Debates between Baroness Barker and Lord Bethell during the 2019 Parliament

Wed 21st Jul 2021
Wed 13th Jan 2021
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Coronavirus Bill
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Committee stage:Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords & Committee stage
Mon 16th Mar 2020

Residential Social Care: Staff

Debate between Baroness Barker and Lord Bethell
Monday 6th September 2021

(2 years, 6 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Lord is right that taxes have to be spread across the whole country, but I remind him that the national living wage has risen by 2.2% in the last year, which benefits everyone across the population.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, a number of local authorities, including Croydon, are insolvent. Have the Government or the Minister’s department made an assessment of the impact of that on the viability of care providers and the capacity of people who need social care, and are entitled to it under the Care Act, to get the services that they need?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I acknowledge the pressure that local authorities are under. We do indeed keep in very close contact with local authorities that have financial pressure; I assure the noble Baroness that we will not be in a position where we breach the Care Act and that we keep very close tabs on the financial support that social care needs.

Covid-19

Debate between Baroness Barker and Lord Bethell
Wednesday 21st July 2021

(2 years, 8 months ago)

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Lord Bethell Portrait Lord Bethell (Con) [V]
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My Lords, the take-up of vaccine will at some point begin to tail off among some demographics. We are redoubling our efforts with our marketing and the availability of the vaccine, particularly among younger groups. The introduction of domestic certification for major events and pubs and clubs, if that is brought about, will create a strong incentive. These are the kinds of measures that we are putting in place to see through the strategy which, as I said at the beginning, is to get the vaccination levels to such a rate that R is below 1.

In terms of social care, as I mentioned earlier, we are looking to consult on domiciliary care and other forms of the healthcare system. On booster jabs, the noble Baroness makes me want to check my notes. In my briefing it says emphatically that flu and Covid jabs can be taken together, but I will take the opportunity of her additional question to offer to write confirming that point in case I have got it wrong.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, throughout the pandemic, epidemiologists have been clearly telling us that when restrictions are eased, there will inevitably be further outbreaks, some of them localised. For the past 15 months, test, trace and isolate has been a shambles. Can the Minister explain what will be done over the summer to improve test, trace and isolate and improve the information going, in real time, to local authorities and to other parts of the NHS, in order that we can move swiftly, as necessary, to very localised lockdowns when that proves necessary for public health?

Lord Bethell Portrait Lord Bethell (Con) [V]
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I completely agree that the post-lockdown wave is a well-known phenomenon, and we are living through the pain of it right now. I do not agree that test, trace and isolate is a shambles, and if the noble Baroness really still feels that way, I would be glad to arrange a briefing for her. As for what more we can do, we are investing heavily in the system and we will continue to improve things, as we have done already.

Health: Dementia

Debate between Baroness Barker and Lord Bethell
Monday 5th July 2021

(2 years, 8 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the focus on diagnosis is critically important. That is why Challenge on Dementia 2020 set a target of two-thirds of people living with dementia receiving a formal diagnosis. At the end of May 2021, DDRs were 68.8%, compared with 61.7% at the end of April. We are working hard to get these numbers back up, and the £17 million fund which I referred to is one contribution to that. But the noble Baroness is entirely right that this is an important area, and we are focused on it.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, during Pride month, the Alzheimer’s Society and Opening Doors London did a lot to highlight the experiences of LGBT people with dementia. Does the Minister agree that when the Secretary of State for Health insists on wearing a rainbow badge, it is unacceptable for people to turn up to services only to be misgendered or to have their family relationships ignored or undermined, and that there should be a process of sorting out training for staff so that people are dealt with appropriately?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I take seriously the testimony of the noble Baroness. I am not aware of the specific concerns that she describes, nor am I completely up to speed on the precise arrangements of the training, but I would be glad to correspond with her on this matter.

Covid-19: Vaccines and Pregnancy

Debate between Baroness Barker and Lord Bethell
Monday 14th June 2021

(2 years, 9 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the JCVI has a clear set of prioritisation protocols, which we are sticking to. The fact of being pregnant does not seem to have a direct impact in terms of severe disease or death, so there is no clear evidence at the moment for putting in or changing the prioritisation of pregnant women. However, we constantly review that and we are naturally concerned to protect both the mother and the child.

Baroness Barker Portrait Baroness Barker (LD)
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The Minister referred to women who do not know that they are pregnant. The place where women go to find out whether they might be is a pharmacy. What are the Government doing to make sure that pharmacies are places where women can access accurate information and guidance?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness is entirely right. Pharmacies have played an absolutely critical role in the vaccine rollout, and we owe them huge thanks for their contribution. Pharmacists have undertaken a huge amount of training in both the delivery and explanation of the vaccine. I attribute some of the success of the vaccine programme to the extremely effective communication from pharmacists on all aspects of the vaccine, including relating to pregnancy.

Covid-19: Over-75s

Debate between Baroness Barker and Lord Bethell
Tuesday 9th February 2021

(3 years, 1 month ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, my noble friend is entirely right about the massive mental health challenge and, if not the challenge to mental health, that of the isolation and loneliness felt by many who are shielding or isolated. Seven hundred and eighty thousand individuals over 70 are considered clinically extremely vulnerable. We have changed the terms of the shielding arrangements to give them more flexibility, and we have published the well-being and mental health support plan relating to Covid-19, which sets out steps to strengthen the support available for those who are struggling. But my noble friend is entirely right: we must do more to support and help voluntary organisations, which play a critical role, as do local authorities.

Baroness Barker Portrait Baroness Barker (LD)
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Another wave of Covid is hitting care homes at the moment. Therefore, there is an urgent need for hand-held rapid testing kits that deliver accurate and swift results. What investment is being made in biotech companies and care staff to develop a rapid testing system that works at scale?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the innovation and partnerships team at NHS Test and Trace has an enormous programme on this. The lateral flow devices are a huge development but, as the noble Baroness undoubtedly knows, the sensitivity of a lateral flow device means that it is not necessarily appropriate for the user case that she described. We have invested in DnaNudge and other small point-of-care devices, but having a fast-turnaround device that can be rolled out in mass numbers is a challenge, and we continue to search for the ideal format.

Mental Health Act Reform

Debate between Baroness Barker and Lord Bethell
Monday 18th January 2021

(3 years, 2 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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The noble Lord is 100% right: we can definitely start work on the recommendations of the report. As I said earlier, we have already done so: committing £400 million to end dormitories in 40 trusts. That sort of parallel processing can be done for other elements of the report. The consultation began last week, which shows our determination to get moving. Some recommendations of the report are spellbindingly obvious; we will work on them immediately. The role of police suites in safe refuge, cited by the noble Lord and by the noble Lord, Lord Winston, is exactly such an example.

Baroness Barker Portrait Baroness Barker (LD) [V]
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My Lords, this is yet another NHS document which makes not a single mention of the needs of LGBT people. The Statement is in effect an admission that the Mental Health Act 2007 was deeply flawed and, as a result, thousands of people have been subject to wrongful treatment. Will the Government act now to stop the abuse of community treatment orders and other elements of that Act that have led to the position that is so accurately described by Sir Simon Wessely?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I confess that the noble Baroness has me on the hop there, because I had not noticed that LGBT issues are not mentioned in Sir Simon’s report. I share the noble Baroness’s surprise about that. Let me return to the document and I will address her point in correspondence.

Covid-19: Variant

Debate between Baroness Barker and Lord Bethell
Wednesday 13th January 2021

(3 years, 2 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Lord has more medical expertise than me to be able to answer that question, but the briefing that I have is that the significant mutation in the Kent variant is not of a kind that should affect the efficacy of either a single dose or two doses of the vaccine. This comes as a significant relief to the vaccine programme. We remain on the balls of our feet, looking out for any variations that might affect vaccine deployment, but at this stage we have not found anything that poses a significant threat.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, the ONS data in the second week of December showed that the number of cases from all variants of the virus had rocketed. Why did the Government fail to act on that information until late December?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness is entirely right that the EpiData showed that the figures shot up in December; that is exactly why we looked extremely carefully at the genomic data from Kent and other places. As she knows, genomic data takes time to process—the tests can take a week to turn around. Looking at all the variants and matching EpiData figures with genomic data is an enormously complicated mathematical task. We moved as swiftly as possible and far faster than in many other countries.

