Health and Social Care: Winter Update

Baroness Brinton Excerpts

Tuesday 21st January 2025 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I want to echo the comments of the Secretary of State in the other place about the appalling treatment of Achamma Cherian, who was stabbed in the Royal Oldham Hospital last Saturday. It is absolutely intolerable for any member of NHS staff to be treated in this way. Can the Minister reassure your Lordships’ House that staff in A&E especially are protected, but also throughout our NHS?

I want also to start by thanking our NHS and social care staff for their remarkable effort. One of the problems that our NHS and social care staff have faced is total exhaustion since the winter of 2019-20. Immediately following the winter pressures, we were faced with a pandemic. Everybody in the NHS is now saying that this winter feels much worse, simply because it is yet another year of winter pressures.

Ambulance services have had to change their advice across the country to warn of being overstretched. A leaked memo from the West Midlands Ambulance Service says that patients who had collapsed with abdominal pain and vomiting, which are category 3 and 4 calls, and even, in the periods of highest demand, with heart attack or stroke, which is category 2, were told, “We don’t have an ambulance available to respond to you and it may be hours before one is available. Is there any way you can arrange safely to get to a hospital emergency department?”

I am minded to tell the House that, when I got a bus the other day that passed University College Hospital at Warren Street, a number of people got off who were clearly extremely unwell and being taken to the hospital by their families. What are the Government planning to do to support patients who need urgent ambulance services that are not available—for reasons that we understand are often to do with backlogs in A&E, queues and so on?

The Statement says that the experience of patients this winter is unacceptable, and we on these Benches agree. It is the opposite of a vicious circle: it is a circle of hell, not just for patients but for staff. I note that the Secretary of State commented in the Statement on what he saw when he was visiting, but worse is to come. We know from the Royal College of Nursing survey published earlier this week that we have patients dying in corridors, with nurses feeling absolutely unable to provide support for them.

It is not just 14 years of underinvestment; frankly, we are now seeing the problems of the wrong reforms that happened some years ago now. That has resulted in particular in pressure on primary care. The Statement focuses on hospitals but does not address the real crises that are going on in primary care.

In addition to the issues of funds and the planned extra doctors, who will take a while to come in, what are the Government planning to do to prevent hospitals constantly referring patients back to primary care when they need just an X-ray or a test, rather than being dealt with by the doctor they are seeing in hospital?

The emphasis of the Statement is obviously on the current high level of infections. It comments on the more than 5,000 patients in hospital beds with flu, but it does not say that we need to add to that RSV, pneumonia and Covid. The problem is that there is no weekly data from the UKHSA, which no longer collects and publishes such data. I hope the Government are prepared to consider reinstating that. An interesting graph on social media about two weeks ago set the peaks and troughs of all these infection spikes over the last three years against the increasingly long absences of NHS staff due to extended sickness, and they mirror exactly. I ask the Minister—who will remember that when she was in opposition, I asked this of many Ministers—what is happening in hospitals to encourage staff, when facing infection spikes, to wear masks and to encourage others to do so? This is about getting the basics right.

The Chancellor has made an investment this year. Compared to past winter investments to cover the winter crisis, how much is going to be there for the long term—or, by the time we get to March, will it all have been sucked up by the current winter crisis?

The Statement says that it is not too late to get yourself vaccinated. I have to tell noble Lords that, if you are a clinically vulnerable patient—and I count myself in that category—it is. GP services keep being given deadlines, which they pass on to patients. Patients then discover that they cannot get the vaccines at their local surgery. If they are inspired to go and find help elsewhere, that is fantastic. However, I suddenly got lots of texts from my surgery saying, “You haven’t been vaccinated yet. Go and get vaccinated”. I had been vaccinated. The problem is that the pharmacy database does not relate to the GP database. When will that be remedied? I have been going on about this problem for well over a decade. It is ridiculous that I have to intervene and say, “Actually I have had it—at your request”.

I have talked before about primary care, and it is shameful that the previous Government did not provide enough vacancies for newly qualified GPs last year. I credit this Government for providing some support and money this year to make sure that is happening. Will this continue to happen in future years or is it one-off, one year’s money? While the extra funding for general practice is welcome, it is not enough without the contractual change between primary care and secondary care. Have the Government taken account of that? It is not solving the real problem, which is that GPs and their staff are facing phenomenal pressure in their systems.

