Covid-19: Dental Services

Baroness Altmann Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness refers to the prioritisation of patients in the constrained appointment flow of dentists. She is entirely right that those who have vulnerabilities, disabilities or other disadvantages should be prioritised: that is the objective of the prioritisation process. She makes the point extremely well and I am happy to take on board any points on where she thinks the system is not working as well as it might do.

[Baroness Altmann (Con) [V]]

My Lords, will my noble friend the Minister tell us what lessons have been learned from the initial response to the Covid pandemic and the blanket closure of dental practices? Does he have any estimates of the number of cancers of the head and neck that might not have been detected because people have not had regular dental check-ups?

[Lord Bethell (Con)]

My Lords, my noble friend is right to allude to the confusion around the closure of dental practices. We have made it crystal clear that in the second lockdown all dental practices—both NHS and private—should remain open; that is part of our commitment to try to clear the backlog. I also acknowledge her concerns about the diagnosis of cancers. I do not have the figures for which she asked, but we certainly appreciate the role that the dental sector plays in detecting many cancers, including oral cancers. Dental services are open to those seeking urgent care and we hope that those urgent care clinics to which I referred earlier can provide some diagnostic analysis in urgent cases.

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Baroness Altmann Excerpts

Wednesday 4th November 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Smith of Newnham, with whom I normally agree; I do on this occasion, in many ways. I do not underestimate the challenges faced by the Government and have enormous sympathy for my noble friend the Minister, but I believe that the measures in these regulations, which we are being asked to approve as a whole—with the dramatic consequences they will have on millions of people’s lives, physical and mental health, personal safety and livelihoods—are flawed. We still have not been presented with an impact assessment, a cost-benefit analysis or alternative scientific views—of which there are many suggesting that these measures are based on questionable data and invalid assumptions.

I find myself agreeing wholeheartedly—unfamiliarly, perhaps—with my noble friends Lord Robathan, Lord Forsyth, Lord Lilley and Lady Noakes. We need to prepare proper analysis and present it to Parliament, with full transparency on all the assumptions, and have an opportunity to amend these measures in the light of evidence.

I do not believe that these regulations had been sufficiently broadly considered. They are not based on rigorous analysis. For example, there is no evidence to suggest that banning communal worship will impact the spread of the virus, especially after churches, synagogues and other religious venues have spent so much to ensure that they are Covid safe, as the right reverend Prelate the Bishop of Winchester rightly said. Where is the evidence that outdoor sports such as golf and tennis, or swimming in a chlorinated pool, are dangerous?

These measures need to be amended, but we are not able to do that. Yet surely we have a duty to satisfy ourselves that they are based on robust data. As an economist, I have plenty of experience of flawed models that assume away the real world or depend on incorrect assumptions. Selected statistics, presentation out of context and failing to consider issues broadly are classic errors. I feel that we are in danger of being misled. Of course I am concerned about the economic impacts of the measures we are being asked to approve, but I am even more concerned about the effect on broader national health, particularly mental health, to which my noble friend Lady Meyer refers in her amendment to the Motion, and the impacts on family life, people in care homes and people missing cancer, heart, stroke or other diagnoses and treatments.

These measures have been hastily put together and I believe they are dangerous. Policy devised in panic is not good policy. Can we not take some extra time—even just a few days—to consider them more carefully, gather more evidence, and produce a proper cost-benefit analysis and impact assessments to allow a more cogent set of measures to be laid before us?

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020

Baroness Altmann Excerpts

Thursday 22nd October 2020 Lords Chamber

[Baroness Altmann (Con)]

I thank my noble friend, for whose stamina, good humour and diligence I have enormous respect, for introducing these regulations. He certainly received the hospital pass. He says that the aim of this SI is to make it crystal clear to the public that people should stay at home and self-isolate but, as the noble Lords, Lord Rooker and Lord Hunt, and the noble Baroness, Lady Meacher, and others have said, for how long? Should it be for 14 days or 10 days, and from when—five days before what? It is convoluted. This SI is part of a broad effort to simplify and clarify the rules, but they have ended up being highly confusing, with huge fines.

With such penalties, it is particularly regrettable that there has been no proper parliamentary scrutiny of these measures. They were not debated in the Commons, even though they were announced about a week before they came into force, and we are now debating them well after commencement. The SI states, for example, that parents are responsible for ensuring that children under 18 self-isolate. Can my noble friend confirm that a parent could be fined thousands of pounds if their rebellious 16 year-old persistently sneaks out of the house to go to the gym? What advice does the Government have for effective restraints or solitary confinement methods for individual homes?

