Medical Teaching and Learning: Ethnic Diversity

Lord Bethell Excerpts

Tuesday 14th July 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what steps they are taking to ensure that ethnic diversity is fully reflected in all aspects of medical teaching and learning.

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

My Lords, the Government understand the importance of racial equality and diversity within the NHS and are committed to ensuring that this is reflected in medical training. We think we could do better, which is why the General Medical Council sets standards to ensure that students and doctors in training have the opportunity to understand the needs of patients from diverse social, cultural and ethnic backgrounds. That is why Health Education England provides a learning module on equality, diversity and human rights for all health and social care staff.

[Baroness Thornton (Lab) [V]]

Thank you, my Lords. I thank the Minister for that Answer. We live in a multiracial society; our NHS serves everyone and is staffed by everyone. However, the training of our doctors, nurses and medical technicians appears not to reflect this fact. We do not know whether current clinical language and learning has exacerbated the dangers to patients from a BME background during the pandemic, for example.

I pay tribute to Malone Mukwende, a student at St George’s, University of London, who published Mind the Gap as guidance for healthcare professionals, showing how skin conditions manifest on darker-skinned patients. This is a question of medical training, not a question of options that people might opt in to. We have to integrate these issues into our medical training to ensure that all healthcare professionals are able to recognise, diagnose and treat all our citizens from all ethnic backgrounds. Are the Government going to act on that?

[Lord Bethell]

My Lords, I welcome the noble Baroness’s point. She is entirely right that we live in an extremely diverse community, and this has an impact not only on the way people present their disease but on how they could and should be treated. This is why we build diversity awareness into our training and why we will build extra programmes into the People Plan that will be published shortly, and that is why we remain committed to this agenda.

[Lord Boateng (Lab) [V]]

[Inaudible.] Disparity in any part of the healthcare system is a threat to public health. In health education, there is underrepresentation of the black British community in student entry, among academic staff and in attainment. What specific actions do the Government intend to take to address this fact in each of those areas?

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[Lord Bethell]

My Lords, the recruitment of 50,000 new nurses, more GPs and new trainees into our medical colleges is being done in a fresh and, importantly, exciting new way, with a much greater focus in the marketing and advertising on attracting those from BME communities. This recruitment programme will, I hope, present a little bit of an inflection point in our approach to recruitment.

[Baroness Jolly (LD) [V]]

My Lords, the Medical Schools Council is steered by an executive committee of 42, which is elected from its membership. Of these, only four are of an ethnic minority background and 11 are women. Apart from encouragement, can the Minister tell the House what the Government are doing to ensure that, across medical and other health professional training, there is proportional representation of both ethnic and gender minority teachers?

[Lord Bethell]

The noble Baroness is right; the representation of BAME communities at the higher echelons of the medical establishment is not good enough. In too many areas, the representation is not fair and does not reflect the much higher proportion of BME workers at other levels of the health service. We are working hard on a variety of agendas: the People Plan, which I have already mentioned, and the NHS workforce race equality standard. These measures are taken seriously and we are working hard to change the balance of representation.

[Lord McColl of Dulwich (Con) [V]]

Does the Minister agree that, in considering this important subject, there is certainly no room for complacency? However, we do need to know accurately the extent of the problem. Certainly, in all my years in medicine, I have always had this subject very much in mind in selecting and teaching students, selecting doctors and management generally.

Incidentally, I have been very close to members of ethnic minorities who have done much better in life than I have: fellows of the Royal Society, members of the Order of Merit, knights of the Order of the Thistle, presidents of royal colleges and even one who became a king.

[Lord Bethell]

My Lords, I completely agree with the noble Lord, Lord McColl, that complacency is our enemy. I recommend to him the NHS workforce race equality standard publication, which is very detailed in its analysis of the problem and is a guide to the challenge we face and a measure of how far we have come. I completely commend the achievements of those in the BAME community who often far outperform those of us who were born in Britain.

[Baroness Prashar (CB) [V]]

My Lords, we all know that incorporating diversity into medical school curricula is an effective way to develop culturally sensitive responses by medical practitioners. However, does the Minister agree that we need medical curricula where diversity is integral and understood in all its dimensions, including institutional and personal biases? Would he also agree that the current guidance, while welcome, is full of good intent but lacks conceptual clarity, and that more effective work is needed to develop a meaningful and more rounded curriculum and means to evaluate its efficacy?

[Lord Bethell]

The noble Baroness put her point well, although the broadband deficiencies meant that I did not get all of it. I emphasise that this area of policy work is very much the focus of the drafting of the People Plan, which will put a spotlight on a number of the areas of our human resources, including BAME people, and we look forward to the publication of that plan.

[Baroness Blackstone (Ind Lab) [V]]

My Lords, while the curricula of medical schools are for them to determine, could the Minister tell the House whether any meetings between the Medical Schools Council and Ministers have taken place recently? Will he ensure that a meeting is arranged in the near future to hear from the medical schools what they are doing, first, to improve the representation of Afro-Caribbean staff and students and, secondly, to ensure that teaching and research properly explore those conditions to which the BAME community is especially susceptible? Black lives really do matter.

[Lord Bethell]

The noble Baroness asks a very specific question; I cannot, I am afraid, answer precisely on what meetings there have been with the medical councils, particularly during the busy Covid period. All I can say is that there is ongoing and regular engagement with the medical schools that focuses very much on the key issues that she describes. Diversity and Inclusion: Our Strategic Framework 2018-2022, from Health Education England, is a very explicit and specific programme of works in which we engage all those in health education. As I mentioned, we are working extremely hard on our recruitment campaigns to ensure that they reach communities otherwise not reached.

[Baroness Hussein-Ece (LD) [V]]

My Lords, while reflecting diversity in medical training and learning is critical, needed alongside that is a change in the culture in the NHS. Evidence shows that racism, bullying and harassment are not diminishing. Is the Minister satisfied that the clinical leadership across NHS services is committed to learning from the research evidence on the impact of racism and discrimination on health, life chances and mortality?

[Lord Bethell]

I am not satisfied; the statistics are not good enough. Twenty-nine per cent of BAME staff experienced harassment. That is not good enough; we must work harder.

[Baroness Falkner of Margravine (Non-Afl) [V]]

Perhaps I might take the Minister upstream a little to the choices made by different communities about entering medical school. What work is being done at 15 and 16 year-old level in schools? Has his department had any conversations with Ofsted about the career choices that kids from diverse communities are making? Many realise that they want to go into medicine when it is too late and they have missed the appropriate A-level subjects so to do.

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[Lord Bethell]

The noble Baroness is entirely right that decisions on careers are often made at school and if we do not get to people then we may miss them for ever. That is why we have built a major schools component into our recent recruitment campaign. It started in April, but it has been delayed by the Covid epidemic; it will restart shortly. I have commended it a couple of times already, but I reassure the noble Baroness that it has a hefty schools component to it, which I understand is working extremely well.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for the Question has now elapsed.

Independent Medicines and Medical Devices Safety Review

Lord Bethell Excerpts

Thursday 9th July 2020 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the report by the Independent Medicines and Medical Devices Safety Review, First Do No Harm, published on 8 July.

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

While the NHS is a beacon of brilliant care and safety in the majority of cases, we must do better, as this report demonstrates. I apologise in full on behalf of the healthcare system to all the families affected in this report for the time it has taken to listen and respond to their concerns. I salute their courage and persistence in coming forward to make these concerns known. Much has already changed. We are introducing major advances in legislation, but we will respond further. In the meantime, I pay tribute to patients who bravely shared their experiences to inform this important report.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, I thank the Minister for his fulsome apology on behalf of the Government to all the victims—all the women and all the families. The first duty of any healthcare system is to do no harm, and the damning report from the noble Baroness, Lady Cumberlege—whom I congratulate—into the use of these medical devices and medicines, including pelvic mesh, reveals shocking failures in this duty of care. What further urgent action will the Minister, along with his colleagues in the department of health, now take to implement the review’s nine recommendations, including a task force and an exhortation to the devolved nations to implement and act on those recommendations?

[Lord Bethell]

My Lords, much has already happened, and I point to the appointment of a national patient safety agency, run by Dr Aidan Fowler, whom I know and to whose fine work I bear testimony. Much is due to happen shortly: I emphasise the introduction of a registry amendment to the Medicines and Medical Devices Bill, which is due to be debated in this House shortly. But there is more to be done. The Government must consider the report’s recommendations, on which we will return shortly.

[Baroness Kennedy of The Shaws (Lab) [V]]

Does the Minister agree that this scandal is about something much deeper than damaging medicines and inadequate healthcare products? Just as the law for generations dismissed the experience of women who were abused and raped and gave little credibility to their testimonies, the medical profession too has to examine its own culture, which as this report shows—

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[Baroness Brinton (LD) [V]]

My Lords, the country owes an enormous debt of gratitude to the many campaigners who have fought tirelessly over decades to get their issues raised and to ensure that this never happens again. It is good that the Government have apologised on behalf of many Governments, and it is reassuring to hear that there will be some amendments to the Medicines and Medical Devices Bill, but the people who are affected need redress urgently. Can the Minister give us an indication of when this will happen?

