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

Baroness Andrews Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, in the time available, I want to ask the Minister a number of questions about this SI and the decision to leave so much of the country designated as “medium” level, but I join other noble Lords in saying how much we appreciate the Minister’s very hard work, stamina and patience on this series of SIs.

It seems that the “medium” level areas are precisely those where there is still a marginal chance that lessons can be learned, and early and swift action can be taken to prevent escalation. One of the most perverse and unwelcome outcomes of how this disease has developed is that, as the WHO said recently, it thrives on poverty and poor housing, and “exasperates inequalities”. One of the very worst things that could happen would be for this already divided country to be driven further apart because those traditional post-industrial communities of the north and west, the Midlands, south Wales and Scotland were to suffer disproportionately. We are certainly not all in this together at the moment, but I sense that it is only a matter of time before we are. Large areas of the country designated at the lowest tier also contain large poor urban communities, where the pandemic takes a fierce hold.

That is why I say, “Thank God for the leadership of the local authorities.” They have stepped up magnificently to protect and provide for their local communities. The most effective thing that the Government could do is to listen more closely and act more swiftly on the advice they are getting from local authorities. They are still not in the driving seat when it comes to NHS Test and Trace, but they need to be. London is the outstanding case in point. Infections are now rising above 100 in 100,000 in several boroughs. The Mayor of London is urging the Government not to wait four weeks, until London has caught up with the worst scenario in the north, but to act now to break the circuit of infection. What is the Government’s response to this? Is the Prime Minister talking to the mayor? Why delay when, as surely as night follows day, and as the Deputy Chief Medical Officer has said, the evidence is that there will be a predictable exponential increase in infection and eventually in hospitalisations. What is the Government’s strategy to deal with London in all its diversity?

Turning to more general questions about the decisions to leave most of the country designated as “medium” level, how is risk defined in those areas so designated? Is there any differentiation within these areas? What are the ranges of the R number? What modelling is being done by SAGE or other groups, and at what level, to establish transmission routes or speed of transmission from areas of high infection to areas of low infection? What advice are the Government giving public health leaders in the south-eastern region, for example, about what they might expect and what they should be preparing for? Given that there are many universities in the south-east, what assessment have the Government made of likely sites for the spread of infection? What advice is now being given to universities across those areas, especially on testing? What precise trigger point would escalate the decision to move regions to tier 2? Which pillars of the Covid-testing strategy are informing these decisions? Given that SAGE has confirmed that the NHS Test and Trace system is having a marginal effect on areas with the highest rates of infection, what evidence is there that it is having a more effective impact, in terms of contact tracing, on areas of medium risk? Have the Government assessed the relative advantages of a Serco track and trace system over those of local authorities?

We are all shocked by the resistance that the Government showed to SAGE advice three weeks ago. Now we are told that the Government might be considering a circuit-breaker. I beg of them not to dither any more, because I predict that we will be here in a few weeks’ time debating a temporary lockdown. The tragedy is that we will have wasted weeks, when we could have saved lives in the process.

Covid-19: Local Restrictions

Baroness Andrews Excerpts

Friday 9th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I note and take very seriously the noble Viscount’s comments on the state of our legislative response to the epidemic. There will no doubt be a time for reflection, learning the lessons of the epidemic and reviewing the legislative processes that we have available. This is not the time; the challenge of Covid is still very much a clear and present danger, but we will take on board his recommendation to reflect and improve on the structures we already have.

[Baroness Andrews (Lab) [V]]

My Lords, to go back to my noble friend Lord Hunt’s question, given the exponential rate of the increase in Covid in the north and Midlands, have we not again lost the advantage of acting early and acting fast? Now we are told that the Government are considering introducing a national scheme based on three tiers of severity. What is holding this up? To what extent and how are local authority leaders—who still say publicly that they are being treated with contempt—involved in this decision? And when will Parliament be told?

[Lord Bethell (Con)]

My Lords, I cannot help but observe the palpable irony of being told, on the one hand, to engage, form alliances and double up on stakeholder engagement and, on the other, being told to hurry up and get a move on. An effective response means a combination of both national and local systems. A huge amount of work needs to be done to build the consensus, support and technical arrangements for that response. We are putting a huge amount of work into that process and look forward to making announcements on it. Until then, I reassure the noble Baroness that officials and politicians are working night and day to make that response as effective as possible.

