Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association. I also want to thank the Minister for his long stint at the Dispatch Box, yet again.
I want to start with the issue about consultation on NHS Digital patient data, which the noble Baroness, Lady Thornton, just alluded to. In 2013, the Government wrote to every household to explain the care.data project. This new scheme has had no such communication with the public. As people hear about it, they are increasingly concerned about the breadth of data that will be captured. Will the Minister agree to use the delay to ensure that every adult in England is written to as a matter of urgency, including an opt-out form they can use if they so choose?
I also want to pay tribute to our health workers and carers—paid carers and especially the unpaid carers—who have gone not just the extra mile over the last 14 months but a whole marathon. Can the Minister say what steps the Government are taking to help the exhausted staff and carers who know that there are many miles still to go before we are through this? Help is needed right now for them in an emergency plan that does not just focus on getting back to work as normal.
The Minister is right to say in the Statement that there is no room yet for complacency. The delta variant will not be the last variant trying to wriggle between those who are protected and those who are not. We are concerned that there is not a focus on communicating to the public about how we need to find a way to live with Covid circulating, as my noble friend Lord Scriven said yesterday. We have moved into Covid being endemic, and the public will want and need to know what they should do over the next few months.
Communication about the vaccine figures is cheering to hear, but still too many Ministers talk about the one-dose level, not the two. The Minister in the Lords, to his credit, usually make that point, but the Prime Minister and many other Cabinet Ministers do not make it clear that we need 90%-plus of adults to have had two doses before we are anywhere near safe, and that social distancing, mask wearing and hand washing will still need to happen.
I thank the Minister for giving more information yesterday on the isolation support pilots. He said:
“In Blackburn and Bolton, this will include trialling broadening eligibility during surge testing, so that all those who are required to self-isolate, who cannot work from home and earn under £26,000, receive a £500 payment.”—[Official Report, 7/6/21; col. GC 202.]
That is still only £50 a day if you are expected to self-isolate. If you are told to isolate on a Monday, and usually work nine to five, this works out at £7.81 per working hour—less than the minimum wage. If the minimum wage is the very minimum that the Government believe an individual can live on, why are they paying less than this to people for doing the great public good of self-isolating? What about people who work in risky occupations and have been told to isolate multiple times over the last year? For them, it is not just one period of 10 days.
From these Benches, we believe that the Government need to pay people’s wages. Now that fewer people should be required to self-isolate, as community cases are lower, we should be diverting resources to really get right what the Government have been getting wrong all along. We must stop Covid in its tracks. Examples from other countries show that paying wages has a strong and demonstrable effect.
On international travel, the red terminal at Heathrow is an improvement, but there are still issues with those arriving from amber countries, who are asked to jump on public transport to get home and need to travel in various ways before they are tested, once in this country.
Given the increase in cases of the delta variant among primary-age pupils, would the Minister outline what measures are being taken to prevent transmission in schools? When will the JCVI report on vaccines for 12 to 17 year-olds? Are any plans beginning to consider whether vaccination should happen for the under 12s? We strongly echo the comments of the noble Baroness, Lady Thornton, about mask wearing in schools. Is this really the right time to stop that happening?
Finally, I note that the consultation on vaccine and testing certificates has closed. Will the Minister say when the Government will publish their plans following that consultation? What type of legislation will be brought in on this, and will Parliament be able to see and comment on any regulation prior to it being enacted?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am thankful, as ever, to both noble Baronesses, Lady Thornton and Lady Brinton, for thoughtful and challenging questions. I will try to deal with as many as I can.
The noble Baroness, Lady Thornton, asked about the narrowing of doses. May I remind her that for those classed as vulnerable and those aged over 50, the dose period has been narrowed from 12 weeks to eight weeks. We are giving some latitude in the areas of special enforcement for the narrowing of the doses. I completely endorse her points on that and reassure her that plans are afoot. As for moving the age group to those aged over 18, our instincts are that the JCVI prioritisation process has worked extremely well. It is clear, it is fair and it has been effective. In conversation with those at the G7, I received a huge amount of admiration from other countries for how well that prioritisation process has gone. Therefore, we are reluctant, at this very late stage, to jump the gun on that, but I take her point that particularly those in areas where the infection rate is ticking up may benefit from early vaccination. Therefore, we constantly look at and review that point.