[Lord Bethell]

I share with the noble Baroness, Lady Brinton, my personal respect and admiration for the campaigners, who are described in the report as having lived through the most awful experiences and who, through personal commitment and determination, have brought attention to these huge failures and have pursued their cause with enormous patience. We owe them a huge debt of gratitude. In terms of commitments on the individual recommendations, I have mentioned what we have done so far and what we have on the near horizon. However, it will take some time for the Government to study these recommendations—to understand from my noble friend Lady Cumberlege herself her detailed recommendations—and to come back on the timetable that the noble Baroness requested.

[Baroness Cumberlege (Con) [V]]

I will be brief; I could talk about this report for a very long time but I will not, as I am very conscious of other people who want to ask questions. I start by thanking Members of both Houses who have supported us throughout this review and indeed the report. I particularly thank the patient groups, of course. We met them on Tuesday and they were fulsome in their support for this report, which means a great deal to us. We called our report First Do No Harm because that is the principle that should start good-quality care—it is about not only doctors but the whole of the healthcare system—but too often we found that it has not.

First do no harm, but then do some good, because the report also looks to the future. Our report is comprehensive and is built on what patients and patient groups have told us. We listened to them—over 700 women and their families face to face, and many others through telephone calls and emails—we heard them, and we believed. Their stories were harrowing and heart-wrenching: the relationships that were broken, the careers lost, the financial ruin that resulted. Terrible harm has been done to them. It showed us that the healthcare system, as a system, has been failing. I am very pleased that the fulsome apologies made today by our Minister and the Secretary of State have acknowledged that.

Our first recommendation has already been fulfilled and I am sure that the patient groups will be warmed by that. I ask my noble friend the Minister: will the Government seriously study our nine recommendations? Some are about the current situation, some the future. They are all really important. The patient safety commissioner is a new idea and Jeremy Hunt, who commissioned our report, has described it as a very bright and good idea to have someone who will fill the gaps that we have found in the whole of the healthcare system. Will the Minister please ensure that our recommendations are implemented? Implementation is key. We do not want this report to sit on a shelf and gather dust, though I am sure that the patient groups will not allow that to happen. It is really up to the Government to grip this issue and make a real difference in the lives of so many people, suffering not only now but in the future. Will he ensure that the patients, who are the experts, will be closely involved in the implementation group—the task force? Will he recognise the knowledge and experience of the task force? Can he also ensure that the experience of the review team, which has worked so hard, is included?

[Lord Bethell]

My noble friend Lady Cumberlege has put it incredibly well and I endorse her testimony about the courage and expertise of the patient groups who informed this report. I am only sad that they cannot be here to share this important moment. I pay tribute to the work of my noble friend and her team working on this. Patient safety is uppermost now in the mind of health carers. She is absolutely cutting with the groove. The words of Jeremy Hunt are very well made, and we are utterly committed to looking seriously at these recommendations.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I add my apologies to the patients and their families and acknowledge the superb work done by the noble Baroness, Lady Cumberlege, and her team. The report makes very salutary reading. Are we going to make sure that we keep central records relating to any type of implant in future, including mesh used in hernias, so that we can follow up individual cases as appropriate? Will the Government consider returning to the Health Service Safety Investigations Bill, which was delayed and abandoned as a result of the recent general election?

[Lord Bethell]

Health records are absolutely key—that is why we have tabled an amendment on them. That amendment enjoys the support of the Government and of me personally.

[Baroness Thornton (Lab) [V]]

I think we can see that we need a longer discussion on this report. It is quite clear that some of its excellent recommendations will require primary legislation and I hope the Minister may have identified them already. We on these Benches are keen to co-operate with the Government and across the House to bring forward the necessary amendments to the Medicines and Medical Devices Bill.

[Lord Bethell]

The HSSI Bill is an incredibly important part of our agenda. It is not currently on our schedule, but we hope to bring it back at some date, or incorporate its contents in another vehicle.

[The Deputy Speaker]

I call the noble Lord, Lord Willis of Knaresborough. No? In that case, I call the noble Lord, Lord O’Shaughnessy.

[Lord O’Shaughnessy (Con) [V]]

My Lords, as a former Health Minister I add my apologies to these women on behalf of the Government I served. They were let down over many years and I pay tribute to their courage in coming forward for this review. I also pay tribute to my noble friend Lady Cumberlege and her review team for a superb, landmark piece of work. I want to press my noble friend the Minister on one issue: he mentioned that Aidan Fowler is the national director of patient safety in NHS England. That is quite right and very welcome, but the report recommends that somebody from outside the system—someone whose first loyalty is to patients themselves, not to the NHS—should be the gateway, the representative on behalf of patients. I know my noble friend wants to consider these recommendations carefully, but will he not rule out the idea of a new, patient-focused commissioner simply because there is someone leading on patient safety in NHS England already?

[Lord Bethell]

I thank my noble friend for his comments and for his role in commissioning this important report. His point on the safety commissioner is extremely well made. I am not ruling out anything whatever, but we need time to study the report before we can make any commitments.

[Lord Patel (CB) [V]]

My Lords, I thank the noble Baroness, Lady Cumberlege, and her team for what is a hard-hitting report, and rightly so. Reading it, I felt anger and shame—anger that so many women patients were treated with such disdain and felt that they were not listened to; and ashamed that members of a profession I belong to showed such ignorance, arrogance, duplicity and callousness towards the very people who put trust in them. As a member of that profession, I apologise wholeheartedly to women who suffered and I hope that the profession takes heed of them. Much of the report draws on narratives from women, and I was struck by one who called herself

“an unsuspecting, unwilling participant in a cruel experiment”.

No patient should ever feel that. I hope this report is a wake-up call for the professional organisations too, to take charge and become more patient-focused, rather than professional-focused, and to deliver the care that patients deserve. I am a long-time supporter of the charity Epilepsy Action. It has welcomed the report and hopes that action will be taken soon, particularly for women and mothers in relation to sodium valproate. I support the questions asked of Ministers and I hope we will soon see action.

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[Lord Bethell]

My Lords, no one who reads the report can help feeling anger and shame; the noble Lord puts it well. I completely endorse his feelings and the Government will be looking at these recommendations closely and acting on them in the spirit he describes.

[Baroness Bryan of Partick (Lab) [V]]

My Lords, I ask this question on behalf of some of the women campaigners. The report states:

“The removal of transobturator tape is technical and complex surgery and there are very few surgeons in the UK capable of undertaking this”.


While this remains the case, will the Minister consider banning these mesh tapes until women can be sure that any post-operative problems can be fully and safely treated?

[Lord Bethell]

My Lords, one cannot read the descriptions of the consequences of some of the surgery around mesh, and the pain and suffering that some of the women endured, without feeling huge anger and shame and instinctively wishing to ban such a thing. However, mesh offers a solution to some women whose prolapse is profound and who have run out of options. There are women for whom mesh has been a great saving and where there has been a successful procedure. Procedures around mesh have improved dramatically. We are reluctant to apply a blanket ban, but we take the recommendations of the report very seriously and will be looking at this procedure extremely closely.

[The Deputy Speaker]

My Lords, the time allowed for this Question has now elapsed.

Social Care

Lord Bethell Excerpts

Wednesday 8th July 2020 Lords Chamber

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

My Lords, we all agree that social care needs to be put on a sustainable footing where everyone is treated with dignity and respect. That is why the Prime Minister made clear commitments in the manifesto and the election, and why the Secretary of State wrote to other parties to begin the process of cross-party talks. We must now come together to find a common solution to this challenge: a long-term plan for social care that enjoys cross-party support.

[Lord Dubs (Lab) [V]]

My Lords, will the Minister confirm that the Prime Minister, said in his first speech in office that

“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … I will take personal responsibility for the change I want to see”?

Is that still the policy, or will the Prime Minister again claim that he has been misunderstood, as with his recent unpleasant attack on social care, for which he has refused to apologise?

[Lord Bethell]

My Lords, that is very much the policy, but I emphasise the following. No plan can succeed unless it gains the support of a wide number of stakeholders, including cross-party support. Attempts to foist a plan from one group on to another simply will not work. That is why a bridge-building exercise is needed and why the Secretary of State has invited others to cross-party talks. I invite all those players to go into that process with a spirit of collaboration.

[Baroness Pitkeathley (Lab) [V]]

It is good to hear that the Minister now accepts that piecemeal reform of social care will not do. Can he confirm that the Government will consider finally putting social care on the same level as the NHS and creating a national care service in which risks and costs are shared? Sharing costs must apply to the whole population for the whole of their lives, not just when they are in need of care—in fact, from the cradle to the grave.