Cannabis Oil

Debate between Baroness Barker and Lord Bethell
Tuesday 12th January 2021

(3 years, 2 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness is being a little unfair; Health Education England published a medicinal cannabis education package on 8 August 2019. But we cannot force clinicians to make prescriptions. That is not how the health service works. We need to work on clinical trials to put in place the correct authorisations and to give marketing authorisations for these important and promising drugs. That will require collaboration between government, the regulator and industry, and I call on industry to step up to that challenge.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, some people in England and Wales are reliant on hormone therapies produced in the EU 27. Who precisely in the NHS is responsible for ensuring continuity of supply of those therapies to patients?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, procurement decisions in the NHS are done by the NHS. I do not think that a specific or unique group is focused precisely on hormone therapies, but I would be glad to go back to the department and write to the noble Baroness to confirm that.

Puberty-blocker Drugs

Debate between Baroness Barker and Lord Bethell
Thursday 10th December 2020

(3 years, 3 months ago)

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Lord Bethell Portrait Lord Bethell (Con) [V]
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I reassure the noble Baroness that patient-doctor confidentiality remains paramount and is respected. To update her, the Tavistock has immediately suspended new referrals for puberty blockers and cross-sex hormones for under-16s. In future, they will be permitted only where a court specifically authorises it. I reassure the noble Baroness that those already on the programme will continue their medication until the review has been finalised.

Baroness Barker Portrait Baroness Barker (LD)
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The legal team that brought the recent case has, over recent years, brought several cases designed to oppose LGBT rights and to restrict the reproductive rights of women and girls. All those actions are consistent with campaigns run by organisations including the Heritage Foundation and the Alliance Defending Freedom—extreme evangelical right-wing American organisations. Will the Minister tell the House which NHS England boards and committees approved the amendment of the gender identity service specification on 1 December, prior to the court requiring them to do so, and in the light of the fact that this judgment can and will be appealed? If he does not have that information now, will he write to me?

Lord Bethell Portrait Lord Bethell (Con) [V]
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Well, my Lords, it is not appropriate for me to comment on those who have brought these cases, and outstanding judicial proceedings exist and are in place at the moment, so it is not possible for me to comment from the Dispatch Box in response to the noble Baroness’s remarks. All I can say is that the NHS, NICE and the Tavistock all have the interests of patients at their heart; we are not ideological about that. We are absolutely committed to the best interests of patients, and I would be glad to write to the noble Baroness to answer in any way that I can the questions she asked.

HIV: Ending Transmissions

Debate between Baroness Barker and Lord Bethell
Tuesday 1st December 2020

(3 years, 3 months ago)

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Baroness Barker Portrait Baroness Barker
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To ask Her Majesty’s Government what progress they have made towards ending HIV transmissions by 2030.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, the Government remain fully committed to achieving zero new HIV transmissions in England by 2030. This is why we endorsed the HIV Commission, which was established by the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation, and we welcome its report, published today. I reassure noble Lords that we will consider all the recommendations carefully, including an interim milestone of an 80% reduction in new HIV transmissions by 2025, and how we can expand testing. We will use the insights of the report to shape our upcoming sexual and reproductive health strategy and HIV plan.

Baroness Barker Portrait Baroness Barker (LD)
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I thank the Minister for that reply. I am very proud to a member of the party which, before anybody else, advocated that there be services for people with HIV and AIDS, and we will be there until this report is fully implemented and the fight against AIDS is won. Will the Government move to introduce a system of opt-out testing so that all people, including men and women from black and minority ethnic communities, can know their status, and we can get sooner to the point where they can get treatment and stop transmission?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness refers to one of the most interesting of the recommendations of the commission’s report. I took a briefing from the commission yesterday; members made that point very clearly, and their arguments were extremely persuasive. We have learned a lot during the Covid pandemic about opt-out testing; I completely understand the value of it, and I will take that recommendation to the department to look at it very closely.

Covid-19: Vaccine

Debate between Baroness Barker and Lord Bethell
Wednesday 11th November 2020

(3 years, 4 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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The noble Lord makes a persuasive case for those who are most vulnerable, including the itinerant and the homeless. We have seen for ourselves the impact of the disease on those who live in close quarters with each other, have health vulnerabilities or are exposed to the disease due to the nature of their circumstances. Those who are most vulnerable should surely be at the top of the list. I do not know the precise arrangements for the homeless and itinerant, but he makes an extremely good point, and I would be glad to get back to him with details.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, as is the case with the ordering of home testing kits, in order to prove one’s identity and access the vaccine, will UK citizens be required to share their credit rating history with US data-mining companies with which the Government have signed contracts?

Lord Bethell Portrait Lord Bethell (Con)
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No, they will not.

Covid-19: Contracts and Mass Testing Programme

Debate between Baroness Barker and Lord Bethell
Wednesday 4th November 2020

(3 years, 4 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the circumstances of the pandemic were exceptional, and I am not sure that any large company had any experience of putting together a national test and trace programme. The firms to which the noble Lord refers have considerable consulting experience and the capacity to support the national rollout of a large organisation such as NHS Test and Trace. They have provided invaluable support to the country at a time of need. All our contracts are scrutinised extremely closely by the finance function in the DHSC, and we are supported in that by the government legal service and finance staff from the MoD and the Cabinet Office, for which we are enormously grateful.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, in July, a company called Topham Guerin was given a £3 million contract, without any tender process, to test public understanding of health messages relating to Covid. It did not have any experience in health messaging; those running the company appeared to be friends of Dominic Cummings and Michael Gove. Will the Government now publish the tender that has subsequently been issued, the research findings and the evaluation relating to this contract? As the country goes into lockdown, it is fair that taxpayers know whether we are paying money for old rope.

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the insight into how the public react to key messages associated with our healthcare and health advice has been absolutely critical. Behavioural change and asking the public to step up to extremely challenging requests from the Government require a huge amount of analysis and study. The support from our own communications team has been supplemented by agency support, which has both the capacity and the expertise to provide the necessary insight. That insight has been critical to the success of our messaging.

Covid-19: Intensive Care Treatment

Debate between Baroness Barker and Lord Bethell
Thursday 29th October 2020

(3 years, 5 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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We go into the second wave in much better shape in relation to coronavirus because we know so much more about the virus. In terms of medicines, the therapeutics, the practices, the training, the configuration of our wards and the building of the Nightingales, there is a huge amount of skill, learning and capacity in the NHS to ensure that everyone has the opportunity to receive the best possible care. I remind noble Lords that these claims not only worry patients, they are deeply offensive to NHS doctors, nurses and therapists who have cared for more than 100,000 Covid patients to date in hospital settings and are committed to providing the best possible care in a second wave.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, triage is a necessary part of emergency medicine, and it will continue to be. Can the Minister say what has been learned in emergency departments in areas that have been in lockdown, such as Leicester, Bolton and Oldham? What learning has there been in those areas that can be sent to other areas to inform what will continue to be a necessary practice and part of good medicine?

Lord Bethell Portrait Lord Bethell (Con)
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Our learning has come a long way. Practices within ICU units have changed as a result of what we have learned in relation to the way that oxygen is administered, the range of drugs available and the turning of patients. To date, triage has not been necessary because the NHS is so good at load management that patients can be dispersed and deployed through the system, which has not been placed under pressure. We expect to be in good shape for the second wave. The principle remains as the national medical director, Stephen Powis, stated in his letter of 7 April:

“The key principle is that each person is an individual whose needs and preferences must be taken account of individually.”


That remains our principle.

Covid-19: South Yorkshire

Debate between Baroness Barker and Lord Bethell
Thursday 22nd October 2020

(3 years, 5 months ago)

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Baroness Barker Portrait Baroness Barker (LD)
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Will the Minister explain to the person in Sheffield who, having registered themselves as being positive for Covid, was contacted four times a day for four days on the trot, and managed to stop it only when they got the nurse to explain that they were so ill that they were in hospital, how their statistics will be recorded by Serco? Can he explain to the people of Sheffield why the Government continue to spend so much money on a system that is so bad?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness alludes to a glitch that the noble Baroness, Lady Thornton, raised yesterday, which I looked into overnight at her suggestion. It is true that if someone lives in a household with several other people who have been reported to have Covid, they are, at the moment, each receiving emails or calls, not on a household basis. We are looking at this and I hope to have it fixed in the next few days. I am grateful to the noble Baroness, Lady Thornton, for raising it.