To conclude, most people are saying that this is the worst crisis we have faced in years. Unlike other parties, particularly the former Government, I am not prepared to blame the current Government for that. I credit the Government for the steps they are taking, but will they look at the longer-term issues that need to be dealt with to get our NHS back in a stable condition so that patients can rely on the service, from ambulances through A&E, general practice and hospital service?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I pay tribute to staff in health and social care for their commitment all year round, but particularly when the pressures are on us all in the winter. The noble Baroness, Lady Brinton, mentioned the nurse who was attacked at Royal Oldham Hospital. Our thoughts and prayers continue to be with her, her family and friends, and we wish her a speedy recovery. I can assure the noble Baroness and your Lordships’ House that protection of staff, and freedom to work and move around without abuse, harassment and discrimination, are all very important to us as a Government. There will be more about that as we talk about the workforce plan.

Let me make a few general points. I thank the noble Baroness and the noble Lord, Lord Kamall, for their questions and observations, all of which are important. As the Secretary of State said in the other place, it is crucial that we are honest, and I hope by now that your Lordships’ House will realise that we are, as a new Government, not frightened to say what the reality is, which is why the noble Lord, Lord Darzi, was commissioned to look into the state of the NHS. The noble Baroness, Lady Brinton, asked about long-term issues and that is exactly where we are.

I acknowledge the significant pressures faced by the NHS this year. However, cold weather, a sharp rise in flu and other infections, and other stresses and strains are not unusual, and we should not be surprised that winter comes every year. It is not acceptable to be going into a crisis every year. We have also taken immediate action. For example, beating the backlog of waiting lists is crucial, as is the 10-year plan because it will create an NHS for all year round. In addition, the emphasis is on getting social care into the right place, both in the immediate and the long term, because—as noble Lords regularly and rightly say—it is inextricably linked with the NHS.

Both Front Bench speakers talked about data and planning and preparation. There was a great deal of planning and preparation for what was then the upcoming winter, which we are now in, across health and social care. In the words of my right honourable friend the Secretary of State, we have been doing our best with the hand that we have been dealt. The noble Baroness, Lady Brinton, acknowledged that and I am grateful for her acknowledgement and her support. Annual winter pressures will always exist, but they should not automatically lead to an annual winter crisis.

These issues will not be solved overnight. It is going to take time, but we believe it can be done. That is why we are making investments—the noble Baroness asked about investment. The Budget committed an extra £26 billion to health and care—not as a knee-jerk reaction but to allow us to plan now and for the future.

On planning and preparation, I assure your Lordships’ House that the Secretary of State meets senior leaders in social care regularly. He also meets the UK Health Security Agency and NHS England regularly. Those groups are key to Ministers keeping on top of this.

We also have an excellent national operations centre, which I pay tribute to—that goes to the point raised by the noble Lord, Lord Kamall. The data available from it allows a focus on individual hospitals and individual patient waiting times. As of last week, we were down to one critical incident across the country, which compares positively with the 24 that were in place before.

The noble Lord, Lord Kamall, asked about lessons learned—if I might paraphrase it like that. I assure the noble Lord that before the spring we will set out lessons from this winter and the improvements that we will make ahead of next winter. For me, that is very welcome, because that is about acting as quickly as possible and looking to the future.

The noble Baroness, Lady Brinton, spoke about primary care, which is key to taking pressure off. I know that the noble Baroness is well aware of the three key pillars of the 10-year plan, which will be available in the not-too-distant future. I am sure that your Lordships’ House will want to discuss that at length, and I will be pleased to do so. To take the points from both noble Lords, that is all about the move from analogue to digital, from treating sickness to prevention, and from hospital to community. Those are not just words; they will greatly assist with the long-term planning that I know both noble Lords are seeking.

The noble Baroness referred to primary care. We have committed to recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme. The key thing about that is that it will increase the number of appointments delivered in general practice. If I might make another point to the noble Baroness, we recently made announcements about GPs being able to make a direct referral for tests and scans to stop the real “around the houses” of sending a patient to see a consultant, who then sends them away for the relevant tests and scans before they can see them in the round. That will do a lot to reduce waiting times and increase access.