[Lord Bethell]

My Lords, the Covid epidemic has been a vivid experience for me personally. I have seen how the Department of Health and Social Care prioritises the care for those in social care. I completely endorse the noble Baroness’s view: piecemeal reform is not on the cards. The Government have made it clear that a holistic solution is needed. That is what we are working to achieve.

[The Lord Bishop of Carlisle]

My Lords, following on from the previous question, given that a long-term settlement for social care is one of this Government’s top priorities, and that there is general agreement that this should involve cross-party consensus and a significant measure of integration with the NHS, does the Minister agree that, in the continuing absence of a White Paper, the time has come to establish a Select Committee or perhaps a parliamentary commission with a specific timescale to make recommendations that might finally resolve this complex issue?

[Lord Bethell]

The right reverend Prelate is entirely right that we will need some kind of formal structure to go about cross-party talks and achieve a solution. That formal structure will need to be agreed in cross-party conversations. Those conversations have been ongoing during the epidemic and are now very much the focus of the Government’s attention.

[Lord Hunt of Wirral (Con) [V]]

My Lords, in the light of the surge in support from neighbours, family and friends for older people who have been shielding at home during the pandemic, would my noble friend agree that it is still the policy of Her Majesty’s Government to encourage people to remain receiving care in their own homes for as long as possible?

[Lord Bethell]

My Lords, the role of carers during the epidemic is one of the great stories of commitment and sacrifice. I pay tribute to all those who have given up their time and taken the risks necessary to perform this important community role. On encouraging people to stay home, there are clear guidelines on who is recommended to stay at home. It depends on clinical need and people’s precise circumstances, according to their GP’s recommendations. I urge all people to follow those guidelines.

[Baroness Brinton (LD) [V]]

My Lords, I remember that there was cross-party support 10 years ago for the Dilnot review’s proposals. I support warmly the comments of the noble Baroness, Lady Pitkeathley, about the need for a national care service. Will this review and White Paper also look at matters that are often forgotten in a care setting: housing standards for life, and sheltered and community settings, to make sure that we do not yet again end up looking at just adult social care and care homes?

[Lord Bethell]

The noble Baroness is quite right to shine the spotlight on those who are in social care but not necessarily aged over 65. Half of all social care costs are now dedicated to those under 65. Housing standards is an important question. The stock of housing for social care will be considered in any forthcoming review. It is imperative that we have a modern and up-to-date industry.

[Lord Balfe (Con) [V]]

This policy could lead to literally unlimited costs and a bottomless pit that would make the National Health Service look like a modest outfit. When we devise this policy, we must make sure that adequate contributions are made by those affected and we do not fall into the trap of saying that inherited potential wealth is somehow to be exempted. People must pay a fair share.

[Lord Bethell]

My noble friend is entirely right: there is a massive potential liability. We are acutely aware of the intergenerational implications of social care reform. It is only right that we treat both those in social care and future generations fairly. Those considerations will be uppermost in our minds.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, can the Minister assure the House that any reform of the social care system will be accompanied by a comprehensive workforce strategy and fundamental improvements to employment conditions by moving away from zero-hours contracts, perhaps to an annualised hours system, to guarantee social care workers regular incomes?

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[Lord Bethell]

My Lords, the precise remit of any review will be the choice of those doing the review when it comes, but I entirely endorse the noble Baroness’s sentiments that the social care workforce is worthy of our respect, particularly for its hard work and commitment during the epidemic. Workforce remuneration has improved since the introduction of the national living wage in 2016. Flexible contracts suit many workers, so a blanket commitment to annual wages is not necessarily suitable, but I endorse a focus on solutions that encompass all aspects of the social care industry, including the workforce.

[Baroness Thornton (Lab)]

My Lords, following on from what the noble Baroness, Lady Brinton, said, the Minister’s party has form for not honouring cross-party co-operation on this issue. To mitigate that, given that the Prime Minister has said that he is currently finalising plans, perhaps the Minister could commit the Government to setting a firm date and a timetable that could be published before the House rises for the Summer Recess? Does he accept that we need a plan to be delivered within a year?

[Lord Bethell]

The noble Baroness is kind to think that I am in a position to articulate a timetable from the Dispatch Box—that is beyond my abilities. However, she is entirely right to focus on the urgent need to focus on this area. The Prime Minister and the Secretary of State could not have been plainer that when the time is right and we have dealt with the epidemic, social care reform will be uppermost in our mind and will be the focus of our attention.

[Baroness Bowles of Berkhamsted (LD) [V]]

My Lords, since 1998 there have been 12 Green Papers, White Papers and other consultations, and five independent reviews, and like the Economic Affairs Committee, they all say that the system needs to be properly funded. Will the Government do that for immediate needs so that the White Paper can go on to do real good for the long term?

[Lord Bethell]

The noble Baroness is quite right to allude to the very large number of White Papers, think tank reports and amount of documentation in this area. All I can say is that I have never seen such acute political will and focus on social care reform. Nor have I seen a Prime Minister, a Secretary of State and a chief executive of the National Health Service to be so focused on the matter and to have raised it as a major priority in all their communications.

[The Deputy Speaker (Lord Alderdice) (LD)]

My Lords, the time allowed for this Question has elapsed.

Covid-19

Lord Bethell Excerpts

Wednesday 8th July 2020 Lords Chamber

[Baroness Thornton (Lab)]

Last Wednesday, the Minister advised noble Lords that the lockdown in Leicester was being carried out under the Public Health (Control of Disease) Act 1984 and that regulations would not be brought to the House. However, on Friday, Leicester regulations were laid. Can the Minister clarify that and explain why there was some confusion and whether this has any practical consequences for implementation and enforcement in Leicester? Will this apply to other cities such as Bradford, Barnsley or Oldham? At Prime Minister’s Questions just now, the Prime Minister stated that the risks associated with asymptomatic transmission were unknown until recently. This is not the case. I am very happy to provide the Minister with SAGE minutes from 4 February, for example, when precisely that was recorded. Can the Minister clarify that statement for the House?

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

My understanding regarding the 1984 Act is that the regulations are published under the appropriate section. They have been published as is appropriate, but they are not brought to the House for debate. If I am wrong, I will be happy to write to the noble Baroness.

[Baroness Brinton (LD) [V]]

Today, the Public Accounts Committee has reported real concerns that the Government have no realistic plan for supplying PPE in the event of a second wave. Can the Minister comment on that? I know I ask this regularly, but can the Minister tell the House when all NHS and social care staff, including those working in people’s homes, can get regular, repeated testing that is not dependent on symptoms? Yesterday, Matt Hancock said that, finally, some day centres, sheltered living and non-care home settings will be able to access tests. Which ones and when? I noticed that, on Monday, the Covid data dashboard was changed, removing posted-out but not returned tests. Does that mean that, in future, posted-out tests will not be counted unless they are returned?

[Lord Bethell]

On PPE, I pay tribute to my noble friend Lord Deighton, who has performed an amazing task in providing an enormous supply of PPE. There is sufficient PPE in the NHS, social care and other parts of the healthcare system for all those who need it. There is a PPE hotline for those who would like to order it directly and, at this stage, stockpiles are being created to get us through the winter months. On tests, a testing portal is available to all of social care. It can be accessed either by social care employers or, if employees or residents want a test, they can order one themselves through the public testing portal. It is my understanding that posted tests are no longer counted in the same way: they are counted not on dispatch but when they are processed. The “test and trace” programme initiated this change in the recent change of data, which I think was 10 days ago.

[Lord McColl of Dulwich (Con) [V]]

My Lords, last week I understated the figures on the deadly combination of Covid-19 and obesity. House of Commons Library figures show that 72% of UK people are either obese or overweight. What is even more tragic, 33% of 10 year- old children are overweight or obese. These appalling figures may help explain the high mortality from the coronavirus in the United Kingdom, so will the Minister endorse the urgent need to persuade people to lose weight? To save lives, we should follow the advice of the Prime Minister himself, who said, “Don’t be a fatty in your fifties”.

[Lord Bethell]

I think my noble friend and I need to have a chat about statistics, because the statistics I have differ from his. Mine suggest that 28% of the public are either obese or overweight, and it does defy common sense that 72% the public are obese or overweight. Maybe he and I can have a chat about that offline: I would be glad to clear it up. However, my noble friend makes a really important point that I and the Government completely endorse: the Covid epidemic has been a wake-up call for the country—in that, he is right. There is an urgent need to address the obesity epidemic and the Government are looking at ways to do so. The Prime Minister is personally vested in it and my noble friend’s points are extremely well made and supported on these Benches.

[Lord Bilimoria (CB) [V]]

My Lords, it is very good to see the Statement saying that new cases are at their lowest since the lockdown began. Will the Minister confirm that 30,000 excess deaths have taken place in care homes, and that almost 20,000—almost 50%—of all the sad deaths have been in care homes? Are care home staff, the 1.6 million people who work in the care sector, as well as the 1 million patients in care homes and at home, being tested every week? Just today, we heard that the accident and emergency department at a London hospital has closed because of infection among the staff. Are all staff at NHS hospitals around the whole country being tested regularly, every single week? Looking ahead, will there be a large-scale flu vaccination campaign as an extra precaution leading up to this winter?