Covid-19: Local Restrictions

Debate between Baroness Barker and Lord Bethell
Friday 9th October 2020

(3 years, 5 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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Well, I very much welcome the noble Lord’s comments, but I reiterate what I said earlier. As my right honourable friend the Secretary of State for Health and Social Care said on 30 September, for significant national measures with effect for the whole of England or UK-wide we will consult Parliament—and, wherever possible, we will hold votes before such regulations come into force. Of course, we will balance that with ensuring that our response to the virus means that it is delivered with speed when required. We cannot hold up urgent regulations that are needed to control the virus and save lives.

Baroness Barker Portrait Baroness Barker (LD)
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What evidence do the Government have that introducing statutory instruments without notice rather than with parliamentary debate and approval is more effective than developing effective local Covid strategies which are understood and adhered to by the population?

Covid-19 Update

Debate between Baroness Barker and Lord Bethell
Tuesday 6th October 2020

(3 years, 5 months ago)

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Baroness Barker Portrait Baroness Barker (LD)
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I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.

The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.

In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that

“its impact has not substantially changed.”

Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that

“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]

When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.

Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?

Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.

I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?

On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?

The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I thank the noble Baronesses, Lady Thornton and Lady Barker, for their remarks. The noble Baroness, Lady Thornton, is entirely right about the situation that we face. The latest update, as of 4 o’clock today, is that we have 14,542 daily positives today: 2,833 are in hospital with Covid; of those, 496 are on ventilators, and I am sad to report there were 76 deaths.

These are numbers that make us extremely focused on the challenge of Covid. Earlier today we debated the rule of six, when there was a large amount of challenge about whether such rules on social distancing were really necessary. We were reminded in clear terms about the social impact of separating those who love each other. Here we are talking about the impact on the health of the nation and the threat presented to those who are vulnerable, elderly and have pre-existing conditions. Getting the balance between these two things is extremely challenging, but that is the strategy of the Government—to bear down on the virus while protecting the NHS, education and the economy until we can see a way out through the vaccine, through therapeutic drugs and through mass testing. That is our approach.

I make no bones about it; the errors made over last weekend with the data was extremely regrettable. It undoubtedly causes grave concern among those in Parliament and the general public. I cannot hide from anyone the importance, impact, and severity of the situation. However, I would like to say a few words in mitigation. First, I pay tribute to those at PHE who have pulled together a remarkable system in extremely difficult circumstances, across the length and breadth of the country, integrating many systems into one. I know that that may seem like a trivial challenge and beside the point when we are dealing with a national emergency like this, but these are incredibly complex and difficult tasks. They have involved extremely committed personnel on the technology side of things who have personally checked a huge amount of the numbers. As my noble friend Lady Harding explained, it was through the perseverance of some of those personnel that the mistake was identified.

Between 17 and 23 September, 87,000 were identified through our testing and tracing programme; that is a phenomenal number of contacts where we had the opportunity to intervene and break the chain of transmission. Some 83.7% of those were reached and asked to isolate. I completely appreciate the concerns of those speaking in the Chamber today about the test and trace programme, but those figures are remarkable. That we have set up a system that can intervene in the lives of so many who are carrying coronavirus and can bring to bear such pressure on the disease after such a start as we had at the beginning of the epidemic is a phenomenal achievement. I know that the last thing one wants to be, at this stage of things, is a hollow champion of empty achievement, but that is a hell of a thing for this country to have got to.

There have been questions about the collaboration between the centre and northern leaders, and I cannot hide the fact that there are some quite fruity discussions on the pages of the newspapers and news channels between different community leaders. However, we have to be adult about this and acknowledge that there are different roles for different parts of government. The mayor of a city simply does not have a huge laboratory in which to do tens of thousands of tests a day. The mayor of another city simply does not have a control room filled with PhD analysts who can crunch the numbers and run massive supercomputers with complex algorithms to look at millions and millions of items of data within minutes. These are not the functions of local government, nor will they ever be.

Likewise, the JBC, the Department of Health and Social Care and the Cabinet Office do not have the local knowledge of what is going on on the ground and are not expected to speak a wide range of languages. We do not know what the behaviours are of people on a street-by-street basis. That is the role of local government, and it is through the collaboration of the local and national that we will beat this disease. To try to throw up a false dichotomy and set up test and trace as a scapegoat to blame and punish for the frustrations we all feel about the disease is counter- productive and reveals a shallow understanding of a complex situation.

The noble Baroness, Lady Thornton, said that perhaps care home testing should be sent to hospitals. In many cases, hospitals are involved in care home testing and handle the staff of care homes, but hospitals have to cover their own clinical demands, and pillar 1 is stretched to do the testing of hospital staff and patients. Landing that additional burden is not something that the NHS would welcome.

With regard to the northern leaders and their running commentary on the work of test and trace, I reassure the House that the conversations held in private on a daily—and sometimes hourly—basis have an altogether more collaborative tone. I have been privy to a large number of those conversations; there is a huge amount of expertise on both sides of the conversation, and one should not take too seriously the knockabout commentary in the newspapers and on TV.

The noble Baroness, Lady Barker, asked for an update on contact tracing, and she is entirely right. To have missed a substantial number of contacts during those days was a really big disappointment, but we have moved a huge amount of resources in order to catch up. There has been a phenomenal catch-up already, and I understand that my right honourable friend the Secretary of State will be updating the other place on the progress of that shortly.

I reassure the Chamber, however, that all those who had a positive test were informed promptly. There was no omission in that respect. Therefore, the primary index case, and the person of greatest threat to community transmission, was identified and isolated, and that chain of transmission was shut down.

I will now address the questions about the CMO and the JBC and their analysis of our numbers. I reassure the noble Baroness, Lady Barker, that the integrity of the CMO is unimpeachable; if he judges that the change in numbers has not changed policy, I reassure the Chamber that that is a good judgment that is completely consistent with the way in which we have behaved over the last few weeks.

The noble Baronesses, Lady Thornton and Lady Barker, both asked about Project Orbis. This is a welcome move, enabling the UK to join an international framework to provide concurrent submissions and regulatory views of oncology products, which may allow UK patients to receive earlier access to medicines in the future. I pay tribute to colleagues at the MHRA, who I know have worked really hard on collaborating with American, Canadian and Australian regulators. I am extremely optimistic about the dividends from this collaboration. It augurs, promisingly, similar future collaborations across the health sphere.

Covid-19: Medical and Funeral Expenses

Debate between Baroness Barker and Lord Bethell
Monday 28th September 2020

(3 years, 6 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the costs of a funeral are indeed a heavy burden on families with little wealth and have to support these payments. The Cabinet Office holds weekly meetings with the funeral industry in order to ensure that measures are in place to support families of the kind my noble friend described. We have put together guidance in order to ensure Covid-compliant funerals at the lowest possible cost, and for those who cannot afford to pay, the DWP has measures in place to make a payment up front for funeral costs in order to support them.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, public health funerals cost on average about £1,500 each. Many local authorities such as Birmingham spend a significant amount on them—almost £1 million in 2019. Local authorities are reporting an increase in demand for public health funerals. Will the Government take that into account in next year’s local government settlement?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I do take note of the point made by the noble Baroness. This is entirely on our radar screen. We are aware of these additional costs and we will take note of the point that she has made.

Covid-19 Update

Debate between Baroness Barker and Lord Bethell
Wednesday 23rd September 2020

(3 years, 6 months ago)

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Baroness Barker Portrait Baroness Barker (LD)
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My Lords, three months ago the Secretary of State said that test and trace was the single most important thing that had to be done to conquer the virus. Yesterday the Prime Minister said it had “little or nothing” to do with the transmission of the virus. These two things cannot both be right. For six months, the problem has been that we have had confused messages, careless use of statistics and a persistent refusal to work with and listen to people who run local public services and know what needs to be communicated to whom and how.