The noble Baroness was right to raise corridor care. She will have heard the Secretary of State say that

“we will never accept or tolerate patients being treated in corridors. It is unsafe, undignified” ”.—[Official Report, Commons, 15/1/25; col. 364.]

He has also made it clear that he is ashamed of that situation. I say that in a spirit of honesty. That is a feeling I share. The Secretary of State also said that he could not, in all honesty, promise an end to corridor care by next year because, as he rightly observed, it will take time to undo the damage that has got us to this place. It will be through investment, reform and planning that we will be able to do that.

The noble Baroness also asked about winter funding. That is a very important point, because over many years we have seen last-minute winter funding arriving too late to make a difference, no matter the intention. This time, as I mentioned, the Chancellor allocated nearly £26 billion to the NHS for 2025-26 in the Autumn Budget. That means, in comparison with the funding that it would have got under the last Government, that the NHS will receive £2 billion more. For me, perhaps the most important point is the ability to plan ahead and factor in the need to support preparation for winter.

There are a number of other points that I could make and I am sure that noble Lords, as we move to further questions, will raise them. In the meantime, I thank both Front Benches for their interest and their questions, but also for their challenge.

First-cousin Marriage

Baroness Brinton Excerpts

Monday 20th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I understand the point that the noble Lord is making, but this is a very complex topic in respect of which there is a great lack of reliable data. Any plans for any health information campaign anywhere clearly need to be considered carefully. Perhaps I can reassure the noble Lord that staff from the Genomic Medicine Service are already working with other national projects, such as Born in Bradford and Best Start for Life in Birmingham, to engage with the communities most affected by first-cousin marriage. Of course, any campaign plans for Shetland and Orkney will be a matter for the Scottish Government.

[Baroness Brinton (LD)]

My Lords, I am grateful to the Minister for referring to the Born in Bradford study because 18 months ago, it reported that over the last decade, the number of intra-cousin marriages in the Pakistani community had substantially fallen. The reasons for this were awareness of the risk of congenital abnormalities, young people staying in education longer, and changing family values. This is clearly a successful project. Is it being replicated elsewhere in the UK?

[Baroness Merron (Lab)]

The noble Baroness is right that consanguineous unions are decreasing. While it had the best data, the NIHR-funded study, Born in Bradford, to which the noble Baroness and I have referred, found that between 2000 and 2010, 39% of British Pakistani couples in Bradford were first cousins. However, that reduced by 27% by 2019, for the reasons suggested. Driving change across whole ranges of areas makes a difference, but it is important that we keep this in perspective and make any communications and support absolutely appropriate.

Hospice Funding

Baroness Brinton Excerpts

Monday 6th January 2025 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I thank the noble Lord for his good wishes and extend my new year wishes to everybody in your Lordships’ House.

To clarify the situation, this is the biggest boost for hospice funding in a generation. It is £100 million in capital, and there is no intention, as the noble Lord asked, to have any less engagement with the third sector—in this case, the hospice sector. The £100 million in capital is for adult and children’s hospices, and £26 million is confirmed for children and young people’s hospices. This has been widely welcomed. The decision in respect of national insurance perhaps would not have had to be made had the financial situation inherited by this Government been somewhat different.

[Baroness Brinton (LD)]

My Lords, I am grateful to the noble Baroness for explaining about the capital grant, but can she get the Government to commit to a long-term revenue funding formula for hospices for those services that are equivalent to those provided in the NHS, so that they are rewarded financially on the same basis as the NHS fairer funding formula?

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making, because planning ahead and certainty are key. I can confirm that my ministerial colleague, Minister Kinnock, will soon meet all major stakeholders to discuss long-term sustainability of funding. We are very aware of the difficulties that have been caused thus far and seeking a way forward.

Food and Drink Industry: Processed Sugar

Baroness Brinton Excerpts

Monday 14th October 2024 Lords Chamber

[Baroness Merron (Lab)]

Taking on board the noble Lord’s point, I feel that it is important that we support people to make healthier choices. The noble Lord will be aware of—and I hope will welcome—the Government’s focus on moving from ill health to prevention. We want to make sure that people live well for longer. It is not only about making informed and heathier choices but about having the means to do so. That is why I particularly want to commend the fact that we will be introducing the restrictions on junk-food advertising to children on TV and online. That will make a major contribution.