Covid-19: NHS Application

Baroness Andrews Excerpts

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I greatly regret that the noble Baroness, Lady Deech, had to make that journey. That is a troubling thing for her to have had to do. I reassure her that 89% of the population have phones whose hardware and software is compatible. Even on today’s numbers, one-third of the 16-plus population of Britain has the app on their phone. This number is high enough to make the app extremely effective; it is an enormous penetration. While this does not account for absolutely everyone, it is terrific progress and we will build on that success.

[Baroness Andrews (Lab) [V]]

My Lords, the Minister just gave a figure for the over-16s. In view of the outbreak of Covid in universities, what proportion of university students have accessed the app and actually used it? Am I right in thinking that it is accessible only if you are over 16? Why is this the case?

[Lord Bethell (Con)]

My Lords, I cannot answer the noble Baroness’s question. There is a very good reason: the privacy arrangements of the app mean that we do not know who has downloaded it. This information is available only to those who have downloaded it. It is precisely because of those privacy arrangements that an enormous amount of trust is placed in the British people. However, I do not deny that it is frustrating that we do not have the kind of demographic insights that the noble Baroness quite reasonably asks for.

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

Baroness Andrews Excerpts

Friday 25th September 2020 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, the commentary by the Secondary Legislation Scrutiny Committee on these regulations and the update which we have just heard from the Minister illustrate beyond doubt what an extraordinary challenge these local authorities are facing as they try to follow and implement government regulations which, as we have already heard, change on a daily or weekly basis and are causing great confusion. They often have not involved the local authorities in their making. Sometimes they have been introduced without consultation or local advice. It is no wonder that communities are confused, but people on the front line are also confused.

I follow the noble Lord, Lord Willis of Knaresborough, in saying that care homes are in the front line. There is no more talk of a ring of steel, but the least they ought to be able to expect in these areas of high infection is priority for testing, speed of turnaround and the greatest possible protection against transmission from asymptomatic visitors and staff. It still seems that that is not the case, and across the region there are reports of scores of incidents where care homes are waiting up to a week for test results. What has to be changed in order to give care homes priority not just in terms of speed of testing and getting results? Is the problem a local shortage of lab equipment and materials or a shortage of skills? Have the Government looked at the possibility of using the capacity of local universities—their lab space and technical skills—to supplement testing? Can the Minister explain why care home inspectors are not being routinely tested when they visit homes? Perhaps the more fundamental question is: what is the argument for care homes remaining in pillar 2 rather than being treated the same as health workers in pillar 1? As my noble friend Lord Blunkett said, we all hope that the lessons from the fiasco this spring have been learned. I hope the Government can reassure us that that is the case.

Covid-19 Update

Baroness Andrews Excerpts

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am afraid that any decision about an inquiry is way beyond my pay scale, but the noble Lord is entirely right: there will clearly be massive lessons that we need to learn about the ways in which we do government, and health, and manage our public health. Those lessons should certainly include the economy since the impact of this disease on it has been profound. We will be living with those consequences for some time to come. We need to learn how to protect the economic future of our children when dealing with these kinds of national epidemics.

[Baroness Andrews (Lab) [V]]

My Lords, one of the most public failures of communication has been the refusal of the Prime Minister to talk to his counterparts in the devolved nations. Yesterday, they had the privilege of a conversation with Mr Gove. The Prime Minister has still not spoken to them since May. I find that extraordinary. I have never seen Mark Drakeford so angry. Does the Minister agree that unilateral decisions taken in England can have a perverse impact, particularly on Wales, as many people live in Wales but work in England? Will the Prime Minister now engage? Will those devolved Ministers be at the COBRA meeting tomorrow, for example? When will the Prime Minister set up the regular, reliable meetings with his counterparts for which they have been asking for months?

[Lord Bethell (Con)]

My Lords, the noble Baroness makes a powerful point but it is at odds with my own experience. I deal with my counterparts in the devolved authorities on a very regular basis. We have extremely strong bilateral relations and I pay tribute to the collaborative spirit in which they go into those conversations. All I can say is that I am extremely grateful to those in the devolved authorities who have worked so closely with us in a four-nations response to this epidemic.