All those are the fundamental reasons we find ourselves in this situation. We still lack an effective and timely track, test and isolate system. In its place and without any evidence base behind them, we have come up with messages which, quite frankly, do not make sense to the general public. The rule of six does not make any practical sense at all, as was very well evidenced today by my noble friend Lord Newby in an earlier interaction with the Leader of the House.

Yesterday, the Prime Minister said the Government now had granular data that enabled them to understand the transmission of the virus. When will that evidence be released? And when will it be released to Members of this House and the other place, who, next week, are going to be asked to renew emergency powers the like of which have never been seen before to this Government? If the Government cannot come up with that evidence—and, I have to say, over the last six months, they have persistently failed to answer any kind of detailed question from Opposition Benches in this House—why on earth should they be trusted to have those powers renewed? When are we going to get the evidence base?

It is helpful, looking at the Secretary of State’s Statement, to see that finally, after repeated questions from these Benches and the Labour Benches, we have got a clearer statement on who is being prioritised for testing and in which area. But, as the noble Baroness, Lady Thornton, said, it is remarkable that there is nothing about black and minority ethnic communities, which we know are at greater risk, and nothing about the important people who work, for example, in domiciliary care, or who work in hospitals but are not medics.

I would like to ask one final question. When will they start listening to local authorities, who are persistently asking, in helpful ways, what they can do to expand the capacity for testing and to make sure that testing is better tied into the rest of the services? We are about to have an app launched, and local authorities are already telling us that there is soft intelligence that people who think they have symptoms but are unable to get a test just give up, and that people whose children are ill give up. It is all well and good for the noble Lord to say, as he did the other day, that they are going to completely redo NHS 111 to make it a more streamlined portal into the NHS, but if people have given up looking for tests long before they should, we are never going to get the data we need to get on top of this.

So I ask, as I did the other day: when they are revamping NHS 111, will they talk to the Royal College of Paediatrics and Child Health about the NHS 111 protocols? I agree with the noble Baroness, Lady Thornton; I think the public are desperate to do the right thing. They have been extraordinarily patient and have listened throughout, giving the Government the benefit of the doubt. But they will not go on doing that indefinitely while the Government continually fail to come up with a decent evidence base for their actions.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am extremely grateful to the noble Baroness, Lady Thornton, for correctly characterising our response to the epidemic as “the best compromise possible”. It is a compromise. We have competing demands on our strategy: we have to protect lives and the NHS, but we also have to be conscious of the economy and the livelihoods of people, and we have to look after our students and pupils. The package of measures being put forward by the Government is the best compromise we can make for this moment, and we are unashamed of that compromise.

But the noble Baroness is wrong when she says we do not have a strategy. The strategy is really clear; it is to suppress the virus and protect the economy and education until the vaccine and mass testing are ready. It may not feel like it now, but there are glimpses of sunlight in the distance. The vaccine and mass testing provide a strong opportunity for us to suppress the virus. The strategy that we have put in place, as the Prime Minister rightly described in his address to the nation, is a way to “get through the months” until we have those arms at our disposal.

Both the noble Baroness, Lady Thornton, and the noble Baroness, Lady Barker, talked about the publication of data. I must confess that I have a genuine sense of confusion about that point, because we publish so much data. If there is one thing that this Government have got wrong, it is that we have published too much data too early. Too much has not been audited; too much has been put out as early as possible in our efforts to be transparent. Tomorrow, we will have a REACT survey; we will have an ONS survey; we will have test-and-trace data. There are SAGE minutes; there is NIHR; there is literally data coming out of every organisation of government. It is a fantastically huge amount of data. It is, I confess, extremely difficult to process all of that data all at once. The story it tells does chop and change at an amazingly fast rate—much faster than any experience I have ever had in my life. It is a rollercoaster that the Government have to ride.

I make no apology, however, for the fact that this Government have sought to act swiftly and to bring in measures quickly when the evidence has changed. In the last few weeks we have seen the latest example of that, where the infection rates have clearly lifted quickly in a way that was not expected, and we have had a discussion about that point in previous sessions in the Chamber. We have moved promptly to address the challenge that those worrying and concerning figures have presented to us.

The noble Baroness, Lady Thornton, raised the question of testing. I completely and utterly acknowledge the frustration of anyone who has not been able to get a test for themselves, for their child or for a loved one. It is true that we have more people wanting tests today than we have supply. However, I cannot avoid pointing out that—boy oh boy—we have come a long way since February, when we were doing 2,000 tests a day, to today, when we are doing 240,000 tests a day, and we are well on the way to doing 500,000 tests a day by October. Our aspiration is to do many times that within the near future.

That is not in any way to avoid the fact that I wish that we had more tests today. I want to convey to the House that this Government are 1,000% committed to answering the needs of this country for testing and have put every resource—human, technological, administrative and financial—behind the testing programme in order to deliver that promise.

The noble Baroness, Lady Thornton, raised the question of tone. I completely accept her point that the people of Britain have made a terrific sacrifice. There is no question at all of blaming the people of Britain, but we have to acknowledge that the spread of the virus indicates as a fact within itself that some people are not respecting the principles of social distance, hygiene and isolation, and we have to move in order to shore up the basic principles of this country and, by the way, of any country that is effectively fighting the virus—because, if we do not, the virus will sweep through the country.

I thought that the Prime Minister put that challenge very well, and in a way that a large majority of this Chamber would support. He said that the choice was before us: we could ask those who are vulnerable and older and shielded to simply lock the door and we could turn our backs on them. That is not the choice that this Government have made. They have made a choice to fight the virus at every level, because we love the people whom we care about; and it is a pragmatic choice, because if we find the virus growing in one part of our society, whether that is young people, health workers or the very young, then sure as night follows day, it will sweep through the rest of society.

I turn to the evidence on the curfew. This is a moment where I do not have the science at my fingertips. However, I have been in pubs and clubs after 10 o’clock enough times to know about the proximity and intimacy of late-night drinking, and I know that what happens then is not conducive to social distancing. This is a moment when plain common sense can tell you that a curfew will help to break the chain of transmission among young people. It is, unashamedly, a signal that we cannot go on like this and, in particular, that young people have to change their behaviours because the signs of infection are crystal clear. The prevalence among young people is too high, and we have to turn that corner.

The noble Baroness, Lady Thornton, asked about symptomatic and asymptomatic testing. The honest truth is that it is very difficult to tell; if someone is standing in a testing queue, we do not turn them away. By the way, in order to get a test, people do have to fill in a form, on which they are asked if they are symptomatic. What we do know from closer analysis and questionnaires is that a proportion of testees—between 20% and 25% at current rates—do not meet the strict criteria of our testing. I am grateful to the British public for beginning to show respect for the fact that every test counts, and for helping us direct them at the most needy.

The noble Baroness, Lady Thornton, asked about domiciliary care, an issue that has been raised in this Chamber a few times. I reassure all those in the Chamber, including the noble Baroness, in answer to her specific questions: yes to PPE, yes to testing and, by the way, yes to new guidelines that help minimise contact and the number of patients seen by each itinerant domiciliary worker; and yes to substantial extra funds for the social care system, specifically to help social care avoid relying on people travelling from patient to patient.

The noble Baroness, Lady Barker, asked about our relationships with local authorities and the local teams. I reassure her that we have moved a very, very long way in the last six months and that the picture she paints is understandable but out of date. We have come a huge way to share all of our insight, data, analysis and systems with local authorities, local directors of public health and local infection teams. Decisions on lockdowns now have a protocol whereby they are led by local teams after engagement with local civic groups and brought to the Secretary of State after they have been agreed at a local level.

Substantial sums—billions of pounds—have been given to local authorities to help them afford the kinds of local intervention that they choose to make in order to support the most vulnerable and disadvantaged during the epidemic. Money is given to local authorities for PPE for the people that they decide need it. Community health is being supported within the NHS in order for communities to be given the support they need. Engagement with local civic groups and business leaders is at a level I have never seen in government before.