[Baroness Brinton (LD)]

My Lords, the Food Foundation review in January this year noted that 41% of multibuys were still high in salt, sugar and fat, with only 3% on fruit, veg and staples. The Minister referred to working with the supermarkets and major manufacturers. Is this issue being raised with them as well? Particularly with the cost of living crisis, it would be extremely helpful if more multibuys were for foods that were good for people, such as fruit and veg, as well as basic staples and carbohydrates.

NHS: Independent Investigation

Baroness Brinton Excerpts

Tuesday 8th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.

I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.

[Baroness Brinton (LD)]

My Lords, the excellent report of the noble Lord, Lord Darzi, refers to the stress our GPs are under and how patients are no longer flowing through the hospitals as they should. One issue is that hospitals are constantly referring patients back to their GPs when they are still on the same treatment pathway. Recently, a member of my family was at a post-op review following a pacemaker operation that had gone wrong. Her heart was still giving her problems, and she was told she had to go back to her GP to start the whole process again. Many patients in hospital clinics are being told to go back to their GP to get a scan or an MRI—which is one of the reasons why they were referred to the hospital. This is not fair on hard-pressed GPs and, above all, patients. Can this practice be stopped?

[Baroness Merron (Lab)]

I am sorry to hear of the circumstance that the noble Baroness raises. I agree with her about the pressure on GPs who, of course, are working harder than ever. We know, not just through the Darzi report but through much evidence, that discharge into the community has to take place at the right time and with the right support, and that is not the case at present. I will certainly take up the specific thing the noble Baroness asks for and look into it in far greater detail, because this is clearly a practice, as she described, that is not supporting patients or GPs but working against them.

Vaginal Mesh Implants: Compensation

Baroness Brinton Excerpts

Thursday 5th September 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I thank the noble Baroness, Lady Cumberlege, for securing this debate and for her unstinting commitment to ensuring that victims of vaginal mesh, sodium valproate, Primodos and other medical problems and scandals continue to have their voices heard. Her report for the last Government, First Do No Harm, published five years ago now, was extraordinary and impossible to ignore, and those of its recommendations that have been implemented have started to change the way that support for patient victims is delivered. I hope—and I will come back to this later—that it is also starting the change in culture that we need to see inside the NHS. We all love our NHS and sometimes it can be hard to admit that some of the senior doctors within it are not the best people to support patients and ensure that patients feel they are getting the right help they need when things go wrong.

I am particularly pleased about the role of the Patient Safety Commissioner, which I remember us debating in 2020. Dr Henrietta Hughes is making a brilliant start, and I thank the noble Baroness, Lady Bennett, for the comments that she made about that. However, I repeat a question I asked when the post was first set up: is the office of the Patient Safety Commissioner getting enough resources to do the job that she so clearly has to? I have no doubt that she is a very able woman but I am concerned about the volume that her office is dealing with.

I pay tribute to the victims of not just vaginal mesh but sodium valproate and Primodos, who have continued to tell their stories. We know that repeatedly telling your story is painful too, but we need to hear them. I thank the noble Baronesses, Lady Sugg and Lady Wyld, and the noble Lord, Lord Mancroft, who told his friend’s personal story, all of whom reminded us of how dreadful the position is. While the difference between these problems and the infected blood scandal is that we are not seeing fatalities, we underestimate the long-term life changes that all these victims have faced, some of them the children of those who were fed medicines during pregnancy, not one of them at fault at all in any way.

There is one voice that we have not heard: that of the NHS whistleblowers. I shall mention one person of whom I had not been aware until there was an article about her in the British Medical Journal earlier this year. Sohier Elneil is a urogynaecological surgeon and an expert in women’s pain. She is the founder of the first NHS vaginal mesh removal centre and a tireless champion of supporting the victims and sorting out the problems. I was shocked to read that, after she started talking about this issue in 2005, she was excluded from events by doctors, then personally attacked and reported to the General Medical Council multiple times, mainly by fellow consultants—those who were the biggest implanters of mesh. She said:

“I was very upset. It felt like a war. They were saying I was removing mesh and harming patients unnecessarily”.