I recognise that my noble friend believes that these measures are designed to protect individuals and their loved ones, but isolation itself costs lives. Psychological damage, collapsing cancer tests and other treatments, and the lack of exercise, as my noble friend Lord Moynihan, has said, have already caused thousands of deaths as a direct or indirect result of lockdown. The poorest groups are the hardest hit, as the Secondary Legislation Scrutiny Committee warns, including so many of the young.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020

Baroness Altmann Excerpts

Tuesday 20th October 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I have sympathy with my noble friend on the Front Bench and I have great admiration for the work that he is doing in this area. But I also have sympathy with the statements which have already been made by other noble Lords. I have continually asked for a broad impact assessment of the damage being caused by these measures. How does the 10 pm curfew work? Why can cinemas stay open after 10 pm but not other hospitality venues?

We seem to have a hokey-cokey policy here. One minute, Durham is in while Gateshead is out, and Newcastle is in and Northumberland is out. On 22 September, Merseyside and the majority of Lancashire were in, and then on 26 September Blackpool went in as well. How are ordinary people who are living in these areas meant to keep up with all of this?

The ONS estimates that 85,400 people have died at home in England and Wales this year, some 25,000 more than the five-year average. That represents around 500 people a day. We seem to be trading off cancer deaths against Covid deaths, with bowel cancer endoscopies running at only 12% of their usual levels. Other checks, such as people not seeing their dentist, mean that head and neck cancers, breast and oesophageal cancers are not being spotted. This will lead to thousands of deaths.

I understand that the Government are facing difficulties in the current situation and that the desire to lock down is great, but just hiding people away is not necessarily the answer to solving the problems we are facing as a country not just from one illness but from all the other dangers that are around us.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Baroness Altmann Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, we have heard that these restrictions are necessary to save lives, but which lives? Lockdown is assessed to have caused thousands of deaths from non-Covid causes. As hospitals in an area fill up, can our National Health Service not accommodate patients elsewhere, including in the Nightingales? Imposing these further, very high restrictions will undoubtedly damage family life and overall quality of life, yet Parliament has not been offered evidence to demonstrate the effectiveness of these measures. It is not clear how they defeat the virus, nor how many lives will be saved by ongoing lockdown.

In addition, I share the concerns of the noble Lord, Lord Robathan, about the dangers of the 10 pm curfew and the ineffectiveness with regard to crowds coming out at the same time. I also share his sympathy for my noble friend the Minister. None of this is easy, and I know that my noble friend is dedicated to his brief. But balancing public health needs with the needs of society, albeit a horrendous challenge, surely needs to be based on sound data. How does a draconian lockdown, or indeed a circuit-breaker, defeat Covid? Will locking down and opening up, followed by new Covid transmissions, perhaps cause more deaths than lives saved from coronavirus? Estimates suggest that the number of people dying from non-Covid causes due to staying away from A&E, and inadequate social care, is, so far, 42,000. I hear that imposing these further restrictions will increase fatalities and, without effective test and trace or a vaccine, they do not offer a remedy.

Since March, 350,000 people have not been referred for urgent cancer checks. Many of those people will die. This is not just about saving lives from Covid—it is about saving lives overall, and our way of life.

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

Baroness Altmann Excerpts

Monday 12th October 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I thank my noble friend for introducing these regulations and share others’ sympathy with the position he finds himself in on the Front Bench. I agree with him and echo his concerns that these measures have greatly affected families; they have interfered with the bonds that many children, parents, siblings, grandparents and friends rely on for their sense of worthwhile living. My noble friend mentioned that these SIs are vital to suppress and eradicate this disease. I understand how they suppress it, but how do they eradicate it?

As the noble Lord, Lord Hain, eloquently explained, we were in this position many months ago; the transmission rate fell but, once freedom was restored, the transmission reappeared. What consultation has occurred with the areas affected by these SIs? For example, will the 10 pm curfew merely transfer meeting to the street, or on to public transport, as all pubs and clubs empty at once?

We are once again being asked to rubber-stamp measures in this House that have already been introduced and amended twice—perhaps shortly to be thrice—yet there are still no impact assessments and no detailed cost-benefit analysis. I also echo the words of the noble Lord, Lord Shipley, in asking for evidence of how the rising number of cases is related to the extent of testing in any area, and how many are among only the young and asymptomatic, which may be of far less concern. These measures are so draconian, intrusive and dangerous to both lives and livelihoods that we surely need much more rigorous analysis than we have hitherto been offered.

When calling for a detailed cost-benefit analysis, we are not just talking about looking at the trade-off between lives saved by lockdown versus costs to business and economic growth, important though that it is. As mentioned so powerfully by my noble friend Lady Morrissey, analysis is required of the costs and benefits of Covid-19 deaths prevented by lockdown versus deaths from other causes caused by lockdown. Deaths and serious ill health, both physical and mental, will be increased by the measures we are debating today.