I will give one example in relation to contact tracing, which the noble Baroness, Lady Barker, specifically asked about. In Leicester, money has been given to the local council for it to commission its own contact tracing, because we recognise that the local authority may well have the insights, cultural connections and sensitivities, and contacts needed for this kind of work. Therefore, we have provided financial and logistical support, and professional advice on how it can fill the gaps. We recognise that a national system cannot do everything, and that we have to be both national and local at the same time.

The noble Baroness, Lady Barker, ended by talking about the public mood and her concerns that people are reaching a state of despair. I completely recognise the exhaustion that many people feel about the state of the epidemic. I particularly recognise the morale within the NHS and social care, where people have worked incredibly hard, often in circumstances and doing tasks that they did not originally sign up for, and the sacrifice that many people have made, whether they work in the healthcare system, are supporting people they love, cannot do the things they want or are isolated and on their own. Of course, lots of people have made massive sacrifices, but I do not recognise the world she describes.

I think the public largely support the steps taken by this Government to suppress the transmission of this virus. After all, it is the virus that is the enemy. In many respects, we have an incredibly united country in fighting that enemy. The way in which the British public have supported the regulations and guidelines, which have had a tough effect on many people’s lives, demonstrates a huge amount of support. No Government —and certainly not this Government—will stretch that beyond what is tolerable. I posit to the Chamber that, to date, that support is still in place, and I remain extremely grateful for it.

Covid-19 Update

Debate between Baroness Barker and Lord Bethell
Monday 21st September 2020

(3 years, 6 months ago)

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Baroness Barker Portrait Baroness Barker (LD)
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My Lords, I thank the Minister for dealing with this Statement, which comes hot on the news that we are at level 4 as regards the pandemic. Therefore, I want to touch on two or three points in this Statement. The first is the Government’s intention to invest £24 million in increasing call-handling capacity through NHS 111, to make it into a gateway to emergency care, providing the first port of call for patients. I must say to the Minister that it is a bit late to be doing that, and most of us should be somewhat alarmed at the news in the Statement that the Government intend to conduct pilots and will roll out NHS 111 First to all trusts from December. I understand the need to run pilots, but does he not think that time is against us?

On 17 September, six council leaders, cross-party, from across Yorkshire and Humber, wrote to the Minister. It is worth paying attention to what they said in their letter. They said: “It would be worth exploring the protocols and policies that might increase demand for what might be considered lower-value testing in a time of capacity constraint. This would include working with NHS 111 and reviewing their protocols. It seems that any childhood illness may result in a Covid test—that is what GPs are constantly telling us—while the Royal College of Paediatrics and Child Health have produced helpful guidance around that.” I ask the Minister if his department has seen that guidance and whether it will pay any attention to it.

Secondly, back to care homes and the ring of steel that never was. It is very welcome that there is going to be further investment in PPE and coverage for staff who have to take time off. However, there is a real danger in this, and there always has been, because social care is much more than care homes. Only 15% of people aged 85 or over are in a care home—most people who receive care are not. It is not uncommon for domiciliary care workers to visit 10 to 15 different homes in a shift. This Statement is silent on this matter which, given that the advisers are telling us they now know more about the transmission rate, is somewhat surprising. I wonder whether the Minister could talk about that.

The big issue in the last few days is the increasing confusion among members of the public as to who should be tested. Even in areas that are on the watchlist, people do not know whether they should be tested only if they are symptomatic or if they are asymptomatic. Some authorities have been given the power to do asymptomatic testing. Going back to that letter of 17 September, I note that the local authority says that it would be happy to have discussions locally but accepts the need for a co-ordinated approach with the Government. There needs to be a public discussion that provides urgently needed clarification from the department on how long these capacity issues are going to be around and what contingencies are going to be in place to manage them, particularly in high-risk areas.

This is not endless carping but a genuine concern for public health, and I therefore look forward to some detailed answers from the Minister.

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness, Lady Thornton, hit exactly the right note: we are at a sober moment and it is clear from the medical authorities that we are at some sort of tipping point. It is not too grand to say that the British nation faces something of a choice about how we approach the months ahead.

I confirm, as the noble Baroness, Lady Barker, has already done, that we are at level 4. The CMO has confirmed that he has taken the advice of the Joint Biosecurity Centre, and this is an indication of the seriousness of the situation. I acknowledge that there is widespread discussion of further restrictions and, as the noble Baroness, Lady Thornton, alluded to, that the Mayor of London, Sadiq Khan, has grave concerns for London. The CMO and the Chief Scientific Adviser have made their grave concerns crystal clear in their briefing this morning, and the graph showing the potential exponential growth in the case rate is extremely daunting.

I acknowledge that there are people who are concerned that we should put further restrictions in place, but I cannot confirm any of those arrangements. There will be a COBRA meeting tomorrow morning, which will be followed by a Cabinet meeting. The Prime Minister will make a Statement in the House of Commons tomorrow afternoon; how it will be repeated here is being discussed in the usual channels.

The expectations are very gruelling. The noble Baroness, Lady Thornton, queried why we did not see this coming, saying that, surely, SAGE and others had predicted this. The situation a month ago was quite different: when you looked at the dashboard, it was not clear that this sudden spike would turn up. However, the example of France—in cities like Marseilles—the hospitals in Spain and countries such as Israel has been extremely challenging and we are therefore moving quickly.

We completely acknowledge the concerns of parents and teachers in schools and the demands that they have put on the testing regime; we are absolutely determined to do whatever we can to keep schools open. We acknowledge the concerns of those with loved ones in social care, and we continue to pledge a very large amount—half of our testing capacity—to put protection in place for those in social care homes, who work with those in social care and who are in domestic care.

The noble Baroness, Lady Thornton, asked about Moonshot, and she is entirely right. The Moonshot project is adjacent to and parallel to our existing testing capacity, which uses the Rolls-Royce PCR test, which is extremely accurate in terms both of sensitivity and prevalence. Those tests take time to turn around, are costly and are best placed one after another in machines in an industrial process.

We are therefore looking at a much more flexible type of testing capacity, which may not need to be quite as scientific in its approach and may have different use cases. Principally, it would enable people to do the things they seek to do: to be in places where social distancing is more challenging, whether that is a place or work or leisure, or a family context. In answer to the noble Baroness, Lady Thornton, we absolutely apply the inclusionary principle, but there may well be a role for owners of venues such as football clubs and theatres to take advantage of these interesting, dynamic and innovative technologies in order to bring back some of the economic, social and cultural parts of the country that we all love, and that many depend on.

The noble Baroness, Lady Thornton, asked about self-isolation and quarantine. She is entirely right: these are critical components of our first-line defence against Covid. The only reason for having a test and trace programme is that people then isolate. If they do not isolate, there is no point in having that programme. We are absolutely focused on doing whatever we can to ensure that those who have been asked to isolate, because they have been in a risky situation or because they have had a positive test, do indeed do that. The fines we brought in at the weekend, or are set to bring in, are evidence of our determination to double up on the isolation principle. We have also brought in economic support for those who are isolating in certain target areas. As I have said at the Dispatch Box previously, those systems remain under review. If there is more that we can do to support those who are isolating, we will consider doing it.

The same is true of quarantine. The concerns of those in this House who would like to see our airports reopened and airlines and international travel restarted have been heard loud and clear. However, quarantining is essential to breaking the chain of transmission and to protecting this country. Until we have quarantine protocols that we can rely on, we have to live with what we have got.

The noble Baroness, Lady Thornton, also asked whether there was a better way for those in a particular place to understand what restrictions they are living under. I entirely agree. The pace at which some local lockdowns have been enforced or changed is extremely difficult to keep up with, even if you live in one area. That is why the app, which will be released on Thursday, will have a postcode checker. You can put in any post- code in the country and it will give you an indication of the lockdown principles and alert level in that area. That is a helpful device which will put many people’s minds at rest.

The noble Baroness, Lady Barker, asked about call handling and 111. I remember that, not long ago, the very existence of 111 was questioned by many. There were those who thought that closing it down might have been a good idea. During the Covid epidemic, 111 has been a phenomenal success. We have put in more resources, more call handlers, more training and more technology in order to make it more successful. It has proven its value in a massive way.