Professor Elneil continued with her campaign, and I have to say that her story did not stop there. She also uncovered some of the doctors being encouraged with financial incentives from the providers of vaginal mesh. It is good that both Henrietta Hughes’ report and that of the noble Baroness, Lady Cumberlege, said that things needed to become transparent. The last Government refused to allow those records to go on to the register at the GMC but they should be on that register, not kept elsewhere, because if a member of the public wants to find something out, the GMC will be the first place they go. Can the Minister say whether that will happen?

Others have already talked about the time limit. I shall make brief mention of the issue relayed by the noble Baroness, Lady Berridge, about the type of inquiry and the ability to make effective reports. In my portfolio I have covered virtually all these inquiries over the past 18 months, and I have heard every single group of victims say that another inquiry has provided the right response for them. None of the inquiries has yet been resolved—even those, such as the Post Office Horizon inquiry and the infected blood inquiry, which we think have been resolved. If the Government will not revisit the deadline, they will be dragged kicking and screaming into a higher level of inquiry as more cases are revealed. Please can the Government, preferably via the Cabinet Office, bring together the learning from all these inquiries about what goes wrong in government to make these things happen?

Palliative and End-of-life Care: Funding

Baroness Brinton Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is right in her observations, and we certainly recognise that times are difficult, particularly for many voluntary and charitable organisations including hospices, for example, due to the increased cost of living. We are working alongside key partners and NHS England to proactively engage with stakeholders, including the voluntary sector and independent hospices, because we want to understand the issues they face and to seek solutions to them.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives has found that the NHS local funding for children’s hospices has dropped by 31% in the last three years. Worse, the previous Government’s £25 million children’s hospices grant has been given to local integrated care boards, many of which have delayed distributing it. As a result, the children’s hospice movement is in real crisis. Please will the Government urgently review the funding that government has in the past put aside for children’s hospices, to make sure that they receive it?

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.

Covid-19 Inquiry

Baroness Brinton Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice president of the Local Government Association. The report by the noble and learned Baroness, Lady Hallett, UK Covid-19 Inquiry Module 1: The Resilience and Preparedness of the United Kingdom, is an effective and thorough distillation of the difficulties, and of the failures by Ministers, officials and perhaps even by wider society as well. She and the Minister remind us that we must always remember the bereaved, those who lost their lives, survivors and those on the front line who dedicated their lives, sometimes literally, to dealing with the crisis that we perhaps failed to deal well with. From these Benches, I start by remembering the hundreds of thousands who died, including some Members of your Lordships’ House, families and friends, those who survived and those whose lives changed for ever as a result. This inquiry and its reports must be the action we need to take to ensure that we do not make the same mistakes again.

My noble friend Lady Tyler reminded us of the scandal of hospitals releasing patients into care homes, bringing Covid with them. I remember the “do not resuscitate” orders placed on disabled patients’ files without their or their family’s knowledge, until that was stopped. I thank Ministers for dealing with that as soon as it appeared to be an issue. We also want to thank the many NHS front-line staff as well as the people in public health, local government, transport and food chains, who, in those earliest and darkest days in March and April 2020—often without PPE, and, for many, with enormous sacrifice—ensured that everything could be done to keep the country going. These people were selfless and are our heroes. I thank the noble Baroness, Lady Fraser, for her focus on those with cerebral palsy and other disabilities. She is right that they are still living with the consequences.

This inquiry has got the measure of those issues. Recommendations must be accepted and acted on as soon as possible. As others have said, who knows when the next pandemic will arrive? The noble and learned Baroness, Lady Hallett, is clear, from the evidence, that it will.

Politicians, civil servants and public officials got it wrong. The noble and learned Baroness, Lady Hallett, says in the report that

“the UK was ill prepared for dealing with a catastrophic emergency, let alone the coronavirus … pandemic”,

assuming that it would be like flu, as in the 2011 strategy and later: the wrong pandemic. Worse, Ministers instructed civil servants and officials to focus all their efforts on preparations for a no-deal Brexit, so pandemic exercises did not happen at the highest levels and those that did happen were ignored in Whitehall.