As for vaccination of children in schools, raised by the noble Baronesses, Lady Brinton and Lady Thornton, as they know, the MHRA has given its approval. The ball is now in the JCVI court. We are going to wait for it to pronounce. The state of our vaccine supplies means that we do not have a supply for children at hand right now, so there is scope for a really thoughtful conversation on that. When the JCVI has pronounced, the Government will engage on its recommendations, but I do hear, loud and clear, the obvious support that it has in this House.
As for the Nepal variant, I cannot say exactly how much of it came from Portugal, but it is true that it was present in the UK before Portugal was green-listed, so I think it is fair to say that not all of it came from there.
Moving on to NHS staff, I completely pay tribute to the contribution of NHS staff and those who work to support the NHS, social care and public health. I recognise completely the picture painted by the noble Baroness: many feel exhausted and burned out. Our focus is therefore on recruitment and the recruitment of more GPs and nurses is going extremely well. I would be happy to share updated statistics on that if it would be helpful. The work plan—the NHS People Plan—has within it a clear outline of the kind of workforce planning that we have in place. That is something that the recruitment programme has fully embraced.
I agree that the pressures on A&E, and on acute late-stage interventions from the NHS, have been rising for years—for decades. This is an unsustainable model in the long run, which is why this Government are fully committed to the prevention agenda. We have put in place plans for the Office for Health Promotion. That will be the device for using data to support our prevention agenda, and we will be working particularly with local authorities, and increasingly through the NHS, to ensure that we are putting in place measures that improve the nation’s health and that we do not just focus on those who are already extremely ill.
Moving on to data, I thank the noble Baroness for her kind comments. I completely agree that transparency is absolutely right. We want to be as transparent as possible, with both the professions and the public. These are complex issues. I accept that we could do better to improve our communications. We will be using this two-month hiatus as energetically as we can to engage the public and the professions in the changes that we are bringing about. They are changes that are absolutely essential for any modern use of data to promote resource allocation—when it comes to the workforce, as the noble Baroness rightly pointed out—and for research. I really would encourage all noble Lords who are interested in this to look at the minutes of IGARD. Noble Lords will see exactly which data uses are being sanctioned, and will be amazed by the extremely high-level, science-led research programmes that the GP data is contributing to. It will reassure noble Lords that this is an extremely well guarded and thoughtful process, and a massive asset to the nation. I agree with the noble Baroness that our data is a huge national asset; it is there to benefit patients and is mainly used for clinical trials and for planning within the NHS. That is right and I can reassure her that that is the way we intend to continue.
The noble Baroness, Lady Brinton, asked about mental health support for care workers and NHS staff. I reassure her that we have put in a huge amount of support for NHS staff: 10,300 calls have been made to the helpline, there have been 4,600 conversations on the national line and 200,000 downloads of the app, and 500,000 have engaged through the web page. The provision of mental health support for NHS staff has been extremely helpful for those stressed by the last few months, but we continue to invest in that area.
I remind the noble Baroness, Lady Brinton, that those receiving isolation payments are still eligible for their benefits. They will get support from housing benefit and other benefits if they qualify.
The noble Baroness asked about schools. The use of testing to protect schools has been one of the phenomenal success stories of this pandemic. There have been 65 million tests deployed since January, and a million tests were deployed on Sunday alone. That is both to break any chains of transmission within schools and to protect the opening of schools, which every parent in the country knows is an essential objective of our pandemic response.
On certification, we are making an enormous amount of progress. That is a Cabinet Office lead. When the plans have been crystallised, they will be published, and I am extremely hopeful that we will be able to make progress.
Lastly, the noble Baroness, Lady Thornton, mentioned the memorial wall. I am aware of it and have seen very moving pictures. I have not yet visited the wall, but I will take this prompt to go. While I am not across the future plans for the wall, I am grateful for the suggestion and will take it up.
The Senior Deputy Speaker (Lord Gardiner of Kimble) (Non-Afl)
My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.
Lord Balfe (Con)
My Lords, could the Government try to get back the initiative so that we are talking about a health service and not constantly talking about Covid? I have some numbers: 114 people are in hospital with the delta variant. Of those, 83 are unvaccinated, 28 have had one dose and just three have had two doses—114 in total. This morning, the cancer support unit released some new figures: referrals are down by 350,000 over the year, there is a backlog of 40,000 new patients, and the survival rate is back to 2010 levels. We have this completely out of kilter, and it is largely because the Opposition are obsessed with it. I ask the Minister to go back to the department and try to reclaim the huge tragedy of unmet need in the National Health Service that has built up because we have done nothing but prosecute Covid. We have to learn to live with it.