How many people will die or suffer life-limiting impacts? Who has done those estimates? For example, Hull University NHS teaching hospitals have already informed thousands of patients that they will have to wait two years for medical treatment. As another example, 16,000 fewer patients than expected are being urgently referred for lung cancer tests just since March—a 50% fall. Some fear going out, but others may develop a cough and just self-isolate rather than going for a check. Even if they try to see their GP, they may have only a virtual consultation, which may tell them to self-isolate. Cancer, heart failure and other illnesses are being worsened by the measures that we are debating today.

This is not an easy situation; we are in a very difficult position. But we need much better and more detailed information and analysis on which we can truly base judgments about these kinds of draconian measures, so that we can satisfy ourselves and the public at least that we understand what the costs are, that they are justifiable and that, in the end, we have a strategy for eradicating this virus rather than just suppressing it on an ongoing basis, with all the damage that that entails.

Food Hygiene Rating Displays

Baroness Altmann Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely acknowledge the persuasive statistics from the noble Baroness. FSA analysis suggests that food-borne illness outbreaks are twice as likely to occur in businesses with a low rating than those with a rating of three, four or five. These are very concerning figures. We completely take on board the statistics that the noble Baroness has cited, and I shall take them back to the department, as she suggests.

[Baroness Altmann (Con)]

My Lords, has the pandemic had any impact on the overall food standards and hygiene ratings of various outlets? Do local authorities need more resources to continue to carry out the checks that they are required to make?

[Lord Bethell (Con)]

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

Covid-19: Adult Social Care Complaints

Baroness Altmann Excerpts

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right that in April 2016 we committed, in fact sheets about the Care Act, to introduce an appeals process. That is still on the horizon, but this is best placed as an overall reform of the social care system that puts it on a sustainable footing where everyone is treated with dignity and respect. We have, therefore, delayed the implementation of this appeal system until we can make it part of a larger commitment to reforming social care.

[Baroness Altmann (Con)]

My Lords, I urge my noble friend to encourage his department to come forward with its plans for social care reform as soon as possible. How many complaints relating to Covid has the Local Government and Social Care Ombudsman received since it reopened on 29 June?

[Lord Bethell (Con)]

Last week, the Local Government and Social Care Ombudsman indicated that it had had around 100 Covid-related complaints. The department is closely monitoring the situation, including through our normal safeguarding networks. The ombudsman has confirmed that the current level of complaints is no higher than normal. We will be making sure that there is no backlog that ticks up this number.

Covid-19: NHS Application

Baroness Altmann Excerpts

Thursday 1st October 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I too congratulate my noble friend on his birthday and I congratulate the Government on introducing this new technology. As he is aware, I am very supportive of this. I would be grateful if he could explain to the House what evidence there might already be from Scotland on the effectiveness of the Protect Scotland app in tracing contacts, ensuring isolation and reducing deaths.

[Lord Bethell (Con)]

My Lords, the Protect Scotland app has delivered huge value for the Scottish people. It has guided many to isolate and it has been downloaded a very large number of times. We seek to get the UK app and the Scottish app working together in the second version. We have learned an enormous amount by collaborating with Scottish colleagues and have gained enormous value from their learnings.

Covid-19: Tracking

Baroness Altmann Excerpts

Wednesday 30th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the ultimate aim of the app is to break the chain of transmission. That is done through a number of ways. One is to provide a proximity alert for those who spend time with people who have tested positive. It also has a check-in capability to help our track and trace efforts, and we are building more applications on it all the time. One encouraging statistic is that until 10 o’clock yesterday, there were 6.5 million check-ins through the app. This is an astonishing number and it shows that those who are socialising are using the app.

[Baroness Altmann (Con)]

My Lords, I congratulate the Government on introducing this system of track and trace using apps. I encourage my noble friend to look carefully at introducing as soon as possible the express system available in the US and having it integrated into the telephones. He may not be aware that a number of people with whom I am in contact have downloaded the current app, found that it drains their batteries too quickly, and have therefore deleted it. Does he agree that if the express system were integrated into the app, it would do less damage to the battery and it would be more likely that people would stay with it?

[Lord Bethell (Con)]

My Lords, we are looking carefully at the Apple express system. It does not contain the substantial investment in the algorithm from the Alan Turing Institute that gives our own app the sensitivity and protection that phone users are seeking from such a device. We have looked carefully and worked extremely intensely with Apple on the battery and our understanding is that the app does not have a large impact on battery use.