Covid-19: Adult Social Care Complaints

Baroness Bennett of Manor Castle Excerpts

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the nature of any future inquiry has not yet been defined. However, all parties will be taking learnings from Covid and bringing forward their lessons-learned experience. As the major regulator, the CQC will play a leading role in bringing together the data and information from the front line but, as the complainant of last resort, the ombudsman will also play an important role in that process by bringing insight from patients and those who have made complaints.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, as the noble Lord, Lord Loomba, indicated, in the context of Covid many families and patients will be looking to stay at home and receive private care there, for longer than they might have. The Minister referred to the “Because we all care” publicity campaign about the ombudsman and its services. However, the annual review of adult social care complaints called for mandatory signposting. Will the Government be introducing mandatory arrangements and rules to be followed by all private providers to ensure that the services of the ombudsman are signposted to people who may need them—not just a publicity campaign but clear direction and information being provided to everyone who might need it?

[Lord Bethell (Con)]

My Lords, I recognise that the ombudsman’s recent report on adult social care did call for a statutory requirement for signposting. We have worked substantially with the sector to improve signposting of the ombudsman and other routes of complaint. The commitment by CQC and Healthwatch to the “Because we all care” campaign is an important and effective measure to fill the gap and raise awareness of the complaints procedure. It is right to wait until we see the results of that campaign. We acknowledge the possibility of mandatory signposting but would like to see a voluntary and more effective marketing campaign work if it possibly can.

Coronavirus Act 2020: Temporary Provisions

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Monday 28th September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I express my enjoyment of our two maiden speeches thus far and look forward to the third.

I am glad that the Minister acknowledged that we cannot say when the crisis will be over. That makes a refreshing change from the World War One-style boosterism of “over by Christmas”; we know what a disastrous impact that approach had a century ago, and I fear it has done great damage today.

It is useful to think back to the mood in your Lordships’ House, Parliament, London and indeed the country six months ago as we passed this Bill. The message on the cover of The Hitchhiker’s Guide to the Galaxy, “Don’t panic”, almost seemed to be projected on the walls of the Chamber in large friendly letters. The noble Baroness, Lady Chakrabarti, referred to the heavy heart that many of us felt at the swingeing provisions of the Act. Six months later, the serious human rights damage and the unnecessary attacks on peaceful protest are clear, as reflected by my noble friend Lady Jones of Moulsecoomb.

We have learned a great deal about the virus that we did not know in March, but the mood of determination to pull together, applaud our NHS and shop for vulnerable neighbours and indeed the promise from the Chancellor to do “whatever it takes” have dissolved, and the Government must take significant responsibility for that. Sadly, “whatever it takes” was a promise that fell apart quickly: local government, huge numbers of self-employed people and those caught in the new starter furlough quickly found that it was not for them. Despite the obvious risks and the still-high levels of the virus around the nations, the message to “stay home” pivoted straight to “get out, mingle and spend money”. It is worth reflecting that it is just one month since Eat Out to Help Out ended.

Let us look forward to the next six months, and three elements that might be in this Act. The first is elections—not a general election, as my noble friend was referring to, although I am far from convinced that stability has suddenly broken out after three elections in five years; we have all heard the rumours. I am talking about the other scheduled, already-delayed elections, elections that are much closer to people’s homes and to decisions that affect people’s lives on a day-to-day basis. The sections of the Act allowing for the delay in elections are still in force. The Government need to publish a plan for elections to go ahead safely in 2021. The election provisions in the Act should be repealed on that basis. Referring to those elections, the Minister said that they hope for normal service to be resumed next May. I say, “Don’t hope. Plan.”

Secondly, on the economy, what is the Government’s long-term plan? Where is the understanding that we will never return to business as usual and that nor should we want to, given the human misery, poverty and environmental destruction that underpinned it? Where is the thinking about how this is a chance to support small independent businesses up down found the land and flourishing newly peopled communities? What were once commuter centres empty most of the time are now humming, with chances for outdoor cafes, catering vans, print and home-office services and computer support, with something like a 15-minute commute—a social and community environmental ideal—to level up by spreading economic activity to every community in the land?

Thirdly, on education, this morning I was reading an email from a desperate home-schooled A-level student left high and dry. Where is the plan to stop SATs and find alternative methods of assessment for GCSEs, A-levels, BTECs and other qualifications next year?

