated market value of £10 billion. We know that it is a huge asset for the country. What is the Minister doing to ensure that this value benefits the NHS, patients and the future development of treatment and services, rather than boosting the wealth and profits of the global companies currently bidding for lucrative NHS data contracts?

[Lord Bethell]

The noble Baroness is absolutely right to emphasise the value of the data. We are blessed in Britain with one of the largest datasets in the entire world. Enormous work has been put into crafting the frameworks, ombudsmen, regulations and oversight necessary to make best use of this data. The Government are investing in projects such as the NHS artificial intelligence lab, which will put government money to work. We are working with partners who will share income from the use of this data.