What we are doing with the trials alluded to by the noble Baroness, Lady Barker, is introducing a pilot so that those going to the emergency services in a hospital can phone 111 to check which services they should attend and, on occasion, book their slot in the emergency services. This is a system that patients have been asking for for a long time. It will help us massively with our load management as well as our Covid hygiene principles in emergency services. The pilots are starting in half a dozen locations, including Cornwall and Warrington, and we have put £24 million and a marketing campaign behind them. My expectation is that this service will prove extremely popular and will change the way in which people engage with hospitals. It will mean that the concerns and treatment of patients will be handled much more efficiently, and patients will go to the place that can best look after their treatment.

The noble Baroness asked about the protection that we are providing for care homes. The winter plan for social care, published last month, is an extremely detailed document that addresses many of the concerns that I have heard here in the Chamber. It is a thoughtful, well-financed and highly detailed plan for how we are going to protect those who are most vulnerable during the winter months. It is backed by an enormous financial commitment, a large number of tests and new guidelines to handle, for instance—as the noble Baroness rightly pointed out—the very difficult challenge of itinerant workers who may work for several different patients all at once; we are providing the financial resources and the new protocols in order to ensure that they do not become vectors of infection.

The noble Baroness, Lady Barker, asked about testing and who should be tested, and addressed in particular the question of asymptomatic testing and public discussion. We are massively engaged in a huge national conversation at the moment with local authorities, civic groups, employers, scientists and every single stakeholder that you could possibly imagine in the testing arena. Every day at the Department of Health we have round tables, webinars and all manner of engagement to understand how best we can serve schools, families, the economy and all the aspects of British life that depend on getting testing right.

One aspect of testing that is being generated by the exciting innovations that I mentioned in my answer to the noble Baroness, Lady Thornton, is the testing of asymptomatic people. That is not possible at the current levels of testing, even at 250,000 per day. We have to be extremely careful, as everyone here knows, to use every test that we have to its most effective use. When there are very large numbers of tests that can be cheaply and quickly delivered, and which are user-friendly by using things such as saliva or even breath tests, that could inaugurate a revolution in the way that we use testing and it may provide a system where those who are seeking to go outside, to go into areas where social distancing is challenging, can check whether they have the virus that morning and, at least for a day or two, have evidence that they will not be vectors of infection. That is potentially a transformative technology and it is the focus of our Moonshot ambitions. The progress that we are making is extremely encouraging and I look forward to updating the House on future days.

Covid-19 Update

Debate between Baroness Barker and Lord Bethell
Monday 14th September 2020

(3 years, 6 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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The change in the alert level is done in consultation with the CMO and it is his advice that the circumstances have not changed enough for us to move it. On the average travel time, most reasonable people would consider six-and-a-half miles a reasonable distance to travel for such an important test.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, why is it safer to allow six individuals from different households to meet together indoors, rather than limiting it to members of two families?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the phenomenon we had noticed was that large groups of people, sometimes in pubs and sometimes in other congregations, would seemingly be from two households, but that the actual definition of “household” was proving to be extremely flexible in the minds of many people. Therefore, putting an integer into the formula makes it much clearer.

Covid-19 Update

Debate between Baroness Barker and Lord Bethell
Thursday 10th September 2020

(3 years, 6 months ago)

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Baroness Barker Portrait Baroness Barker (LD)
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My Lords, this is a Statement made two days ago in the other place, but it has been largely overshadowed by yesterday’s deluge of hyperbole and hokum. The Prime Minister said yesterday:

“We know, thanks to NHS Test and Trace, in granular detail, in a way that we did not earlier this year, about what is happening with this pandemic. We know the groups that are suffering, the extent of the infection rates, and we have been able, thanks to NHS Test and Trace, to do the local lockdowns that have been working.”—[Official Report, Commons, 9/9/20; col. 609.]


If that is true—and given the record of the Prime Minister and Health Secretary, one is always entitled to ask whether it is—how come local authorities and directors of public health are given only limited access to the test and trace case management system and not given full access to the contact system? Why are the Government sitting on data or passing it to companies run by their mates, instead of passing it to local authorities, which, for weeks, have been trying to predict and manage the inevitable spike in infections that follows people starting to travel and going to school and university. Why are they not getting that data in a timely manner?

From the start of this pandemic, experts advised the Secretary of State to invest in public health teams and NHS labs that are numerous and easily reached by many communities, including in rural areas. Instead, he gave the money to outsourcing firms such as Serco and G4S, which have no expertise and have not had to compete for the contracts. He could have invested in local public services; instead he has built a system on a foundation not fit for purpose. On Tuesday, in the Statement, the Secretary of State for Health said of care homes that

“we have met our target to provide testing kits to all the care homes for older people and people with dementia that have registered to get tests.”—[Official Report, Commons, 8/9/20; col. 517.]


But on Monday, the Government were forced to apologise for continuing delays to Covid-19 testing for care home bosses and GPs, who are threatening that these will lead to more infections among vulnerable people.

The Secretary of State’s own department, the Department of Health, admitted to breaking its promise to provide test outcomes within 72 hours. Care managers have described the Government’s centralised testing service as “chaotic” and “not coping”, amid reports that whole batches of tests are coming back not only late but also void. Testing officials told care homes by email on Monday morning that

“immediate action has been taken at the highest levels of the programme to bring results times back”

within 24 hours.

“We apologise unreservedly to … you … and your staff.”

The ring of steel that the Secretary of State claimed to have put around care homes never was. With upwards of 40,000 deaths, when will the Government sit down with care home providers, local authorities and CCGs to develop a comprehensive system of testing and supply of PPE? It does not have to be world beating; it just has to work.

The Prime Minister’s Statement yesterday would have been risible were the consequences not so serious. Most ludicrous of all was the announcement of a team of Covid-secure marshals to enforce the new laws on public gatherings. The Government could have done any number of things. They could have announced resources to enable the rehiring of retired public and environmental health professionals, since there is a shortage. They could have given funding to local community and voluntary groups to communicate ongoing health risks and the law to communities. They could have given additional funding for trained police officers to work with health officials and businesses to improve adherence to infection control. But, no, instead we got another vacuous attempt to steal the headlines. Maybe these marshals, with no training, no resources, no local management and no authority could join up with the 750,000 volunteers for the NHS and the trackers, and like them they could sit and twiddle their thumbs, waiting for the phone to ring.

One thing we can be sure of is that this is another stunt which will be an utter waste of time, money and resources. Local authorities, police forces, health authorities and schools are using their professional expertise and local knowledge to plan effective public health interventions. They are not only following the science but also using it to actively protect people in their authorities. In stark contrast, this Government ignore advice, misrepresent the science and carry on winging it, but the data on infections and the lack of reliable testing are evidence that the Prime Minister’s bumbling bombast and the Health Secretary’s growing litany of half-truths are indicators of world-beating incompetence and, sadly, people in black and minority ethnic communities and poor communities will suffer the consequences. It is time for the Government to change.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I am enormously grateful for the thoughtful and informed questions from the Front Bench, and I echo the comments about teachers made by the noble Baroness, Lady Thornton. The return to school is a fundamental priority of the Government. It is a massive challenge for those involved, for governors, teachers, parents and school kids. I endorse the thanks the noble Baroness gave to teachers, who are performing incredibly well. The high return rates—percentages in the mid to high 90s—is remarkable and shows enormous confidence in the system among schoolchildren and their parents.

I also echo the noble Baroness’s thanks to NHS and social care staff who are preparing for winter. Enormous amounts of preparation are going into that. In response to the point made by the noble Baroness, Lady Barker, I reassure the Chamber that engagement with social care, local charities and local councils is incredibly intense and we are working extremely hard with local partners in all areas.

The noble Baroness, Lady Thornton, asked when the new regulations will be delivered. I am afraid that I cannot confirm the precise date, but I can reassure her that this Government are committed to being accountable to Parliament for those regulations and I look forward to that debate.

The noble Baroness also asked about the sequence of announcements. I reassure her that the Prime Minister brought his Statement to Parliament in good faith to update Parliament first. We cannot prevent leaks from happening, and leaks that get on to social media and then into the papers are something that we did not design or deliberately create. They are something that we regret. It would have been massively our preference for the Prime Minister to put Parliament first in his announcement.