We should be seeing significant elements of the Act repealed now, replaced by a plan and a way forward. I hesitate to interfere with the words of the late, great Douglas Adams but they need amending for this current time. We could project on the walls of No. 10 in large friendly letters, “Stop panicking and plan”.

Health Protection (Coronavirus, Restrictions on Gatherings) (North of England) Regulations 2020

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Friday 25th September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association.

The Minister, in introducing these six statutory instruments, said that they had “Done so much good”. I certainly would not deny the level of effort from the public right through to Westminster, but what is inescapable is a sense of a Government flailing around, laying down statutory instruments, changing them shortly afterwards and acting as though Westminster knows what is best—from Leicester to Lakeside and Newcastle to Newquay. In the meantime, the virus keeps advancing.

I note that what I am about to say reflects the thoughts of Pendle council, as shared with us by the noble Lord, Lord Greaves, and that it also reflects what the noble Lord, Lord Beith, said about clearly dividing laws and guidance. We need a set of alert levels, with enforceable laws that operate for businesses and groups, and a practical guide for action for the police and officials—to act on, for example, an illegal rave or a pub failing to collect contact-tracing evidence. That should be combined with guidance for the public.

As we said in this House on Wednesday, the rule of six means that many households could legally mix in one day, which would obviously be unwise. This is not useful guidance for action, let alone a practical rule. People are making up their own rules, sometimes for want of clarity and useful rebuttal from the Government based on the infodemic that the noble Baroness, Lady Bull, outlined.

Deciding on local alert levels and communicating them should be in the hands of local government, as should contact tracing and support for self-isolation, with appropriate resourcing from the centre. General, practical guidance to all on how and why to minimise risk can be distributed both nationally and locally, while acknowledging the practical difficulties in childcare, for example, as noted by the noble Baroness, Lady Bowles. Will the Government now consider—after stepping back, drawing breath and taking time to think, as the noble Lord, Lord Dobbs, said—a COBRA meeting to help them divide laws from guidance, stop focusing simply on testing numbers and look at testing effectiveness, and give back control to local authorities, which understand the demography and geography of how to control the virus in their area?

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 2) Regulations 2020

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Friday 18th September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, it seems that this House will be spending our Fridays far into the future debating new government diktats after the fact, producing outcomes that, as the noble Lord, Lord Scriven, said, could be seen as farcical, a view that many other noble Lords have reflected. Is centralised decision-making the right approach, even putting aside the democratic concerns? The situation in different parts of England is fast-moving and the economic, geographic and demographic make-up of different regions, cities, rural areas, et cetera, is very varied.

While we in your Lordships’ House spend much of our lives glued to news feeds, most people do not, and the general state of the nation is confusion. Have the Government considered instead creating a clear framework of levels of lockdown—as, for example, was done from the start in New Zealand—providing practical, straightforward guidance about personal risk reduction, as the noble Baroness, Lady Ludford, suggested, and then leaving it to the local authorities to decide, day to day, how to implement and communicate them, guided by local health officials given appropriate resources? That would be a radical change from our usual centralised decision-making—taking back local control—but would be a move, I suggest, to a new and more thoughtful strategy, as the noble Baroness, Lady Neville-Rolfe, said. At the same time, given the excellent results from local test and trace, why not give the entire responsibility for that to local teams, provided with the appropriate resources?

My second question concerns the limits on family gatherings—the rule of six—and, in particular, its impact on childcare. Have the Government assessed the impact on NHS workers and other essential workers with younger children or children home from school? Have they made an estimate of the numbers affected? If so, will the Minister inform the House of that, either today or by letter? This is a limited but terribly important impact assessment, although provision of the broader types of impact assessment, referred to by the noble Baroness, Lady Noakes, would be extremely welcome.