[Lord Bethell]

The noble Lord is entirely right to emphasise the importance of flu vaccination. We are very focused on getting the right amount of flu vaccination stocks and encouraging take-up once the WHO has nominated the right vaccination and we have stocks of it in this country.

[Lord Mann (Non-Afl) [V]]

Small sports clubs are particularly vulnerable to the lack of people paying to go in. When will the Government come forward with plans to allow small numbers of people to pay to be spectators at sports such as football or rugby league, socially distancing in the same way as is now allowed in cinemas, pubs and restaurants?

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[Lord Bethell]

I welcome the start of cricket, which I understand began today. I correct the noble Lord on one small thing: cinemas are not open, nor are they likely to be in the near future. The CMO, under the advice of SAGE, is considering the provision of new guidelines for spectators at sports. I do not know exactly when that will be, but it is certainly under review.

[Baroness Jones of Moulsecoomb (GP) [V]]

My Lords, when our Prime Minister was Mayor of London and I was on the London Assembly, part of my job was to keep a close eye on what he said and did. It is my informed opinion that when he spoke about care homes and the 20,000 deaths, he was intending to pass criticism and blame away from himself and his Ministers. Is the Minister prepared to disagree with my informed opinion?

[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.

[Lord Truscott (Ind Lab) [V]]

My Lords, the fall in cases is welcome, but is it not becoming clearer that in aiming to create spare bed capacity in the NHS at the expense of the elderly, Her Majesty’s Government ended up putting saving the NHS ahead of saving lives? Another example of that is the strict criteria applied to hospital admissions. Should these criteria not be immediately relaxed to save lives?

[Lord Bethell]

The noble Lord make his point well; however, I did not hear all of it. We are working extremely hard to increase the number of admissions in hospitals and all parts of healthcare. We are trying to restore confidence in the healthcare service to address public concerns, and I appeal to all those who have appointments or who are feeling poorly to take the opportunity to phone 111 and book themselves into hospitals or into the appointments they need, because we desperately need people to return to the NHS.

Independent Residential Care

Lord Bethell Excerpts

Tuesday 7th July 2020 Lords Chamber

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

My Lords, this disease has targeted the vulnerable, and those working and living in social care have faced daunting threats. The Government have intervened with £3.7 billion for local authorities, including specific funds such as the £600 million infection control fund and the £500 million announced on 2 July. Delivery is being supported by our social care Covid-19 task force.

[Lord Laming (CB) [V]]

My Lords, I am grateful to the Minister for that reply, but he will know that, nowadays, residential care homes are provided not by local authorities but by thousands of independent organisations. It is now thought that some of these organisations may be in financial difficulties. Can the Minister tell the House what plans are in place to protect the residents of a home which ceases to operate, especially as these residents are not only very vulnerable but, frankly, have nowhere else to go?

[Lord Bethell [V]]

My Lords, the noble Lord is entirely right. The protection of residents is our number one priority and our responsibilities under the Care Act 2014 remain in place. The care home economy is mixed. We are looking very carefully at the financial resilience of all the providers involved. We are providing the funds necessary to see them through this epidemic and we will do whatever it takes to protect residents.

[Baroness Armstrong of Hill Top (Lab) [V]]

My Lords, given the unfortunate words of the Prime Minister last night, where he seemingly blamed care homes for high rates of Covid-19, when will the Government actually produce the long-promised proposals for the future of social care, which will guarantee quality through acknowledging the need for a skilled, stable and trained workforce, properly valued?

[Lord Bethell [V]]

My Lords, we are enormously grateful to all those working in the care home sector, who have protected residents through this awful epidemic, and we continue to support them. We have increased recruitment in the area, and are in the midst of an enormous recruitment marketing campaign to bring new, qualified people into the care home sector. The Secretary of State wrote to relevant stakeholders on 14 May, inviting them to cross-party talks on the care home sector. We are continuing those conversations and hope to bring them to a head at the earliest opportunity.

[Baroness Brinton (LD) [V]]

Yesterday, our Prime Minister said that

“too many care homes didn’t really follow the procedures”.

In March, the care sector asked for testing for patients discharged from hospital. The Government’s reply—not necessary. The sector could not get the promised PPE as government supplies failed to appear. All our amazing 1.6 million care home workers needed testing from March—it took the Government three months. Complex government guidance changed frequently, sometimes even daily. Our care homes have had to cope with 30,000 excess deaths in three months and massively increased costs. Does the Minister agree with our Prime Minister, or with the National Care Forum, which said that Boris Johnson’s remarks were, “frankly, hugely insulting”?

[Lord Bethell [V]]

I thank all those who work in the care home sector for the enormous amount of sacrifice and commitment that they have shown to protecting residents. The noble Baroness, I think, portrays the situation unfairly. Guidelines have changed quickly because the situation changed quickly. PPE demand could never have been expected at the levels it reached; the Government responded incredibly quickly to move PPE into both NHS and social care. On testing, we started from a very low base; testing has now been introduced in care homes for both patients and staff. The Government will continue to be committed to protecting both staff and residents in the care sector.

[Lord Mackay of Clashfern (Con) [V]]

My Lords, is the money that the Government give to local authorities for social care ring-fenced for that purpose?

[Lord Bethell [V]]

My Lords, the money that my noble friend refers to is not currently ring-fenced. Local authorities have been written to, to explain that the money should be prioritised for Covid—but, at the request of the local authorities themselves, the money was not ring-fenced.

[Baroness Hollins (CB) [V]]

My Lords, the Vivaldi project found that, in care homes where staff received sick pay, there were lower levels of infection in residents. During the next pandemic, will our priority to be to save the NCS—the new national care service—as well as the NHS, or will we have an integrated NHCS national health and care service, or, what other urgent measures are Her Majesty’s Government considering to protect care?

[Lord Bethell [V]]

The noble Baroness puts her question extremely well, but I am afraid it is beyond my ability to predict as she asks exactly what the shape of the national care provisions will be. What I can say is that the role of agency staff was always, from the very earliest stage, one of the gravest concerns we had. The CMO flagged it very early, and we moved as quickly as we could to tackle the difficult issue of itinerant staff, and to put in place both the funding and the procedures to anticipate problems of infection around staff who move from one home to the next.

[Baroness Thornton (Lab) [V]]

My Lords, I return to the question raised by my noble friend Lady Armstrong and the noble Baroness, Lady Brinton, because, while it is obviously welcome for the Minister to thank those who work in care homes for the sacrifices that they have made, he needs to acknowledge the hurt that the Prime Minister has caused with his words. Will the Minister clarify which procedures care homes are accused of disregarding? Are they procedures related to the Government’s policy of allowing hospital patients to be discharged without testing, to the failure to provide the required PPE or, perhaps, to setting up the testing programme so late?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, it is not the role of a junior Minister to speak on behalf of the Prime Minister, but I can say that the Prime Minister, the Secretary of State and I are all enormously grateful for the huge amount of work that social care staff have put into this epidemic. I have seen with own eyes the commitment and expertise that they have provided during these very difficult days. We are, as a nation, enormously grateful for their hard work and skill.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, the pandemic has placed a very harsh spotlight on the resilience of the care system, with 30,000 excess deaths in care homes in England and Wales in a three-month period. At the weekend Sir Simon Stevens made it crystal clear that we just do not have a fair or properly resourced social care system with proper workforce support. With some homes already running close to bankruptcy due to the additional costs and occupancy rates slipping below 87% when many smaller homes become financially unviable, what immediate steps are the Government taking to protect these smaller homes?

[Lord Bethell [V]]

The noble Baroness is entirely right that the issue of excess beds is an unfortunate and unwelcome added pressure on an already pressured system. Sir Simon Stevens was echoing the sentiments of the Government and the Secretary of State when he said that we need to move towards a long-term settlement for social care. That was very much the commitment of the Prime Minister during the election and in the manifesto. Steps have been taken towards working on that but we have been interrupted by Covid-19. It remains a number one priority for the Government. In the meantime, we will be putting in the financial resources necessary to provide the resilience for those smaller homes of which the noble Baroness speaks.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, does my noble friend think it reasonable that, 12 months after the Economic Affairs Committee produced the report Social Care Funding: Time to End a National Scandal, we have not had a debate on the report or a response from the Government? He talks about providing resources for social care. That report identified an £8 billion gap just to get back to the standards we had in 2010. Does he not think that instead of the occupants of Nos. 10 and 11 Downing Street standing on their doorsteps and putting their hands together to clap the achievements of social care workers, their hands should be put in the Treasury’s pocket to find the money now urgently needed to prevent the collapse of nursing homes and to prevent us continuing to rely on the good will and hard work of people who are being pressed beyond endurance? This delay cannot go on longer and longer, which has been the pattern for the last decade.