Lord Bethell (Con)
My Lords, I completely understand my noble friend’s concerns, but I do not accept that we have done nothing. It is quite wrong to suggest that the NHS has done nothing but Covid. In fact, I am incredibly impressed by how well services have been maintained during an extremely difficult period. Were he to join clinicians in the NHS or the department, he would know that there is a laser-like focus on catching up. I remind him that there were 1.86 million urgent referrals and over 470,000 people receiving cancer treatment between March 2020 and January 2021—that is not doing nothing. An extra £1 billion is being used to boost diagnosis and treatment across all areas of elective care. On 25 March, NHS England published its 2021-22 priorities and operational planning guidance, and there is a Minister-led group under Minister Ed Argar, which is absolutely focused on the restart in cancer care in particular. I reassure my noble friend that there is a focus on this, and we are doing everything we can to get through the incredibly important backlog of work that needs to be done.
Lord Mackenzie of Framwellgate (Non-Afl) [V]
My Lords, the Statement confirms that a continued increase in vaccinations is essential to defeat the new delta variant, which has now become dominant. I believe it is the six-month anniversary of the first vaccination, so I congratulate the noble Lord on the progress so far. Has he considered consulting behavioural scientists about what incentives might create a greater vaccine take-up, as has happened to some extent in the United States? Also, there are still many vaccine sceptics out there who are influenced by conspiracy and other ridiculous scare stories propagated deliberately on social media. Can the noble Lord reinforce the Government’s message with a campaign to vaccinate for victory on the very same platforms that are carrying the negative messages?
Lord Bethell (Con)
My Lords, I am grateful for the noble Lord’s comments. Yes, we are engaged with behavioural scientists, but I reassure him that lotteries for vaccines are not on the cards. Taking vaccines into communities has proved an extremely effective measure. I led a call with council leaders in the north-west—from Lancashire and Greater Manchester—and there I heard about the effective use of small mobile units and tents to bring vaccination teams into either religious or community settings to make it easier to get a vaccine. That simple measure appears to be a really winning formula, and one that we are investing in in a very big way.
Lord Moynihan (Con)
My Lords, I echo my noble friend Lord Balfe’s figures on Covid-19 hospitalisations: of the 114 people in hospital, just three had received both doses of vaccine. Does my noble friend the Minister agree that the best approach the Government can follow is to continue with an urgent and comprehensive vaccination programme—with the further easing of restrictions secondary to the goal of a successful national vaccination campaign—using, not least in local communities, positive influences in communities wherever possible? Will he also accept the thanks of the Olympic and Paralympic athletes for the positive approach the Government and the International Olympic Committee have taken to ensure that athletes and their support staff will be vaccinated before leaving for the Olympic and Paralympic Games in Tokyo?
Lord Bethell (Con)
I am extremely grateful for my noble friend’s comments on the Olympics, and we wish our Olympic champions all the best luck. We keep our fingers crossed for Tokyo, under very difficult circumstances. On the vaccination programme, he is entirely right: positive influences are key. It has been interesting that the positive influences we think have made the biggest impact are not necessarily only the celebrities—they are community influencers who work in clinical settings and are present at a grass-roots level in communities. That is why a large volume of videos, endorsements, community meetings and answering quite reasonable, but sometimes very sensitive, questions from the public have been the essence of our vaccination communications programme. It seems to be extremely successful: the younger age groups seem to be stepping up for the vaccine in proportions that we could not have believed possible some months ago, and we hope very much that this will continue.
Lord Taylor of Goss Moor (LD) [V]
My Lords, my 13 year-old son is a chorister at Truro Cathedral, where they have composed a song, “Gee Seven”, which 25,000 children across this country and others will sing online to G7 leaders tomorrow. He says the thing that they want most is for the parents and grandparents of children in poorer countries that have not had access to vaccines to get the access that parents and grandparents have had in this country, so that those other children can feel safe about their families. Will the Minister and his colleagues think about that before vaccinating teenagers in this country, who are not at great risk? The COVAX programme is currently 192 million doses short of its targets for supporting poorer countries. Incidentally, if that is not enough morally, he might also consider that so long as we are not successfully vaccinating in these poorer countries, the chances of new and more dangerous variants coming to this country and causing deaths again are all the more likely.