Covid-19 Update

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Thursday 10th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, my understanding is that the risk assessment is done by the local police force in conjunction with Public Health England, but I am happy to check that and write to my noble friend. With regard to Extinction Rebellion, I found the protest last week particularly tedious but I am not sure if it will be outlawed quite yet.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the Minister has taken great pains today to stress the need to ensure that our limited number of tests are well used. I want to revisit the issue I have raised with him before: the list of symptoms as a result of which people are encouraged to take a test. I am sure he is aware of the University of Belfast study of paediatric infection rates, which showed that among children with antibodies a cough was no more common than among those without, while gastrointestinal symptoms such as diarrhoea, vomiting and abdominal cramps were significantly associated with coronavirus infection. Given that many other countries, including the United States, and the World Health Organization list a greater range of symptoms, will the Government consider communicating clearly with the public when the tests are needed, based on the scientific evidence?

[Lord Bethell (Con)]

The noble Baroness raises a very difficult subject. A huge amount of work has gone on in this country and others to define the most effective possible list of symptoms. The honest truth is that this disease manifests itself in different people in a great many different ways, and we have done a huge amount to try to understand the list of symptoms to be described in a way that will capture the greatest number of people in the clearest way possible. We keep that under review, but the work that has gone into it could not have been more thorough.

Childhood Obesity

Baroness Bennett of Manor Castle Excerpts

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay tribute to those at Public Health England who brought together the obesity strategy announced in July and who will continue to work on the obesity strategy. We are consulting on where the ultimate home for that team should be. I emphasise that the obesity strategy launched in July was the most holistic and joined-up piece of policy on obesity in recent times. I emphasise that the money that has come from the sugar tax is now going to pay for sports in schools.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the noble Lord, Lord Dubs, referred to the need for what the IPPR—in a report from last week that I am sure the Minister is aware of—called a “whole society” approach. The current strategy focuses on a few aspects of consumption. Will the Government consider the issue of production and the fact that large multinational companies are making huge profits from unhealthy products, particularly in the beverage sector? What will the Government do to make sure that they make a larger contribution to solving the problem they have created?

[Lord Bethell (Con)]

My Lords, I welcome the IPPR report, but it is not true that the Government do not have a whole-society approach. Our approach to obesity involves physical education, supporting underprivileged families, addressing issues with marketing and a whole range of different issues. As for the noble Baroness’s points on profit, this Government are not against profit, but we are for healthy outcomes for young people.

Medicines and Medical Devices Bill

Baroness Bennett of Manor Castle Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, many noble Lords, including the noble Baronesses, Lady Andrews and Lady Walmsley, have made reference to the extremely strong—you might almost say scathing—report of the Delegated Powers and Regulatory Reform Committee. It is worth going back to its conclusions, in which it states that Ministers are

“given very wide powers to almost completely rewrite the existing regulatory regimes for human and veterinary medicines and medical devices”.

This Bill sees the Government seize control, rejecting the oversight and scrutiny of the elected Members in the other place and the technical experts here. In the best Trumpian style, it declares that the rules will be whatever they want them to be. Forget checks and balances, forget consultation and careful consideration; let Ministers rip. Indeed, that is what the Minister suggested he wanted in his opening remarks, focusing on speed of action, which would happen with scant parliamentary scrutiny. What he is suggesting is something new and radical.

Yet, as the Delegated Powers and Regulatory Reform Committee points out, the Government claim elsewhere that this is like-for-like replacement of existing powers. The Government cannot have this both ways: it is either new and radical or just more of the same. However, the Minister is clearly right: this is new and radical, because what exists now is

“a mechanism for transposing into UK law EU rules on medicines and medical devices ... The new powers are subject to no such constraint”.

The answer here is not to concentrate power in the hands of the Government. The current system is clearly not good enough, but the answer is not to take away controls and oversight but rather to strengthen them through democracy, openness, a focus on the patient experience and independent expertise. As the Cumberlege report suggests, a commissioner for patient safety is crucial, and I am pleased to offer the Green group’s support for the noble Baroness’s proposed amendment, which she just outlined. We need a more democratic, listening approach, as the noble Baroness, Lady Cumberlege, demonstrated so effectively, not a centralised, unchecked one, in which few have input.

Let us consider what the UK regulation might look like if the Bill goes through. We will have a Minister who will be bombarded by well-funded industry lobbyists on what the new rules should look like. A pharmaceutical company or a device manufacturer has not taken the Hippocratic oath. Their job—their legal obligation, in fact—is to maximise profits, and their profits are very large. As the former editor of the New England Journal of Medicine suggested, an appropriate metaphor for the pharmaceutical industry is an 800-pound gorilla. “What does that do?” he asked rhetorically. Whatever it likes. Your Lordships’ House might like to contemplate the image of Matt Hancock up against that gorilla.

