Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020
Baroness Barker Excerpts(4 years, 11 months ago)
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Baroness Barker (LD) [V]
My Lords, had these regulations been provided in April with proper consultation, they might have been credible, but today, with our “world-beating” track and trace system, which fails to notify 20% of contacts of people who have tested positive, and with Public Health England releasing data to local authorities only once a week and without patient identification, they are highly questionable. When will local authorities be given real-time data and the powers that they really need—for example, to instruct the opening of facilities such as toilets? When will the Government release the scientific basis for treating different businesses in inconsistent ways? Will they monitor the differential impact of these regulations on black and minority communities, and will they act swiftly to end such discrimination?
Pharmacies
Baroness Barker Excerpts(4 years, 11 months ago)
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Lord Bethell [V]
As the father of four small children, I completely endorse the noble Baroness’s point. Many a night have I been outside a hard-working pharmacist’s shop looking for advice, support and essential medicines. I pay tribute to the hard-working community pharmacy sector, whose pharmacists are often up until midnight helping their local communities and hard-hit fathers like me.
Baroness Barker (LD) [V]
What advice has the department had from local directors of public health about the resources that are necessary to ensure continuity for community pharmacies during local lockdowns?
Lord Bethell [V]
We are fully engaged with the sector. The National Pharmacy Association and the other stakeholder groups are in close communication with the department to ensure that they have the PPE, medicines and finances to keep going during the epidemic. The voice of the DPHs is involved in that stakeholder engagement.
Covid-19: Mental Health Services
Baroness Barker Excerpts(5 years ago)
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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.
Covid-19: Masks
Baroness Barker Excerpts(5 years, 1 month ago)
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Baroness Barker (LD) [V]
My Lords, on 4 March, the government advice on face masks was that they do nothing, so do not wear them. On 17 April, the advice was that they do more harm than good, and on 11 May, it was that wearing one is an added precaution. As of 4 June, wearing them is to be compulsory. In that time, the science did not change but the death toll rose. Why have the Government failed to distinguish between PPE standards necessary in acute treatment settings and masks which are suitable for people using public transport? Why, given this record, should the public trust them during a second spike?
National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020
Baroness Barker Excerpts(5 years, 1 month ago)
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Baroness Barker (LD) [V]
My Lords, these fees are a perfect encapsulation of the disparity between health and social care. Prior to the emergence of Covid, the social care sector was in crisis. Since 2010, local government finance has reduced by 50%, but statutory responsibilities have not. Local authorities have had staff reductions, to the point where there are senior directors, front-line staff and very few people in between.
On 25 February, the Department of Health and Social Care guidance told local authorities:
“It remains very unlikely that people receiving care in a care home or the community will become infected … There is no need to do anything differently in any care setting at present.”
On 14 May, the Health Secretary, Matt Hancock, stated that
“right from the start we have tried to throw a protective ring around our care homes.”
The public response was incredulity, because by that time there had been 10,000 deaths in care homes in England and Wales, according to the ONS—a quarter of all deaths. I repeat the statement from Martin Green, chief executive of Care England, who asked to
“see the evidence of what exactly the protective ring consists… and when exactly they instituted this protective ring”,
asked why
“we had our PPE distribution networks disrupted to send things to the NHS”
and
“why we had our primary care support withdrawn from many care homes?”
Why are they still waiting for it?
On 18 May, in their Covid recovery strategy, Our Plan to Rebuild, the Government pulled another fast trick. On clinical support, the strategy states that
“the Government is accelerating the introduction of a new service of enhanced health support in care homes from GPs and community health services, including making sure every care home has a named clinician to support the clinical needs of their residents by 15 May.”
But that should have been happening already under various pieces of legislation. In truth, the NHS abandoned care homes at their point of greatest need. Nevertheless, I ask the Minister: what progress has there been towards that 15 May deadline?
It is time for the Government to stop announcing new responsibilities for local government and start listening to local authorities about what they need central government and the NHS to do, so that there can be a joint strategy to manage Covid and its lasting impact on communities. Inadequate testing, little tracking and no isolation means that care homes will not be ready to withstand a second spike. They simply will not be able to provide what these older people desperately need.