Covid-19 Update

Baroness Andrews Excerpts

Thursday 10th September 2020 Lords Chamber

[Lord Bethell (Con)]

I answered the question as clearly as I possibly could. This is about communication and clarity and making sure that people understand the instructions; it is not about science. If that is not effective then the guidelines are pointless.

[Baroness Andrews (Lab)]

My Lords, perhaps I may take the Minister back to the question asked by the noble Baroness, Lady Walmsley. I was sorry to hear him say rather dismissively that people are clogging up the system because they seek some sort of reassurance, although they do not have symptoms. That seems to me a perfectly natural and human reaction. Can he confirm that basically government policy now is actively to discourage anybody without any symptoms in any situation seeking a test? If that is the case, what is his answer to the letter that he received from the directors of public health in the south-east, who are deeply worried that an area of low infection could easily become an area of high infection? What will he say to the universities that have introduced testing for all students, asymptomatic or not, because they want to protect their local communities, given what we know from America—from Chapel Hill, for example—about the absolutely devastating effect that university populations can have?

Covid-19

Baroness Andrews Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Andrews (Lab)]

My Lords, I take the Minister back to airports. I have three questions. First, what is the science telling us about the likely impact—I know that this is a difficult question—of people coming off planes from highly affected countries? Have we done any research on that? Secondly, the Minister said that it is very difficult to test when people come off aircraft because the disease may be inhabiting them but not presenting. Other countries, however, are testing at five-day and even 10-day intervals: have we considered that? Thirdly, if our only strategy is quarantining, are we collecting data on how people are conforming? Are they staying in isolation? How do we know that? Can the science and the data be made available to us? If there is an unknown or even a known loophole, how do we fill that if quarantining is our only strategy?

[Lord Bethell (Con)]

The noble Baroness asks three extremely perceptive questions. With regard to the science of testing at airports, a huge amount of work is being done on this, and I pay tribute to the work of the scientists at SAGE, who have, I think, published several papers on this matter.

The number that sticks in my mind is SAGE’s estimate that of those infected who pass through an airport only 7% would be captured by what is called day zero testing—a tiny proportion. That uncomfortable and inconvenient statistic holds us back from doing what we would love to do—it just does not work. We are looking at seven-day testing, eight-day testing and 10-day testing. This is a lot about risk management: there is a risk curve. I would be happy to share a copy of the SAGE report, which is public, that shows that curve.

The noble Baroness is right to raise quarantine implementation: it is a cause of concern. Quarantine is critical to the effective implementation of our epidemic management. It is a trust-based system. Anyone who has read the papers will know that that trust-based system is under pressure. We are keeping it under review and will be looking at whether it needs to be updated.

Covid-19: Local Restrictions

Baroness Andrews Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Baroness that local support, trust and collaboration between actors from all political parties are essential to fighting Covid effectively. I pay tribute to the very large number of dialogues and collaborative interventions we have had across the country with local actors from all political parties. Yes, local lockdown decisions are not always popular. They are tough choices and elected representatives find them difficult, but we have found that politics does not play a part in those decisions and we stick to that.

[Baroness Andrews (Lab) [V]]

My Lords, it seems to have been decided that areas of low infection do not need the same degree of access to testing as the known hotspots. Indeed, there are accounts of people in London being directed to Wales because there is not sufficient testing capacity. Is this not exactly the way in which to miss the next hotspots and possibly the trigger of a national spike? Is it not another stable door that is left open? On what scientific evidence was this decision made and will it be published?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right that testing capacity is naturally prioritised to those areas with a major outbreak and that, when supply is constrained, some of the recommendations for travelling, particularly later in the day and in the afternoon, can involve long distances. Our objective is to put in place massive testing capacity right across the country in all areas, whether high or low in infection prevalence. That is our ambition.

Medicines and Medical Devices Bill

Baroness Andrews Excerpts

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

[Baroness Andrews (Lab)]

My Lords, it is a privilege to follow the noble Baroness and to pledge our support—I feel sure of that in this House—for what she is trying to achieve, in the light of what she has achieved so far. We all look forward to what the Minister will say in response to her plea.

This is a Bill that we can and should welcome, in many respects. For example, I share many of the ambitions mentioned by the noble Lord, Lord O’Shaughnessy, when he spoke. It sets out a necessary regulatory framework; my concern is that it comes with unnecessary risks as well. It spans the range of human and veterinary medicine. It includes clinical trials and the ability to prescribe. It addresses some of the abuses raised by the noble Baroness in her report, and it raises fundamental questions about capacity and professional standards. That means it is important, not least for the reasons which the noble Baroness has just explained in her example, that the balance between powers and accountability—between patient safety and risk—is got absolutely right. We will obviously probe this in detail as the Bill goes through the House.

