Commonwealth Fund Report: NHS Ranking

Debate between Lord Bethell and Baroness Neville-Rolfe

Tuesday 14th September 2021 Lords Chamber

[Baroness Neville-Rolfe (Con)]

I hope my noble friend has seen recent reports from NHS doctors in the Daily Mail and elsewhere about the slowness of the NHS to embrace obvious change. Does he think that there are sufficient resources such as GPs, hospital doctors, nurses and medical equipment, to allow the new money being made available announced last week—for which, thank you—to be spent effectively, thereby lowering waiting times? I worry that it will just boost pay cheques, as we saw under a previous Administration.

[Lord Bethell (Con)]

My Lords, I take my noble friend’s point: there are hot spots of innovation and change in the NHS, of which we should be proud, but she is right that the NHS is a large organisation and change can be challenging. In particular, I pay tribute to the Office for Life Sciences, the Accelerated Access Collaborative and NHSX—three organisations within the NHS that are driving change. I also pay tribute to the People Plan, which is putting innovation at the centre of the culture within the NHS. I agree with my noble friend that more can be done in this area.

NHS Update

Debate between Lord Bethell and Baroness Neville-Rolfe

Thursday 22nd July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, we will be accountable for the use of DNR and it is right that the noble Baroness’s specific question should be asked: were any groups disproportionately at the wrong end of this? She is right to ask the question. I cannot give her a precise date for the inquiry, but I have given absolutely cast-iron reassurances that it will happen. I am very tired, as is everyone else, and the thought of starting an inquiry today while preparing for the winter is not one that will help our productivity or help to save lives in the difficult time that we have ahead. The right time for the inquiry is probably when the pandemic is truly behind us.

[Baroness Neville-Rolfe (Con)]

My Lords, the NHS is highly regarded by most people because it is available to all for free. But, as the Statement rightly recognises, despite record investment, it faces major challenges. In particular, survival rates for many cancers trail those in comparable countries. How do we secure the necessary improvements in the NHS, especially at a time when it faces record waiting times?

[Lord Bethell (Con) [V]]

My noble friend gives me an opportunity to raise one of my main ambitions for the health service, which is clearly outlined in the life sciences vision. She is right: we catch too much cancer at stage 3 or 4, when there is sometimes not much that we can do, and anything that we do will be very expensive and make only marginal differences. That is not the same in all countries and it is not good enough in this country. That is why we need to invest in diagnostics and preventive medicine. We need to reweight our health system away from clinical interventions on lumps and bumps at a very late stage. We need to interact with patients at a much earlier stage of their disease. Only in that way will we be able to afford the healthcare system that this country deserves and to give people longer, better lives.

Future of Health and Care

Debate between Lord Bethell and Baroness Neville-Rolfe

Tuesday 23rd February 2021 Lords Chamber

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness, Lady Watkins, for her generous remarks on competitive tendering and discharge to assess. These are examples of where we have listened to stakeholders and those in the NHS who have called for changes. In terms of the powers given to the Secretary of State and the link with social care, it is worth remembering that this Bill is a stepping stone towards other changes. Changes to social care funding can take place largely without any legislative change; they can be introduced by secondary legislation. Changes to the funding model in social care are a matter for a very large engagement process that will include other parties, as the Prime Minister has outlined, and will include very considerable engagement with stakeholders.

In the meantime, we are seeking to correct an overreach in the seclusion and mandation of the NHS to give the Secretary of State the kinds of powers that are reasonable in a parliamentary democracy in the governance of such a large and important national institution. Those powers are to be used with restraint and a degree of circumscription, but they rebalance the political geography of the NHS to give it full accountability. As such, they give the kind of authority the Secretary of State needs to institute the kinds of social care reforms I know the noble Baroness, Lady Watkins, is interested in.

[Baroness Neville-Rolfe (Con) [V]]

While the costs of reorganisation are certain, the expected benefits may or may not be realised. The fate of the Lansley reforms is a lesson for us all. The country will judge the performance of the NHS over the coming decade in the light of this truth. Will the Minister specify objectives against which the new reforms can be assessed?

[Lord Bethell (Con)]

My Lords, the objectives outlined in the White Paper are reasonably clear. The four headline objectives are to make it easier for different people in the system to join up to find ways to address complex issues, to remove unnecessary bureaucracy, to empower local leaders to make the best decisions for the populations they serve and to facilitate a range of other improvements held back by existing legislation.

This is a large Bill with a very large number of measures. It is not, and does not pretend to be, unified by a single thought or held together by an ideology or motivation of any particular philosophy. It is the application of a very large number of recommendations that have come out of a huge engagement with the NHS family, patients and other stakeholders. As such, it is a pragmatic, thoughtful and restrained approach to an important piece of legislative housekeeping of this much-loved healthcare institution.