Hospitals: Patient Safety
Baroness Barker Excerpts(5 years, 1 month ago)
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Lord Bethell
My Lords, there was some interruption in hearing my noble friend’s question but, if I understood him correctly, the answer is that all patients are now tested on entry to hospital. Until their test result has arrived, they are treated as though they have Covid-19 and isolated wherever possible.
Baroness Barker (LD)
How will the Government enable hospitals to work on a regional basis, co-operatively, to optimise the use of surgical and radiological resources?
Lord Bethell
I am afraid that at the moment, I cannot give a precise and thorough answer to the perceptive and very detailed question asked by the noble Baroness, but I will be glad to.
Mental Health Services
Baroness Barker Excerpts(5 years, 1 month ago)
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Lord Bethell
I recognise the insight of my noble friend Lady Newlove, who speaks from experience of these matters. I reassure her that the funding in place from the long-term plan for mental health has been substantial and will support a dramatic change in mental health services. We will be supporting mental health workers who, as my noble friend says, have delivered under difficult circumstances. Their creativity is demonstrated by the introduction of video and other technical facilities to keep mental health services going during the lockdown. I pay tribute to their inventiveness and creativity at this time.
Baroness Barker (LD)
My Lords, is data on mental health support, A&E presentations, referrals to community mental health services, crisis resolution callouts and detentions under the Mental Health Act being collected during this period—yes or no?
Lord Bethell
My Lords, I understand that it is a firm “yes”, but I will check that answer and revert to the noble Baroness if there is any different information.
Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020
Baroness Barker Excerpts(5 years, 1 month ago)
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Baroness Barker (LD)
My Lords, the United Kingdom has been a world leader in transplant research and reconstructive surgery since the 1940s, and we continue to be the home to world-leading developments in bioscience. Moreover, we have been the outstanding leader in the ethical regulation of cutting-edge medicine and medical technology, due in no small part to the work of your Lordships’ House and the work of Baroness Warnock.
What we have today is a public policy settlement under which research scientists and medical practitioners develop pioneering research. That takes place within a framework of legal principles which is subject to parliamentary scrutiny and is regularly updated as the science advances. I pay tribute to the then Prime Minister, Gordon Brown, for setting up the Organ Donation Taskforce, which in 2008 published the Organs for Transplants report. The report provided a series of recommendations to help us to increase our organ donor rate by 2013. That 2008 strategy did indeed manage to increase the rate of donations by 50% from deceased donors and by 30% from living donors. However, that is still not enough; we need more organs, because people are dying. In 2013, NHS Blood and Transplant published its report, Taking Organ Transplantation to 2020, which set out a more detailed plan.
I congratulate the noble Baroness, Lady Finlay, and others who worked very hard to secure the Organ Donation (Deemed Consent) Act 2019, which amended the practice of the 2004 Act but not its principles by moving to an opt-out principle for routine donations. That was necessary, because many of the most suitable organ donors are people who have been involved in accidents or who have sudden life-threatening illnesses and have not given prior consent. At the point of such an emergency, they and their families are unable to give the consent that they may have wanted to do.
These are decisions that ideally are taken in advance after long and detailed consideration, but which often arise in an emergency medicine setting. I suggest to noble Lords that they go back and look at the contribution made in another debate by the noble Baroness, Lady Tonge, who comes from a family of medics. All her family members had discussed the matter and decided that they were all in favour of organ donation. However, when her daughter died in a very tragic accident, not only did nobody raise the matter with them, but they did not think about it either. That has always been a matter of regret to her.
The policy intent has always been to exclude novel and rare transplants, including situations in which cells are retrieved from organs that could be used to create an advanced therapeutic medicinal product, as other noble Lords have said. Although some people who wish to do so can leave their bodies to medical research, that research is regulated separately by the Human Tissue Authority, so there really should be no confusion between medical research and transplantation. However, the Minister stated that if a transplant that is currently considered to be rare or novel were to become common, the process of amending the law would be the one that we are following now: discussion, consultation and proposals brought forward by law. My question is this: what would be the trigger for proposing such a change in the law? As other noble Lords have said, looking back over the past 17 years, should we not be looking at a periodic review of transplant law—say, every five to seven years?