[Lord Bethell [V]]

My noble friend asks the question extremely well. The Lords Economic Affairs Committee report is an extremely thoughtful and respected piece of work. Under normal circumstances we would certainly have had that debate and moved forward on this incredibly important issue, which was flagged both in the election and in the manifesto as a major government priority. However, I cannot hide from my noble friend that the Covid epidemic has disrupted progress, particularly on this delicate issue, which requires a huge amount of management time by senior healthcare officials, who are utterly consumed by Covid at the moment. Please be under no illusion that this is a major priority for the Government. Once the preparations for winter are in place, it will be at the top of the list.

[Lord Harries of Pentregarth (CB) [V]]

The Covid crisis has revealed the crucial role that care homes and care workers play in our national life. Does the Minister agree that it is high time to take a radical look at the role of care homes and of social care more generally, especially the status and the pay of care workers, who have revealed their worth so wonderfully over these last few months?

[Lord Bethell [V]]

The noble and right reverend Lord is entirely right: the value and contribution of care home workers to society and to the communities that they work in go way beyond the actual monetary value of their salary. We completely respect and pay tribute to the contribution that they have made, particularly during this epidemic. We have sought during the epidemic to run recruitment campaigns to bring in new workers and to help plug any skills gaps, but this is the kind of issue that needs to be addressed in a long-term plan. We have already started work on that plan and look forward to bringing it to Parliament when the kind of cross-party support that is needed is in place.

[Baroness Falkner of Margravine (Non-Afl) [V]]

My Lords, I welcome the initiation of cross-party talks. The Minister will know now that more than two-thirds of the public want to fund health and social care through higher taxation. Will he now accept that as a principle if that is the result of the cross-party talks, instead of his Government ruling out tax increases?

[Lord Bethell [V]]

The noble Baroness makes her case well. There are a large number of considerations in this matter—my noble friend Lord Forsyth has already made a strong case for the recommendations of the Economic Affairs Committee—and we need to look at all of them. It is an extremely complicated area. We need to get buy-in from cross-party support and from a wide number of stakeholders and the businesses involved. Once we are in that position, we will be able to make a plan that delivers a long-term solution to this knotty problem.

[Lord Desai (Lab) [V]]

My Lords, we must welcome Sir Simon Stevens’ promise to help independent care providers, but will we make sure that when the money goes to those providers they pay their staff properly, give them protective equipment and do not let them go on working in an unsafe and underpaid profession?

[Lord Bethell [V]]

My Lords, the role of the staff is essential. We have put in place an infection fund of £500 million to help to provide a safe working environment for staff, and we are looking at mobilising a huge PPE effort, led by my noble friend Lord Deighton. The protection and payment of staff are essential. However, a long-term solution for staff will depend on a long-term deal. We are working on that but I cannot give any assurances until the important work of building cross-party support has been fulfilled.

Medicinal Cannabis

Lord Bethell Excerpts

Monday 6th July 2020 Lords Chamber

[Baroness Meacher]

To ask Her Majesty’s Government what action they plan to take to improve access to cannabis for medicinal purposes for (1) patients, and (2) research, in the United Kingdom.

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

My Lords, I thank the noble Baroness, Lady Meacher, for her Question. There is no legal impediment to prescribing medicinal cannabis where clinically appropriate, and the Government are keen to make progress in this area. However, these are largely untested, unlicensed products. To support further NHS funding decisions, we have committed public funds to develop the evidence base. I thank NHS England, NHS Improvement and the National Institute for Health Research for their work to establish much-needed clinical trials and call on the industry to support clinical trials in refractory epilepsy and other treatment areas.

[Baroness Meacher (CB) [V]]

My Lords, from 1 November 2018 consultants have been able to prescribe medical cannabis as an unlicensed medicine, as the Minister implies, yet NHS doctors remain unwilling to prescribe, partly because medical cannabis remains on the list of controlled drugs. Hundreds of thousands of patients with severe and chronic conditions who find that cannabis is the only medicine that controls their symptoms without unpleasant side-effects continue to risk arrest every day by growing or buying their medical cannabis at exorbitant prices. Does the Minister agree that this is contrary to the patients’ human rights? How can we criminalise patients for saving the NHS huge sums of money by looking after themselves and doing harm to no one? Will the Minister appeal to Matt Hancock to write to the Home Secretary, urging her to remove medical cannabis from the list of controlled drugs?

[Lord Bethell]

There is a difference between the issue of controlled drugs and that of access to regulatory approved drugs. The noble Baroness is right that medicinal cannabis offers huge hope to those in pain and with severe symptoms. However, it is only through the process of regulation, clinical trials and scientific proof that we can guarantee that the benefits of this important medical opportunity are truly exploited.

[Lord Howarth of Newport (Lab) [V]]

My Lords, is the Minister aware of the predicament of the person who suffers chronic and unbearable pain from degeneration of the spine, the only effective relief for which is medicinal cannabis in the form of Bedrocan? Is he aware that her medication is not allowed to be prescribed by a GP on the NHS, that it costs her an unaffordable £750 a month to obtain it on private prescription, that she can obtain it at an affordable price in Holland, that due to the circumstance of the pandemic she cannot make that journey, but that she is none the less expected to pay the Dutch pharmacist for the medication being held for her? What is she to do, and how will the Minister help?

[Lord Bethell]

My Lords, I cannot comment in detail on the specific situation the noble Lord refers to. I recognise the high costs of medicinal cannabis, and we have done an enormous amount to bring those costs down and to regularise the transport and regulation of those drugs, but this is the way our medical arrangements are made in this country. Private prescriptions are an option for those who can seek them, and we are working hard to get more of these medical cannabis treatments on the NICE schedule, but they require clinical trials.

[Baroness Walmsley (LD) [V]]

My Lords, will the Minister accept that the existing protocols and regulatory mechanisms suitable for most pharmaceutical medicines are not capable of handling medical cannabis, which has multiple active ingredients and is therefore not suitable for the usual randomised control trials? Does he therefore agree that a new regulatory system is required for medical cannabis, as there is in many other countries?

[Lord Bethell]

I do not think the noble Baroness is right. There are always groups advocating that their medicines are different from every other type of medicine, but the processes of clinical trials have served medical science extremely well. I share her frustration that the process of medical trials around cannabis has not moved quickly enough. That is why NIHR is looking again at the way these trials are funded; I have spoken to it about how this can be accelerated.

[Baroness Fookes (Con) [V]]

Given the importance my noble friend attaches to tests, may I ask whether any have started, the dates on which they started and when we might expect results?

[Lord Bethell]

The noble Baroness is very specific in her questions, and I am afraid I am not able to answer them specifically because they are subject to restrictions and confidentiality. Where I agree with the thrust of her question is that we have been in a bit of a cul-de-sac in this area, but the department is working hard to unblock the problems that have existed. Despite Covid, we appear to be making some progress on this.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, two cannabis medicines have MHRA approval. One of them, Sativex—prescribed within the NHS for multiple sclerosis—has a high level of the active cannabinoid THC, so we know cannabis has medical value. There is no doubt that many more cannabis medicines will be licensed in the coming years. Does the Minister therefore agree that while we are reviewing our current trials, we should evaluate whether it is justified to regard cannabis, in a medical way, as a controlled drug in the long term?

[Lord Bethell]

The noble Baroness will not be surprised to learn that I have just spent three and a half months looking at drugs that might make a difference to Covid, only to find that many of them are not helpful and often quite dangerous, so I do not share the optimism bias that many have towards unlicensed drugs. We remain conservative in our approach to clinical trials. I agree with the noble Baroness and others who have suggested that progress on this should be quicker, and I am leaning into the subject to try to bring that about as soon as we can.

[Baroness Thornton (Lab)]

My Lords, it is deeply concerning that no new NHS prescriptions for full extract cannabis oil have been issued since the medicinal use of the drug was legalised more than 18 months ago. This leads to a health inequality: 313 private prescriptions for unlicensed cannabis medicine items, including full extract oil, have been issued. Does the Minister share my concern that only wealthy families and those who can successfully raise funds in the region of £2,000 a month have access to cannabis medicines, while children from poorer families who are unable to afford the prescription are going without? What does he think needs to happen next?

[Lord Bethell]

The noble Baroness shines a spotlight on an uncomfortable but realistic fact of life in our medical service: those with money are able to pay for treatments beyond the reach of those who rely on the NHS for absolutely everything. Another area that concerns me is that those who have relied on fundraising have found that Covid has restricted the amount of money coming from donors. That is why we have put money into medical research charities and support charities that can help support those fundraising for their medicine.

[Baroness Brinton (LD) [V]]

Since the law changed in 2018, only two children with severe epilepsy have accessed whole-plant cannabis medicine via the NHS. Recently, a child ended up in intensive care in the middle of the Covid pandemic and almost died because her parents could not fundraise the money to buy her medicine privately. Does the Minister accept that this is a complete failure of the policy and that a new regime for the regulation and control of access to medical cannabis is now required?