Covid-19

Debate between Lord Bethell and Baroness Neville-Rolfe

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for the noble Lord’s fascinating mathematics, but there are other principles at stake here and I am not quite sure that his arithmetic can be leaned upon. One of those principles is personal responsibility. We cannot pay the entire nation a huge wage to stay at home for the entire epidemic; we have neither the cash resources nor the value base to do that. We must look to people to do the right thing. If we do not, we will end up with a country that is dependent on the Exchequer for its money and has the wrong values for the kind of enterprise economy that we need to build to get out of this epidemic.

[Baroness Neville-Rolfe (Con)]

Does the Minister realise that the imposition of a 10-year prison sentence for providing an inaccurate travel history on Covid forms is wholly disproportionate? Existing powers should not be misused for this purpose. Such a measure would require proper reflection and parliamentary debate, and it should therefore be in a new Bill if the Government wish to persist with it. In the meantime, will the Minister amend the present proposals significantly?

[Lord Bethell (Con)]

I do not agree with my noble friend on this in any way—fraud is fraud. If you put people in danger, you deserve to serve the consequences. It will be up to either the magistrate or the Crown Court to determine the sentence. The sentence is laid out in law, not by me or any new measure. Those who put the entire nation at risk by bringing variants of concern into the country should be aware that the courts may take an extremely dim view of their actions.

Covid-19 Update

Debate between Lord Bethell and Baroness Neville-Rolfe

Monday 14th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we have a very clear example of what will happen to the economy if the infection comes back. We will have to close down society as we did before, and the economy will suffer profoundly as a result.

[Baroness Neville-Rolfe (Con)]

Most of the Covid measures made under the Public Health Act 1984 have major adverse effects on the economy and on the treatment of other fatal diseases. We cannot go on like this indefinitely until we have a vaccine. We need a new strategy that offers a degree of protection where it is needed, for example in care homes and for the very elderly, and that restores economic and social life. Are the Government now developing such a strategy, and when will we hear about it?

[Lord Bethell (Con)]

My Lords, my noble friend describes in the most beautiful and succinct way exactly the strategy that we are following. It balances on the one hand a fight against disease, a breaking of the chain of transmission, the protection of the NHS and the saving of lives, and on the other a measured, thoughtful and reasonable opening up of the economy, workplaces, schools, shops and other valued economic assets. We are working hard to get that balance right. I believe that we have got it right, but we are open to suggestion and we review the situation incessantly. Until we have a vaccine and other therapeutics to fight this disease, that is the life and the road that we will be walking.

Covid-19 Update

Debate between Lord Bethell and Baroness Neville-Rolfe

Thursday 10th September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord, Lord Berkeley, is entirely right that the impact of this on our economy is profound, affecting the tourism economy, business and the professions. It is not something that we undertake lightly. However, it is the science-based belief of the CMO that the challenge presented by global travel is so profound that this is a step we have to take. When there is a surfeit of testing—when there is a vast amount of it—we may be able to put in place much more extensive measures, but, even so, the CMO remains extremely cautious on this point. However, we are working with Heathrow, the airlines and the airports to keep the matter under review. We take into consideration pilots and are working closely with them to try to resolve the issue.

[Baroness Neville-Rolfe (Con)]

I do not want to add to my noble friend’s difficulties, but I have received some worrying reports that pregnant women are prevented having the father of the baby with them right through labour or when undergoing related treatments, such as scans. This can be devastating, especially if there is bad news, such as a miscarriage. Can my noble friend the Minister do his best to get the rules changed across the country, so that parents can support each other at this vital time?

Covid-19

Debate between Lord Bethell and Baroness Neville-Rolfe

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

The truthful answer to the noble Baroness is that I know that there is an outbreak at Banham but I do not know the operational details of the kind she describes. What I can say is that the system is deliberately constructed so that a local director of public health, or the local authority, has the option, if they think it has local relevance, to bring in the resources that are needed for any particular arrangement. If, for some reason, a local director of public health, or the local infection control team, sees an opportunity for bringing in outside resources—a charity, a company, a technology—that is entirely appropriate and welcome. That is exactly the kind of local intelligence and expertise that we depend on to be effective. A central track and trace operation cannot do everything; that point that has been made in this Chamber hundreds of times and is a point that we entirely embrace. I am, in fact, hugely encouraged by the anecdote the noble Baroness tells.

[Baroness Neville-Rolfe (Con)]

My Lords, I was not surprised to see a report in July that a majority of postal tests were not really working. My husband received a surveillance test, but the lancets did not make a hole big enough to provide enough blood, the little bottle for collecting it was too narrow, and follow-up tests were equally problematic. However, my question today is about masks, which were not mentioned in the Statement. On what scientific advice are government recommendations on the wearing of masks based? This is a subject of heated debate in my household—my positive experience of masks in Asia against the scepticism of the scientifically trained.