I have spoken about black and minority-ethnic communities in your Lordships’ House before. In 2003 my friends Joe and Grace Desa lost their 13 year-old only child Daryl to a brain haemorrhage. Grace and Joe showed remarkable dignity during that unimaginable tragedy. One of the things that comforted them was that many people benefited from organs and tissues donated by Daryl. In 2018, when we looked at the figures again, we saw that people from black and minority communities were still waiting longer than others and that there was comparatively low organ donation from people from the same ethnic groups. It is really important that we make these groups the focus of particular awareness campaigns. I know that my friends Joe and Grace took part in them to try to increase donations from people from south Asian communities.
I welcome the emphasis in this new code of practice on taking into account family and religious beliefs, but I go back to the point made by the noble Baroness, Lady Deech. Is the intention of the code of practice to ensure that a family’s religious belief can take precedence, but not where an individual who has mental capacity has made a deliberate decision that they wish to be a donor? Can the Minister clarify that point? What good practice guides will be given to make sure that specialist nurses who work in organ donation work to clear guidance?
I too hope that the Government set up an independent inquiry into the effects of Covid on black and minority-ethnic populations. I hope that it will not just be about the emergency process that we have been under for the last two months but will look over the longer term at what Covid has done to affect health inequalities in Britain, including transplants.
My final point has not been mentioned by other speakers in this debate. The Human Tissue Authority operates under the EU organ donation directive and the EU tissues and cells directive. If there is no deal, the EU organ donation and tissues and cells directives would no longer apply in the UK. The Government have previously said that in the event of no deal, organisations and authorities in the United Kingdom will continue to work to the high practice standards they do now, but if we are no longer under those same directives as the rest of Europe, people in this country who need organ donations will no longer be treated on the same basis as those in other European countries. The UK would be treated as a third country. Will the Government confirm that if there is a no-deal Brexit, people requiring tissues and transplants of organs from other countries will be at a disadvantage? Will they issue updated guidance on this? The guidance they produced back in 2018 no longer stands.
We all want better and quicker availability of life-saving transplants for people who need them. We broadly support these regulations, and I hope the Government will make sure that in these difficult times there are the resources to make them happen in practice.
Covid-19: Testing
Baroness Barker Excerpts(5 years, 1 month ago)
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Lord Bethell
The noble Lord is entirely right. Speed is essential and the South Korea example is a good one. More than half of our tests are turned around within 24 hours. I pay tribute to the track and trace team, who handled an extremely complex and difficult laboratory failure last weekend and used innovation to turn around 50,000 tests, the results of which were reliably given to people. However, we will continue to work on shortening the result times and getting the information back speedily so that isolation can happen in a thorough way.
Baroness Barker (LD)
What is the average time between a swab being taken and a patient getting the result, and what is the average time for that test result to show up in national tracking data?
Lord Bethell
The average times are not at my disposal, but I reassure the noble Baroness that more than half the results are turned around within 24 hours. Our target time is currently 48 hours and the vast majority of tests are done within that time. As the noble Lord, Lord Wood, rightly said, speed is of the essence, and we are working hard to compress those times.
Health Protection (Coronavirus, Restrictions) (England) Regulations 2020
Baroness Barker Excerpts(5 years, 2 months ago)
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Baroness Barker (LD)
My Lords, in the Covid emergency legislation and these regulations, the Government have taken unto themselves enormous powers which remove from citizens many basic legal rights. Having done so, the Government should be under an obligation to subject their decision-making to scrutiny which is reasonable and timely. The fact that we are discussing today regulations already implemented in March is yet more evidence that the decisions made unilaterally by the House authorities to restrict House business and the ability of Members to take part are hugely damaging to democracy and preventing transparency.
The Minister, Jo Churchill, introducing the regulations in another place on 9 March, said:
“Tackling covid-19 requires a robust, integrated and proportionate response”.—[Official Report, Commons Delegated Legislation Committee, 9/3/20; col. 1.]
Today it is our duty to test whether the Government have done that so far.
What we have a today is a set of regulations based on assumptions that the greatest threat to public health would arise from individual people ignoring advice to observe lockdown and defying advice on physical distancing. With some exceptions, the public have observed the public health advice pretty well. Where groups of people have not followed advice, local government, particularly mayors, has stepped in to restore compliance.