[Lord Bethell]

The noble Baroness’s point on fundraising is well made, and I think I answered it in my previous answer. We are looking at it closely. On policy-making in this area, it is extremely tough to regulate innovative drugs that simply do not have clinical trials and evidence bases behind them. We have put a huge amount of effort into this area. We are working closely with industry; I call on industry to do everything it can to help this process. We are trying our hardest to provide the right regulatory environment. As the noble Baroness pointed out, we have already made important changes to the law.

[Lord Norton of Louth (Con) [V]]

My Lords, the report of NHS England and NHS Improvement, commissioned by the Secretary of State, was published last year. Very little appears to have been done to implement its recommendations. Can my noble friend say which recommendations have been implemented and what plans he has to ensure that they are all met?

[Lord Bethell]

The noble Lord is right to point out the importance of that report, which we have taken very seriously. We have worked closely with industry to find a suitable product to take into the trial process, and it is a great shame that we have not found the right combination. We are looking at how to address that cul-de-sac and I hope to unblock it shortly.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for the Question has elapsed and we come now to the third Oral Question.

Food: Fruit and Vegetables

Lord Bethell Excerpts

Monday 6th July 2020 Lords Chamber

[Baroness Boycott]

To ask Her Majesty’s Government what steps they are taking to increase the consumption of fruit and vegetables by (1) children, and (2) adults.

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

The Government are committed to encouraging children and adults to eat at least five portions of a variety of fruit and vegetables every day. Healthy Start vouchers enable low-income and disadvantaged families to purchase fruit and vegetables. Mandatory school food standards and the School Fruit and Vegetable Scheme also encourage fruit and vegetable consumption. Public Health England encourages the eating of fruit and vegetables through the Eatwell Guide, catering guidance and marketing campaigns, including Start4Life, Change4Life and One You.

[Baroness Boycott (CB) [V]]

My Lords, I thank the Minister for his Answer and declare my interests, as set out in the register. As noble Lords know, diets low in fruit and vegetables are now directly associated with 20,000 deaths a year in the UK. Despite the Government’s costly Five a Day campaign, our vegetable consumption is steadily declining and now equals what it was in the 1970s, with only 28% of adults eating the recommended amounts. First, what are the Government’s new plans to promote fruit and vegetables to adults?

Secondly, Professor Greta Defeyter, a colleague of mine at Feeding Britain, has discovered a dramatic reduction in disadvantaged children’s daily fruit and vegetable intake since the suspension of the School Fruit and Vegetable Scheme. Can the Minister give both a date for the scheme’s return and a figure for the money that would have been spent on the scheme since March this year, but has not?

[Lord Bethell]

My Lords, I pay testimony to the hard work of the noble Baroness in this important area. The schemes she mentions have been incredibly impactful and this subject is very important. The progress made by the Start4Life, Change4Life and Eatwell programmes has been encouraging, as it has raised awareness of options for children and adults. The battle they face against decisions people make about their diet is extremely tough, but we remain committed to those programmes and will continue to invest in them.

[Lord Duncan of Springbank (Con) [V]]

I ask the Minister what work the department has undertaken to explore the impact of fresh fruit and vegetables on the development of mental health in young people. In particular, what impact has there been from their being deprived of that during this period of home-schooling?

[Lord Bethell]

My noble friend touches on an interesting area. I cannot answer it precisely. I am not sure that we have taken any assessment of the effect of eating vegetables and fruit during the lockdown, but I will find out from the department and write to the noble Lord.

[Baroness Bull (CB) [V]]

Can the Minister clarify where responsibility lies for overseeing the nutritional quality of food delivered to children eligible for free school meals? During Covid, reports have circulated on social media of packages containing crisps, chocolate biscuits and a block of fat marked “for cooking only”. In response to a letter by leading food policy experts, sent to both Defra and Public Health England, each body seemed to indicate that the other should be held responsible. Does the Minister agree that, without clarity on this, the focus on good nutrition is at risk and accountability too easily sidestepped?

[Lord Bethell]

The noble Baroness is right to cast a spotlight on an apparent area of policy confusion. Labelling is normally associated with Defra, and the provision of school meals with the Department for Education. If there is ambiguity about that, I would be happy to chase it down for the noble Baroness.

[Baroness Blower (Lab) [V]]

My Lords, the School Fruit and Vegetable Scheme is a good scheme. My limited research suggests that children in year groups not currently eligible for the scheme miss their fruit and vegetables. Will the Government therefore consider extending it to all primary-age classes on reinstatement? Will the Minister undertake to work with teachers and the Royal Horticultural Society to promote gardening to grow vegetables, on school sites, for consumption by children?

[Lord Bethell]

I also pay tribute to the School Fruit and Vegetable Scheme. However, it falls outside the remit of the Department of Health, so I do not have details about the scheme to hand, but I would be glad to track them down and throw my weight behind it.

[Baroness Bakewell of Hardington Mandeville (LD) [V]]

My Lords, in the past we have seen government-sponsored television advertising on specific themes. The Covid-19 pandemic is an excellent example. Diabetes is on the increase and, in extreme cases, leads to limb amputations, which are at a frightening rate. Given the proven links between the consumption of fruit and vegetables and good health, would the Minister sponsor such a scheme of television advertising for healthy eating, among his government colleagues?

[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.

[The Earl of Caithness (Con) [V]]

My Lords, this subject is one of many covered in the House of Lords report published today by the Food, Poverty, Health and Environment Committee, called Hungry for Change. I hope my noble friend has already been briefed by his civil servants on this. Will he work with his fellow Ministers in Defra to get the food industry to make available a wider range of vegetables—not just pre-packaged carrots and other vegetables, all of the same size, shape and colour—and at a more affordable price?

[Lord Bethell]

I thank my noble friend for reminding me of the important Hungry for Change report; I pay tribute to it and to its recommendations. If I understand his question correctly, the food given to schoolchildren falls within the realm of the Department for Education. He makes an important point about offering variety and a wide range of foods, and I am sure that that is on the department’s agenda.

[Lord Curry of Kirkharle (CB) [V]]

My Lords, home production of both fruit and vegetables is declining, with last year being the lowest for 20 years in vegetable production. If we do achieve an increase in consumption, much of that food will come from increased imports from countries that are water deficient. Will the Minister reassure the House that the Government have a cross-departmental strategy to address this, leading to increased consumption matched by increased production?

[Lord Bethell]

The noble Lord is quite right about the home production of food. During the Covid epidemic, Project Defend was put together to ensure that, as a country, we have resilient supply chains for key products, including food. The project will look at this area to assess whether interventions are necessary and will co-ordinate cross-governmental action.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for this Question has elapsed.

Covid-19: Mental Health Services

Lord Bethell Excerpts

Thursday 2nd July 2020 Lords Chamber

[Baroness Barker]

To ask Her Majesty’s Government what steps they are taking to ensure that mental health services are available in (1) acute, and (2) community, care settings (a) during, and (b) after, the COVID-19 pandemic.

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

My Lords, the mental health challenge of Covid is a serious matter, and I pay tribute to NHS mental health services in both acute and community care settings, which have remained opened for business throughout this time, including delivering support digitally, over the phone and, where possible, face to face. There are no plans to stand down that support after the peak of the pandemic and we remain committed to our NHS long-term plan ambitions for increasing mental health services in acute and community care settings.

[Baroness Barker (LD) [V]]

In July 2019, the Government committed £2.3 billion for services for 370,000 people with severe mental illness. Will the Minister give an undertaking that if, as expected, Covid-19 causes greater demand for mental health services, that money will be increased?

[Lord Bethell [V]]

My Lords, we are investigating the long-term implications on our services from Covid-19. We are engaging with counterparts across Whitehall and, if necessary, we will invest further money. However, the mental health impact of Covid is not clear yet, and we await the final implications of that.

[The Lord Bishop of Coventry]

My Lords, at least one of the churches in my diocese recently set up a mental well-being centre, providing support groups, a helpline and signposting to professional services. Has the Minister considered inviting churches and other faith communities, with their knowledge of, trust within and connections to the local community, including networks of young people, to participate in the response to the mental health needs caused by Covid-19?

[Lord Bethell [V]]

The right reverend Prelate makes a good point, and I thank very much indeed those from all faith groups who have provided important pastoral support during this difficult time. On a practical matter, the funding for the mental health projects from our £5 million fund has gone to 130 different charities through the coronavirus mental health response fund. We are assessing the impact of those and we look forward to the recommendations of the Mind and mental health consortia which are behind that fund.

[Baroness Redfern (Con) [V]]

Mental health community projects are supporting people during coronavirus, and the Government’s announcement in May of £5 million of additional funding marked the first round of funding to be allocated to the sector. When will the second wave of projects receive funding, and will that include extra training for staff and to recruit more to service the 24/7 helplines?