The report talks about the lack of leadership, appropriate challenge and oversight. I shall contrast our experience with what happened in Taiwan. I use this as an example to the noble Lord, Lord Frost, of how it is possible to have not just a learning Government but a learning society. That country learned from its previous experience of SARS and other national emergencies, and its pandemic system moved swiftly into action. The key was reminding citizens of what was expected every day and taking them with them. The spread was so low that Taiwan did not have to lock down. Every single day, there was a Minister and an official on TV not doing press conferences, but taking questions live from the public until all the questions were finished every day. Taiwan had six deaths in the first year.

I want also to raise a point on Sweden. Although I have heard the noble Lord, Lord Hannan, make many points about Sweden in the past, the one thing he never mentions is that Sweden’s culture is very like that of the Taiwanese in that the relationship between the governors and the governed is much more trustworthy than we have in this country. I am sure that is one of the main reasons that things worked.

The Taiwanese version of test, trace and isolate, including universal masking being totally accepted and digital technology helping people to isolate, was operated locally. If people were asked to isolate, they had a call every day from someone in their local council or nearby to ask what they needed from the shops or the chemist, and it was brought to their door. People knew they were supported—no civil emergency but a nation working together—and the key to their success was learning from SARS.

So I ask: have we learned from Covid? The noble Lord, Lord Bilimoria, recounted the Premier League arrangements made possible by regular testing. He is absolutely right; that is an example of where we did get it right in this country, but we needed to get it right for everyone.

I believe that the recommendations must be accepted and acted on as soon as possible; that is one of the reasons why we need a module now that reports so that work can proceed, advising government, Civil Service, the NHS and other public bodies.

I am so pleased to see the noble Baroness, Lady Thornton, in her place. She and I were the two Opposition Front-Benchers in January 2020 and, between us, we saw Covid through with the support of our colleagues. We covered over 580 pieces of legislation in Parliament, and well over 300 of those were on health. I give way to the noble Baroness.

[Baroness Thornton (Lab)]

I think that, possibly, I saw the noble Baroness and the Minister more than I saw my husband for several months.

[Baroness Brinton (LD)]

I confess that I was probably in the same position. The noble Baroness, Lady Thornton, and I were always commentating on the regulations, but it was always post-event. One issue we need to look at is emergency legislation being enacted with us being able to see it only after it has happened. I understand that that was the case at the start, but we were still seeing emergency legislation only two years on. That is unacceptable.

My noble friend Lady Tyler talked about vulnerable people at risk because of poverty. The noble Baroness, Lady Coussins, rightly made the point, as she always does, about language support being so vital. Your Lordships will not be surprised to hear me say that clinically vulnerable people have expressed concern that the modules outlined at the start of the inquiry seem to ignore their plight. The noble and learned Baroness, Lady Hallett, said that the experience of vulnerable people would be threaded through her inquiry and its reports. I want to thank her for her clear recommendations in relation to clinically vulnerable people as well as those who are vulnerable for other reasons. Six of the 10 recommendations specifically mention them. I may mention them again later.

Can the Minister assure the House that the recommendations will be implemented at pace throughout all levels of national, state and local government and public agencies? Nobody has mentioned that the inquiry reprinted the extraordinary spidergrams that constituted the departmental and structural response to the emergencies. The report also noted that many with civil emergency pandemic preparedness responsibilities had full-time roles in their departments, meaning that planning and review were easy to push into the future. Will key staff with this responsibility now have time to read, think and do the regular reviews and exercises to ensure that, as and when an emergency occurs, a smoothly run system will kick into place as it did in Taiwan and Sweden?

It was also egregious that preparing for Brexit knocked everything else out of the way in Whitehall, including postponing those regular pandemic exercises. As other noble Lords have asked, how will this new Government remove groupthink from their and officials’ behaviour? As the noble Lord, Lord Harris, pointed out, we may need a change in system thinking too.

Interestingly, groupthink has also come up in the Horizon Post Office inquiry and the Infected Blood Inquiry; I am sure it will also come up in the Grenfell Tower inquiry tomorrow. This is a massive undertaking for government. The comments from the noble Baroness, Lady Thornton, about the role of Parliament were important as well: about how important our role of scrutinising government becomes at times like this. Can the Minister tell us what success will look like to the Government about how things have really changed, because groupthink about success is also sometimes part of the problem? I am very pleased that the Government are proposing a duty of candour. I think such a duty will help change the practice of Ministers being told what civil servants think Ministers want to hear.