The noble Baroness also asked about the testing system. The capacity of the testing system has never been higher: it has increased by 10,000 per day for the last two weeks and continues to increase dramatically. But demand has never been higher either, and there are good, laudable reasons why that demand is going up. The number of tests for supporting the vaccine programme has gone up. The number of tests to support our therapeutics programme has gone up. The surveillance of local prevalence has gone up, and the marketing around the use of tests by those who show symptoms has proved to be much more effective and the take-up among those who have Covid-19 symptoms has gone up. For those reasons we are extremely pleased by that effect.

However, there has also been a significant rise in the use of tests by asymptomatic individuals, largely tied to children returning to school. That is why we have been clarifying the guidance on the use of tests—that they should be used by those who have symptoms and not by those who are asymptomatic. One day, when the capacity is there and the system can bear it, I hope that we will move towards a system where anyone can have a test whenever they like, however they feel, but right now we must live within the system that we have. We are doing hundreds of thousands of tests per day and clarifying with teachers and parents that tests should be used by those who show symptoms and not by those who are seeking some other form of guidance.

Regarding the questions asked by the noble Baroness about the moonshot, I am a little confused. “If we cannot do millions of tests today, how can we expect to be able to do millions of tests tomorrow?” seems to be the question. I will answer it very clearly. The innovation around testing has moved much quicker than anyone could have expected in terms of scale, cost, accuracy and speed. The industry and the professionals in the NHS, academia and private business have come together in a triple helix to collaborate in a massive revolution in testing, which has changed considerably in this country from the days when we were struggling to do 2,000 or 3,000 tests per day to when we had the capacity to do 200,000 or 300,000 tests per day.

We have a clear view of how we can dramatically increase the tests. That clear view has two components: those tests that use existing technology that is purchasable in today’s world, and a clear idea of where innovation will take us in the very near future. This Government are committed to grabbing the opportunity of that innovation in order to dramatically increase the number of tests. There will be nay-sayers who will question whether that innovation will deliver, and undoubtedly there will be set-backs. Not everything will deliver as promised. However, I am extremely optimistic that we will be able to harness the power of science and innovation to invest in the backbone of our data and our delivery mechanisms, and to engage with the British public to deliver a testing system that enables us to return to the life that we love.

The noble Baroness, Lady Thornton, questioned whether the testing system could be relied on to deliver results. Let me explain: the people of Luton and Leicester have used testing and contact tracing, and infection rates are dramatically lower—less than half what they were in late July. Those are two excellent case studies of how our system of testing and contact tracing has turned around difficult situations and pushed back the spread of Covid by breaking the chain of infection. The noble Baroness also asked what we will do to improve the system as it stands. There are three areas of improvement: first, technology; secondly, infrastructure, by which I mean the data and the presence on the ground; and thirdly, engagement with the public so that they understand how to engage and we understand better how to interact with the public.

The noble Baroness, Lady Barker, asked about the contact system and gave some statistics. I reassure her that since 28 May we have rung 272,000 people who have been reached by the test and trace system. Where communication details have been provided, the service has reached 88.6% of close contacts, and 78.4% of people who have tested positive have been reached. Within the bounds of epidemiological effectiveness, these are extremely impressive statistics. Compared with those from other countries, they range among some of the highest. It is an incredibly impressive set of results for a system that was stood up in relatively recent history. Local public systems are complementing the central contact tracing hub, and I pay thanks to all those local authorities that either work with their full-time employees, or, as is often the case, have employed local businesses, to support it.

We have hit our target on care homes—the noble Baroness, Lady Barker, might like to take a moment to celebrate that. We are also trying to work with a degree of transparency in our operations. I do not regret for a moment the fact that the operational senior leadership in the track and trace team has been on the level about the present supply constraints, with social care and the general public. I reassure the noble Baroness, Lady Barker, that care homes absolutely remain top of our priorities. Many of the frustrations the public face, such as longer distances to travel, are exactly because we have put care homes first and have therefore had to dial down some of the availability of tests to the public. We sit down with care homes to discuss winter preparations. An indication of that is the 31 billion items of PPE that we have contracted to buy for this winter—an astonishing figure. That pays great tribute to the work of the noble Lord, Lord Deighton, and the PPE team, who have built up a fantastic stock.

Finally, I would like to express a small amount of confusion about the remarks from the noble Baroness, Lady Barker. On the one hand, she attacked the involvement of major private companies and central control of our track and trace system, but on the other hand, she attacked civic engagement, the volunteering of members of the public to support our track and trace system, and local initiatives whereby NHS trusts have brought back retired staff. The combination of these two themes is the heart of our success, and I celebrate both.

Pharmacies

Debate between Baroness Barker and Lord Bethell
Monday 20th July 2020

(3 years, 8 months ago)

Lords Chamber
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Lord Bethell Portrait Lord Bethell [V]
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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 Portrait Baroness Barker (LD) [V]
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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 Portrait Lord Bethell [V]
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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

Debate between Baroness Barker and Lord Bethell
Thursday 2nd July 2020

(3 years, 9 months ago)

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Baroness Barker Portrait Baroness Barker
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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.

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

Hospitals: Patient Safety

Debate between Baroness Barker and Lord Bethell
Thursday 21st May 2020

(3 years, 10 months ago)

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Lord Bethell Portrait Lord Bethell
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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 Portrait Baroness Barker (LD)
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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 Portrait Lord Bethell
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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

Debate between Baroness Barker and Lord Bethell
Tuesday 19th May 2020

(3 years, 10 months ago)

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Lord Bethell Portrait Lord Bethell
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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 Portrait Baroness Barker (LD)
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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 Portrait Lord Bethell
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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.

Covid-19: Testing

Debate between Baroness Barker and Lord Bethell
Thursday 14th May 2020

(3 years, 10 months ago)

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Lord Bethell Portrait Lord Bethell
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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 Portrait Baroness Barker (LD)
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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 Portrait Lord Bethell
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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.

Covid-19: Personal Protective Equipment

Debate between Baroness Barker and Lord Bethell
Thursday 23rd April 2020

(3 years, 11 months ago)

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Lord Bethell Portrait Lord Bethell
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I completely agree. I utterly reject the suggestion that British manufacturers are incapable in this area. I share with my noble friend, though, that this is a low-margin, high-volume game, and those low-margin, high-volume manufacturers are largely found in countries such as China, Turkey and Myanmar. That does not mean that we cannot do local manufacture. We have had 25,000 offers of support from businesses as of yesterday. We are processing those responses, and 175 are through to an advanced round. We have already had three companies deliver PPE goods to the NHS to help our hard-working NHS and care workers.

Baroness Barker Portrait Baroness Barker (LD)
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Has the Department of Health and Social Care raised with the Treasury the issue of care homes having to pay VAT on PPE, which the NHS does not?

Lord Bethell Portrait Lord Bethell
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The noble Baroness raises a good point. I do not know the precise answer and would be glad to write to her with a clear answer.

Covid-19: Care Home Deaths

Debate between Baroness Barker and Lord Bethell
Wednesday 22nd April 2020

(3 years, 11 months ago)

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Lord Bethell Portrait Lord Bethell
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I echo the noble Baroness’s timely comments on the role of BAME workers, many of whom have provided an amazing service and put themselves in harm’s way to care for those who are vulnerable. The idea that they are being disproportionately hit by this disease is extremely distressing. The numbers are not to hand so I cannot share precise numbers at the moment, but we are looking into this at speed and trying to understand the causes and the impact of this awful phenomenon. I commit to bring those numbers to the House as soon as they are available.

Baroness Barker Portrait Baroness Barker (LD)
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I have heard about a care home which lost one-third of the residents in one weekend. It is that bad. I am told that the Clipper system for ordering PPE is not working and consequently homes are having to try to source PPE by their own independent means and, unlike the NHS, they have to pay VAT on those expensive items. That will push some organisations that were already fairly vulnerable over the edge and they are going to close, so what are the Government going to do to stop that?