[Lord Bethell [V]]

I pay tribute to charities and other community projects which have contributed to a wide range of projects across mental health, learning disabilities, dementia, isolation, befriending, domestic abuse, women’s issues and BAME groups. As I mentioned earlier, the Mind and mental health consortia are making recommendations about the progress of the fund. I look forward to their recommendations and we will act on them wherever we can.

[Baroness Greengross (CB) [V]]

My Lords, one consequence of the pandemic has been increased rates of violence or harm against old, young and other vulnerable people. Increased pressure on people’s mental health during the lockdown will likely have contributed to that. Should the Government make it obligatory for threats of violence, which could be bravado but which could also be dangerous, to be reported to the police as well as to social services, and would such measures help reduce domestic and other forms of abuse and ensure early intervention when someone is having a serious mental health episode?

[Lord Bethell [V]]

My Lords, threats of violence under any circumstances are reprehensible, and those aimed at the old and the vulnerable are in a category of their own. It is up to the clinical judgment of those involved in social care to decide whether the involvement of the police is of benefit and worth. I would not want to apply a blanket ruling on that, but the noble Baroness makes an extremely important point, which we are constantly reviewing.

[Baroness Blackstone (Ind Lab) [V]]

My Lords, there is increasing evidence that the mental health of children and young people has been badly affected by the Covid-19 lockdown. Given that the provision of mental health services to this age group was already inadequate, why has progress in implementing plans in the Green Paper on child mental health been so poor, particularly in the rollout of child mental health teams? What steps will the Government now take to rectify that?

[Lord Bethell [V]]

The noble Baroness is likely correct that the epidemic has had a particular effect on children and young people. The evidence on this is not crystal clear, but that is the strong instinct of all those in the field. I personally welcome the reopening of schools, which will have a particularly beneficial effect on those children who at present are stuck at home and do not have the support of the school system. Mental health services for young people are part of our long-term plan, with the additional £2.3 billion of spending on mental health. Our ambitions in that area remain enormous.

[Baroness Jolly (LD)]

My Lords, the Mental Health Act is no longer fit for purpose. With outdated legislation, both children and adults are at risk while either at home or in a care setting. In the aftermath of the Covid epidemic, there is no time for delay. When should we expect a Bill here in Parliament? If that is not in the Minister’s brief today, would he write to me?

[Lord Bethell [V]]

My Lords, we remain committed to publishing a White Paper that will set out the Government’s response to Sir Simon Wessely’s independent review of the Mental Health Act 1983 and pave the way for reform of that Act. We will publish it as soon as possible. The Covid epidemic does nothing but incentivise us to move as quickly as possible on this.

[The Earl of Sandwich (CB) [V]]

My Lords, does the Minister share my concern that the data he kindly supplied in Written Answer HL5619 on 22 June shows an 11% increase in March in prescriptions for anti-depressants over the same month last year? Is he therefore considering urgent measures to increase the funding and availability of psychological therapies instead?

[Lord Bethell [V]]

My Lords, I am as concerned about the over-prescription of anti-depressants as the noble Earl and would much prefer people to take cognitive therapies than drugs wherever possible. As I mentioned earlier, we have invested in two major rounds of support for community groups to help those struggling with their mental health, and we are reviewing additional funding for those schemes. We will keep a careful eye on the prescription of anti-depressants, which we are all concerned about.

[Baroness Thornton (Lab)]

My Lords, health and social care workers battling through the coronavirus pandemic are paying a heavy mental and emotional toll and will continue to do so. Yet the current mental health support available is not adequate. Will the Government commit to appointing a new independent national well-being guardian to co-ordinate and oversee a proper mental health support package for all NHS and care staff?

--- Later in debate ---

[Lord Bethell [V]]

My Lords, the work on the NHS people plan continues during the epidemic and we look forward to making the first announcement on that shortly, which will cover many of the concerns of the noble Baroness. I also remind the House that, on 15 June, Public Health England unveiled its psychological first-aid training course, developed by PHE, which has proved extremely helpful, as has the confidential helpline that was unveiled on 8 April, which we continue to support.

[Lord Rennard (LD) [V]]

My Lords, people with diabetes are twice as likely to experience depression as those without, and a third of Covid-19 deaths in England are linked to people with diabetes. A survey by Diabetes UK shows that three-quarters of people with diabetes who have felt that they needed specialist mental health support cannot access it. How can the Government help to ensure that more people are tested for diabetes and that those with the condition receive comprehensive check-ups, including screening and support for mental health issues?

[Lord Bethell [V]]

My Lords, we are investing in new and additional diabetes testing arrangements. Testing is essential for the diagnosis and management of this affliction. The noble Lord is entirely right that the connection between Covid deaths and diabetes appears profound. It is a wake-up call for the whole country and puts a spotlight on the large amount of diabetes in the UK. We will unveil plans in the future for refocusing on this important public health issue.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, all supplementary questions have been asked, so we now move to the next Question.

Ultra-processed Foods

Lord Bethell Excerpts

Thursday 2nd July 2020 Lords Chamber

[Baroness Bennett of Manor Castle]

To ask Her Majesty’s Government what plans they have to reduce the amount of ultra-processed foods available for purchase in the United Kingdom.

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

My Lords, to address the consumption of food and drinks high in fat, sugar and salt, Public Health England oversees the sugar reduction and wider reformulation programme on behalf of the Government, as set out in the three chapters of the child obesity plan and the 2019 prevention Green Paper Advancing our Health: Prevention in the 2020s. In addition, the Government provide healthy eating advice through the Eatwell Guide, social marketing campaigns and food procurement and catering guidance.

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

I thank the Minister for his Answer, but I am disappointed that he did not use the term “ultra-processed foods” in it, which represent 57% of the calories in the British diet. In the past couple of years, we have seen three studies which I shall quote from briefly. The first is from the US, which said that

“Ultra-processed foods cause excess calorie intake and weight gain.”


A French study states

“a 10% increase in intake results in a 14% increase in death,”

and a UK study says that

“a 10% increase in intake results in an 18% risk of increase in obesity in men.”

This is a relatively new area of science, but do the Government not understand that we have to acknowledge that these ultra-palatable foods that are designed not to satisfy have to be part of what the Prime Minister has said is going to be a new focus on tackling obesity?

[Lord Bethell [V]]

My Lords, the noble Baroness has made her point well. When the pandemic began, the national food strategy team were investigating the health risks associated with a diet heavy in ultra-processed foods. The team is in the process of restarting its work and will return to the question of ultra-processed foods in its final report, which it currently plans to publish over the winter.

[Baroness Young of Old Scone (Lab) [V]]

My Lords, the noble Baroness, Lady Bennett, has demonstrated that there is a bigger killer on the block than Covid, and that is ultra-processed foods. Covid has increased the focus on the need to reduce obesity and diabetes and to promote healthy eating, but we have run out of road on the kind of voluntary approaches that the Minister has just described. Will the Government now regulate for the rapid reformulations of ultra-processed foods? The responsible supermarkets want a regulated level playing field so that they can get on with helping us all avoid what is now the biggest cause of premature deaths: the consumption of ultra-processed foods.

[Lord Bethell [V]]

The noble Baroness is entirely right to say that Covid has focused our minds on obesity and the role of diet. However, voluntary approaches are necessary. We have to take people, industry and government with us. That is the core of our approach and it will remain our approach.

[Baroness Walmsley (LD) [V]]

My Lords, will the Prime Minister’s proposed obesity strategy include the full range of obesity services up to tier 4 in all areas, plus ensuring prevention measures such as calorie labelling, portion size, reformulation and the restriction of price promotions of HFSS foods? Will there be independent evaluation of the measures to be proposed?

[Lord Bethell [V]]

My Lords, it is not my role to pre-empt the Prime Minister’s strategy formulation, but the noble Baroness has articulated a very reasonable list of the potential measures. We are closely focused on this area. We are measuring ourselves keenly and our objectives are clearly laid out. The focus is on getting movement on this important area.

[The Earl of Caithness (Con) [V]]

My Lords, I hope that my noble friend the Minister is as saddened as I am that, in this country, we eat more ultra-processed foods than any other country in Europe. That is a shameful position to be in and clearly the government policy is not working. Would he consider discussing with his noble friend in the Treasury the introduction of VAT on ultra-processed foods?

[Lord Bethell [V]]

My Lords, I completely agree with my noble friend that Britain’s record on obesity and the diet that we as a country eat is not one that we can celebrate or be proud of. The sugar tax has proved a successful measure. It shows the Government’s determination to make progress in this area and, if necessary, to use fiscal means to do so.