The report is clear that the local directors of public health were not utilised effectively. They and their teams of local government environmental health officers were often ignored and dictated to, and they were ignored in their roles in local areas. The Association of Directors of Public Health continued to do all that they could throughout. I remember a conversation with one of them about 10 days after the February half term in 2020. It was evident to him at that point that a number of families had picked up Covid in northern Italy, and it was spreading swiftly into his local schools. They could not get this taken seriously further up the line despite needing powers to be able to close down independent schools—they could close down state schools but not independent schools. As a result, independent schools and the families of those attending them had a faster spread than elsewhere.

The noble Lord, Lord Lansley talked about the 2011 plan thinking only about schools in high-impact areas. Our early experience post that February 2020 half term may have guided people to say, “If we can’t control spread in schools, we’re going to have to do something else”. There was no test, trace and isolate at that point, and spread was just not contained.

The Minister talked about flexible systems, but will they also be local? Directors of public health and their teams in local councils and local NHS are well placed to help. Please can we guarantee that they will be involved?

The noble Lord, Lord Frost, was unhappy with module reporting. I disagree with him because the major changes that have to happen, and which are recognised by many past Ministers and the new Government, are major and will and should take time to get right. We do not know when the next pandemic will happen; perhaps it is brewing already. There is not just anti- microbial resistance, as outlined by the noble Lord, Lord Lansley, but the person-to-person transmission of avian flu, now happening in parts of the US, Texas in particular. Time is not on our side.

The Minister said in the previous Statement in late July, following the publication of this report, that the previous Government had changed the way they accessed, analysed and shared data. It is essential to get that right but the last Government and UKHSA have cancelled wastewater testing for Covid, which is essential for early detection and monitoring. It continues in Scotland, which is one of the differences there, and in the USA and other countries. This makes it difficult for officials to spot early signs of increased cases and outbreaks.

The cancellation of Covid testing unless you are in hospital or in a care setting means that it is very difficult to gauge the level in the community. The ONS and ZOE data were helpful. Will the Government reconsider that background data? The noble Lord, Lord Hannan, said that Covid is endemic. It is not endemic yet. I hope we are out of a pandemic but Covid is not everywhere and safe for everybody. It is not endemic.

Knowing what is happening becomes important. We have hospitals telling clinical staff not to wear masks, even though there is Covid in their hospital. One academy school is saying this week that it is fine for symptomatic Covid children to return to school immediately, and we have schools still refusing to provide ventilation in classrooms that would allow clinically vulnerable children to return to school.

In July, the Minister said in the Statement that the Government’s first responsibility is to keep the public safe, so can the Minister assure your Lordships’ House on the urgent and outstanding issue of PPE, masks and ventilation being provided and encouraged where necessary to help reduce spread. I am not talking about everywhere, but where necessary.

I am also glad that the noble Lord, Lord Reid, referred to mpox. I am pleased that the noble Baroness, Lady Chakrabarti, raised TRIPS waivers and Gavi as well. They are really important. I know somebody who is going to the DRC next week. They will be working in the refugee camps and their doctor went to UKHSA to ask whether they could have a vaccination. They were told that the UK is not issuing any vaccines. Unfortunately, there are no vaccines in Goma in the DRC at all. This is not on. Perhaps the Minister could find out what is happening and why this Government are not taking this report seriously.

I wanted to talk about other things such as the longer-term effect of long Covid. I want to mention very briefly that the NHS has fired many of its front-line clinical staff who got severe long Covid because they could not prove they got the Covid in the hospitals. That is a disgrace and I think it will come back to bite the NHS in the future.

I want to end by referring to Pale Rider by Laura Spinney, published in 2016, on the Spanish flu. In the final chapter, on memory, she says:

“Memory is an active process. Details have to be rehearsed … But who wants to rehearse the details of a pandemic? … Instead, there was silence and a loss of memory”.


Are we sure that we will not have a loss of memory in the next three to five years? Will the recommendations from the noble and learned Baroness, Lady Hallett, make us become that new learning for government and society so that next time we can respond like Taiwan and Sweden?