We have already seen drug companies flexing their muscle in the notable case of Selexipag—also known as Uptravi—using a patient representative group as cover for a massive lobbying effort. We know that pharmaceutical companies are lining up for a post-Brexit bonanza, increasing the price that the NHS pays for drugs. As the noble Lord, Lord Alton of Liverpool, made clear in his excellent speech, there is a huge problem in our system with conflict of interest, which is only likely to grow.

I am most often talking about the disastrous model of US healthcare in the context of the rush to privatise our NHS, but a significant contributor to its disastrous and highly expensive outcomes is the political power of the pharmaceutical companies. This Bill is not “take back control”. This is “abandon control” and, when you are talking about medicines and medical devices from the industry that gave us thalidomide, the US opioid epidemic, Primodos and pelvic mesh, that is a frightening development.

Smoking

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Monday 20th July 2020 Lords Chamber

[Lord Bethell [V]]

I take a different view from the noble Baroness on the success of pubs’ efforts to introduce social distancing. I spent the weekend in a number of pubs and I was extremely impressed by the measures that publicans have put in place. That is why we support the role of local authorities in judging the right measures for the right pubs and why we will support the government amendment.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I am sure that the Minister is aware that the rate of smoking among adults in Blackpool is almost double that of Westminster. Given the Government’s levelling-up agenda, plus the fact that we know that smoking is related to illnesses that amplify the impact of Covid-19, and indeed threaten greater rates of death, why have we not seen emergency legislation to bring in a smoke-free 2030 fund, which has already been well explored and set out?

[Lord Bethell [V]]

I completely agree with the noble Baroness that there is a massive health dimension to the levelling-up agenda. Health inequalities affect families the hardest and the Government are highly focused on them. However, it is not our style to introduce emergency legislation, because we believe that prevention is better than cure and that people have rights and choices to make for themselves.

Independent Medicines and Medical Devices Safety Review

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Wednesday 15th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right. The report must not be left on the shelf. We have already done much, and in the Medicines and Medical Devices Bill we will do more. The other recommendations will be taken extremely seriously.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, this wonderful but deeply disturbing report has so many points to make, but one point that has not been brought out in coverage as much as it might have been is the noble Baroness’s recommendation that the responsibility for ensuring transparency of interests should fall not only on the medical profession but also on manufacturers, who must take responsibility for ensuring that, where they are creating potential conflicts of interests with medical professionals and researchers, they show that. Can the Minister tell me what plans the Government have to make sure that manufacturers are being open, honest and transparent in all their dealings and that, should they not act in that matter, action is taken?

[Lord Bethell]

The noble Baroness is entirely right that transparency is essential in order to have a fair and equitable healthcare system. The GMC has already considered these areas and has moved a long way. The world has changed considerably since many of these horrific events took place, but I am sure there is more to be done and this recommendation, like others, will be considered seriously by the Government.

Food: Fruit and Vegetables

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Monday 6th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is right about the effects of diabetes, and the impact of Covid on those with diabetes has been profound. It is described well in the PHE report and is a source of enormous sadness. The Government are looking at ways to react to the Covid pandemic, but my instincts are to regard it as an inflection point for the nation’s health. The Government will look at ways to mark this moment with a suitable campaign to encourage healthy eating.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the Minister may be aware of the pioneering work of the American nutritionist Clara M Davis, in the 1920s, who found that just-weaned infants, allowed to choose their own food from a range of healthy natural options, chose a balanced highly nutritious diet and enjoyed it. But our children see a continual parade on their screens and in the shops of highly processed food of low nutritional quality. Does the Minister not think that we need to create space, in their stomachs and minds, to allow the healthy fruit and vegetables in?

[Lord Bethell]

The noble Baroness does me a great service to point out the good work of Clara M Davis, who I was not aware of previously. She makes a very good point: the effect of advertising on children in school is profound—and not just on children but on adults, as well. The danger of ring-fencing children is that they do not learn how to make proper choices in the long term. That is why the emphasis of our work is on ensuring that children learn the difference between good and bad food, learn how to make the right decisions and learn the habits that can set them up for a lifetime.