[Baroness Boycott (CB) [V]]

My Lords, there is no doubt that HFSS foods are unhealthy, particularly for young children, who are showing such alarming rates of obesity. We also know that advertising works. However, recent research by Cancer Research UK shows that over half of all food adverts on TV during children’s peak viewing hours, 6 to 9, are for processed foods that are high in sugar and fat, while fewer than one in 15 are for fruit and vegetables. The consultation on whether the Government would introduce a nine o’clock watershed for such adverts was completed and delivered in June 2019. Can the Minister update the House on the progress of that consultation and tell us when we are likely to have the Government’s response?

[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.

[Baroness Bakewell of Hardington Mandeville (LD) [V]]

My Lords, we have seen research showing a direct link between the rise in the incidence of diabetes and the consumption of highly processed foods. In the past, when such evidence on health of certain products has been produced, the Government took action to ban television advertising of them. Cigarette smoking is a prime example. Following on from the Minister’s response to the noble Baroness, Lady Boycott, can he say whether the Government will consider banning all television advertising that features ultra-processed foods?

[Lord Bethell [V]]

My Lords, the noble Baroness has made the point on smoking well. However, we have an issue in that there is no generally recognised agreement on the definition of ultra-processed foods. We are also conscious of the fact that we have to take the British public with us and that regulation and advertising bans on their own do not have the impact that we need to make. None the less, as the sugar tax has demonstrated, we are prepared to use regulatory and fiscal means if progress cannot be made, and we will maintain a review of this area.

[Lord Whitty (Lab) [V]]

My Lords, does the Minister recognise that the key players in the food system are the large producers, the large supermarkets and the big caterers? Between them they set the prices and standards for small producers and farmers as well as spending huge amounts of money on advertising ultra-processed foods, as the noble Baronesses, Lady Boycott and Lady Bakewell, have just said—20 or 30 times as much as they spend on advertising fresh fruit and veg. Given that the Minister is reluctant to go for an advertising ban, how do the Government propose to get these large companies to help to deliver a more balanced, affordable and nutritious diet rather than, to facilitate the reverse, as they do now?

[Lord Bethell [V]]

My Lords, I take some issue with the noble Lord’s demonisation of big companies and his characterisation that our food industry is dominated by a small number of them. Actually, the food industry in the UK is extremely diffuse and, when we consider regulation and advertising, we have to bear in mind that it is often the small producers, the small farmers and the small businesses which are affected by those measures. They have an effect on business, an effect on jobs and an effect on tax, so this is not a simple matter. That does not mean that we are not serious about the subject, but we have to bear in mind the effects on the entire supply chain, which includes many important British companies.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, the time allowed for this Question has elapsed.

Covid-19: Mental Health

Lord Bethell Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bradley]

To ask Her Majesty’s Government what action they are taking to address the impact of the COVID-19 pandemic on mental health.

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

My Lords, we have released tailored guidance to help people deal with their mental health on GOV.UK and the Every Mind Matters website. NHS mental health services have remained open for business, offering support using digital, telephone and face-to-face approaches as appropriate. We have provided £9.2 million of additional funding to charities to support adult and children’s mental health. We are working with the NHS, Public Health England and others to gather evidence and assess potential long-term impacts of Covid-19 as we plan for support for mental health through the recovery phase.

[Lord Bradley (Lab) [V]]

I refer to my interests in the register and thank the Minister for that reply. However, as he will be aware, research on the impact of the pandemic already shows that demand for mental health and well-being services is increasing substantially. Will he therefore ensure that specific funding across government is available to groups who are particularly at risk at this time, including: those who have had the virus and been treated in hospital, who suffer from high rates of PTSD; people who have been bereaved in distressing circumstances; those living and working in care homes and in our hospitals; and children, who require immediate psychological support as they return to school?

[Lord Bethell]

The noble Lord is entirely right to be focused on the potential increase in demand for mental health services, although it is an area where we have some reassurance that the explosion of mental health demand has not hit the heights that at one point we feared. None the less, we have ploughed money into mental health charities and have recruited 3,500 volunteers who are helping with the Check-in and Chat Plus process. We remain incredibly vigilant in this area, and I entirely support the focus on specific mental health issues which the noble Lord outlined.

[Baroness Whitaker (Lab) [V]]

My Lords, in view of that response, what efforts have the Government made to both establish and address the mental health of Gypsy, Traveller and Roma people, which is always significantly more precarious than the average and which is now exacerbated, particularly in the case of families on the roadside with poor hygiene facilities, those subject to racial abuse—which has increased—and rough sleepers from the Roma community with poor English?

[Lord Bethell]

The noble Baroness is entirely right to focus on the Roma community, which, like many communities who are outside the mainstream, is hard hit by the results of Covid. Many such families live near me in Wiltshire. I reassure her that local authorities have continued to mobilise both digital and face-to-face mental health services in an entirely exemplary way, and I pay tribute to their hard work in this area.

[The Lord Bishop of London [V]]

My Lords, the Government are providing NHS staff with free access to online therapy and group counselling sessions, among other things, which is much needed and very welcome. Can the Minister say whether the same quality of care, recognition and access to mental health support is being given to parts of the social care sector such as nursing homes, care homes and home care workers, who have faced similar traumatic experiences to those of NHS staff?

[Lord Bethell]

The right reverend Prelate is entirely right to be focused on the support offered to both NHS and social care staff. There is considerable potential trauma in this area, and those who have been on the front line are under more pressure than one could possibly imagine. We have put in place schemes specifically targeted at both NHS and social care staff, and I reassure the right reverend Prelate that there is parity between the two sectors.

[Baroness Blackwood of North Oxford (Con) [V]]

My Lords, the first UK study of neurological and psychological complications of Covid-19 was published last week. It found that 31% of patients developed an altered mental state arising from both neurological and psychiatric diagnoses. This is a relatively small cohort study, but the breadth and prevalence of the complications uncovered mean that larger studies are crucial to truly understand the scale of the challenge. With recovery, we have proven our capability to run outstanding trials at pace, so can the Minister please outline his plans for research into the acute and longer-term mental health effects of Covid?

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of longitudinal studies. The UK household longitudinal study data, which analyses the GHQ-12 scores, has been upgraded. We will continue to invest in that, and Public Health England has been tasked with monitoring the development of mental health issues across the country.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, research shows that the pandemic has had a disproportionate impact on some of the most disadvantaged, particularly those from BAME communities. During this period, many mental health and community services have moved online. While that is an appropriate first response, charities are now expressing concern that it is not an effective response for many, including the elderly, those with learning disabilities and those with severe mental illnesses. Can the Minister say what urgent steps the Government are taking to restore effective treatment and care for all, including face-to-face services, with all necessary PPE and testing in place?

[Lord Bethell]

My Lords, we are feeling our way in this area. There have been benefits from some of the moves online. People have been able to see more of their consultants, they have found that some of the content provided has been helpful, and the reach has gone up. However, I completely agree with the noble Baroness that it will not work for everyone. I pay tribute to mental health professionals who have maintained face-to-face contact during the epidemic, with all the threats associated, and we continue to look closely at how to fit appropriate technology and digital access to the right people and in the right format.

[Baroness Wyld (Con) [V]]

My Lords, what is the Government’s assessment of the impact of Covid-19 on antenatal and perinatal mental health services, and what steps are they taking to ensure that expectant and new parents are able to access the support they might need in person, particularly given the nuanced nature of potentially accessing services for the first time?

[Lord Bethell]

The area of antenatal and natal services has developed a huge amount of concern and, as my noble friend may remember, we adjusted the guidelines to give parents greater access to mother and child at an early stage. This area does concern us. However, it is a relief that, generally speaking, the disease has not hit pregnant women and early born children in the way that it has hit elderly people, and for that we are grateful.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I refer to my interests in the register. As acknowledged by the Minister, the impact of nursing people with Covid-19 on the mental health of nurses is estimated to be considerable. A recent brief report from the University of Manchester into suicide by nurses identified a higher prevalence in female nurses than in women from other professions. It is vital that there is a dedicated support offer for the mental health and well-being of the NHS and social care workforce. Will the Minister ask Her Majesty’s Government to consider extending the current England-wide practitioner mental health service commissioned for doctors and dentists to include all nurses employed in the NHS, community and social care settings?

[Lord Bethell]

My Lords, the confidential helpline for the health and well-being of NHS staff was launched on 8 April. That remains in place and has delivered important mental health support for NHS staff. I will take away the noble Baroness’s recommendation to extend it to a wider community.

[Baroness Thornton (Lab) [V]]

I return to the Question asked by my noble friend Lord Bradley. We know that around a third of schools currently do not provide school-based mental health support and that many young people struggling to cope will not meet the criteria of the NHS mental health services in their area. Will the Minister consider the request of Young Minds for the Government to provide ring-fenced funding to ensure that schools can bring in the extra support needed to help their children?

[Lord Bethell]

I should be very glad to look at that request and would be grateful if the noble Baroness would forward it to me. The Young Minds movement is very important. I would say that young people, particularly girls, have been a focus of mental health issues. That has come out in the figures and it is a situation that concerns us.

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, the time allowed for this Question has now elapsed.