[Lord Bethell (Con)]

My Lords, I am terribly sorry that my noble friend’s husband had a tough time with the home testing kit. That is not the experience of hundreds of thousands of people who have taken those surveillance kits, and we know that for a fact because hundreds of thousands have been returned, providing incredibly valuable information that is informing all the conversations and decisions that we discussed earlier. As for masks, the CMO has made it very clear that the scientific evidence is not conclusive, but it is reasonably evenly balanced. It is extremely difficult to prove one way or the other the efficacy of masks, but the experience of countries that are fighting the epidemic effectively has often involved masks in one way or another, and my own experience in Asia reinforces that. That is why we have made the recommendations that we have, and we keep it under review until further science emerges. The British public have shown for themselves an interest in and a relatively high commitment to wearing masks, which I think is instructive.

Covid-19: Response

Debate between Lord Bethell and Baroness Neville-Rolfe

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Lord is entirely right that Covid will lead to changes both subtle and profound in the way we do many things in our life, including patterns of commuting, and a renewed commitment to modes of transport that support our health, particularly cycling and walking. Local authorities such as TfL already have strong bicycling and walking plans. Those will undoubtedly be enhanced, and the Government entirely support them.

[Baroness Neville-Rolfe (Con) [V]]

My Lords, with an eye to its impact on any autumn resurgence, I hark back to questions asked on 11 March by the noble Lord, Lord Kennedy of Southwark, and my noble friend Lord Forsyth, about deep cleansing. My experience of countries in Asia, such as Singapore and Korea, which also pioneered mask use, is that they appear to be much better than us at cleansing medical facilities and other risky premises. They use mists and sprays, applied aggressively in the hands of cleaning professionals, rather than relying on the random impact of risk assessments, NHS and care home cleaners and controllers, and personal hygiene routines, which the Minister emphasised. What does the latest guidance say about cleaning and cleansing? Can we do better?

[Lord Bethell [V]]

My Lords, we can undoubtedly do better in the area of hygiene. The guidance is very clear on what types of detergents work and how they should best be administered. I pay tribute to the cleaning staff in the NHS, who have worked incredibly hard during the epidemic, putting themselves at risk; they have done a very good job. None the less, our view is that the greatest challenge is to change the behaviours of the British public. Work still needs to be done to persuade all of us to wash our hands more and to maintain cleaner personal hygiene. Transmission of the disease happens most often through manual contact—touching the face and shaking hands. That can only be challenged by washing hands.

Covid-19

Debate between Lord Bethell and Baroness Neville-Rolfe

Wednesday 8th July 2020 Lords Chamber

[Lord Bethell]

I completely understand the history of the noble Baroness’s role at City Hall, but I completely push back against her characterisation of the Prime Minister’s intentions. He has made it very clear that he is incredibly grateful for the hard work and sacrifice of those who work in the care homes sector, and I think we can take him at his word on that.

[Baroness Neville-Rolfe (Con) [V]]

There is a real degree of confusion about masks. Originally, Ministers said that they did not do much good; now, the President of the Royal Society claims they are essential. A study at Jena, west of Leipzig in Germany, underlines their value. Will my noble friend clarify the position and explain his reasoning?

[Lord Bethell]

The Government’s approach to the epidemic is to emphasise the three main pillars of our strategy: hygiene, social distancing and isolation. They are based on clear science and evidence. The issue of masks is highly contested. There is possibly a benefit from wearing masks—that is why we have put in place the requirement to wear masks on public transport—but the science remains clear that they are not a replacement for hygiene, social distancing or isolation. On that, we are clear.

Covid-19: Government Response

Debate between Lord Bethell and Baroness Neville-Rolfe

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

The Government’s commitment to isolation is spelled out clearly in guidelines published by Public Health England, and it is promoted every day with the Government’s “stay at home” slogan. On the 200,000-test aspiration, we have put in place a remarkable platform for testing. We have strong partnerships with important companies, we have sourced new supply chains of critical reagent swabs and other supplies that are in short measure, and we are making the logistical arrangements necessary for a massive expansion of testing. I believe that those will take us to whatever is necessary to meet the testing needs of the country.

[Baroness Neville-Rolfe (Con)]

My noble friend has described a situation that is still worrying. The rate of deaths and of new infections is still much higher than we wish, and we may soon be faced with a situation where the rules in different geographical locations or in different institutions vary, so we need more information. To enable us to seek optimum changes, could he please publish more information—for example, on how many cases came from hospitals and where, how many involve hospital or care workers, and how many involve other key workers, overseas visitors, self-isolators and the like?

[Lord Bethell]

The Government have gone about the Covid crisis with a great amount of transparency; a very large number of figures are published every single day. I am afraid that some of the questions my noble friend asks are beyond the reach of measurement in our statistical accountability at the moment, but I completely take on board and celebrate her call for transparency. We are working as hard as we can to get as many numbers out to the public as possible.