I have two concerns. One is how patient safety can be protected within the context of creating an attractive environment, whatever that means. The other is the speed, direction and potential impact of the cumulative divergence from the stability and standards of inherited EU law. The Bill is designed to achieve just that and to accelerate it. Our task in this House is how to anticipate impacts and correct for perverse consequences. That is why I feel that the better purposes of the Bill are undermined by the fact that it is a skeleton Bill. We are not surprised, of course; this is what we have come to expect. Skeleton Bills have become not the exceptional position, as urged by the Constitution Committee, but the default position of this Government, who are so committed to accelerating deregulation and for whom, frankly, Brexit provides the obvious opportunity.

The first 15 clauses of the Bill consist entirely of powers to make provisions by regulations about human and veterinary medicine and medical devices. I hope that the House will challenge in particular the provocative powers of delegation in Clauses 1, 8 and 12, not least given the chaotic conditions that we seem to be approaching with no deal at the end of this year. However, it is the fundamental disregard for Parliament which explains the exasperation expressed by the Constitution Committee and the DPRRC in its report on the Bill, the latter in particular towards the flimsy and, frankly, disingenuous justifications that were offered for the use of powers.

Noble Lords will also find if they read the whole report that there is more than a disregard for the job of Parliament. In some cases, the suggestion is that the new powers offer the same restraints as the existing ones. They do not. This is why the Bill presents such a risk. The anticipated divergence is away from a stable regulatory framework into an unknown environment in ways that cannot be tested in this House because the design, as well as the delivery, is in secondary legislation. The Bill is divergence by delegation.

The Secretary of State has made no bones about this. At Second Reading in the other place he spoke of the Bill giving

“the means to depart from EU rules and regulations in future, moving at a faster pace … it ensures that we can easily amend regulation through secondary legislation without having to bring a new Bill”.—[Official Report, Commons, 2/3/20; col. 659.]

The DPRRC has replied that the Secretary of State has taken upon himself

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

In the strongest language that I can remember, it describes the powers taken to allow regulations for making the disapplication of legislation subject to conditions set out in a protocol—whatever that might mean—as

“yet another example of ‘camouflaging legislation’.”

This is Parliament; this is our job: to expose legislation, not camouflage it. Will the Minister assure us that he will listen and respond positively to the call for restraints and the removal of those powers in the Bill that have been so insufficiently explained by the Government so far? He will save himself a lot of grief if he does.

Covid-19: Response

Baroness Andrews Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness raises an incredibly important issue and I pay tribute to Kate Bingham, who is running the Vaccine Taskforce. She is tackling exactly the issue that the noble Baroness raised. GPs are right to be concerned about capacity, which is why we are looking at ways of massively increasing the capacity to deliver such a vaccine. We will definitely look at resources such as returnees, pharmacists and other sources of people power to deliver the vaccine into the arms of the nation. On the anti-vaxxer groups, the fake news and wrong stories around vaccines are an area of deep concern. We are working with faith groups and other civic leaders to put right the arguments for a vaccine because, at the end of the day, any vaccine requires the participation of a large proportion of the country in order for it to be truly effective. It will cause huge disruption and personal suffering if trust is not maintained in the efficacy of such a vaccine.

[Baroness Andrews (Lab) [V]]

Where does the Minister think the greatest risks of a second wave of Covid-19 now lie? What specifically needs to be achieved by early autumn to prevent that, and what extra support will be provided specifically for care homes?

[Lord Bethell [V]]

The noble Baroness invites speculation; I wish that I knew the precise answer to that key question. We are extremely vigilant in a large number of areas, including the measures to release a degree of social distancing and on foreign travel, as she knows. We know that if the country remains committed to the basic principles—hand washing and hygiene; social distance; and isolation when necessary—those three principal pillars will be the ones that defend us from the spread of the disease. We are doing everything we can to shore up those pillars, and that is particularly true in social care, where we have massively boosted testing for both staff and patients and brought in hygiene control, particularly around PPE. We will continue to support the sector financially to ensure that agency workers can be used as little as possible.