Ironically, we have seen instead that the biggest threat to life since the pandemic began has been in care homes, where it is said that there have been more than 10,000 deaths. That is not the fault of local government or local resilience hubs, which know and understand the needs of care providers and vulnerable groups in their area; it is a direct consequence of central government’s failure to prioritise testing in care homes and testing of people being discharged from hospitals into care homes. Seven weeks in, local government and care providers are still being sent detailed guidance which is constantly changing, and they have to grapple with three different systems for ordering PPE, none of which works properly. Unsurprisingly, the death rate among staff in care homes is much greater than that in hospitals.
In this morning’s Question about care homes, the Minister said:
“I reassure the House that deaths in care homes have always been part of the official figures.”
I ask him to write to me setting out the exact basis for his statement, because the Government’s advice of 28 February on Covid in care homes stated that it was very unlikely that people receiving care in a care home or a care setting would become infected. Can he explain why in daily press conferences in March and April Ministers specifically used the number of deaths from Covid in hospitals? Has he listened to the BBC Radio 4 programme, “More or Less” which has cited frequent use of different statistics at different times by Ministers and government spokespeople in response to questions on these issues?
Since the beginning of the pandemic, decision-making has been based on two assumptions: first, that the main and lasting impact of the virus would be on the NHS and, secondly, that central government, and not local government, are always best placed to lead every initiative. As some of us have been saying since March, those assumptions may have been temporarily correct for the initial medical emergency, but they are the wrong basis on which to prevent further major outbreaks. The key to managing the virus while a vaccine is developed is to work in partnership with regional and local government, businesses and charities to design, implement and monitor effective public health systems.
The regulations that we are discussing today have been overtaken by events. However, as the country prepares to exit lockdown, it is more necessary than ever that we have regulations which make clear the legal basis on which government decisions and actions have been taken, and which make a distinction between the law and good practice.
Yesterday, the Government released what they called Our Plan to Rebuild, the Covid recovery strategy. It is not a plan; it is a set of assertions and aspirations not particularly well communicated. Page 33 announces 14 supporting programmes. On closer inspection, there are at most 10 programmes, all of them centrally determined. Other Governments within the UK and local government are simply the recipients of more responsibilities. Some of those are extremely complex, such as rebuilding a social care system which is broken, but there is little detail about how it will be funded. What we have is yet another example of central government issuing demands and announcing initiatives, such as the GoodSAM app, when they have not thought through how they will work in practice. It is more like a plan for central government to get the glory while local government gets the blame.
The Government’s mantra is that they are following the science, but the job of government is more than that. It is the job of government to listen to scientific advice, consult relevant authorities and develop clearly understood legislation that will work. The public want to know what they can do safely to expedite the end of lockdown.
Will the Minister assure the House that no new criminal offence for individual citizens will be created as a result of this plan until the law and regulations have been voted upon by both Houses? There is an urgent need for clear legislation regarding key elements of yesterday’s announcements so that public health officials, local authorities, the police, schools, workers, employers and businesses understand their legal obligations and rights. Will the Minister undertake to bring the regulations, with the accompanying evidence base, to the House at the earliest opportunity? Will the Government allow sufficient time and information for Members of the House to understand how those regulations will be implemented?
When the emergency Covid legislation was passed, Ministers stressed that the government powers in that legislation would be turned on and off as necessary rather than being permanent. At that time, we asked for an updated table of measures in force at any one time so that people having to implement the laws knew under which legislation their actions would be authorised. Can the Minister say when that will happen? It is becoming a matter of urgency.
The Government have had unprecedented support from opposition parties and the population of the United Kingdom. For that to continue, they have to provide timely and accurate information that is trusted by those who hear it. I am afraid that this week, that has not been the case. By not doing so the Government have damaged their ability to take the swift action they have said they needed to take all along. The more the Government move into issuing statements based on soundbites rather than scientific evidence, the more difficult it becomes for politicians on all sides to support them in what they do. I hope that the Minister will take lessons from these regulations and that when the Government bring forward the next lot, they will have listened to the powerful messages given to them from right across the House this afternoon.