Lord Bethell Portrait Lord Bethell
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The noble Baroness is entirely right to raise the question of PPE. Looking into the medium and long term, there is undoubtedly going to be a massive demand for PPE in hospitals, care homes and the wider workplace. That has put a dramatic pressure on global supplies. Britain, like every other country, is queuing for supplies of PPE. The Government are throwing enormous resources at increasing supplies. The Clipper system is one of the essential components of getting supplies into the workplace and I believe that is beginning to kick in and is working well.

Coronavirus Bill

Debate between Baroness Barker and Lord Bethell
Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Wednesday 25th March 2020

(4 years ago)

Lords Chamber
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Baroness Barker Portrait Baroness Barker
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Can the Minister concede that we are tabling this amendment because of how the NHS and medical services are affected by the Bill. We are not asking for any change in the criteria for abortion. We are asking simply for the process of the administration of decision-making to change.

That is being done right across the whole of the health service. The Minister has explained that telemedicine is being rolled out at a surprising rate. I do not understand why an experienced clinician or a midwife cannot make the judgments that he was talking about via video. They see women all the time and they will be able to make the same judgments. I do not understand that. If the Government do not accept this proposal, I ask him to accept that they should at least be under an obligation to continue to meet very regularly with the Royal Colleges and the organisations involved in this situation day to day, and they should be willing to come back with the power to make this change under a separate piece of legislation—because if, in seven weeks’ time, there is a clear pattern of women being failed, we cannot let it continue.

Lord Bethell Portrait Lord Bethell
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I completely recognise that the noble Baroness’s intentions are totally and 100% benign. She has the interests of the women concerned at heart. That intention is completely clear to me and I utterly endorse it. Where there is a difference of opinion and where we have taken a huge amount of advice—we have worked with the scientific advice in the department —is in the fact that the changes being offered are a fundamental change to the way abortions are regulated and administered in this country. Those regulations and administration arrangements have been worked on for years and are subject to an enormous amount of consensus. Her point on monitoring the situation is exactly the one that the noble Baroness, Lady Watkins, made earlier. I commit the department to monitoring it. We will remain engaged with the Royal College of Obstetricians and Gynaecologists and other stakeholders. She is absolutely right that we can return to the subject with two-monthly reporting back, and it can be discussed in Parliament in the debates planned on a six-monthly basis.

Covid-19: Critical Care Capacity

Debate between Baroness Barker and Lord Bethell
Monday 23rd March 2020

(4 years ago)

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Lord Bethell Portrait Lord Bethell
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My Lords, the decision by Northwick Park was entirely welcome, because we welcome the realism and practicality on the part of the management in seeking help when it is needed. We are moving at pace to address the issues around PPE, and I can confirm that there is a massive amount going into the system as we speak. We currently have 3,700 critical care beds; total usage is currently 2,428, of which 237 are Covid-19 related; and our ambition is to increase this dramatically to perhaps 30,000 in time for the crisis arriving in full.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, to increase the number of freelance locums working in the health system, will the Government make specific changes to the NHS Pension Scheme, in particular the death in service benefits, so that we can increase the number of qualified staff? Can the Minister also confirm that the Government are making sure that all GPs and pharmacists have sufficient stocks of asthma and COPD medicines to keep people out of hospital?

Lord Bethell Portrait Lord Bethell
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My Lords, we are greatly relying on an influx of staff such as freelance locums in order to increase the numbers at the front line in dealing with Covid-19. Arrangements for the pension scheme are included in the Bill that we will bring to the House tomorrow. On supplies to GPs and pharmacies, a huge procurement programme is going on at the moment, and we are taking stocks out of our no-deal preparations in order to ensure that both GPs and pharmacies are well stocked.

Covid-19 Update

Debate between Baroness Barker and Lord Bethell
Monday 16th March 2020

(4 years ago)

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Lord Bethell Portrait Lord Bethell
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On the provisions for those on zero-hours contracts, that is an area that is particularly knotty and difficult. It is absolutely the focus of the current negotiations on statutory sick pay and other provisions; it is one we care very much about getting right. As for the advice for those in the House of Lords, I cannot repeat the advice of the CMO more times than I have already. I very much hope that everyone will follow it.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, based on the models that the Government are using, can the Minister say when he thinks we will reach the peak transmission spike?

Lord Bethell Portrait Lord Bethell
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The situation is fluid. The CMO spoke about this in detail at the press conference. He is not speculating or giving an exact date, because the modelling is not as clear as one would hope it to be. However, it will certainly be within weeks, rather than months.

Health: Lesbian, Bisexual and Trans Women

Debate between Baroness Barker and Lord Bethell
Thursday 5th March 2020

(4 years ago)

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Baroness Barker Portrait Baroness Barker
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To ask Her Majesty’s Government what steps they are taking to improve health outcomes for lesbian, bisexual and trans women.

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I welcome this timely Question ahead of the national LBT Women’s Health Week. The Government remain committed to providing comprehensive healthcare for all, irrespective of gender or sexual orientation. Throughout the LGBT action plan, we are taking steps to ensure that the needs of LGBT people are placed at the heart of our services. While we have made significant progress, we are not complacent. We recognise that more must be done to continue improving access to and the provision of health services.

Baroness Barker Portrait Baroness Barker (LD)
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I thank the Minister for that Answer. Despite a legal duty to be inclusive, there is growing evidence that LGBT women’s health is neglected. Across all cancers, we have a higher incidence than our heterosexual counterparts. Will the Department of Health and Social Care work with NHS England to change commissioning standards and to monitor services and outputs for LGBT women?

Lord Bethell Portrait Lord Bethell
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The noble Baroness is absolutely right. The national LBGT survey and the recent GP patient survey indicate that health outcomes for LBT women are lower than average, and this causes concern. We are interested in finding ways of commissioning services so that that can be rectified. It is not just in cancer services but in smear tests and other areas of clinical provision.

--- Later in debate ---
Lord Bethell Portrait Lord Bethell
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The noble Baroness is entirely right to ask about training, which is at the heart of our LGBT action plan. NHS England has funded the Royal College of Physicians to develop the UK’s first accredited training course on gender medicine and has developed online and video content to help to create the type of training we believe will have an impact. The training of the workforce and its awareness of LBGT needs will be at the heart of improvement in this area. That is why we are focusing our efforts on training.

Baroness Barker Portrait Baroness Barker
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My Lords, the Government funded Dr Michael Brady’s post but he does not actually have any authority to bring about change in the NHS. Does the noble Lord agree that such change will come about only when its leadership and the various medical professional bodies admit the present failings towards women? Women are dying as a result. There needs to be change and that change needs to be urgent.

Lord Bethell Portrait Lord Bethell
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I assure the noble Baroness that there is full recognition and awareness of and concern about this issue. The impact of Dr Michael Brady, whom I spoke to yesterday, is profound. He has a very high profile within the department, and the work he has done is valued and will make an impact.

Health: Sexually Transmitted Infections

Debate between Baroness Barker and Lord Bethell
Monday 24th February 2020

(4 years, 1 month ago)

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Lord Bethell Portrait Lord Bethell
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Undoubtedly, the increases in gonorrhoea, syphilis, chlamydia and genital warts are of grave concern to the Government. None the less, there are huge areas of progress. New diagnoses of HIV have reduced by 29% since 2015, and the HPV vaccination programme has proved extremely encouraging. There is undoubtedly a need to figure out a new strategy for how local councils will deliver sexual health. That is why we have put the resolution of this at the centre of our sexual health strategy, which will be published later this year. Co-commissioning with the NHS will, as promised by the Secretary of State, be a key feature of that strategy and will benefit from the increase in the preventive health budget.

Baroness Barker Portrait Baroness Barker (LD)
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My Lords, does the Minister recognise that while there has been good news for some people on HIV, there is a consistent pattern of higher rates of infection among black and minority ethnic communities? What will the strategy do to tackle that inequality?

Lord Bethell Portrait Lord Bethell
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The noble Baroness makes a very important point. Engagement with groups from BAME organisations has highlighted that question. There is undoubtedly a change in behaviours around sexual conduct that it is extremely difficult to address. Advertising and engagement with groups play a part, but clearly the problem is more complicated and sophisticated than that. That is why we will put innovation at the centre of our strategy. The HIV Prevention Innovation Fund was an interesting precedent and may be one way in which we can address the kinds of problems that she rightly highlights.