Lord Bethell (Con)
My Lords, the noble Lord points out a dreadful dilemma that is on our minds all the time. I completely agree with his point that supporting those in the developing world is a priority and responsibility for those of us in the developed world. His son is entirely right that we should be thinking very much of those who are vulnerable or in urgent need as we consider our vaccination programme. But our responsibility as a Government is to the British people. We must look after the British people first, and there is no benefit to anywhere in the world if Britain comes close to shaking off this awful virus but falls over at the last minute because we have not seen the job through. We intend to support COVAX in the way he describes—in particular, the manufacturing of the vaccine in regional hubs. There, the AstraZeneca and Oxford vaccine has played a critical role. The profit-free availability and generous licensing arrangements being offered by AstraZeneca are having a huge impact on the global rollout of the vaccine. In the meantime, we are absolutely driving through the vaccine programme here in the UK, in the knowledge that, if Britain can emerge safely, that is of benefit not only to British taxpayers and patients but to the whole world.
Lord Lancaster of Kimbolton (Con)
I remind your Lordships’ House of my interest as Deputy Colonel Commandant Brigade of Gurkhas. I thank my noble friend for his part in ensuring the Government’s swift response to the plea for help from Nepal in the delivery of some essential medical supplies. But there is one element missing: vaccines. Given that the Government have committed, via the COVAX consortia, to deliver 2 million vaccines to Nepal, and given that my noble friend has just said that vaccinating the developing world is a priority, I simply ask him why the UK cannot deliver those 2 million doses of vaccine bilaterally now and simply net them off our contribution to COVAX in future.
Lord Bethell (Con)
My Lords, I pay tribute to my noble friend for his advocacy on behalf of Nepal; we are all extremely moved by the stories from Nepal and the challenge that it has had from Covid. We are extremely supportive of his initiative for both medical supplies and the vaccine but, as I said, there is a sequencing challenge here. Our priority as a Government is the British people. It is important that we see the job through. As the noble Baroness, Lady Brinton, pointed out, there is a threshold to which we need to get the British public to ensure that the R rate remains below one and that the new India variant, or any other variant, does not run amok and drive up hospitalisation in the UK. Until we have reached that point, we must focus on the job at hand. In the meantime, and in parallel, we are doing absolutely everything we can to grow global manufacture of the vaccine and ensure that countries such as Nepal receive secure and reliable supply. My noble friend should be reassured that we are absolutely firm in that commitment.
Baroness Ritchie of Downpatrick (Non-Afl) [V]
My Lords, we have often heard it said that we will not all be safe until the whole world is safe. Today, UNICEF, the children’s charity, is lobbying the G7 Ministers, asking for an ongoing distribution of vaccines to poor and developing countries, rather than supplying surplus vaccines at the end of our programme, because they may not be able to use them in the best possible way at that stage. Will the Minister, further to the answers he has already given, go back to his ministerial colleagues and the Prime Minister and urge them to please undertake that global vaccination programme, along with other G7 countries, now? The WHO said yesterday that inequitable vaccination is a threat to all nations.
Lord Bethell (Con)
I completely endorse the sentiments of the noble Baroness and can absolutely reassure her that this is top of the agenda for the G7 leaders’ meeting later this week. The Prime Minister will absolutely be ramming home the message that she put extremely well. Roughly 1 billion vaccinations have been done around the world so far; that leaves another 7 billion or 8 billion to do. We need manufacturing on a scale that the world simply does not have today to see that job through. That is why the UK has contributed so much through the AstraZeneca vaccine, which is a wonderful, portable, cheap and flexible platform for creating vaccines for the world. We are ensuring that that magic source is available to all those who can contribute vaccine manufacturing capacity anywhere in the world. In the meantime, we will ensure that any capacity that we have after we have done the British public is made available, but we have to see the job through here in the UK. It would be utterly counterproductive if the UK, having got so far, tripped over at the last hurdle.
Lord Caine (Con)
My Lords, having spent much of the Whitsun Recess trying to do my best to support the beleaguered hospitality sector in west and north Yorkshire, two messages rang out loud and clear: first, the problems that many establishments are facing with staff shortages, in part due to Covid restrictions, which are affecting levels of service; and, secondly, the absolute calamity for many establishments if the lifting of Covid restrictions is delayed beyond 21 June. Can my noble friend therefore assure the House that, in taking what I accept are finely balanced decisions about lifting restrictions, the plight of our hospitality sector and the livelihoods of those who work in it will be properly considered?
Lord Bethell (Con)
I pay tribute to those in the hospitality and related sectors—both those who manage and those who work in it. It has been one of the toughest aspects of this awful pandemic to see these valued and important industries really hammered by the closures that have been necessary to stop the transmission of this awful disease. I hear my noble friend’s message absolutely loud and clear. We are on the final slopes of this journey. We want to ensure that, when we open, we stay open and there is no yo-yoing. That is why we are committed to looking at the data in the run-up to 21 June. His point is extremely well made, and we will definitely take it on board.
Baroness Uddin (Non-Afl)
I thank the Minister for repeating the Statement and, in doing so, pay my respects to all carers, particularly those unpaid carers, without whom many more may have perished. I have two points. First, how are the Government encouraging GPs and hospitals to monitor and collect information on patients who may be concerned about or reporting long Covid symptoms without knowing it, and those who may be complaining of or experiencing post-vaccination effects? Secondly, now that the JCVI recommendation is being considered for vaccination of 12 to 15 year-olds, the Minister will be fully aware of the major concern aired by parents—who are all over the radio, with their views and questions—feeling confused about informed choices. Can the Minister assure all parents that, if vaccination is approved, they will be given the fullest information available on the potential side-effects, and that no parent who may choose to opt out of the vaccination for this age group will be pressured or demonised?
Lord Bethell (Con)
I am enormously grateful to the noble Baroness for raising in the same breath the importance of secure data arrangements and the question of what we are doing on long Covid, because we could not do what we are doing on long Covid if we did not have access to GP records. The truth is that we are doing an enormous amount. Long Covid, as the noble Baroness knows, is touching more than 1 million patients here in the UK. We have got NICE to take steps to put in place a really clear clinical definition. The NHS has mobilised Covid-specific clinics, which we acknowledge are under pressure but which are an extremely valuable resource for understanding this dreadful condition. NIHR has mobilised research resources, and I pay particular tribute to Great Ormond Street and its CLoCk research project, which is looking at long Covid among children—something which of course concerns us all. Lastly, the royal colleges have done an enormous amount to present both new data and training tools to their members and to feedback information from the front line. Long Covid will be one of the lasting and most concerning aspects of this dreadful pandemic, but we are putting everything we can into dealing with the consequences.
Lord Cormack (Con)
My Lords, may I once again raise with my noble friend an issue that I have been returning to for some months now? When are we going to ensure that all those who attend to the most intimate needs of residents of care homes are vaccinated? There are still far too many who have refused vaccination; it should be a condition of employment that they are vaccinated. My noble friend has indicated sympathy with this point of view, but nothing has yet been done.
While I am on my feet, as we have plenty of time and we are allowed to raise two points, why was the advice to choral societies changed after 17 May? Suddenly, 2 million singers and 40,000 choirs can only rehearse with six people indoors. This has caused enormous distress and the cancellation of many performances. It has damaged morale in places such as Lincoln very significantly.
Lord Bethell
I pay tribute to my noble friend. He was an early bird in championing the vaccination of social care workers. He has made his point clearly and has definitely influenced policy in this area. I would like to reassure him that it is simply not the case that nothing has been done. A review is going through the matter at the moment. This is not something, I am afraid, that could be implemented by government fiat; it is important that we go through the process, not least to maintain people’s trust. One of the aspects of the successful vaccine rollout is that we have not behaved abruptly. We have not sought to admonish or to demonise anyone who is hesitant about taking the vaccine. Instead, we have sought to engage, and that is the reason why we are going through an extremely thorough review and engagement programme. I completely understand my noble friend’s frustration that this cannot be done more quickly, but I would like to reassure him that, on balance, this is the way in which to get the task done in the most impactful and effective way that we can think of.
On choral societies, I completely sympathise with my noble friend’s point. I was at Garsington Opera on Sunday, and my spirits were lifted by the sound of the singing in that wonderful place. I have only the assessment of the PHE officials to hand; it has become clear that the dangerous presence of aerosols in the air has been the really effective transmission mechanism for this dreadful disease. It is just an unavoidable and inescapable truth that people singing their heads off will fill a room with loads of infectious aerosol, and that is the reason why this decision has been made. It is regrettable, and I understand the consequences and I have been contacted by many who are concerned and affected by it. But I would like to reassure my noble friend that it has been done for the best reasons and for, I believe, very strong scientific reasons.